Dealing with Opiod Overdose Epidemic

“It is the deadliest drug overdose crisis in U.S. history. CDC’s National Center for Health Statistics indicates that there were an estimated 93,331 drug overdose deaths in the United States during 2020, an increase of 29.4% from the 72,151 deaths predicted in 2019.In 2016 alone, drug overdoses likely killed more Americans in one year than the entire Vietnam War.” – German Lopez, Vox

Paramedics responding to a call regarding an unconscious person found a man down behind his desk at work. He was limp and barely breathing. Pupils were pinpoint. He was one breath away from death. It was not a setting you typically identified with drug abuse.

What Are opioids?

Opioids are a class of drugs that include illegal drugs such as heroin, but also come in the form of prescribed painkillers such as fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Signs and Symptoms

These class of drugs can cause depressed or slowed breathing, confusion, lack of oxygen to the brain and death.

Symptoms of Opioid Overdose Include:

• Confusion, delirium or mood swings
•  Nausea or vomiting
• Constipation
• Pinpoint pupils
• Extreme sleepiness or inability to wake
• Breathing problems (slowed and irregular)
• Cold, clammy skin
• Bluish skin especially around lips and fingernails

Interventions

Lifesaving treatments include intubation, treatment for cardiac arrest, and intravenous fluids and drugs to counteract the opioid narcotic.

According to the American Heart Association 2015 guidelines update, the term “Opioid-associated life-threating emergency” is used for first aid and non-healthcare providers. Naloxone has an excellent safety profile and can rapidly reverse CNS and respiratory depression in a patient with an opioid-associated respiratory emergency.

It can be administered intravenously, intramuscularly, intranasally, subcutaneously or nebulized for inhalation. Appropriate dose and concentrations differ by route and there are no known major clinical effects associated with naloxone. In advanced courses such as Advanced Cardiac Life Support for the Experienced Provider, naloxone serves as a cocktail of drugs given to the unknown unconscious patient.

We now give users and their family naloxone to counteract overdoses. These are take home pens, prepackaged to deliver a dose of naloxone. They are similar to life saving Epi pens but are now being prescribed for opioid abusers and to family members.

Those using opioids regularly one develop a tolerance to the drug — a phenomenon that can trigger the cycle of addiction. It tricks the brain by making you feel so good with extreme floods of endorphins, when so close to death — the opioid high. This means that the same amount of the drug no longer has the same effect as it once did. When this occurs, users will take more and more of the substance to elicit the desired response. This ever-increasing dosing places one at a greater risk for overdose.

Opioids in the Workplace

According to the Centers for Disease Control and Prevention (CDC), prescription drug abuse was the fastest growing drug problem in the United States as of 2012. One major contributing factor to this growing drug problem in the United States is the increased use and prescribing of opioid analgesics, which, over the past decade, have caused more overdose deaths than heroin and cocaine combined.

National Safety Council surveyed businesses and found that construction, entertainment, recreation and food service sectors have twice the national average of employees with substance use disorders. They also found:

• Industries dominated by women or older adults had a two-thirds lower rate of substance abuse
• Industries that have higher numbers of workers with alcohol use disorders also had more illicit drug, pain medication and marijuana use disorders
• Employers were most concerned about the costs of benefits (95 percent), the ability to hire qualified workers (93 percent) and the costs of workers’ compensation (84 percent) – but less concerned over drug misuse (67 percent) and illegal drug sale or use (61 percent)
• Workers in recovery have lower turnover rates and are less likely to miss work days, less likely to be hospitalized and have fewer doctor visits

Healthcare cost for employees who misuse drugs are three times higher than for the average employee. Employers can take some steps to protect themselves and their employees.

Opioid Death Prevention

Employers must first recognize prescription drugs impact the bottom line. Start by enacting strong company drug policies and expand drug testing panels to include opioids. Train personnel to recognize signs of opioid use. The American Heart Association HeartSaver CPR, First Aid and AED course teaches signs and symptoms of opioid use and how to use Epi and Naloxone pens.

Treat substance abuse as a disease and leverage your employee assistance programs to support employees.

According to the National Institute on Drug Abuse, every day, more than 90 Americans die after overdosing on opioids. Rarely is this a case of accidental death, but it's certainly a lack of awareness.