Prepping for an Overdose: How to Educate Active Opioids/Heroin Users

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“Opioid abuse is an equal-opportunity killer. It threatens all of our children, all of our families, in every corner of this state, at every economic level.” ~ Washington State Governor Jay Inslee According to the American Society of Addiction Medicine, nearly 30,000 Americans died in 2014 due to fatal overdoses of opioids – prescription painkillers and illicit street drugs like heroin. In fact, the Centers for Disease Control and Prevention estimate that up to 61% of unintentional poisonings are due to opioids. What makes this number even worse is the fact that nonfatal overdoses happen 3 to 7 times more often than those that are fatal. Every single day in the United States, there are 6000 emergency room visits because of overdoses. That same year, another 2.5 MILLION US citizens struggled with Opioid Use Disorders (OUDs), and an additional 12 MILLION abused an opioid at some point. Only 1.4 MILLION sought treatment foran OUD. Yet even in the face of such a calamitous epidemic, most people are still woefully misinformed about the dangers. In some ways, that isn’t surprising, because many physicians misunderstand opioid addiction, and consequently, over-prescribe.

Knowledge is Power in the Battle Against Opioid Abuse

One of the cornerstones of recovery from addiction is education. There is a real need to be able to assess the knowledge of both the general public and at-risk individuals. Such an assessment could be used to:

  • Improve existing prevention, intervention, and recovery efforts
  • Create new interactive and cooperative treatment strategies
  • Complement naloxone-based interventions

Each of these is important, but the last – complementing naloxone-based interventions – is particularly crucial. Right now, one of the most visible interventions undertaken is the push to increase access to the anti-overdose emergency medication naloxone.

Naloxone Alone Is Not the Answer

While increasing the availability of naloxone is an important tactic in the fight against opioid overdoses, its use is limited in some settings, particularly when it is currently available in theory only, rather than in practice:

  • When the authorization exists, but not the funding
  • When naloxone administration training programs have not yet been implemented
  • When there is pushback from some sections of the population, with the argument that overdose rescues only serve to enable opioid addicts
  • When there is a backlog in distribution

To maximize effectiveness, interventions intended to decrease the rates of opioid abuse and reduce the number of opioid fatalities need to be implemented before the emergency need for naloxone arises.

What Methods Exist to Evaluate Patient Knowledge about Opioids?

Right now, there are three opioid overdose knowledge assessments:

  • the Opioid Overdose Knowledge Scale (OOKS),
  • the Opioid Overdose Attitudes Scale (OOAS), and
  • the Brief Overdose Recognition and Response Assessment (BORRA)

While these assessments can be used to assess knowledge AFTER a naloxone intervention, they are of little in those situations where naloxone is not available. Furthermore, due to their length and complexity – up to 36 questions – it can be difficult for a service provider to correctly score and interpret these assessments.

Are There Better Solutions Available to Evaluate Patient Knowledge about Opioids?

Researchers at Johns Hopkins University School of Medicine and the University of Vermont have developed the Brief Opioid Overdose Knowledge (BOOK) questionnaire, designed to be an easier method for quickly assessing gaps in an individual’s knowledge about the risks of opioids. One of the biggest differences is the simplicity of the BOOK questionnaire – it consists entirely of 12 True or False questions, making it much easier for a provider to quickly determine what their patient does or does not know. With this determination, an intervention or opioid treatment plan can be quickly customized.

What are the 12 Questions on the BOOK Questionnaire?

On the BOOK questionnaire, participants can answer “Yes”, “No”, or “I Don’t Know”.

  1. Long-acting opioids are used to treat chronic “round-the-clock” pain.
  2. Methadone is a long-acting opioid.
  3. Restlessness, muscle and bone pain, and insomnia are symptoms of opioid withdrawal.
  4. Heroin, OxyContin, and fentanyl are all examples of opioids.
  5. Trouble breathing is NOT related to opioid overdose.
  6. Clammy and cool skin is NOT a sign of an opioid overdose.
  7. All overdoses are fatal (deadly).
  8. Using a short-acting opioid and a long-acting opioid at the same time does NOT increase your risk of an opioid overdose.
  9. If you see a person overdosing on opioids, you can begin rescue breathing until a health worker arrives.
  10. A sternal rub helps you evaluate whether someone is unconscious.
  11. Once you confirm an individual is breathing, you can place him/her into the recovery position.
  12. Narcan (naloxone) will reverse the effect of an opioid overdose.

How Effective Will the BOOK Questionnaire be at Preventing Opioid Overdoses?

By itself, an educational tool such as the BOOK assessment will not have as big or as direct an effect on the number of opioid overdoses as naloxone intervention, but any accurate assessment of the knowledge of at-risk people will help identify what other interventions are needed. At the very least, it can improve communication between doctors, pain management specialists, therapists, substance abuse treatment providers, and patients, who can then work cooperatively to create individualized, targeted heroin treatment plans.