SAFE Glen Cove Coalition: International Overdose Awareness Day

August 31st was International Overdose Awareness Day, a global event to raise awareness of overdoses, reduce the stigma of more than 500,000 drug-related deaths and acknowledge the grief felt by families and friends by providing a public opportunity to mourn free of guilt and shame. Goals also include providing information about risk for overdose and community services and preventing drug-related harm through evidence-based policy and practice.

Several factors initiated the opioid epidemic and propelled its growth. The American Pain Society introduced pain as the fifth vital sign in 1995. That same year, Purdue Pharma marketed oxycodone (OxyContin), employing marketing campaigns that emphasized the benefits that extended pain relief provided while downplaying the implications. Purdue, as well as Allergan, Endo International, and Teva Pharmaceutical Industries Ltd, also downplayed the serious risk and likelihood of addiction that occurs with their opioids. Seventeen years later prescribers had written more than 259 million opioid prescriptions, enough for every adult in the country to have a bottle of pills.

Advertising and false information concerning extended-release opioids' addictive properties are not the only reasons this epidemic continued to spiral. The FDA found that several major drug distributors were complicit in the unregulated narcotics distribution. Distributors shipped a staggering number of shipments to retail pharmacies across the country, neither questioning nor reporting them to the Drug Enforcement Administration. Chain retailers operated within loopholes of the law to dispense opioids to an unwitting public. Some tactics include providing seminars on pain management and safety, self-policing opioid orders without oversight, and using work-arounds to evade hard limits on purchasing.

The United States has enacted legislation and constructed evidence-based guidelines over the past 5 years to mitigate excessive opioid use. The Centers for Disease Control and Prevention (CDC) issued evidence-based guidelines in 2016 for prescribing opioids for chronic pain in adults. The recommendations include prescribing the lowest effective dose and analyzing risks and benefits when prescribing up to 50 morphine milligram equivalents (MME) per day. Prescribers should avoid or justify daily doses of 90 MME or more. The Centers for Medicare & Medicaid Services followed in the CDC's footsteps in 2018; Medicare Part D sponsors must limit opioid prescriptions to 7 dates in opioid-naive patients.

Stricter regulations on opioids have provided mixed outcomes. Approximately 80% of new heroin users reported that prescription pills were their gateway. Individuals suffering from opioid use disorder have drug-seeking behaviors that cannot be corrected through law. When obtaining a prescription becomes too difficult, their next step is finding illicit drugs.

The first step to combating the opioid crisis is being aware of the issue and spreading knowledge about it. Public awareness has significantly increased over the past 5 years. Just 6 states had laws that expanded access to naloxone or limited criminal liability prior to 2012. By the end of 2017, 46 states and the District of Columbia enacted laws that provide protection for first responders who administer naloxone. In addition, 46 states now have statutes that allow pharmacists to dispense naloxone to third parties or first responders via direct prescription or standing order. The FDA approved the nasal spray formulation of naloxone for use in the community setting without medical training being required in April 2019 maintaining that 21% of opioid overdose deaths can be averted.

International Overdose Day was initiated in 2001 by a member of The Salvation Army in Australia. Since then, many community members as well as government and non-government organizations over the world have held events to raise awareness and honor those lives lost. For more information please visit www.overdoseday.com.

The SAFE Glen Cove Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” in order to educate and update the community regarding opioid use and its consequences. The Coalition hosts NARCAN trainings in collaboration with Nassau County representatives and local community-based organizations. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.