The world is struggling with two major health emergencies: COVID-19 and the opioid epidemic.

While COVID-19 is constantly in our thoughts, the opioid epidemic may not be top of mind for most. But, for first responders kneeling on cold sidewalks injecting Naloxone into unconscious casualties and parents who’ve just found their teenager dead in bed from an overdose, it’s a devastating reality.

Government health agencies have given us reams of instructions for protecting ourselves from the COVID-19 virus. They’ve not yet, however, provided clear guidelines about preventing death from an overdose. Healthcare professionals are urgently searching for solutions to the opioid crisis. Meanwhile, this article will outline four action steps people can take to start saving lives today.

The overdose epidemic does not discriminate

I have two kids aged 19 and 22. My daughter is a university student living at home, and my son shares an apartment with friends in Vancouver. I worry about them taking risks and getting poisoned by drinks or drugs laced with fentanyl or worse.

My husband and I have done our best to be good parents, teach our kids right from wrong and talk openly about uncomfortable topics like addiction. The overdose epidemic doesn’t discriminate, though, and being a good kid from a good home doesn’t make you immune to death by overdose.

Across the globe, lives are being ruined and lost at alarming rates, and communities large and small are feeling the impacts. According to the latest World Drug Report, an estimated 585,000 people died due to drug use in 2017. Opioids account for more than 70% of drug-related deaths, with more than 30% of those deaths caused by overdose.

Stop the blame game

People love to blame others for bad things that happen in the world. The opioid epidemic is one of the worst disasters of our time, and the internet is full of articles, videos, reports, and TED talks about the whodunit. Theories about what started this global crisis and why it continues include:

• Massive marketing efforts by large pharmaceutical companies
• Doctors over-prescribing pain medications
• Dealers smuggling dirty drugs across borders
• Lack of support for those with mental health issues
• Stigma towards people struggling with addiction

Focusing on who’s to blame is not the best use of our time when loved ones are dying in bedrooms, gutters, and coffee shop bathrooms. We’d be wiser to focus on finding solutions to this colossal crisis or at least support groups trying to do this.

Organizations are tackling the problem from all angles. They’re looking at housing the homeless, creating employment opportunities, and decriminalizing drugs. Health agencies continue to develop harm reduction programs like safe drug supply and needle exchange programs. Advocacy groups and community action teams hold awareness events, and educators focus on prevention by delivering drug and alcohol presentations in schools.

But what can the rest of us do to prevent senseless deaths from an opioid overdose?

How we can help:

Here are four things we can do to stay safer and equip ourselves with skills to help a person suffering from an opioid overdose.

• Ask questions about pain management before accepting prescriptions for opioid painkillers.
• Educate ourselves with first aid, CPR, and Naloxone training.
• Learn about the Lifeguard app.
• Check-in with loved ones.

1. Pain management

During the week of my final exams at university, I had three wisdom teeth removed. The timing was unfortunate, but my teeth wouldn’t wait. The day after my teeth came out, I had an exam. From a corner of the auditorium ceiling, I remember looking down at myself working on my test. I have no idea what kind of painkillers the dentist gave me, but they were strong.

Years later, I took my teenaged son to have a wisdom tooth removed. The dentist prescribed Oxycodone-Acetaminophen for the pain. His advice was, “Take the pain meds straight away. Day three is the worst if you don’t keep up with painkillers. Don’t try to tough it out.”

Also known as Percocet, this medication controls pain but is highly addictive. In my son’s pill bottle, there were 24 tablets — twenty-four strong opioid pills for a sore tooth.

I cautioned my son about the dangers of opioids and advised him to switch to Tylenol sooner than later. Fortunately, his pain was short-lived, and he only took one of the Percocet tablets. His mouth healed quickly, and that was the end of the story. For others, a single prescription of opioid painkillers following an injury or operation can lead to the slippery slope of opioid misuse and sometimes, tragically, death.

According to the Mayo Clinic,

“The length of time you use prescribed opioids also plays a role in potential addiction. Researchers have found that taking opioid medications for more than a few days increases your risk of long-term use, which increases your risk of addiction. The odds you’ll still be on opioids a year after starting a short course increase after only five days on opioids.”

There’s a place for opioids in pain management; however, there are serious risks associated with their use. It’s critical we carefully consider these risks alongside their benefits. It’s up to us to ask questions, educate ourselves, and take responsibility for our health.

Doctors can provide information about pain management that doesn’t involve prescription opioids. Some options may work better and have fewer risks and side effects. These include pain relievers such as acetaminophen, ibuprofen, naproxen, physical therapy, exercise, and cognitive behavioural therapy.

What can we do?

• Ask questions about pain medications and avoid prescribed opioids. Before an operation or medical procedure, ask what painkillers the doctor or surgeon is planning to use. If they prescribe an opioid analgesic, ask what alternate drugs and pain management strategies are available.
• Search medicine cabinets for expired medications and take them to the local pharmacy for safe disposal.

2. Educating ourselves — First Aid and Naloxone training

Last year a friend was walking in downtown Vancouver when she found a man unconscious on the sidewalk. As she was calling 911, a passing cyclist stopped, threw a Naloxone kit onto the street beside her, and cycled off. Our friend knew what Naloxone was but had never used it before. She unzipped the kit, quickly read the instructions, injected the drug into the man’s arm, and saved his life.

How Naloxone works:

Naloxone can quickly reverse the life-threatening effects of an opioid overdose. In the brain, Naloxone and opioids bind to the same receptor sites. If too many opioids are attached to these receptors, breathing can slow or stop. Naloxone knocks opioids off the receptors and reverses the effects of the drugs temporarily, restoring breathing.

Naloxone is a safe drug with a low risk of serious side effects. If given to a person who is not experiencing an opioid overdose, it does no harm. You can administer Naloxone by injection or by nasal spray. It’s easy to do, but it helps if you’ve taken a short course or at least watched a how-to video.

As breathing is affected during an overdose, we need to know how to give a person rescue breaths. People learn rescue breathing, CPR, and other skills during a first aid course. Those looking to learn or refresh their first aid skills can find a class via their local Red Cross agency.

Mental Health first aid teaches people how to recognize when someone is struggling with a decline in their mental health or experiencing a mental health crisis. The training gives participants knowledge and skills to assist them.

What can we do?

• Learn how to administer Naloxone by watching the Naloxone Saves Lives video from Toward the Heart.
• Get a Naloxone kit and keep it with our first aid supplies.
• Take a first aid & CPR class.
• Take a Mental Health first aid virtual class.
• Watch a 15–25 minute interactive lesson on how to respond to an overdose.

3. The Lifeguard App can help save people who use drugs alone

The vast majority of fatal overdoses occur when people are using drugs alone. Lifeguard is a free phone app (on the ios app store and Google Play). The app brings emergency responders to people who may be overdosing on drugs. The purpose of the app is to reduce the risk of fatal overdose for individuals using alone.

How the Lifeguard app works:

When a person is ready to use their drug, they open the app, Select the drug they’re using and start the app timer. Before the timer begins, they confirm their address and provide additional details to help emergency services find them if needed. Then they tap the start button to activate the timer. The timer begins to count down from one minute. With 10 seconds remaining, an alarm will start to sound and get progressively louder. To silence the alarm, they can tap the stop button. If they’re unable to stop the alarm and the Lifeguard app will contact EMS.

EMS will call their mobile phone immediately to confirm they are OK. If they don’t answer the phone, Emergency Services will send an ambulance. The app’s alarm will continue to sound to help paramedics find the person. The Lifeguard app can also connect people to EMS/911, the 811 nurses line, the suicide prevention line, and the crisis intervention line.

What can we do?

• Watch a short (4 minute) video about the Lifeguard app and share the video with our friends, family, and anyone at risk of using drugs alone.

4. Check in with loved ones

Now, more than ever, people are struggling with their mental health. The COVID-19 pandemic has led to increased isolation, and many people turn to substances because they are lonely. Those who live alone are especially at risk of depression, and if they also use drugs, death from overdose.

In an excellent article in Psychology Today, Robert Weiss, Ph.D., MSW, suggests,

“Addiction is not about the pleasurable effects of substances, it’s about the user’s inability to connect in healthy ways with other human beings. In other words, addiction is not a substance disorder, it’s a social disorder.”

Weiss talks about how people with substance use issues need to connect with safe, supportive, reliable, empathetic people in order to recover.

Addiction isolates people.

People may use substances to cope with depression, anxiety, and stressful situations — avoiding their feelings — and reality. They may cover up their fear and guilt with angry outbursts and emotionally abusive behaviours.

“Hurt people, hurt people.”

― Yehuda Berg

Those struggling with addiction are hurting — and in turn, they may hurt their friends and family, damaging relationships. As the disease progresses and the person’s isolation increases, the result may be death from despair.

What can we do?

• Check-in with loved ones — elderly relatives, teenagers, young adults living away from home, friends who live alone. How are they doing? How are they feeling? Do they need help with anything? Offer support.

Recap: Four ways we can help save lives

1. Ask questions about pain management before taking opioid painkillers.
2. Gain life-saving skills with first aid, CPR, and Naloxone training.
3. Learn about the Lifeguard app and share the information.
4. Check-in with loved ones regularly to see how they’re doing.

We can all do something to help prevent people from dying of an opioid overdose. And while we’re at it, let’s look after our mental and physical health so we don’t become a statistic in this escalating epidemic. Instead of being part of the problem, we can become part of the solution.

©Gill McCulloch, April 2021

References:

1. NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937046
2. Addiction, Isolation and the Cycle of Loneliness. https://vertavahealth.com/blog/addiction-isolation-and-the-cycle-of-loneliness/
3. The Folly of Fr. Martin & The Power Of Connection. https://sobertostay.com/the-folly-of-fr-martin-the-power-of-connection
4. Opioid overdose — World Health Organization. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
5. Toward the Heart.com, Naloxone Saves Lives video
6. The United Nations Office on Drugs and Crime (UNODC) ‘World Drug Report 2019’