Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States

Abstract

Drug overdose is quietly competing with vehicular accidents as a leading cause of accidental injury death in this country. Opioid drugs are driving this surge, contributing to the loss of well over 16,000 Americans every year. The rising death toll has several causes including fluctuating drug potency, adulteration of street drugs, and changes in tolerance after a period of abstinence. The most striking aspect of this epidemic is that many overdose fatalities are avoidable. Even after a dangerous dose of opioids is consumed, death can still be prevented. Timely administration of naloxone, an effective antagonist, supported by simple first-aid measures, fully revives the victim in the vast majority of cases. This cheap, generic prescription drug is widely and safely used by emergency rooms and first responders for precisely this purpose. Opioid overdoses typically take substantial time to turn deadly and are often witnessed by others, leaving significant opportunities for life-saving interventions. Yet, for a number of reasons, emergency medical help - including naloxone and basic first aid - often comes too late. Some communities have addressed this problem by initiating naloxone prescription programs (NPPs). These initiatives train drug users and others to identify the symptoms of overdose, call 911, provide rescue breathing, and administer emergency doses of naloxone. Preliminary results show that NPPs are a promising intervention with the potential to save thousands of lives without harmful side effects. Unfortunately, a number of legal and practical obstacles have impeded wider implementation of NPPs. With support from Drug Policy Alliance, the authors convened a summit on opioid overdose in which experts from the field of drug policy, opioid overdose, medicine and public health discussed strategies for preventing avoidable overdose by increasing access to naloxone and important basic overdose education. This White Paper presents the findings from the conference and sets forth recommendations for increasing access to this life saving intervention.