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.

As better and more comprehensive education is provided both to the general public and practicing clinicians the hope is to reduce the negativity surrounding the users of opioids, and to eliminate demeaning language coupled to them as well. This could improve patient morale and help the needless continuation of physical suffering within patients, as they would be more comfortable approaching and using opioids for therapeutic purposes1. That being said there are those within our communities who do abuse these substances and pharmacists must recognize the signs of abusers, it is important for them to reach out, without comment, to help those suffering from opioid abuse once they have been

Since 1999 to 2015 more than 183,000 people have died in the United States from overdose involving prescription opioids (www.CDC.gov). The number of deaths in the US, involving prescription opioids, has nearly quadrupled. The number of opioids overdose nearly equaled the number of deaths involved in a car accident and, surpassed gunshot homicides (www.CDC.gov). Death ages range from 45-years of age to 64-year-olds, and is highest among non-Hispanic whites, American Indian and non-Hispanic blacks. Kentucky was dealing with at least 50 overdose cases per day. At the National level, there are several states that had the highest unintentional deaths due to opioids and are predominantly rural states, such as West Virginia, New Mexico, Utah, Louisiana, Oklahoma, Nevada, Kentucky and Tennessee (http://hhs.gov). Canada has become the second largest consumer of prescription opioids to the United States. Since 2007, 47,000 per year are due to drug overdose, and the numbers continue to grow. In 2015 has been a record high, in opioid overdose. Many doctors liberally

Milwaukee is currently facing an epidemic. This epidemic is the usage of opioids. Every year, the death toll grows from opioids usage. Opioid overdoses are America's leading killer. People are becoming more and more addicted to them and it is causing the user to overdose on the drugs. There are many types of opioids with different usages. This causes short and long term effects which can later lead the body to experience withdrawal from the drugs.

Naloxone is an FDA approved overdose reversal medication. Naloxone is a prescription medication that when administered to an individual experiencing an opioid-related overdose restores the individual to consciousness and normal breathing (NAMSDL.org, 2016). Naloxone is always effective when administered correctly (NAMSDL.org, 2016). Since 2000, the drug overdose rate involving opioids has increased 200% (NAMSDL.org, 2016). Treatment centers, physicians and first responders in the rural areas of the United States need more access to naloxone to prevent opioid-related overdose deaths. The U.S Surgeon General Vivek Murthy stated, “People find themselves in overdose situations don’t have to lose their lives because family members or emergency responders don’t have access to the reversal drug naloxone” (Wolf, 2016). Expanding access to rural areas can save lives and prevent deaths.

Opioid overdoses have been a problem over the past two decades. These overdoses usually happen to those that are addicted to the painkiller, morphine. However, this narcotic has recently changed from morphine to a new form of heroin. New reforms such as, “safe injection sites”, have been offered as solutions to lower the high overdose rate from opioid, but is this method going to lower or raise the overdose rate? These safe injection sites will not be beneficial because, the users will just be using the drugs outside of the safety injection sites, no one will want to be paid to watch others take drugs, the government would just be funding the habitual drug abuse industry, and the better option to lower the opioid overdose rate is for State Addictive Drug Centers (SAD) to be in charge of administration.

Proponents of harm reduction argue that instead of penalizing individuals for partaking in illicit drug use, it is more productive to create policies and procedures that reduce the likelihood of harmful consequences of such drug use (14). Naloxone, an opioid antagonist and overdose reversal medication, has been shown to be a highly effective harm reduction strategy. If used quickly, naloxone can prevent and overdose and reverse the effects of opioids (15). Previously only used by EMT’s and other medical professionals, allowing laypersons to access and use naloxone has successfully prevented opioid-related overdoses (13, 16-18). While naloxone is the most studied and validated harm reduction method, others have been employed nationally. Though not validated through peer-reviewed literature, Project Lazarus and the Harm Reduction Coalition, two harm-reduction centered non-profits, advocate that when using drugs, people should use together, and avoid mixing drugs as a means of reducing the likelihood of overdose (19-22). Many fatal-overdoses result from poly-substance drug use and therefore, the recommendation of avoiding poly-substance use bares significance even if this harm reduction strategy has not been analyses in a scientific context

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

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

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.

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.

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).

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).

Drug addiction is a growing epidemic in the United States. Every day, the families and loved ones of those in treatment for heroin addiction fear that they may lose a parent, sibling, child, or friend to an accidental overdose.  A new law, however, offers hope for patients seeking addiction treatment, as well as their families. The law, known as Lali’s Law, is part of the Comprehensive Addiction and Recovery Act and will allow for the opiate overdose reversal drug, naloxone, to be available nationwide without prescription.

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.