Opioid Related Overdose Case Study

As we learned in class last week, victimless crime can be one of many things. Victimless crime is defined as a crime taking place where there are no harmful injuries done from one person to another. Instead, the damage being done is committed by the individual who is committing the crime. Some examples of a victimless crime are, Drug use, prostitution, gambling, suicide, traffic citations and trespassing.

Many people may not realize this but multiple states, including Michigan, are facing an epidemic. It is not a disease, however, it is a heroin epidemic. In a country where addictive opioid pain-killer prescriptions are handed out like candy, it not surprising heroin, also known as smack or thunder, has become a serious problem. The current heroin epidemic Michigan is facing, as are dozens of other states, has spiraled out of control in recent years. In Michigan, some of the areas hit hardest by this drug are in the southern portion of the state, like Wayne, Oakland, and Monroe Counties. The connection between painkillers and heroin may not be clear, but this is because both are classified as opioid drugs, and therefore cause many of the same positive and negative side effects. As a country, we are currently the largest consumer of opioids in the world; almost the entire world supply of hydrocodone (the opioid in Vicodin) and 81% of the world’s oxycodone (in Percocet and OxyContin) is used by the United States (Volkow). Along with consuming most of the world’s most common opioids, we have gone from 76 million of these prescriptions in 1991 to 207 million in 2013 – constantly increasing except for a small decrease starting in 2012 (Volkow). This widespread use has caused numerous consequences from increasing emergency room visits – for both painkillers and heroin – to sky-rocking overdose cases all over the country (Volkow). Michigan, unfortunately, currently has one of the

There is no question that the alarming rate of deaths related to opioid overdose needs to be addressed in this county, but the way to solve the problem seems to remain a trial and error approach at this point. A patient is injured, undergoes surgery, experiences normal wear and tear on a hip, knee or back and has to live with that pain for the rest of their life or take a narcotic pain medication in order to improve their quality of life and at least be able to move. The above patients are what narcotic pain medications were created for, a population of people that use narcotic pain medications for fun is what is creating a problem. Narcotics are addictive to both populations, however taking the narcotic for euphoric reasons is not the intention of the prescription that the physician is writing. The healthcare system needs to find a way to continue to provide patients that experience chronic pain with the narcotics that work for them while attempting to ensure the Drug Enforcement Agency (DEA) doesn’t have to worry about a flood of pain pills hitting the streets by granting access to the population with a substance abuse problem.

Part of this team are pharmacy interns who distribute naloxone (Narcan) rescue kits to the patient every saturday morning. The naloxone rescue kits were donated by the Steve Rummler Hope Foundation. The Steve Rummler Hope Foundation partnered with HCMC with a mission to heighten awareness of the dilemma of chronic pain and the disease of addiction and to improve the associated care process.4 The pharmacy intern spends about fifteen minutes educating the patients on signs and symptoms of opioid overdose, how to respond and how to use the naloxone rescue kits. This program has been successful with distribution of a total of 150 kits as of October of 2016. In addition, patients often provide success stories of occasions when they saved the lives of a loved one or a friend using the naloxone rescue

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

Once more, the lives of Canadians are being claimed by addiction and overdose of a new drug in the streets. For those of you who don’t know what fentanyl is, it’s a powerful opioid, 100 times stronger than morphine, that is often prescribed to help patients manage moderate to severe pain. As a highly addictive substance, many are now dependent on it, and it is one of the most frequent causes of drug overdose. Readily available for purchase online are quantities of pure fentanyl from China, but when improperly diluted in clandestine labs, it can lead to an immediate overdose. Recently, an antidote for opioid overdose called naloxone has become available without prescription, so that anyone can use it. Fentanyl has become a severe problem in the past few years, and while we yet to find a way to eliminate dependence on this drug, we must keep those who use it safe.

Opioid abuse has become so widespread in Baltimore that on March 1, 2017, the governor of Maryland, Larry Hogan, declared a state of emergency. The rise in the number of opioid-related overdoses in the Baltimore have skyrocketed in the past few years. According to the Maryland Department of Health and Mental Hygiene, 1089 people, a majority from Baltimore, died of a fentanyl overdose in 2015. In 2016, the number rose to 1856 deaths. (Maryland Department of Health and Mental Hygiene 14). The spike in overdose deaths can be contributed to the increased use of Fentanyl. Fentanyl is 50 times more potent and costs less than a third of heroin (Adwanikar; Duncan). Drug dealers mix fentanyl with heroin to make their product less expensive to produce

More than 28,000 families a year get the terrifying call that their loved one has overdosed. Majority of the time police officers are the first to arrive at the scene of an overdose, accident, or crime. Some law enforcement officers are equipped with the lifesaving opioid antidote, Narcan, however, not all law enforcement in America carries the drug. Currently, over 1000 police departments carry the drug but, still that is not enough.

Arizona Law Enforcement Agencies and first responders are now able to obtain and use Naloxone on people with suspected opioid overdoses (Arizona Department of Health Services, 2017). There is also a new standing order that lets pharmacist dispenses Naloxone to any person the requests it. Naloxone is used to reverse the effects of opioid drugs (Arizona Department of Health Services, 2017). The state of Arizona is also offering free training on suspected opioid overdoses, suspected opioid deaths, naloxone doses administered, naloxone doses dispensed and neonatal abstinence syndrome to healthcare professionals licensed, administrators of a healthcare institution, correctional facility, emergency medical services/ first response agencies, law enforcement officers, medical examiners, and pharmacists (Arizona Department of Health Services, 2017).

More recently, numerous programs across the United States have distributed naloxone, paired with education on how to identify, prevent, and treat overdoses, to the lay public (e.g., friends and family members of people who use opioids). In addition to naloxone distribution programs for friends and family members of people who use opioids, programs training first responders like police, firefighters, and emergency medical technicians who traditionally have not been trained to use naloxone, have also demonstrated positive results [19,20]. Despite evidence of safety and efficacy, naloxone distribution programs, like other harm reduction interventions, face logistical and ideological challenges [21,22]. First, individuals who witness an overdose may not call for medical attention or administer naloxone because of legal concerns

Naloxone, better known by its brand name Narcan, is an opiate antagonist that has the ability to reverse opiate overdoses. Due to the opiate epidemic, Narcan is being distributed in communities where opiate abuse is prevalent, and individuals in these communities are now administering the drug. However, administering the drug to someone with a suspected opiate overdose can be dangerous whether they are a skilled professional or civilian: “Administering narcan can be a wild experience the first time you do it because it's one of very few drugs that works very very rapidly and causes a very dramatic effect in a very short period of time especially depending on the dose.There's been a bad habit of people in the past to give very large amounts of naloxone very quickly and that can cause a patient to go from completely unconscious barely breathing or sometimes not even breathing at all and then within in a matter of seconds they can be awake alert breathing, One of the side effects is extreme agitation so these patients can become extremely like I said agitated or sometimes even combative or violent. So now we are learning as providers it's better to give it in more measured doses give smaller amounts at a time to prevent that sort of effect from happening.” said Sean McMullen a paramedic with Gila River EMS (McMullen). Since individuals can become combative and

UCF’s College of Medicine was recently recognized by the White House as one of 60 medical schools across the country to pledge to teach students about the dangers of prescribing opioids to patients for pain. The pledge follows President Obama’s public-private efforts to fight the nations epidemic of prescription opioid and heroin abuse, according to a press release from UCF.

In response to the ever-growing opioid epidemic in the United States, many elected officials, health-centered agencies and addiction support groups have been advocating for friends and family members to arm themselves with naloxone, an opioid antagonist commonly known as Narcan. Narcan (naloxone) can be given by intramuscular (IM) injection - into the muscle of the arm, thigh or buttocks - or with a nasal spray device (into the nose).

In this Daily Herald article, Dr. Kenji Oyasu, the medical director of Brightside Clinic, a Northbrook, IL, drug rehabilitation clinic, discusses the importance of making naloxone available without a prescription. He also addresses which stage in drug addiction treatment the

The usual treatment given to overdose patients is naloxone. However, if the individual does not respond to the standard treatment of opioid, most often, doctors conclude that the individual may have used acetylfentanyl and not heroin.