Preventing Opioid Overdose in the Clinic and Hospital

Abstract

Drawing from existing opioid prescribing guidelines, this article describes how medical providers can reduce the risk of overdose. Through primary prevention, providers can prevent initial exposure and associated risks by educating patients, using risk stratification, minimizing opioid dose and duration, and avoiding coprescribing with sedatives. Secondary prevention efforts include monitoring patients with urine toxicology and prescription monitoring programs, and screening for opioid use disorders. Tertiary prevention includes treating opioid use disorders and providing naloxone to prevent overdose death. Specific preventive strategies may be required for those with psychiatric disorders or substance use disorders, adolescents, the elderly, and pregnant women.

Opioid Prescribing in United States Health Systems, 2015 to 2019

“…5 This trend may be a reflection of successful health system interventions aimed at limiting or eliminating opioid prescribing without compromising patient outcomes. [21][22][23][24][25] Efforts to limit opioids and use of alternative pain management strategies postoperatively continue to expand and have been the focus of recent recommendations of the American Society for Enhanced Recovery and Perioperative Quality Initiative. 26 These efforts are expected to play an important positive role in limiting opioid prescription and their associated risk while improving pain management for patients.…”

“Naloxone? Not for me!” First cross-assessment by patients and healthcare professionals of the risk of opioid overdose

“…A loss of tolerance to opioids can occur in as little as 3 days without use. Many publications have identified loss-of-tolerance situations as particularly high-risk of opioid overdose [ 20 , 20 , 31 – 37 ]. For instance, in Ireland, official recommendations specify that OSTs should not be provided to patients who have experienced a treatment interruption of 3 days or more, unless the prescriber confirms the appropriate dose to be dispensed [ 24 ].…”

“…The summary of product characteristics for methadone and buprenorphine mention an increased risk of sedation, respiratory depression, coma, and death in the event of concomitant use of sedative substances. A large number of publications warn that the concomitant use of CNS depressants increases the risk of opioid overdose [ 20 , 32 , 36 , 37 , 40 ]. Alcohol is the substance most commonly found with opiates in overdose victims [ 22 ]; its use significantly increases the risk of overdose [ 41 ].…”

It Is Time to Implement Primary Prevention in the Workplace to Ameliorate the Ongoing U.S. Opioid Epidemic

“…For opioids, it includes giving workers information at the time of injury on how to speak to their healthcare providers about opioid use and alternative pain treatment. 13 Tertiary prevention attempts to reduce the impact of an ongoing disease or injury to help prevent long lasting impacts 14 ; for opioids, it includes increasing employer-sponsored access to mental health and substance use treatment and recovery programs and the availability of naloxone in the workplace.…”