Much of the danger relates to opioids’ mechanism of action. According to Mark P. Schwartz, MD, Medical Director of Inpatient Detox Services at Penn Medicine Princeton House, opioids work by activating the brain’s mu-opioid receptors. This activation results in the commonly observed effects of opioids, such as analgesia and euphoria. Unfortunately, overactivation can suppress breathing, causing death.
“You don’t need to be opioid dependent to experience an opioid overdose,” explains Dr. Schwartz. “Respiration can cease with high doses of opioids, or with lower doses
in conjunction with sedatives like alcohol or benzodiazepines.”
Fortunately, there is an antidote to opioid overdose.
Naloxone, or Narcan®, is an opioid antagonist that occupies mu-opioid receptors and displaces opioids already bound to these receptors, which may allow breathing to resume. Available both by prescription and without a prescription, it can be given by nearly anyone to treat an overdose. While it doesn’t resolve a substance use disorder, it can prevent death and provide the opportunity to refer the survivor to appropriate treatment services.
“It’s so important for health care providers to educate patients and their family members about naloxone and how to administer it,” says Dr. Schwartz. “If there is an opioid in a household—prescribed or illicit—then naloxone also should be present.”
Protection for the Provider
In New Jersey, Good Samaritan laws protect both professionals who prescribe naloxone and lay people who administer the medication. In fact, a provider does not have to see
a patient to prescribe naloxone, and it can be provided to family members, too.
At Princeton House, a movement is underway to encourage providers to prescribe naloxone at discharge for any patient at risk for overdose, along with their family members. Medical staff lectures, grand rounds, and meetings with Emergency Department teams are part of this ongoing education.
“The benefits of naloxone are clear,” adds Dr. Schwartz. “The more we get naloxone into the community, the more lives will be saved.”
1. cdc.gov/drugoverdose
3 main signs of an overdose:
|
|
Commonly Used Opioids |
|
| Generic | Brand Name |
| Fentanyl | Duragesic, Actiq |
| Hydrocodone | Vicodin, Lorcet, Lortab, Norco, Zohydro |
| Oxycodone | Percocet, OxyContin, Roxicodone, Percodan |
| Morphine | MSContin, Kadian, Embeda, Avinza |
| Codeine | Tylenol with Codeine, TyCo, Tylenol #3 |
| Hydromorphone | Dilaudid |
| Oxymorphone | Opana |
| Meperidine | Demerol |
| Methadone | Dolophine, Methadose |
| Buprenorphine | Suboxone, Subutex, Zubsolv, Bunavail, Butrans |
For more information about Princeton House services, visit princetonhouse.org.
Article as seen in the Winter 2020 issue of Princeton House Behavioral Health Today.
