● Breathing difficulties, breathing that is slow, shallow, or not present at all, or the presence of the “death rattle” ● Hard to arouse ● Face is pale ● Skin is clammy to the touch ● Body is limp ● Fingernails or lips are blue or purple ● Person is vomiting or making gurgling noises ● Person is unable to speak, is confused, or has slurred speech ● Heartbeat is very slow or stopped Often laypersons attempt to help the overdose victim in ways that may actually harm the person more. The health care professional should educate the layperson on the appropriate way to respond to an opioid overdose. Things that patients should be counseled to do or avoid when responding to an opioid overdose include: 197 ● DO call 911 for emergency medical attention upon finding a person who has overdosed. ● DO support the person’s breathing by performing rescue breathing. ● DO administer naloxone as prescribed in the kit. ● DO turn the patient onto their side so they are in the recovery position if he is breathing independently. ● DO keep the person warm and don’t leave them alone. ● DON’T try to forcefully stimulate the person, such as by slapping them, as this can cause further injury. They may be unconscious if you are unable to wake the person by shouting, rubbing your knuckles on the sternum, or lightly pinching them. ● DON’T put the person into a cold bath or shower. This increases the risk of falling, drowning, or going into shock. ● DON’T inject the person with any substance (speed, saltwater, milk, heroin). The only safe treatment for opioid overdose is naloxone. ● DON’T try to induce vomiting to remove drugs that they swallowed. Choking or inhaling vomit into the lungs can cause a fatal injury.
These symptoms are unpleasant, and some patients may become agitated and combative and require medication (e.g., benzodiazepine) to remain calm. Withdrawal symptoms include the following: 197 ● Body aches ● Diarrhea ● Tachycardia ● Runny nose ● Sneezing ● Piloerection ● Nausea ● Vomiting ● Restlessness ● Agitation ● Abdominal cramps ● Increased blood pressure The FDA has approved injectable naloxone, intranasal naloxone (Narcan nasal spray), and a naloxone autoinjector (Evzio) for the treatment of opioid overdose. Injectable naloxone can be administered intravenously, intramuscularly, or subcutaneously in healthcare settings at doses of 0.4 mg to 2 mg every two to three minutes until respiration is restored. The Narcan nasal spray is a prefilled, needle-free device that requires no assembly. It can deliver a single 4-mg dose of naloxone into one nostril. The Evzio autoinjector is injected into the anterolateral aspect of the thigh to deliver naloxone 2 mg / 0.4 mL in a prefilled autoinjector injected either intramuscularly or subcutaneously. Once Evzio is turned on, the device provides verbal and visual guidance to the user describing how to deliver the medication, similar to automated defibrillators, in a safe, confident manner. Both Narcan nasal spray and Evzio are packaged in a carton containing two doses to allow for repeat dosing if needed. Caregivers should be advised to repeat doses in two to three minutes if no response is seen or until emergency responders arrive. 182,197,19 8 Counseling Patients on Opioid Overdose Risk and Response Evidence has shown that laypersons can learn to recognize the signs of an opiate overdose. They also can learn how to safely administer the antidote, naloxone. Naloxone kits are safe, cost effective, and reduce overdose deaths. Multiple health organizations recommend providing naloxone kits to laypersons who may witness an opioid overdose, to patients in substance abuse treatment programs, to people with substance use disorders who are leaving prison or jail, and as a component of responsible opioid prescribing. 182 It is important to educate patients, family, and caregivers of the danger signs of respiratory depression and drug overdose. Everyone in the household should be advised to obtain immediate medical attention by calling 911 while administering naloxone intranasally, intramuscularly, subcutaneously, or intravenously if the person demonstrates any signs of overdose. Signs of opioid-induced overdose include: 182,197
Book Code: CA23CME
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