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CASE PRESENTATION

A 34-year-old male was found unconscious and with abnormal breathing by his roommate. The patient has a known history of chronic pain as well as opioid use disorder who was recently started on daily sublingual Suboxone (a combination medication containing buprenorphine and naloxone). 911 was called and the roommate was instructed to check for a pulse which was present. He was instructed to administer the take-home naloxone kit provided by their pharmacy, for which 0.4 mg was given intramuscularly in the lateral thigh. Within 3 minutes the patient’s eyes opened and he appeared to be breathing spontaneously. Paramedics arrived on scene 10 minutes later to find the male with a respiratory rate of 8 bpm, SpO2 81%, a Glasgow Coma Scale (GCS) of 7 (E2V1M4), pupils 1 mm bilaterally, but with a strong carotid pulse. Blood pressures, heart rate, temperature, and blood glucose were within normal limits. Airway management was provided including face-mask ventilation (FMV) with an oropharyngeal airway (OPA) while an intravenous (IV) was established. A second dose of naloxone was administered intravenously at 0.4 mg. One minute later, the respiratory rate improved as well as GCS, from 7 to 14. The OPA was removed, and the patient was transported to the emergency department (ED) for ongoing assessment and management.

INTRODUCTION

How Common Is the Opioid-Related Overdose?

The opioid epidemic has been a global health crisis with a significant mortality and disease burden. In Canada, nearly 25,000 deaths were attributed to opioid toxicity deaths between 2016 and 2021. Increasing mortality has been attributed to two overarching themes: historical overprescription of opioids for pain and the contamination of illicit drugs with fentanyl, fentanyl analogues, and other opioids. Given this alarming number of opioid-related deaths, our strategic priority must be to reduce the risk of death of the opioid user.

Despite increasing mortality rates, there have been significant developments aimed at reducing opioid-related overdoses and death. These initiatives cross multiple domains, including patients, families, health care providers, the general public, and policymakers, and are described under three general pillars: primary prevention, access to treatment, and harm reduction. Primary prevention includes education to high-risk population groups, prescription monitoring programs, and increasing access to chronic pain specialists. Treatment access refers to expanding the availability of opioid agonist therapy (OAT) programs for medications such as methadone and buprenorphine, and ensuring that formularies cover costs. Lastly, the philosophy of “harm reduction” accepts the behavior as reality and shifts the focus from prosecution and focuses on reducing its harmful consequences such as infectious disease, incarceration, and death. Harm reduction strategies include safe injection sites, widely distributed naloxone kits, and Good Samaritan laws protecting individuals who seek to provide or receive medical assistance during illicit overdose who would otherwise fear criminal prosecution.1

Although it is abundantly clear that reducing opioid-related deaths is a multifaceted issue, the ...

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