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Naloxone’s Place in the Treatment of Opiate Use Disorders

Naloxone’s Place in the Treatment of Opiate Use Disorders

Imagine that someone close to you has a severe peanut allergy. You would want that person to have an EpiPen, right? Let’s assume that he’s bright and knows better than to eat peanuts, it’s still better to be safe than sorry. Now let’s say that peanuts are his favorite food and that they’re all that he thinks about when he can’t eat them. Last month, he went into anaphylactic shock and nearly died on two separate occasions after eating a box of Goobers, and even that wasn’t enough to stop him from eating peanuts again. In that case, you’d really really want him to have the EpiPen.

That’s essentially what Naloxone is; an EpiPen for opiate overdoses. Naloxone is an opiate antagonist that functions as an overdose antidote by displacing opiate molecules attached to the brain’s opiate receptor sites. It’s available in an intramuscular injector and an intranasal preparation. When a person overdoses on an opiate or opioid, they become unconscious and their central respiratory drive is suppressed. This can cause cardiac arrest and ultimately death. Naloxone, when delivered in a timely manner and in the proper dose, can restore an overdosed individual to consciousness and normal breathing. Time is precious. Historically, Naloxone was only available to medical personnel at hospitals and to EMS workers. Changes in legislation resulting from advocacy efforts and changes in prescriber practices have made Naloxone available to opiate users and their families.

In 2015, The American Society of Addiction Medicine (ASAM) updated its recommended practice guidelines to include the statement;

“The Guideline Committee, based on consensus opinion, recommends that patients who are being treated for opioid use disorder and their family members/significant others be given prescriptions for naloxone. Patients and family members/significant others should be trained in the use of naloxone in overdose.”

Here’s a puzzle for you. Three IV drug users are shooting heroin in an abandoned building. One is on probation, one has an outstanding arrest warrant, and the third is unconscious on the floor and foaming at the mouth. Which of the other two is most likely to dial 911 and direct EMS and the police to the location where the three IV drug users are currently trespassing, in possession of illegal drugs and possibly implicated in another person’s overdose? I have no idea either. Part of ASAM’s rationale for making Naloxone available to individuals with opiate use disorders is that they are most likely to be present when another individual is overdosing. The thought is that while someone in that circumstance might be reluctant to dial 911, they might be more willing to intervene by sharing their Naloxone with another opiate user who has overdosed, thereby preventing a fatality.

The overarching rationale behind this shift in recommended provider practice is based on a population health management approach to the epidemic of death by opiate or opioid overdose. The idea is to get Naloxone into the hands of as many people as possible who are likely to be present when someone has overdosed in order to save lives. According to ASAM, this strategy saves lives and has been proven to do so since the first opioid overdose prevention program began distributing Naloxone in 1996. Additionally, states where overdose death rates are the highest are those that did not have community-based opioid prevention programs. More specific Naloxone based statistics are available at http://www.asam.org/docs/default-source/advocacy/naloxone-talking-points.pdf?sfvrsn=2.

We have elected to remove any ambiguity by making Naloxone and the related training available.

The language of the ASAM practice update does not indicate at what point during treatment a patient diagnosed with an opiate use disorder should be prescribed Naloxone or trained to use it. It simply states that any patient being treated for an opiate or opioid use disorder should be prescribed Naloxone. We are an abstinence based program and our goal for all of our clients is complete recovery from substance use disorders. At our center, we have elected to remove any ambiguity by making Naloxone and the related training available at the highest level of care such that any client who receives medical services at Life of Purpose can be prescribed Naloxone should they opt to accept it.

Our hope is that they never have to use it.

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