Opiate Overdose

Importance: Opioid use disorder (OUD) involves compulsive opioid use that causes substantial distress or impairment at work, school, or home. OUD, which is the third most prevalent substance use disorder worldwide, affected an estimated 3.7% of US adults (9 367 000) in 2022 and caused 53 774 deaths in the US in 2024. Medications for opioid use disorder (MOUD) reduce morbidity and mortality. Individuals with OUD also benefit from medications to treat opioid withdrawal and reverse acute opioid overdose.

Observations: Methadone, buprenorphine, and naltrexone are medications approved by the US Food and Drug Administration (FDA) to reduce unregulated opioid use. Methadone and buprenorphine reduce the risks of overdose and all-cause mortality. However, only 25.1% of people in the US with OUD were treated with these medications in 2022. MOUD should be selected based on shared decision-making that considers availability and convenience of treatment options and patient preferences. Buprenorphine and naltrexone are prescribed in office-based settings and can be taken at home. Outpatients with OUD in the US can only obtain methadone in person at federally regulated clinics. After stopping or substantially reducing use of opioids, individuals with OUD develop symptoms of opioid withdrawal, such as anxiety, insomnia, pain, nausea, vomiting, and diarrhea. Medications for opioid withdrawal include opioid agonists (eg, methadone and buprenorphine), α2-receptor agonists (eg, lofexidine and clonidine), and medications to treat pain (ibuprofen) and nausea (ondansetron). Individuals being treated for acute withdrawal should also be prescribed MOUD to decrease the risk of all-cause mortality (adjusted hazard ratio, 0.52; 95% CI, 0.42-0.63 for MOUD vs no MOUD). Individuals who use opioids may develop opioid overdose, which can cause respiratory depression, stupor, and, if severe, coma and death. Opioid overdose can be treated or can be reversed with naloxone, an opioid antagonist that is FDA approved and should be administered at the lowest dose needed to restore a normal respiratory rate (eg, naloxone 0.4 mg intramuscularly or 2-4 mg intranasally). Community-wide distribution of naloxone to people who use opioids and their social networks has been associated with 25% to 46% lower community opioid overdose rates.

Conclusions and relevance: All individuals with OUD should be offered treatment with MOUD to reduce opioid use. Methadone and buprenorphine decrease opioid-associated and all-cause mortality in patients with OUD. Opioid withdrawal symptoms may be treated with opioid agonists, α2-receptor agonists, and medications for pain and nausea. All individuals with OUD should have access to opioid antagonists, such as naloxone, to treat opioid overdose.

Author/s:

Miriam T H Harris, Zoe M Weinstein, Alexander Y Walley

What Parents Should Know About Naloxone, a Medication That Reverses Opioid Poisoning or Overdose

Alex Haga — Sun, 01 Dec 2024 19:14:03 +0000

Date Added:

December 1, 2024

Journal/Publication:

JAMA

Publication Date:

November 25, 2024

URL:

What Parents Should Know About Naloxone, a Medication That Reverses Opioid Poisoning or Overdose

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.4419

Keywords

PMID (1):

39585663

MeSH

Information for parents about naloxone. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page describes naloxone, a medication that reverses opioid poisoning or overdose.

Author/s:

Barbara H Chaiyachati, Rachel E Linstead, Lindsay A Thompson

Intranasal Naloxone for Opioid Overdose

Erin Blanchette — Wed, 03 Jan 2024 21:23:11 +0000

Date Added:

January 3, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

December 21, 2023

URL:

Intranasal Naloxone for Opioid Overdose

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.23248

Keywords

PMID (1):

38127361

MeSH

A summary of intranasal naloxone for treatment of opioid overdose. James W. Mold, MD, MPH

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In 2021, opioid overdose deaths exceeded 80 000 in the US.1 Naloxone, a competitive opioid receptor antagonist that reverses symptoms of opioid intoxication and overdose by displacing opioids from μ-opioid receptors, is a safe and effective medication for preventing opioid overdose death. Naloxone meets US Food and Drug Administration (FDA) criteria for approval without a prescription: its benefits outweigh risks, it treats a condition that can be identified by people in the community, it has a low potential for misuse, and it can be labeled to facilitate correct administration.

Author/s:

Jessica L Taylor, Karen E Lasser

AAFP Chronic Pain Management Toolkit

Devin Evans — Wed, 03 Mar 2021 06:00:00 +0000

Date Added:

March 3, 2021

Journal/Publication:

American Academy of Family Physicians

Publication Date:

March 1, 2021

URL:

AAFP Chronic Pain Management Toolkit

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

An AAFP-endorsed toolkit for helping patients who are experiencing chronic pain. James W. Mold, MD, MPH

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Chronic pain is common in the U.S., with anywhere from 11% to 40% of the adult population reporting daily pain.1 Approximately one-third of patients experiencing pain receive a pain medication.2 While the number of prescriptions for pain management have declined in recent years3, opioid misuse remains a significant public health crisis. Roughly 21-29% of patients who are prescribed opioids for chronic pain will misuse them.4

This increase leads to a rise in opioid overdoses—at least half are attributed to prescription medications—and morbidity and mortality. Numerous groups—including the AAFP, other medical societies, the National Academy of Medicine and the U.S. Congress—are emphasizing the need to improve chronic pain care.