Preventing Fatal Opiod Overdose: A Q&A with Josiah “Jody” Rich, MD, MPH

Posted Thursday, November 15, 2012

Josiah “Jody” Rich, MD, MPH

In an article in this week’s issue of the Journal of the American Medical Association, Miriam Hospital physician and researcher Josiah “Jody” Rich, MD, MPH, along with colleagues at Northeastern University School of Law and Boston University School of Medicine, call for urgent federal measures to combat preventable overdose deaths involving opioid drugs like oxycontin.

Rich offers additional insight on the article, “Prevention of Fatal Opiod Overdose,” and explains why opiod overdose has become a serious health issue in the United States.

Why is opiod overdose a major problem, not just here in Rhode Island, but across the country?

Rich: Over the past decade, we have had an increasing supply of heroin with increased purity and decreased cost. In addition, we have had a dramatic increase in the availability of prescription opiates such as vicodin, percocet, oxycodone and oxycontin. The overall combined increase in availability of opiates has led to a dramatic increase in opiate overdose deaths, both in Rhode Island and across the nation. In 1998, a total of 36,450 overdose deaths were reported in the country. In Rhode Island, we are among the most heavily impacted states and currently have over four people a week dying of an overdose. Most of these people are in the 25-54 age category. Opiate addition is a chronic relapsing disease, which is characterized by increasing tolerance, which means that higher and higher doses are needed to achieve the same results, and a withdrawal phenomenon that causes people to be extremely ill if they try to stop using opiates. As a result, most people who become addicted to opiates tend to increase their use over time and tend to use multiple times a day, every day.

Fortunately, there is effective treatment for opiate addiction. Pharmacological treatments include methadone maintenance which can be dispensed through federally regulated programs and buprenorphine (or suboxone), which can be prescribed by any specially certified physician (requires an eight hour training that can be done online).

What are the barriers to preventing fatal opioid overdoses?

Rich: When someone experiences an opioid overdose, the overdose can be reversed successfully with the administration of a medication called “naloxone” or “narcan”. Naloxone can be administered either by injection or through an intranasal spray. Across the country, over 50,000 lay people have been trained to recognize an overdose and to treat it with naloxone. This has led to over 10,000 reported rescues from overdose.

The most important barriers to implementing effective fatal overdose prevention include education of both the people who use opiates to how to prevent and recognize and treat opiate overdoses, and to actually distribute the training and the availability of naloxone to people in the field.

You suggest a more comprehensive approach to curbing overdose rates. Can you explain?

Rich: Drug use and in particular, opiate use, is a highly stigmatized behavior in our society. As a result, people who are using illicit drugs keep that hidden from many people in their lives; thus, there is decreased awareness of the dangers of opiate use and a decreased willingness to enter treatment. Among the general public end, people use illicit opiates and there is not enough knowledge about how overdoses occur, how to watch out for them, how to prevent them, and what to do when an overdose occurs. Much can be done at the federal, state, local, community, family and individual level to prevent fatal overdoses. The first is to prevent the development of opiate addiction in the first place and the second is to identify people who have opiate addiction and get them into comprehensive, effective evidence-based treatment and the third is to promote education and understanding about opiate addiction, overdose and prevention, as well as to limit the supply of opiates and expand the availability of training and naloxone availability.

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