Emergency opiate overdose kits in maine

The use of a drug called Naloxone has helped prevent overdose deaths due to opioids across the United States. Many states are now teaching non medically trained persons to use Naloxone at the first signs of opioid overdose. Maine hopes to be the next in creating an initiate for prescription opioid overdose prevention.

What are opiates and what do they do

Opioids are powerful analgesics the cerebral aspect of pain more so than the periphery aspect. They can be found in the juice of opium poppy or within our own body as endorphins. Opiate drugs include Morphine, Codeine, Heroin, Oxycodone and Methadone. Opioid pain relievers work by mimicking the actions of our body’s natural endorphins by inhibiting responses of neurons in the dorsal ganglia that relay signals from pain receptors (Julien, Advokat & Comaty, 2011). Opioids should typically be used short term rather than chronic pain as chronic pain lies more within neuroadaption than acute pain receptor signaling. There are three opiate receptors in the body- mu, kappa, and delta- but drugs that agonize the mu receptor have the greatest analgesic responses as well as the highest potential for abuse. Drugs such as Morphine agonize the mu receptor (Julien, Advokat & Comaty, 2011). Effects of Opioids include analgesia, euphoria, sedation, relief from anxiety, depression of respiration, nausea, and constipation. Opiates have a high rate of tolerance and addiction.
What is Naloxone
Naloxone is an opioid antagonist (an antagonist opposes the effects of the drug). Naloxone has a higher affinity for opioid receptors in the central nervous system, but instead of activating opioid receptors like morphine, oxycodone, methadone or illegal substances such as heroin do, it just blocks the receptor from other drugs but doesn’t activate the receptor. Thus it blocks opioids from reaching the receptor but doesn’t have a physiological response on the body. This makes naloxone a safe drug to use because it has no effects on the body if no opioids are in the system. Naloxone is non-habit forming and has no potential for abuse. Naloxone can be used to prevent or reverse overdose due to opioids. According to the Center of Disease control and Prevention, Naloxone has saved over 10,000 lives through the administration of non-medically trained bystanders and countless more by medical personnel (Branson). However, with regular opioid users, Naloxone can cause withdrawal symptoms such as body aches, diarrhea, tachycardia, fever, runny nose, sneezing, sweating, yawning, nausea, vomiting, nervousness, restlessness, irritability, shivering or trembling, stomach cramps, weakness, and the appearance of hair on the skin standing on end(Wheeler, Burk, McQule & Stancliff, 2012). While Naloxone is relatively safe, it can cause some severe side effects, including tachycardia, arrhythmia, chest pain, shortness of breath, hallucinations, delusions, loss of consciousness, or difficulty breathing (Wheeler, Burk, McQule & Stancliff, 2012). If any of these effects should occur, one should call their doctor or emergency personnel immediately. Naloxone can be administered via nasal spray or intramuscularly. Before administering Naloxone, rescue breaths should be performed on the overdose victim for a few minutes. The nasal spray container must be assembled according to the directions and then half of the spray would be injected into each nostril. Following the administration of the nasal spray, rescue breathing would be continued. If the victim were still unresponsive after three to five minutes, another dose of naloxone should be administered. For the injectable Naloxone admission, the syringe should be injected in the thigh, upper and outer portion of the butt, or the shoulder. If the needle isn’t big enough to sufficiently reach the muscles, it is also an option to inject under the skin. Again, continue rescue breathing after injection and if the victim has not responded after three to four minutes, administer another dose (Wheeler, Burk, McQule & Stancliff, 2012). With either form of administration, emergency personnel should be contacted immediately.
How will Naloxone help Maine
Data collected since 2007 show that about five percent of Maine women admitted to a substance abuse treatment facility have been pregnant, and over half of these admissions were due to opioid substances (“Substance abuse trends,” 2013). Of inpatient hospital admissions, opiates- including prescription narcotics, methadone, and heroin- had more admissions that all other drugs combined, excluding alcohol which had about double the admissions of opiates. Between 2006 and 2009, not only has opiates been the highest proportion of outpatient visits for substance abuse, over alcohol and all other drugs combined, but it was also the only category of drugs that drastically increased(“Substance abuse trends,” 2013). Opiate outpatient visits have nearly doubled between 2006 and 2009 whereas alcohol and other drugs have remained steady during this same time period. Between 2000 and 2010, death due to substance abuse and overdose has increased for prescription drugs but decreased for illicit drugs. While in most cases of overdose, the victim is not alone, death usually occurs because peers are unwilling to call medical services due to fear of punishment. The use of non-prescription pain killers among young adults is on average 13 percent, of which the highest percentage is ages 25-36. Between the years of 2008 and 2012, pharmaceutical narcotics had the highest proportion of arrests in Maine at about 40 percent of arrests due to drugs being pharmaceutical opiates (“Substance abuse trends,” 2013). In 2008, 73 percent of prescription drug overdoses were due to opiate pain relievers (Paulozzi, Jones, Mack, Rudd, 2011). Many opiate users sell their medications illegally which costs insurance companies up to $72.5 billion annually, all of which gets spread among those you purchase insurance. In 2010, almost five percent of the population 12 years of age and older had used prescription opiates nonmedically. (Paulozzi, Jones, Mack, Rudd, 2011) In 2008, drug overdose death was nearly as high as motor vehical accident deaths, which contributes the largest proportion of deaths in teens and young adults (Paulozzi, Jones, Mack, Rudd, 2011). Maine is above the national average of drug overdoses (national average of 11.9 and Maine at 12.3) and sales of prescription opiates (national at 7.1 and Maine at 9.8), and right at the national average of overdose deaths due to prescription drug overdoses (national 4.8 and Maine at 4.7) all of which were measured in deaths per 100,000 (Paulozzi, Jones, Mack, Rudd, 2011).


Works Cited
Branson, F. (n.d.). Overdose prevention and opioid safety. Project Lazarus. Retrieved from http://www.projectlazarus.org/

Julien, R., Advokat, C., & Comaty, J. (2011). A primer of drug action. (12 ed., pp. 315-335). New York, NY: Worth Publishers.

Maine Department of Health and Human Services, Office of Substance Abuse and Mental Health Services. (2013). Substance abuse trends in maine state epidemiological profile 2013. Retrieved from Hornby Zeller Associates, Inc Website: http://www.maine.gov/dhhs/samhs/osa/pubs/data/2013/SEOWEpiProfile2013FINAL.p df

Paulozzi, L., Jones, C., Mack, K., Rudd, R. (2011). Vital signs: Overdoses of opiate pain relievers--- United States—1999-2008. Morbidity and Mortality Weekly Report, 60(43), 1487-1492. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

Piper, T., Stancliff, S., Rudenstine, S., Sherman, S., Nandi, V., Clear, A., & Galea, S. (2008). Evaluation for a naloxone distribution and administration program in new york city. Substance Use and Misuse, 43, 858-870. doi: 10.1080/1082608701801261

Wheeler, E., Burk, K., McQule, H., & Stancliff, S. (2012). Guide to developing and managing overdose prevention and take-home naloxone project. Harm Reduction Coalition, 58- 64. Retrieved from http://www.harmreduction.org