Surgeon General’s Advisory on Naloxone and Opioid Overdose

By June 4, 2018 Uncategorized No Comments

The Opioid Epidemic

I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of the overdose-reversing drug naloxone. For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life.

BE PREPARED. GET NALOXONE. SAVE A LIFE.

Over the past 15 years, individuals, families, and communities across our Nation have been tragically affected by the opioid epidemic, with the number of overdose deaths from prescription and illicit opioids doubling from 21,089 in 2010 to 42,249 in 2016.1  This steep increase is attributed to the rapid proliferation of illicitly made fentanyl and other highly potent synthetic opioids. These highly potent opioids are being mixed with heroin, sold alone as super-potent heroin, pressed into counterfeit tablets to look like commonly misused prescription opioids or sedatives (e.g., Xanax), and being mixed (often unknowingly) with other illicit drugs like cocaine or methamphetamine. The resulting unpredictability in illegal drug products is dramatically increasing the risk of a fatal overdose. Another contributing factor to the rise in opioid overdose deaths is an increasing number of individuals receiving higher doses of prescription opioids for long-term management of chronic pain.  Even when taking their pain medications as prescribed, these patients are at increased risk of accidental overdose as well as drug-alcohol or drug-drug interactions with sedating medications, such as benzodiazepines (anxiety or sleep medications).

The Overdose-Reversing Drug Naloxone

Naloxone is an opioid antagonist that is used to temporarily reverse the effects of an opioid overdose, namely slowed or stopped breathing. Expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic. Naloxone is a safe antidote to a suspected overdose and, when given in time, can save a life. Research shows that when naloxone and overdose education are available to community members, overdose deaths decrease in those communities.2  Therefore, increasing the availability and targeted distribution of naloxone is a critical component of our efforts to reduce opioid-related overdose deaths and, when combined with the availability of effective treatment, to ending the opioid epidemic. In most states, people who are or who know someone at risk for opioid overdose can go to a pharmacy or community-based program, to get trained on naloxone administration, and receive naloxone by “standing order,” i.e., without a patient-specific prescription.3  The Centers for Disease Control and Prevention advises health care providers to consider offering naloxone to individuals when factors that increase risk for overdose or concurrent benzodiazepine use are present.4  Furthermore, most states have laws designed to protect health care professionals for prescribing and dispensing naloxone from civil and criminal liabilities as well as Good Samaritan laws to protect people who administer naloxone or call for help during an opioid overdose emergency.3, 5 Naloxone is increasingly being used by police officers, emergency medical technicians, and non-emergency first responders to reverse opioid overdoses. There are two FDA-approved naloxone products for community use that are available by prescription, but too few community members are aware of the important role they can play to save lives.

If you or someone you know meets any of the following criteria, there is elevated risk for an opioid overdose.

  • Misusing prescription opioids (like oxycodone) or using heroin or illicit synthetic opioids (like fentanyl or carfentanil).
  • Having an opioid use disorder, especially those completing opioid detoxification or being discharged from treatment that does not include ongoing use of methadone, buprenorphine, or naltrexone.
  • Being recently discharged from emergency medical care following an opioid overdose.
  • Being recently released from incarceration with a history of opioid misuse or opioid use disorder.

It should be noted that, in addition to the above patient populations, patients taking opioids as prescribed for long-term management of chronic pain, especially those with higher doses of prescription opioids or those taking prescription opioids along with alcohol or other sedating medications, such as benzodiazepines (anxiety or insomnia medications), are also at elevated risk for an overdose.

Information for Patients and the Public

  • You have an important role to play in addressing this public health crisis.
  • Talk with your doctor or pharmacist about obtaining naloxone.6
  • Learn the signs of opioid overdose, like pinpoint pupils, slowed breathing, or loss of consciousness.7
  • Get trained to administer naloxone in the case of a suspected emergency.8
  • If you have an opioid use disorder, effective treatment is available. Research shows a combination of medication, counseling, and behavioral therapy can help people achieve long-term recovery. Call SAMHSA’s National Helpline 1-800-662-HELP (4357) or go to https://www.findtreatment.samhsa.gov/
  • Naloxone may be covered by your insurance or available at low or no cost to you.9

Information for Prescribers, Substance Use Disorder Treatment Providers, and Pharmacists

  • You have an important role to play in addressing this public health crisis.
  • Learn how to identify patients at high risk for overdose.8
  • Follow the CDC Guideline for Prescribing Opioids for Chronic Pain. 4
  • Utilize your state’s prescription drug monitoring program (PDMP).
  • Find out if your state permits pharmacists to prescribe naloxone independently, or dispense naloxone under a standing order or collaborative practice agreement.
  • Prescribe or dispense naloxone to individuals who are at elevated risk for opioid overdose and to their friends and family.
  • Naloxone may be covered by insurance or available at low or no cost to your patients.9

BE PREPARED. GET NALOXONE. SAVE A LIFE.

References

  1. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017/ CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
  2. Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ (Clinical research ed.). 2013;346:f174.
  3. Prescription Drug Abuse Policy System, Naloxone Overdose Prevention Laws, 2017. Available at www.pdaps.org.
  4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2016;65(1):1-49. Available at https://www.cdc.gov/drugoverdose/prescribing/guideline.html.
  5. National Association of State Alcohol and Drug Abuse Directors. Single State Agency for substance abuse: Resource to check third party prescription laws and Good Samaritan laws. http://nasadad.org/ssa-web-sites/.
  6. Prevent & Protect, Frequently Asked Questions about Naloxone, 2018, Available at http://prevent-protect.org/individual-resources/faq-individual/.
  7. Centers for Disease Control and Prevention. Preventing an Opioid Overdose Tip Card, Available at https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-Carda.pdf.
  8. Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) 16-4742. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. Available at https://store.samhsa.gov/shin/content//SMA16-4742/SMA16-4742.pdf.
  9. National Institute on Drug Abuse. Opioid Overdose Reversal with Naloxone (Narcan, Evzio). January 2018, Available at https://www.drugabuse.gov/related-topics/opioid-overdosereversal-naloxone-narcan-evzio.

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