After a spike in deaths from opioid overdose, House pushes for intervention

The AOA House of Delegates approved a resolution today calling for continued evaluation of interventions to prevent opioid overdose deaths. Prompted by the recent sharp increase in such incidents, the resolution recommends normalizing take-home naloxone hydrochloride, a widely used emergency room drug that can reverse the effects of an opioid overdose.

“We’re seeing more and more opiates, especially in the younger populations,” says Marla Kushner, DO, a Board member of the American Osteopathic Academy of Addiction Medicine. “In my practice, the majority of the patients I see are 18- to 25-year-olds. And most of the patients are college students or working. This not a disease of the unmotivated. This is a disease of people who usually are very high-functioning—until the disease takes over their lives.”

Deaths in women from opioid pain relievers increased fivefold from 1999 to 2010, a recent Centers for Disease Control and Prevention study found. In men, deaths increased 3.6 times.

While naloxone hydrochloride is predominantly used in the ER, it is approved by the Food and Drug Administration for home use only when prescribed by a physician.

Programs around the country have experimented with giving the drug to opioid users and their families and training them on how to use it in the event of an overdose. Overdose prevention programs nationwide have reported more than 10,000 overdose reversals from 1996 to 2012 as a result of using naloxone in the home.

One particular challenge of gaining widespread acceptance of take-home naloxone hydrochloride is the stigma of opioid dependence, even among physicians, says Dr. Kushner.

“If we were looking at a drug that would quickly reverse a diabetic coma, physicians would approve it pretty quickly,” she says. “But because of the nature of this disease, with drugs, whether it’s illegal opiates or prescription opiates, it’s not always viewed the same way. But it really is a disease of the brain. We really need to view it in the same way that we view other chronic diseases.”

William Morrone, DO, suspects physicians may also question the public’s ability to properly administer naloxone hydrochloride.

“The whole goal is not to treat the overdose in the field,” says Dr. Morrone, who is the president-elect of the American Osteopathic Academy of Addiction Medicine. “The goal is to buy time and reverse the overdose five or 10 minutes before EMS gets there, and then the patient gets a second chance.

“Sometimes physicians are uncomfortable with teaching and delegating a clinical skill to midlevels or to the public. But that’s what we do with insulin and EpiPens.”