The drug overdose epidemic is a multifaceted crisis being handled on multiple fronts. Drug overdose deaths, including those involving opioids, continue to increase across the United States.
The epidemic consists of multiple factors. The general population has increased not only through children, but in terms of people coming of age paired with an increased need for pain medication. The amount of pain medication has also increased over the years as synthetics permeate the market. As the healthcare industry faces increasing drug overdoses at record high rates, EMS professionals work hard as feet on the street treating victims of this epidemic every day.
Opioids and Benzodiazepines
Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the sensation or intensity of pain. Opioids include medications such as Morphine and Vicodin. More than 30 percent of overdoses involving opioids also involve benzodiazepines, a prescription sedative commonly prescribed for anxiety or insomnia. Common benzodiazepine medications include Valium, Xanax and Klonopin.
Overdose deaths from opioids, including prescription opioids and heroin, have increased more than five times since 1999. Deaths from drug overdose are on the rise in both men and women of all races and adults of nearly all ages.
Synthetics
Synthetic opioids include drugs such as codeine and fentanyl. Recently, parts of the Northeastern United States have been dealing with a rise in deaths from K2, a synthetic cannabinoid. The increase in the use of synthetic drugs, combined with the classic pain medication modality, the chances of overuse and contraindications from other medications grow every day.
Drug Interactions
The drug overdose epidemic stems from a variety of issues including those encountered by patients taking other medications. A classic example involves a patient taking blood pressure medication to control hypertension (high blood pressure). When that patient breaks a bone and is prescribed an opioid pain killer, under justified circumstances, you have a synergistic effect of two medications.
A synergistic effect is the interaction between two or more drugs which causes the total effect of a drug to be greater than the sum of the individual effects of each drug. A synergistic effect can be beneficial or harmful. This is where education becomes essential. Patients are unaware of how medications work and interact and tend to follow medication labels to the letter. If instructions say to take one to three pills per day, most patients normally take the highest dose. Educating patients and pointing them to local agencies or pain specialists can help manage their pain. Pain specialists answer important questions and can direct patients on how to tell if and when they should take a higher or lighter dose; the difference of taking one pill versus taking three.
Overdoses involving opioids killed more than 42,000 people in 2016, 40 percent of those deaths were from prescription opioids. In 2016, the states with the highest rates of death due to drug overdose were West Virginia, Ohio, New Hampshire, the District of Columbia and Pennsylvania.
The Role of Emergency Medical Services
When someone overdoses on any type of narcotic, the primary treatment given is respiratory care. Narcotics hurt or kill people by compromising the respiratory system; the user stops breathing. The primary focus for EMS paramedics is treating the respiratory compromise with supplemental oxygen and then the underlining medical condition, the overdose itself.
Narcan is the primary medication used to save those from an opioid overdose. It’s available in a nasal spray and an intravenous injection. For police, it is recommended either in a pre-measured nasal spray (4mg) or an auto injector. EMS paramedics use a nasal misting system or an intravenous injection with a dosage measured based on the patient’s body weight and tolerance.
Patients being treated in drug overdose situations require a high concentration of oxygen for supplemental care, either by a non-rebreather or a bag valve mask in cases where patients have stopped breathing completely. Then, EMS paramedics work to block the negative effects of the drugs obstructing the patient from breathing. Supplemental treatments help maintain proper blood pressure and electrolyte balance.
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