Educational Intervention with Naloxone Administration to Prevent Opioid Overdose Mortality

Introduction

Mortality related to opioid overdose has gradually increased over the past decade.  To put an end to this fatal epidemic, drug treatment centers are distributing naloxone in combination with administration training and resuscitation education (World Health Organization [WHO], 2018).  These innovative practices have been proven to be effective in decreasing the number of opioid-related deaths. 

There are a variety of interventions that have been visited to decrease the number of overdose deaths within the United States, including identification of at-risk patients, improved inter-healthcare communication to prevent co-prescribing of opioids/narcotics, follow-up appointments for individuals with a substance use disorder, and limiting licit opioid distribution (Boscarino et al., 2016).  For individuals who have been on long-term opioid treatment or have a known opioid use disorder (OUD), offering education on the risks of overdose, signs/symptoms, and rapid opioid reversal with the proper use of naloxone, premature deaths related to opioid overdose can be reduced (Lynn & Galinkin, 2018).  The following paper discusses the effectiveness of combining an educational intervention with naloxone administration in preventing opioid overdose mortality.

Definition

 There are several terms that form the PICOT question; the main terms of the PICOT question will be defined within this section, with a brief overview of opioid drug addiction.

   Opioid drug addiction is a well-known issue, and with it, brings major health concerns, mainly overdose and death (Painter, 2017).  Daily, patients are admitted to emergency rooms and intensive care units across the country diagnosed with opioid-related overdose, resulting in potentially severe irreversible injury.  Nurse practitioners will be at the forefront of these trying times, caring for patients with addiction issues and having the obligation to connect them to resources and treatment options (Painter, 2017). 

Listed below are key terms that will be used throughout the entity of this capstone project.

• Opioids are either opium poppy derivatives or synthetic equivalents, that have highly addictive properties of pain relief and euphoria (WHO, 2018).  Some of the more common types of opioids, include the illicit drug, heroin and the licit drugs, including codeine, morphine, oxycodone, and fentanyl (WHO, 2018). 
• Overdose is the intentional or accidental use of a prescribed or illegal drug at an amount that is larger than the individual can safely tolerate, resulting in severe central nervous system adverse effects or fatality (Thanacoody, 2018). 
• Naloxone is an opioid antagonist that can be safely administered via multiple routes to reverse the detrimental side effects of opioids (Lynn & Galinkin, 2018).

Epidemiology

Overuse of illicit and prescription opioids, resulting in addiction is becoming commonplace and unfortunately becoming an increasing issue worldwide.  Astonishing statistics show that approximately 275 million individuals worldwide between the ages of 15 and 64 years old, have attempted drugs at least once during 2016, and of those, 34 million people attempted opioids (WHO, 2018).  Because of this a longstanding dilemma of opioid-related overdose has occurred.  Opioid-related overdose is the leading cause of accidental deaths in the United States, taking nearly 50,000 lives in 2017 (National Institute on Drug Abuse [NIDA], 2018).  Because of the new laws in effect in certain states mandating the extreme limitation of prescription opioids, the current epidemic is bound to spiral out of control based on statistics alone.  One such statistic shows that 94% of respondents in a 2014 survey of individuals receiving treatment for opioid addiction progressed to heroin use because opioids were costly, and they were harder to acquire (American Society of Addiction Medicine, n.d.).  

Clinical Presentation

Prescription opioids, heroin, and illicitly-manufactured synthetic opioids are contributing to the increase numbers in fatal overdoses (U.S. Department of Health & Human Services, 2018).  Prescription opioids and fentanyl are often prescribed to relieve moderate to severe acute or chronic pain (Centers for Disease Control and Prevention [CDC], 2017).   However, with the pain relief there are a variety of side effects that can occur that can increase in severity as more of the medication is ingested and accumulates in the system.  Side effects can include sweating, dry mouth, dizziness, constipation, hyperalgesia, sleepiness and progress to dependence and tolerance (CDC, 2017).

Complications

Although there are several complications that can occur form opioid use, this paper will focus on opioid use disorder and opioid overdose.  Opioid use disorder (OUD), commonly known as opioid addiction, is when the use of opioids consistently negatively affects activities of daily living, resulting in poor work performance, disturbance in homelife, and social ineptness/isolation (CDC, 2017).  Opioids are similar in that they all potentiate immense respiratory depression, bradycardia, hypotension, pupil constriction, pallor, and unconsciousness and if taken in large amounts can cause a nonfatal or fatal overdose (CDC, 2017). 

Diagnosis

 In diagnosing an opioid overdose, there are crucial diagnostic measures that need to be implemented to confirm accuracy of diagnosis and substance confirmation so that proper treatment can be instituted.  These measures include presence of central nervous system collapse accompanied by physical mutilation from needle injection, nearby drug accounterments, and thorough history from witnesses/bystanders, with confirmatory diagnostics of a therapeutic trial of naloxone, EKG, radiographic examinations, and opioid urine screen (Thanacoody, 2018).

Conclusion

The current opioid epidemic is calculated to increase in intensity within the upcoming years and strategic planning is underway to prevent future opioid-related deaths from occurring.  Areas of importance that lawmakers are addressing and incorporating into their policy changes relating to the current opioid predicament, include educating prescribers on the importance of co-prescribing naloxone to high-risk opioid users, increasing education and the availability of naloxone in the community, and implementing more effective treatment options for individuals suffering from an opioid use disorder (Kerensky & Walley, 2017).  Hopefully, by increasing society’s knowledge on opioid overdose and naloxone accessibility/administration will prove to be a resolution to the opioid epidemic.

The PICOT question that will be addressed within this project is:

Does offering an opioid educational intervention and naloxone instruction to individuals with an opioid use disorder decrease the number of opioid-related overdose deaths as compared to no educational intervention/instruction after an overdose incident?

One such plan, includes offering opioid education and teaching correct naloxone administration to individuals attending overdose rehabilitation programs (Lott & Rhodes, 2016).  Individuals with a known opioid use disorder (OUD) are at risk for an initial or repeated attempt of overdose.  For this reason, OUD individuals should be educated in the prevention, detection, and appropriate response to overdose.  Educational intervention should include signs of opioid overdose, proper   administration of the reversal agent, naloxone, and essential overdose after-care (American Society of Addiction Medicine [ASAM], 2016).  Overdose mortality can also be reduced by offering naloxone to the community by way of over the counter availability, third-party prescription, or dispensing it to bystanders at opioid overdose prevention programs (OOPP) (Neergaard, 2016).  The increase number of opioid-related overdoses has warranted a need for increased accessibility and naloxone education for the community, who are on the frontlines of America’s opioid epidemic. 

References

• American Society of Addiction Medicine. (n.d.). Opioid addiction 2016 facts and figures. Retrieved from: https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
• Boscarino, J., Kirchner, H., Pitcavage, J., Nadipelli, V., Ronquest, N., Fitzpatrick, M., & Han, J.  (2016).  Factors associated with opioid overdose: A 10-year retrospective study of patients in a large integrated health care system.  Substance Abuse and Rehabilitation, 7: 131-141.  doi: 10.2147/SAR.S108302
• Centers for Disease Control and Prevention. (2017). Opioid basics. Retrieved from: https://www.cdc.gov/drugoverdose/opioids/index.html
• Kerensky, T. & Walley, A. (2017). Opioid overdose prevention and naloxone rescue kits: What we know and what we don’t know.  Addiction Science & Clinical Practice, 12: 4. doi: 10.1186/s13722-016-0068-3
• Lynn, R. & Galinkin, J.  (2018).  Naloxone dosage for opioid reversal: Current evidence and clinical implications.  Therapeutic Advances in Drug Safety, 9(1): 63-88. doi: 10.1177/2042098617744161
• National Institute on Drug Abuse.  (2018).  Overdose death rates.  Retrieved from: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
• Thanacoody, R.  (2018).  Opioid overdose.  Retrieved from: https://bestpractice.bmj.com/topics/en-gb/339
• U.S. Department of Health & Human Services. (2018). Surgeon General’s Advisory on naloxone and opioid overdose. Retrieved from: https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html
• World Health Organization. (2018). Information sheet on opioid overdose.  Retrieved from:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            https://www.who.int/substance_abuse/information-sheet/en/