Treatment providers

Tools and tips to integrate overdose education and naloxone into drug treatment.

Drug treatment can decrease opioid overdose risk by helping individuals stop or reduce their drug use. At the same time, drug treatment lowers a person’s tolerance to opioids which can actually increase risk for overdose. The periods before, during, and after drug treatment can be particularly risky times for overdose.

 

Talking about overdose   picture of client and counselor talking

Overdose can be a sensitive topic for both clients and counselors. Clients may not feel the topic is relevant to them. Counselors may feel uncertain how to discuss the realities of overdose risk during relapse while simultaneously building client confidence in recovery. The key to reducing any discomfort is to:

  • integrate overdose prevention into multiple areas of the treatment program.
  • normalize overdose education for all treatment clients.

The following are good opportunities to discuss overdose with clients:

  • Intake assessment
  • New client orientation or OTP induction
  • Individual counseling
  • Group sessions, especially relapse prevention groups
  • Review of positive drug screen results
  • Discharge planning
  • When a client overdoses
  • International Overdose Awareness Day (August 31, just before National Recovery Month)

To help normalize conversations about overdose:

  • Make overdose a visible topic. Lobby posters, educational brochures, and handouts show that staff care about overdose and want to talk about it.
  • Make it a standard practice to discuss overdose with all clients, so no one feels singled out for being more “at-risk” than others. Start conversations with:
    • I talk with all of my clients about overdose because the topic is so important right now. And because I want everyone to have the best information.
    • Even if you never used opioids or you think you’ll never use opioids again, you probably know someone who still does. You might need to help someone else someday.
    • We can feel confident that we’ll stay abstinent, but we’ve all seen relapse happen. And with opioids, the risk of overdose is real. So we want everyone to have this information – to help yourself or maybe someone you care about.
  • Emphasize concern for the client’s safety and survival. No slip up or relapse should be fatal.
  • Reinforce the client’s ability to help others and the community. You can help spread this information to others or you might even be in a position to safe a life.
  • See overdose education as an opportunity to have deeper conversations about behavior change.opioid overdose brochure cover

These tools offer talking points to guide conversations about opioid overdose prevention:

Screenshot of title slide from SAMHSA video

 

Overdose prevention in drug treatment

There are many ways to incorporate overdose prevention into drug treatment.  Specifically, treatment providers can:

  • Train staff to recognize and respond to overdose incidents on site and to administer naloxone.
  • Include overdose risk as part of routine intake assessments.
  • Integrate overdose prevention topics into client education curriculum.
  • Train staff to discuss overdose risk within relapse prevention counseling.
  • Provide clients with naloxone (e.g., through prescription or direct distribution).

For more information on how to integrate overdose prevention into drug treatment:

 

Naloxone

ASAM logo

The American Society of Addiction Medicine (ASAM) recommends that drug treatment agencies:

Drug treatment agencies can connect their clients with naloxone in a number of ways:

  1. Purchase naloxone for staff to distribute directly to clients.
  2. Have a Medical Director or other prescriber write prescriptions for naloxone that clients can then fill at any pharmacy.
  3. Partner with a local pharmacy that can directly prescribe naloxone (and in some cases, deliver to your facility). See a list of WA pharmacies here.
  4. Partner with a community program that can come to your facility to provide client education and distribute naloxone.

For more information or technical assistance on naloxone for drug treatment clients, email the Center for Opioid Safety Education at info@stopoverdose.org.

 

Medication-assisted treatment: long-term overdose prevention

While naloxone is a short-term antidote to opioid overdose, stabilizing and treating opioid use disorder with medication-assisted treatment offers long-term protection against overdose. Recent research showed that individuals enrolled in MAT were 50% less likely to die from an overdose than those enrolled only in psychological-based treatment. Pierce et al. Impact of Treatment of Opioid Dependence on Fatal Drug-related Poisoning. Addiction. 2016 Feb; 111(2): 298–308.

MAT is widely regarded as the best practice standard of care for opioid use disorder. The following resources provide more information about the clinical effectiveness of medication-assisted treatment; tools and trainings available for treatment professionals; and where to find MAT services in WA State.

Research

Advocacy

Clinical tools, training and information on medicationsCover of TIP 63

MAT services in WA State

 

Opioid treatment programs (OTP)

The Substance Abuse and Mental Health Services Administration officially endorsed overdose education and naloxone distribution in opioid treatment programs in its 2015 Federal Guidelines for Opioid Treatment Programs.

In particular, SAMHSA recommends:

  • Overdose prevention, including prescribing or dispensing naloxone, is an essential complement to both detoxification and medically supervised withdrawal…” (p.24)
  • “Because of the risk of fatal overdose if relapse occurs, medically supervised withdrawal services [both voluntary and involuntary] should be accompanied by relapse prevention counseling, overdose prevention education and naloxone prescription.” (p.26)
  • “Patients known to be using benzodiazepines should be counselled as to their risk [of overdose] and provided with overdose prevention education and naloxone.” (p.38)
  • Treatment orientation should include “signs and symptoms of overdose, use of the naloxone antidote (prescriptions should be given to patients on entry into treatment) and when to seek emergency assistance.” (p.42)

Overdose prevention and naloxone training for individuals who take methadone can be successfully implemented in a variety of ways:

  • Overdose risk assessment upon intake
  • Patient education (1-1 or groups) on how to prevent, recognize and respond to an overdose
  • Dispensing or prescribing naloxone
  • Collaborative monitoring of patient dosing medications and prescriptions from other healthcare providers
  • Relapse prevention counseling
  • Training for staff on how to recognize and respond to an opioid overdose, including administration of naloxone.

If your program wants to integrate overdose prevention into its service delivery model, here are some helpful resources:

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