Legislative: Responding to the Fatal Opioid Overdose Epidemic: A Call to Nurses

Abstract

People who weren't familiar with the opioid overdose epidemic were shocked by the tragic death of Philip Seymour Hoffman. Many of my friends and co-workers (who know I work with clients suffering from opioid dependence) asked me what I thought of his death. I took this opportunity to explain to them that Mr. Hoffman's death was in no way a solitary event. Drug poisoning (overdose) has now surpassed motor vehicle accidents as the leading cause of accidental-injury death in the United States (US); approximately 41 people die every day of a drug overdose involving prescription painkillers (CPC, 2012; Paulozzi, 2012). In the state of Ohio, approximately five people per day fall victim to fatal, opioid-related overdoses; and in my county in Ohio, we lose an average of one person every other day (lOhilQ-D£p..artm.eii.Lo.fu.ealth.-2Q.13).Opioid overdoses affect individuals, families, friends, and communities. The societal costs of opioid overdoses exceed 20 billion dollars annually; everyone is affected in some capacity (Inocencio, Carroll, Read, & Holdfored, 2013). Nurses have a social responsibility for the holistic welfare of all individuals. Given the widespread and multifaceted reach of care delivery, nurses are uniquely positioned to combat the opioid overdose epidemic on many fronts. This column will discuss how nurses are well positioned both to address the opioid epidemic and support the use of naloxone to reverse opioid-related overdoses and also to promote legislation to increase access to naloxone and decrease fatal opioid overdoses.Nurses are encouraged to become active in the prevention of opioid-related overdoses and to incorporate overdose prevention into their daily practice. Both prescription and illicit opioids, including heroin, morphine, codeine, methadone, hydrocodone, oxycodone, hydromorphone, and fentanyl, contribute to the fatal opioid overdose epidemic. When someone is experiencing an opioid overdose, a potentially fatal cyanotic cascade of events ensues: breathing slows, oxygen levels in the blood decrease, and oxygenation to vital organs decreases. Within minutes unconsciousness, brain damage, coma, and death may follow (Harm Reduction Coalition, 2013V Respiratory depression is the hallmark symptom of an opioid overdose. Overdoses, in which a person has not ingested opioids, cause respiratory depression infrequently. Opioid overdoses are rarely immediate; and there is usually of window of time to intervene. Naloxone hydrochloride, brand name Narcan®, is a Food and Drug Administration-approved medication which, if administered in time, has the potential to effectually reverse opioid overdoses, allowing victims to receive the treatment they need (Boyer, 2012).In 1996, community-based opioid overdose prevention programs (OOPPs) began distributing naloxone to individuals who are at high risk for witnessing an opioid overdose. Naloxone distribution has now reached over 50,000 individuals; over 10,000 overdose reversals have been reported (Wheeler. Davidson, Jones, & Irwin, 2012). Opioid overdose programs aim to teach those people who are at risk for witnessing an overdose how to prevent overdoses, recognize overdoses, respond appropriately to overdoses, and administer naloxone to reverse overdoses. Data from the 188 OOPPs in the United States indicates that people can and are willing to respond to overdoses, and that OOPP participants are saving lives by reversing overdoses (Wheeler et al.r 2012).Naloxone is safe, effective, and has no abuse potential; yet there remain barriers and opposition to preventing the widespread dissemination of naloxone to the public. First, opponents often argue that naloxone distribution provides people with a 'license to use' opioids. However there is no evidence to support this claim, and research indicates that participants in opioid overdose prevention programs report decreased heroin use (Seal et al., 2005V A nurse-led, opioid-overdose-prevention program in Ohio has adopted the slogan 'Prevention not Permission. …