S2 Ep12: #23 Opioid Overdose Treatment and Prevention with Dr. Alex Walley
Sep 21, 2023
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Dr. Alex Walley, a medical doctor and researcher specializing in opioid overdose treatment and prevention, discusses various topics including optimal ways to respond to hospital overdoses, ideal doses of naloxone, counseling patients on overdose response and prevention, and the importance of good Samaritan laws in overdose situations.
When responding to an opioid overdose, focus on the person's respiratory rate and oxygenation rather than just their level of consciousness.
Naloxone can be administered through various methods, such as nasal spray, injectable, intravenous injection, or via an ET tube.
When administering naloxone, strike a balance between reversing the overdose and avoiding precipitated withdrawal by titrating the dose to the individual's needs and closely monitoring their vitals.
Deep dives
The importance of focusing on respiratory rate in opioid overdose response
When responding to an opioid overdose, it is crucial to pay attention to the person's respiratory rate and oxygenation rather than solely focusing on their level of consciousness. Opioid overdoses can progress rapidly, particularly with the introduction of fentanyl into the drug supply. Immediate administration of naloxone may not always be necessary if the person's oxygenation is adequate. It is important to monitor their vitals and provide appropriate care based on their individual needs.
Different administration methods of naloxone
Naloxone, an opioid antagonist and reversal agent, can be administered through various methods. The most common method is intranasal nasal spray, which delivers a fixed dose of naloxone. Injectable naloxone, administered intramuscularly, is more commonly used in harm reduction programs due to its lower cost. Other methods of administration include intravenous injection, subcutaneous injection, or via an ET tube. Each method has its own advantages and considerations, but the key is to ensure naloxone is readily available for use during opioid overdose response.
Factors to consider in naloxone dosing
When administering naloxone, it is important to strike a balance between reversing the overdose and avoiding precipitated withdrawal. The goal is to improve the person's respiratory rate without plunging them into severe withdrawal symptoms. Titrating naloxone to the individual's needs and closely monitoring their vitals can help achieve this delicate balance. Higher doses of naloxone are not necessarily more effective and may lead to unnecessary discomfort. Careful consideration of each person's situation and response is key.
Overdose response in the hospital setting
Recognizing and responding to possible opioid overdoses in the hospital requires a comprehensive approach. Monitoring vital signs and assessing the person's oxygenation are essential in determining the appropriate course of action. Naloxone should not be administered indiscriminately, especially if there is no evidence of respiratory depression or reduced oxygen levels. A thoughtful evaluation of the situation, close observation, and collaboration with nurses and other healthcare providers can help avoid unnecessary interventions and ensure the person receives the appropriate care.
Future trends in naloxone availability and affordability
Efforts are underway to increase the availability and affordability of naloxone, especially with the introduction of over-the-counter options. Multiple formulations are being developed, and increased market competition is expected to drive down prices. Promoting naloxone distribution through community-based programs and advocating cost coverage by insurance plans can further improve access. Collaboration between healthcare providers, nurses, social workers, and those with lived experience is essential in transforming the healthcare system to be more inclusive, patient-centered, and effective in addressing substance use disorders.
Prevent opioid overdoses in your community! We discuss opioid overdose prevention and treatment so you can counsel patients who use substances on ways to decrease their risk of overdose. We discuss optimal ways to respond to hospital overdoses, ideal doses of naloxone, and how to monitor a patient experiencing an overdose clinically. We’re joined by Dr. Alex Walley, MD MsC @AlexanderWalley (Boston University School of Medicine).
Claim free CME for this episode at curbsiders.vcuhealth.org!
By listening to this episode and completing CME this can be used to count towards the new DEA 8-hr requirement on substance use disorders education.
Credits
Producer: Natalie Stahl, MD, MPH
Show Notes, Infographic, Cover Art: Carolyn Chan, MD, MHS
Hosts: Carolyn Chan, MD, MHS and Natalie Stahl, MD, MPH
Reviewer: Sarah Leyde, MD
Showrunner: Carolyn Chan, MD, MHS
Technical Production: Podpaste
Guest: Dr. Alex Walley
Show Segments
Intro, disclaimer, guest bio: 00:00
Guest one-liner: 05:10
Case from Kashlak: 07:20
Overview of the Overdose Crisis: 08:13
Changes in Messaging for Fentanyl OD Prevention: 16:10
Naloxone formulations: 22:15
Dose and frequency of naloxone: 24:50
Counseling a patient on overdose response/prevention: 31:25
Good Samaritan Laws: 38:00
Responding to hospital overdoses: 40:45
OTC naloxone: 51:14
Take Home Points: 55:50
Outro: 59:19
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