Talk to ten people at a weekend barbeque, and at least one is close to someone who has overdosed or knows someone who has lost a loved one to drug overdose. My own case in point: a colleague has a sister who overdosed but fortunately was revived; one of my physicians told me of her best friend’s nephew dying from overdose; a client shared with me the loss of her young nephew to overdose over the winter holidays; my former intern lost her cousin earlier this year to overdose; and my own family has also been touched. Every day, an estimated 68 people – approximately 25,000 a year – lose their lives to opioid overdose.
It doesn’t matter if the overdose was due to prescription pain pills or heroin – the loss of life is tragic. A common theme among these losses: all of these senseless deaths could have been prevented. Our government has educated the nation about the hazards of smoking and AIDS, the dangers of drinking and driving, the need to wear seatbelts, the importance of putting babies to sleep on their backs, and the signs and symptoms of heart attack in women. These and many similar public health initiatives have saved countless lives. Yet where are the overdose awareness campaigns, the public health education efforts, deployment of US Department of Health and Human Services resources? The bully pulpit of the White House?
Last week Senators McConnell and Markey called for a Surgeon General’s Report and Call to Action on the prescription opioid and heroin crisis. Dr. Vivek Murthy, our new Surgeon General, has an enormous opportunity to educate and mobilize the public towards ending the overdose epidemic.
Here are three things about opioid overdose that every American needs to hear from the Surgeon General:
(1) Opioid overdose is a national crisis – no family or community is immune – and stigma associated with substance use disorders helps no one. The prevalence of prescription and non-prescription opioid misuse and abuse is at an all-time high, with more Americans dying each year of overdose than in motor vehicle accidents. Families and communities never before touched by prescription painkiller addiction or heroin use are finding their lives forever changed – with the tragic loss of loved ones, particularly young people.
A significant number of people with opioid dependency report having been sexually abused, have undiagnosed or untreated mental health issues, and other co-occurring serious health issues. Passing judgment and promoting stigma associated with opioid dependency do not help people get better. If you know someone who struggles with misuse or abuse of opioids there are numerous ways you can help them, including saving their life (see below).
(2) There are some telltale signs and symptoms of overdose and if you know what to look for, a layperson can recognize an overdose and take simple steps to save a life. Whitney Englander of the Harm Reduction Coalition tells me that she has heard too many stories of parents who thought their child was deeply snoring, when in fact he/she was overdosing; this unfamiliar gurgling sound known as a “death rattle” is a common sign of overdose.
The World Health Organization refers to the opioid overdose triad: pinpoint pupils; unconsciousness; and respiratory depression. In addition, the Harm Reduction Coalition has a great website that explains how to recognize an opioid overdose, other common signs and symptoms to know, and most importantly what to do in response.
Since consumption of too many opioids can overwhelm the receptors in the brain that control breathing, people who overdose do not get adequate oxygen to their brains; this happens over time and the difference between death and survival depends on how quickly oxygen gets into the person’s body. So rescue breathing, like you learned in that old-school CPR class, is essential.
In addition to rescue breathing, there is a safe, effective, FDA-approved overdose rescue drug – naloxone –that is easy to use, and when administered in a timely fashion, saves lives. In fact, studies have found parents, friends, spouses, and other by-standers can effectively administer naloxone and save lives. Yet, the Obama Administration at the highest levels continues to shy away from calling for – and actively supporting and funding national efforts – to make naloxone directly available to the parents, friends, roommates, and spouses who are in a position to save a loved one’s life. Tragically, the Administration’s hesitation is preventing parents, family, and friends from being empowered to save their loved ones’ lives.
(3) Opioid dependency can be treated and people can successfully achieve recovery – with help. Opioid dependency is a medical condition – a brain disease that requires medical and behavioral interventions. The Substance Abuse Mental Health Services Administration (SAMHSA) reports, “research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication assisted treatment (MAT) is clinically driven with a focus on individualized patient care.” Getting someone with opioid dependency into an evidence-based treatment program that includes MAT can help get him/her on the path to long-term recovery. If you know someone who needs help, the SAMHSA has a general treatment locator and specific ones for methadone and buprenorphine.
Indeed there are many other things the Surgeon General should tell Americans about opioid overdose – the importance of safe storage and appropriate disposal of prescription pain medication to prevent diversion, the fact that not all types of pain require prescription opioids, how to seek help for mental health issues, etc. but the length limit here precludes discussion of all of the important information HHS and the White House should be conveying. If they communicated – far, wide, frequently, and loudly – about the three above, it would be a much-needed, life-saving start.
Ilisa Halpern Paul is President of the District Policy Group, a boutique health policy and government relations consulting practice within Drinker Biddle & Reath, LLP.