Opioid Use Disorder: Mitigating Overdoses
Jennifer Sills is a bilingual physician associate (PA-C) practicing in Miami Beach, FL. Jennifer specializes in internal medicine and Psychiatry. She is dedicated to educating her patients, promoting wellness and preventing and treating human illness. She has the ability to perform physical exams, order and interpret ancillary... more
The state-by-state legislation on prescriptive authority is continuously changing and expanding. In 2016, Florida approved House Bill 423 to allow PAs and NPs to rx Schedule II-V drugs. One stipulation of HB 423 includes limiting the prescription of Schedule II substances to a 7-day supply. Other conditions include requiring CME to ensure the safety of prescribing controlled substances.
*Poppies aren’t permitted in
According to strategies for appropriate opioid prescribing FL APRN/PA requirement, the rate of overdose deaths increased 58.9% during 2003-2019 and in 2009, 1 in 8 deaths in Florida was attributable to drug overdose. From 2018 to 2020 total drug-related deaths increased by 17%. Opioid-related deaths increased by 28% and opioid-caused deaths increased by 42% (NETCE). Opioid-related overdose deaths in Massachusetts increased by 2.5 percent in 2022 compared to 2021, with rates among Black, non-Hispanic residents making up the largest increase, according to preliminary data released today by the Massachusetts Department of Public Health (DPH).
There were 2,357 confirmed and estimated opioid-related overdose deaths in 2022, surpassing the previous peak in 2021 by an est 57 deaths. Preliminary data also show there were 522 confirmed and estimated opioid-related overdose deaths in the first three months of 2023, a 7.7 percent decrease (an estimated 44 fewer deaths) from the same time period in 2022. Enactments of restrictive MAN DATES to govern opioid prescribing and dispensing have created difficulty for patients in accessing legitimate opioid therapeutics and resorting to heroin.
In the case of opioid overdose, symptoms include mental clouding, stupor or coma, miotic pupils, bradypnea, diminished response to painful stimuli, and mottled, cooled skin. Respiratory depression is the most feared acute adverse effect. Direct suppression of the brain stem respiratory center leads to bradypnea, shallow respirations, and a significant overall reduction of tidal volume. Death from opioid overdose is almost always caused by respiratory depression.
Sequelae of nonfatal overdose include:
- Pulmonary conditions, most frequently edema
- Pneumonia
- Cardiac complications such as arrhythmia, acute cardiomyopathy, and hemoglobinemia
- Rhabdomyolysis (disintegration or dissolution of muscle cells leading to myoglobinuria)
- Neurologic damage through prolonged hypoxia
It is important to assess dependent opioid users for other psychiatric and substance use disorders, especially alcohol and cocaine dependence because they are frequent comorbidities in opioid-dependent patients and can aggravate depressive symptoms. Bipolar illness is rare but has substantial treatment implications. Anxiety disorders frequently co-occur with depression, and traumatic experiences and post-traumatic stress disorder are common and should be thoroughly evaluated and treated. Independent disorders are psychiatric conditions occurring during periods of sustained abstinence or having an onset before the substance-use disorder. A positive family history can aid in identifying an independent psychiatric disorder.
Comprehensive assessment tools can reduce the chance of a missed or incorrect diagnosis. Patients with psychiatric comorbidities often exhibit symptoms that are more persistent, severe, and resistant to treatment compared to patients who have either disorder alone. Assessment is critical to identify concomitant medical and psychiatric conditions that may need immediate attention and require transfer to a higher level of care. The ASAM recommends that clinicians also assess social and environmental factors to identify facilitators and barriers to treatment, specifically to pharmacotherapy.
According to the World Health Organization, people likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose.
https://harmreduction.org/resource-center/harm-reduction-near-you/
(https://www.who.int/publications/i/item/9789241548816 Last Accessed: March 30, 2021)
