Is Suboxone treatment a fit for you?
Find out now
Is Suboxone treatment a fit for you?
Find out now
Is Suboxone treatment a fit for you?
Find out now

How to Prevent or Reverse an Opioid Overdose

By Lane McKenna
Nov 01, 2021

An estimated 2.3 million Americans suffer from opioid use disorder, 1.7 million stemming from prescription pain medications like oxycodone and morphine, and 652,000 from illegal opioids like heroin.[1]

Related overdose deaths from opioid use killed nearly 50,000 people in 2019 — a six-fold increase since 1999.[2,3] 

The risks of a fatal overdose are high in part because stronger synthetic opioids such as fentanyl have become more readily available. Fentanyl is both a prescribed opioid but is also illicitly manufactured and distributed. 

Fortunately, strategies do exist that can help prevent opioid overdoses or combat them should they occur.

Causes of Opioid Overdoses

Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they diminish the body’s perception of pain. Opioids can also cause mood-altering effects, slowed breathing, and constipation. 

A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea and vomiting, to severe allergic reactions (anaphylaxis), and respiratory suppression and overdose.[4]

Anyone who uses opioids for long-term management of chronic pain is at risk for opioid overdose. This also applies to individuals who use heroin or misuse prescription pain relievers.

Opioid overdoses occur as a result of many factors, such as when someone:

  • Deliberately misuses a prescription opioid.
  • Takes an opioid as directed, but the prescriber miscalculated the dose, an error was made by the dispensing pharmacist, or when the patient misunderstood the directions for use. 
  • Takes opioids with other medications such as benzodiazepines, other sedative-hypnotic agents, or alcohol — all of which cause respiratory depression.
  • Deliberately uses illicit opioids such as heroin, or opioids contaminated with other even more potent opioids such as fentanyl.

Whether an overdose is intentional (suicide) or accidental, the physiology is the same. While it may be "easier" to overdose on an illegal opioid, overdose risks with prescription opioids are still alarmingly high. 

Opioid Overdose Symptoms

Opioids bind to opioid receptors and activate the “reward centers” which creates a “high,” but they also activate the respiratory center which can cause respiratory depression. Symptoms of overdose include excessive sedation or lack of response to voice or touch, slowed breathing, and general somnolence.

Signs of an Overdose

  • Less than 8 breaths per minute, shallow, or no breathing
  • Gasping for air when sleeping, gurgling, or deep snoring
  • Not speaking
  • Pale or bluish skin; blue/gray nails and lips
  • Slow heartbeat or no pulse
  • Low blood pressure
  • Pinpoint pupils
  • Not arousable; no response to sternal rub — a technique where you rub the victim’s chest very hard. (If you arouse them or wake them up at all, they have not overdosed).

How to Respond to an Opioid Overdose 

  1. Call 911. 
  2. If someone is not breathing, begin rescue breathing (1 breath every 5 seconds).
  3. Administer nasal naloxone (if no response, repeat every 3 to 5 minutes).
  4. Stay with the person until help arrives.

Opioid Overdose Treatment with Naloxone

The most effective treatment for an opioid overdose is administering naloxone (brand names Narcan and Evzio). This medication rapidly reverses an opioid overdose. 

Naloxone is an opioid antagonist that attaches to opioid receptors and reverses and blocks the effects of other opioids. It can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. 

If you are unsure if someone has used opioids or not, you should still give naloxone just in case. Naloxone is a safe medicine and should not have any harmful side effects for someone who does not have opioids in their system.

According to the U.S. Surgeon General, anyone who is at risk of an opioid overdose, as well as their family members and friends, should have this potentially life-saving medication within reach at all times.[5]

All individuals who use narcotics, either legally or illegally, should have naloxone available in their homes and carry it with them in case of emergency. 

If you or a loved one uses an opioid, ask your doctor about getting naloxone to have in case of emergency. You can also inquire as to whether your state permits over-the-counter naloxone to be purchased or if a prescription is necessary.

The National Institute on Drug Abuse (NIDA) created an online resource to raise awareness about naloxone. It includes information on where to get this medication:

How to Administer Naloxone

Naloxone should be given to any person who shows signs of an opioid overdose or when an overdose is suspected. Naloxone can be given as a nasal spray or injected into the muscle, under the skin, or into the veins. 

Once administered, naloxone can stay in the body for 30 to 90 minutes while most opioids stay in the system much longer.

When naloxone wears off, the opioid that caused the overdose can rebind to the opioid receptors and the person can overdose again. Thus, multiple doses of naloxone may be required. A person is not considered “in the clear” until waking up and being observed for at least 2 to 4 hours.

Steps for responding to an opioid overdose can be found in the Opioid Overdose Prevention Toolkit.[4]

Other Opioid Overdose Interventions

There are a few other interventions that have been proven to help prevent overdose deaths: 

  • Attempting to stimulate the person by talking to them or shaking them gently.
  • Moving the patient so that they are lying on their side and not on their back to help prevent them from inhaling their own saliva or vomitus.

Remember that you can never “get in trouble” for helping someone during an overdose, even if you were also using substances.

Do not let this be a barrier to helping someone in need. Law enforcement and health care professionals will be glad that you helped prevent someone from overdosing, no matter what.

How to Prevent an Opioid Overdose

  • Take your medicine exactly as prescribed. 
  • Take medication only if it has been prescribed to you by your doctor. Make sure to tell your doctor about other medications you are taking.
  • Do not take more medication or take it more often than instructed.
  • Call your doctor if your pain gets worse.
  • Never mix pain medicines with alcohol, sleeping pills, or illegal substances.
  • Store medicine safely where children or others can’t find or reach them.
  • Dispose of unused opioid medication properly.
  • Get help if you think or know you have an OUD.

Treating OUD to Lower Overdose Risk

It is important to provide treatment for people struggling with OUD to prevent overdose or even death. 

Organizations such as SAMHSA and the CDC, along with numerous leading medical institutions, endorse Medication for Addiction Treatment (MAT) over abstinence-only therapy. 

It is estimated that 90% of those trying abstinence-only therapy will relapse within the first three months, adding substantially to the risk of overdose and death.

By contrast, approximately 50% of patients will remain in recovery 12 months after starting buprenorphine/naloxone (Suboxone), a recommended MAT therapy, cutting the mortality rates by two-thirds for treated patients, according to one study. [6]

It is difficult to misuse Suboxone because it blocks opioid receptors in the brain from illicit substances, so patients are less likely to relapse when they have Suboxone in their system.

Learn More About Bicycle Health’s Opioid Overdose Prevention Program

Looking to learn more about how Suboxone can help you or your loved one stop feeling stuck on opioids? Schedule a meeting or call us today at (844) 943-2514 to see if one of Bicycle Health's online Suboxone providers might be right for you.

Photo Pixabay

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

Is Suboxone treatment a fit for you?

Contact us directly to speak with a specialist.

Citations

1. Center for Behavioral Health Statistics and Quality (CBHSQ). 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.

2. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.

3. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep. 2021;70:202–207. doi: http://dx.doi.org/10.15585/mmwr.mm7006a4

4. SAMHSA Opioid Overdose Prevention Toolkit. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.

5. U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose. Washington, DC: U.S. Dept. of Health and Human Services; 2018.

6. Pierce M, Bird SM, Hickman M et. al. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2015;111(2): 298-308. doi: https://doi.org/10.1111/add.13193

Articles related

Bicycle Health Online Suboxone Doctors

Safe, confidential, & affordable treatment for opioid use disorder.
Learn More