The use, overuse, and abuse of opioids in the United States is a multifaceted issue that emergency medical services (EMS) face. Although the media has spotlighted the negative impact of opioid overdose and diversion, EMS systems still rely on opioids to manage pain.
As the death rate from opioid overdoses continues to rise in the United States, new strategies have been introduced in recent years to protect the public. In 1999, there was approximately one death per 100,000 from overdoses of heroin, prescribed opioids, and other synthetic opioids like fentanyl (chart below). Overdoses from the use of heroin and other synthetic opioids remained relatively low until 2010-2013 when there was a rapid rise in opioid death rates. From 1999-2017, the CDC reports almost 400,000 people have died from an overdose involving an opioid.
[chart source] retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
Naloxone, a medication that reverses the effect of opioid overdose, was first approved for healthcare providers to treat opioid overdoses in the 1970s. To lessen the death rates from opioid overdoses, laws were passed in all 50 states and the District of Columbia to increase public access to naloxone (DeSimone, Tilleman, Kaku, & Erickson, 2018).
While public access to naloxone has increased, without proper education on why and how it should be used, it will not be as effective as it could be. Many EMS agencies are involved in training programs for law enforcement officers and the public on how to administer naloxone. It is essential to remember when training lay rescuers to emphasize that if the patient is not breathing, they should begin CPR (AHA, 2015, p S416).
See the post Creating a Complete Simulation for Overdose Recovery
Another issue that EMS faces is diversion of opioids by EMS providers who abuse them. In her May 13, 2019 presentation to state EMS officials at the National Association of State EMS Officials (NASEMSO) Annual Meeting, Special Agent Virginia Keys discussed the role the Food and Drug Administration (FDA) Office of Criminal Investigations has in protecting the public by investigating drug tampering by the medical community. Medical providers who draw off medication and replace it with water pose a risk to the patient, who will not receive the intended medication. To help reduce diversion, all medical providers need to be familiar with the tamper-evident aspect of medication packaging and report any irregularities immediately. To learn more, go to www.fda.gov/oci.
When conducting public or law enforcement opioid education, it is important to communicate that life cannot be sustained without circulation and ventilation. If a patient is not breathing, they need to be ventilated. If a patient does not have a pulse, they need CPR. These necessary treatments can be lost in a rush to administer naloxone, but without them, naloxone will be of no use. When teaching EMS providers about the proper indications and use of opioids for treating pain, make sure to include education about proper storage and signs of tampering.
EMSEd™ by Pocket Nurse® has a full line of simulated opioid medications and naloxone packaged like the clinical products. EMSEd also has task-trainers that students can use to perform the skill of naloxone administration. Including these products in training increases the realism and familiarity with opioids without the risks associated with the clinical product.
This is a guest post from J. Todd Vreeland, EMS consultant for EMSEd by Pocket Nurse. Vreeland is the owner of J. Todd Vreeland Consulting, committed to ensuring the protection of the public through high-quality EMS education and patient-centered delivery of out-of-hospital medical care.
American Heart Association. (2015) 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S315–S367. (Circulation. 2015;132[suppl 2]:S315–S367. DOI: 10.1161/CIR.0000000000000252.)
DeSimone, E., Tilleman, J., Kaku, K., & Erickson, C. (2018) Expanding Access to Naloxone. US Pharm. 2018;43(3):16-20. Retrieved from https://www.uspharmacist.com/article/expanding-access-to-naloxone