Bailey Dillon, PharmD Candidate 2023
Overdoses are the leading cause of injury-related death in the United States with recent increases influenced by multiple factors including the COVID-19 pandemic.1 In 2019, over 70% of overdose deaths involved an opioid.2 In 2020, there was a significant increase in opioid overdose deaths with a total of 68,630. This has increased from less than 50,000 deaths due to opioids in previous years.3 Reasons for overdose include: intentional, accidentally taking the wrong medication/dose, the medication being laced with an unknown ingredient (such as fentanyl) or substance abuse (thinking one can handle more than they can).
Substance use disorder was listed as one of the top ICD10 codes in a recent study conducted by RTI assessing the Dispensary of Hope program.4 Among the patient population used in the report, “substance use disorder” was documented as one of the top ICD10 codes found among patients enrolled in the Dispensary of Hope program. It is important to note that Dispensary of Hope does not distribute controlled substances. If these patients cannot afford or get access to prescription opioid medications, they are getting them from the streets. They are taking opioids from non-pharmaceutical sources without knowing the exact content of what is in them and how they were made. Most of them have stronger doses and deadly ingredients within them that may be unknown to the user which makes it far more likely to cause an overdose.
Opioids were originally created in the 1800s for pain control and initially thought to not be addictive. However, after years passed, addiction to these medications became apparent. They activate endorphins in the brain, boosting feelings of pleasure and altering perceptions of pain. This addiction has caused an opioid epidemic nationwide. This outbreak has come in waves with the first one being in the 1990s, then 2010, and 2013.5 The graph above represents the increase in death from increased use in recent years.
Naloxone, an opioid antagonist, was developed in the 1960s by Dr. Mozes J. Lewenstein and Dr. Jack Fishman. It is FDA approved to rapidly reduce an opioid overdose, and works by competing or displacing opioids at the receptor site. Naloxone can be administered in many different routes: intranasal, subcutaneous, intravenous, and intramuscularly. In certain states, a prescription is not necessary. New Jersey has recently updated a standing order to allow all pharmacists to dispense an opioid antidote to any individual or entity, regardless of whether the individual or entity holds an individual prescription for the opioid antidote.6 This opens up the possibility, for those who are concerned about overdoses, to walk into a pharmacy and access naloxone without any questions or information requested. This also can increase the awareness of naloxone and use. It is important to know which patients are at risk for an opioid overdose and should have naloxone at their disposal. Patients taking opioid dosages at or above 50 MME/day are twice as likely to overdose compared to those taking 20 MME/day, and the risk further increases as the MME/day increases.7
Did you know that Dispensary of Hope has Naloxone available in inventory? In the current Dispensary of Hope inventory, there is a large quantity of 10/20ml prefilled syringes of naloxone 2mg/2mL solution for injection (NDC: 55150034510). This supply could save many lives and it is completely free to the patient. It is important to educate patients on the risks of overdoses and how having naloxone available at home could save their lives or someone they love. Over 100 people die every single day due to drug overdoses.8
Drug Overdose Epidemic. Centers for Disease Control and Prevention. Updated March 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/drugoverdose/epidemic/index.html
Overdose Death Rates. National Institute on Drug Abuse. January 20, 2022. Accessed June 8, 2022. https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates
Task 5: Final Report. Dispensary of Hope. Published March 31, 2022. Accessed June 7, 2022.
Opioid Data Analysis and Resources. Centers for Disease Control and Prevention. Updated June 1, 2022. Accessed June 7, 2022. https://www.cdc.gov/opioids/data/analysis-resources.html
Updated Guidance for Pharmacists Dispensing Opioid Antidotes. New Jersey Office of the Attorney General. Updated April 5, 2022. Accessed June 7, 2022. https://www.njconsumeraffairs.gov/phar/Documents/Guidance-for-Pharmacists-Dispensing-Naloxone-05262022.pdf
Calculating Total Daily Dose of Opioids for Safer Dosage. Centers for Disease Control and Prevention. Accessed June 6, 2022. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf