August 31: International Overdose Awareness Day

The Reality of Overdose in America 
 #EndOverdose | #OverdoseAware | #IOAD2021

Prince, Anna Nicole Smith, David Ruffin, Mac Miller, Heath Ledger, Gerald Levert, Rodney King, Juice WRLD, Janice Joplin, Howard Hughes, Phillip Seymour Hoffman, Jimmy Hendrix, DMX, Chyna, John Belushi, Dorothy Dandridge, Judy Garland, Margaux Hemingway, and Frankie Lymon. We all know the celebrity faces of overdose and the loss felt over the decades. Whether accidental or intentional (suicide), these are the names we associate with overdose. However, hundreds of thousands outside the public eye die annually from overdose. Among those unknown to society at large are the two children of a California physician practicing in the field of addiction medicine, the 31-year-old son of John Ryan, Founder of International Overdose Awareness Day, and the nephew of my high school classmate who we lost to overdose earlier this month. The statistics are both daunting and staggering. In 2019, nearly 50,000 people in the US died from opioid-involved overdose. In the 12 months ending May 2020, 81,230 individuals suffered a fatal overdose. This is documented as the largest increase ever recorded and is attributed to the COVID-19 pandemic’s impact on access to treatment and the ubiquitous availability of more potent fentanyl. Fentanyl is now the primary driver of overdose deaths and its potency is rendering the induction of buprenorphine treatment more challenging. 

Overdose Morbidity vs Mortality 

When we think about overdose, we tend to focus primarily on the associated deaths. But what becomes of those who survive an overdose? Survivors often suffer permanent injury.  Non-fatal overdose from opioids is a significant contributor to morbidity in the US.  Emergency department data from 2017 revealed that 967,615 individuals in the US were treated for a non-fatal drug overdose secondary to opioids, non-heroin opioids and heroin. Those who misuse prescription opioids and other substances such as heroin and fentanyl are risk for adverse health consequences with lasting effects.  The fact is that virtually every episode of use carries with it the risk of overdose. These adverse health consequences include but are not limited to: 

• Opioid-induced respiratory depression 
• Hypoxic brain injury 
• Stroke 
• Kidney failure 
• Seizure disorder 
• Amnestic syndrome 

Impact on Families and Communities 

The economic burden in the US of OUD in 2017 was reported to be $471 billion.  The financial burden of fatal opioid overdose in the same year was $550 billion. These are the economic costs to our country.  However, the toll on families can never be measured in dollars. Families pay the emotional toll of watching a loved one suffer through their disorder and often through the cycles of treatment and relapse and in some cases non-fatal or fatal overdose.  

Bringing Overdose out of the Shadows 

Today, August 31, is International Overdose Awareness Day. It is when we recognize, acknowledge, and remember those lost and those impacted by drug overdose. On this day, candlelight vigils will be held, musicians will perform in concert to pay tribute to those we have lost, and tributes will be posted on social media to remember loved ones no longer with us due to an overdose. It is also the day we can pledge to join the worldwide movement to advocate for the prevention of drug overdose and bring overdose out of the shadows. There are several ways that we can all support the overdose prevention movement: 

• Provide MAT certification training for physician assistant students 

• Become a preceptor for physician assistant students and train them to treat patients with OUD/SUD 

• Become an MAT DEA X-waivered provider 

• Advocate for increased MAT access in the emergency departments of your local community 

• Advocate for increased Narcan/Naloxone prescribing and distribution in your own community 

• Encourage the use of the Center for Disease Control Overdose Data to Action Program in your community.  This program enables communities to access data on drug overdose morbidity and mortality allowing communities to target overdose prevention activities. 

• Promote awareness of the available forms of harm reduction including the distribution of fentanyl test strips 

• Recognize the signs of drug overdose:  
  • Clammy face or difficulty speaking
  • Limp body, limp extremities, blue lips, or fingernails 
  • Difficulty arousing from sleep, no response to external stimuli 
  • Shallow or absent breath sounds 
  • Absent heart sounds, decreased heart rate 
  • Snoring or gurgling sounds

For more information on International Overdose Awareness Day or to post a tribute to a loved one please go to the website: www.overdoseday.com.