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Opioid Harm Reduction

Lately, we have all been steeped in the public health jargon of pandemics, epidemics, and public health emergencies. In the last few years, COVID and more recently, mpox, have often dominated the news cycle. Yet there is another epidemic that has been with us much longer and which unfortunately seems to be gaining steam, while the others either have or are expected to subside. I’m talking about the epidemic of overdose deaths resulting from opioids.

Opioids originated as the naturally occurring chemical, morphine, obtained from the opium poppy and have been used both recreationally and medically for a very long time. The United States has seen various epidemics of opioid misuse and overuse since at least the 19th century. Opioids interact with the brain in a variety of ways, producing pain relief and intoxication as well as a litany of potential adverse health effects ranging from nausea, vomiting, and itching to altered mental status, coma, and cessation of breathing. These latter effects result in death from overdose.

Susceptibility to overdose death varies widely based on a variety of factors including the strength of the opioid itself and the individual’s tolerance to the chemical. Opioids are highly addictive substances and it is not difficult for appropriate short-term use of medically prescribed opioids to lead to misuse, chronic use, addiction and overdose.

The root causes of the current opioid epidemic are many but include the improper prescribing and overprescribing of prescription opioids, the various impacts of the pandemic, and the widespread availability of illicit opioids such as heroin and the synthetic opioid, fentanyl.

Fentanyl has especially been a significant problem recently due to its illicit manufacture and marketing as a street drug. Originally developed as a medical treatment, fentanyl is a super potent opioid, which is 50-100 times stronger than morphine. Because of its highly addictive characteristics, fentanyl is commonly used to “lace” other street drugs such that the user may not even be aware of its presence. Similarly, so-called “rainbow fentanyl” is often disguised as candy or even sidewalk chalk, targeting children and teens who may be unaware of the presence of a drug.

Just as the opioid epidemic is complex, with many different variables, so too must the solution be multi-faceted. There is no single magic bullet to solve the now decades long opioid epidemic which currently claims more than 100,000 lives in the United States annually and is the leading cause of injury-related death.

One of the solutions is a risk-mitigation strategy called harm reduction. In the case of opioids, one aspect of harm reduction involves educating drug users, their family and friends, and the public about recognizing the risk for overdose and its signs and symptoms and then making the drug, naloxone (also known as Narcan) widely available wherever there is a potential risk for overdose.

Naloxone reverses the effects of opioids and is generally safe and easy to use with proper basic training. A single dose of naloxone, administered as a prepackaged injection or nasal spray can save a life due to overdose resulting from intentional or non-intentional use of an opioid.

Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.