Understanding Medication to Treat Opioid Use Disorder for Treatment Court Participants

Opioid Overdose Basics

Prescription opioids (like hydrocodone, oxycodone, and morphine) and illicit opioids (like heroin and illegally made fentanyl) are powerful drugs that have a risk of a potentially fatal overdose. Death from an opioid overdose happens when too much of the drug overwhelms the brain and interrupts the body's natural drive to breathe. Anyone who uses opioids can experience an overdose, but certain factors may increase risk, including but not limited to:

• Combining opioids with alcohol or certain other drugs
• Taking high daily dosages of prescription opioids
• Taking more opioids than prescribed
• Taking illegally manufactured opioids, like heroin or fentanyl, that could possibly contain unknown or harmful substances
• Certain medical conditions, such as sleep apnea, or reduced kidney or liver function
• Age greater than 65 years old

If you have not yet fully stopped using, do not give up hope. It often takes multiple attempts before a person can stop using completely and progress on the road of recovery. In the meantime, if you ever use again, here are suggestions to reduce the risk of overdose and other harmful consequences:

• Try not to use alone.
• Have naloxone nearby.
• Have a phone nearby.
• Go slow; if possible, try to get fentanyl strips and test your drugs for fentanyl. Fentanyl is more likely to cause an overdose.
• Do not use shared drug equipment, as it increases the risk of HIV and hepatitis C.
• Talk to the doctor about PrEP (pre-exposure prophylaxis to prevent HIV) if you inject drugs or engage in risky sexual behavior.
• Find out where nearby syringe service programs are.

Signs and Symptoms of an Opioid Overdose

During an overdose, breathing can be dangerously slowed or stopped, causing brain damage or death. It is important to recognize the signs⁴ and act fast. Signs include:

• Small, constricted “pinpoint” pupils
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Limp body
• Pale, blue, or cold skin

It may be hard to tell if a person is high or experiencing an overdose. If unsure, it is best to treat it like an overdose—you could save a life.

1. Call 911 immediately.
2. Administer naloxone, if available.
3. Try to keep the person awake and breathing. Perform CPR if the person is not breathing.
4. Lay the person on their side to prevent choking.
5. Stay with them until emergency workers arrive.

It is also important to know what not to do.

• Do not slap or try to forcefully stimulate the person—it will only cause further injury. If shouting, rubbing knuckles on the sternum (center of the chest or rib cage), or light pinching will not awaken the person, they may be unconscious.
• Do not put the person into a cold bath or shower. This increases the risk of falling, drowning, or going into shock.
• Do not inject the person with any substance (salt water, milk, “speed,” heroin, etc.). The only safe and appropriate treatment is naloxone.
• Do not try to make the person vomit drugs they may have swallowed. Choking or inhaling vomit into the lungs can cause death.