Opioids are a class of medication that include heroin, as well as prescriptions medications such as:

• morphine
• codeine
• methadone
• oxycodone (Oxycontin, Percocet)
• hydrocodone (Vicodin, Norco)
• fentanyl (Duragesic), hydromorphone (Dilaudid)
• buprenorphine (Subutex, Suboxone).

Opioids are extremely effective in controlling pain; however, they also carry risks such as significant constipation, physical dependence, and respiratory depression. Respiratory depression is also known as an “opioid overdose,” and occurs when breathing slows or stops, leading to death. This is why it is important to be careful when using these medications.

What are the risks of an opioid overdose?

You are more likely to experience an opioid overdose if you:

• Take 50 morphine milligram equivalents (MME) or more of prescribed opioids every day

• Take opioid medications together with other sedating drugs, such as benzodiazepines and muscle relaxers

• Have conditions such as lung disease, kidney dysfunction, liver dysfunction, or if you are HIV-positive

• Have a decreased tolerance due to recent abstinence or break in therapy

• Have a history of illicit substance use disorder

• Have a history of overdose from opioids

• Use any illicit drugs or have an opioid use disorder

How can an opioid overdose be prevented/stopped?

Avoid the risk factors listed above at all costs. If you are prescribed opioid medications by a physician, it is important to take them as sparingly as possible, and no more than prescribed. If you have a substance use disorder, talk to your doctor about seeking treatment.

In an overdose, Narcan ® (naloxone) is a medication that rapidly reverses the effects of opioids long enough to call an ambulance. The Centers for Disease Control and Prevention (CDC) recommends that naloxone be provided to all patients who have or know someone with risk factors for opioid overdose. Extensive administration education is provided to all who receive the medication.

Overview of naloxone:

Naloxone (nal-OKS-one) blocks the effects of opioids on the brain and restores breathing. It is safe to give to anyone who is experiencing a known or suspected overdose caused by opioids. It has very few side effects and drug interactions. It will produce withdrawal symptoms. In situations where an overdose was caused by non-opioid drugs, naloxone will not be effective.

Naloxone only lasts 30-60 minutes in the body, but opioid medications typically last much longer. That is why it is so important that if someone receives naloxone, emergency medicine services (9-1-1) are called and that they go to the hospital. As soon as naloxone wears off, the risk of overdosing returns.

Keep naloxone on hand if you or someone you know has risk factors for opioid-related overdose. It’s like having a fire extinguisher – hopefully you will not need to use it, but it can be the difference between life and death.

If you are at risk for opioid overdose, educate your family and others around you on how and when to use naloxone.

How do I get naloxone?

Naloxone can be accessed at many pharmacies and public health agencies. If you believe you or someone you know has risk factors for an opioid overdose, ask your pharmacist or health department about accessing naloxone.

How do I use naloxone and recognize an overdose?

1. The signs of an overdose include:

   1. Slow breathing (less than 1 breath every 5 seconds) or no breathing

   2. Vomiting

   3. Pale and clammy face

   4. Blue lips or nails

   5. Slow heartbeat

   6. Snoring or gurgling noises

   7. Unresponsive

2. Try to wake the person

3. Call 9-1-1

4. Make sure nothing is in the person’s mouth

5. Give rescue breathing

6. Use naloxone and continue rescue breathing

7. Turn the person on their side if the person begins breathing on their own. This is to avoid choking.

8. Stay with the person until EMS arrives

Visit the State of Ohio Board of Pharmacy website for more information on administering naloxone.   https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx

References:

NARCAN nasal spray. ADAPT Pharma. https://www.narcan.com/. Accessed June 10, 2020.

Naloxone resources: pharmacist dispensing of naloxone. State of Ohio Board of Pharmacy.https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx. Accessed June 10, 2020.

Prevention of lethal opioid overdose in the community. UpToDate. Wolters Kluwer. Available athttps://www.uptodate.com. Accessed June 9, 2020.

Streamline processes for providing naloxone. Pharmacist’s Letter. 2018.https://pharmacist.therapeuticresearch.com. Accessed June 9, 2020.

Images:

1. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/ohio-opioid-involved-deaths-related-harms

2. https://www.narcan.com/

3. https://www.narcan.com/