By Laurel Hallock-Koppelman, DNP, FNP-C, APRN
International Overdose Awareness Day is August 31. Founded in 2001, this day acts as a time to reflect without judgment upon the lives that have been lost to opioid overdose and to promote the discussion of overdose prevention worldwide. It is a time to share resources for individuals who use drugs and information about harm reduction modalities.
According to the Centers for Disease Control and Prevention, there were more than 100,000 drug overdose deaths reported in the United States from April 2020 to April 2021, an increase of more than 25% from the previous 12-month period. One wonders if the increase was related to isolation and coping during the COVID-19 pandemic as well as decreased access to substance use treatment services. Regardless of the cause of this rise, people remain at risk for overdose death caused by decreased oxygen to their brain or lungs when they use too much of a drug or multiple drugs — whether the drugs are prescribed or not.
Alcohol (which is a drug), stimulants, depressants and other substances can lead to overdose death, particularly in combination with one another. Even medications that have been prescribed long term — such as opioids like oxycodone for pain — may have the potential to cause respiratory depression and death, regardless of the length of time one has been taking these medications. All opioid prescriptions for pain should be accompanied by a prescription for naloxone, which is a reversal agent for opioid overdose. Health care providers, including nurse practitioners, assess patients for medications that may increase the power or effects of the patient’s current prescriptions and warn of the risk of overdose.
Overdose deaths may occur with non-prescription drugs as well. If you use opioids like heroin, fentanyl or other pills that were not prescribed, there is a risk that those pills may not be pure substances or may be contaminated. This year where I live, two teenagers obtained opioid-like pills from friends who had varying levels of fentanyl pressed into the tablets. Fentanyl can be 50 to 100 times stronger than morphine, making one contaminated pill possibly more deadly than another. Both teenagers died from these pills. The impact on the community has been palpable, and more people have been talking about overdose risk, but I cannot imagine the sorrow that their loved ones have experienced. This should not have happened to teens in the prime of their lives.
Prevention is key. Talk to your NP and your family about the potential for impure substances. Tell your teens not to take pills or other substances that have not been prescribed to them and dispensed by a pharmacy. Do not buy potentially counterfeit pills from the internet or on the street. There is no way of knowing if that substance contains other medications that can cause overdose death.
Families and loved ones should have open and honest communication about substance use. If you find out your loved one is using drugs, consider harm reduction practices in addition to finding treatment for a person who wants help. Harm reduction is the act of reducing the negative impacts of behaviors that could cause poor social and physical outcomes. It does not promote the use of drugs but recognizes that drug use does occur and should happen as safely as possible to avoid overdose death and prevent the transmission of hepatitis C, HIV, skin infections, cardiac complications and more.
Here are some ways you can help with harm reduction.
- Fentanyl Test Strips — Obtain fentanyl test strips so you can check substances for fentanyl contents before use.
- Naloxone — Anyone who uses drugs or knows someone who uses drugs should have access to this potentially lifesaving medication. This overdose reversal drug works only on opioid overdose but will not harm someone who is using other substances. Many states have Good Samaritan laws in place, so if you use naloxone on someone to help reverse an opioid overdose, you are not held liable. In Oregon, you can obtain naloxone from a pharmacist without a prescription.
- Needle Exchange — For persons who use substances by injection, consider accessing a needle exchange for clean needles, sharps containers and information on safer use practices, such as not licking or sharing needles and never using alone.
As a family NP, my focus is on prevention and on reducing stigma against those who use drugs. This starts with avoiding words and labels like addict, junkie, drug seeker and drug user. By using people-first language. such as “person who uses drugs”, we are reminded to respect individuals. A person who uses drugs is someone’s child, someone’s mother or father, someone’s grandparent or sister. Indeed, International Overdose Awareness Day is also a day to remember the loved ones of those who have lost their lives to overdose. Their lives have been forever changed. We have the power to make change by talking about overdose and helping to prevent its occurrence. Contact your NP or other health provider for more information on overdose prevention and effective harm reduction strategies.