Opioids and Overdose Prevention
Background Information & Current Trends
What are Opioids?
Opioids are a class of drugs naturally found in the opium poppy plant. Many prescription opioids are used to block pain signals between the brain and the body and are typically prescribed to treat moderate to severe pain. In addition to controlling pain, opioids can make some people feel relaxed, happy or “high,” and can be addictive. Additional side effects can include slowed breathing, constipation, nausea, confusion, and drowsiness.
These pain relievers are powerful drugs — very similar to heroin in their chemical makeup, and habit-forming by their very nature. Anyone who takes prescription opioids can become addicted to them. As many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. Once addicted, it can be hard to stop.
The risk of addiction is particularly concerning for teens because their brains are still developing. Because their internal reward systems are still being developed, a teen’s ability to bounce back to normal after using substances may be compromised due to how substances affect the brain, making teens more vulnerable than adults to developing an addiction.
What is fentanyl?
Fentanyl is a powerful synthetic opioid drug that is approximately 100 times more powerful than other opioids. Fentanyl is often added to illicit street drugs such as fake pills and white powder. Fentanyl and other opioids cause overdose by slowing breathing and eventually can cause death.
There has been an increase in overdose deaths in King County, driven largely by fentanyl found in illicit pills and powders. These deaths are occurring more frequently among people 18 or younger. All people should:
- Beware of counterfeit pills that may look like prescription drugs. They likely contain fentanyl.
- Only consume a pill that you directly receive from a pharmacy or your prescriber.
- Know that pills purchased online are not safe.
The United States Drug Enforcement Administration (DEA) sent a message to the public recently warning about new forms of fentanyl that have begun circulating in Washington targeted towards children and young adults. These versions of the drug are formulated in brightly colored pills, powders, and blocks that have been termed “rainbow fentanyl” in many media reports. Every color, shape, and size of fentanyl should be considered extremely dangerous.
Are Young People Misusing Opioids?
According to the U.S. Department of Health & Human Services, teens and young adults are the biggest misusers of prescription pain medication. Young people may misuse prescription opioids for many reasons, including curiosity, peer pressure, and wanting to fit in. Another reason teens and young adults may decide to take prescription opioids is because they can be easier to get than other drugs. Studies show that 53% of people ages 12 or older who obtained prescription pain medication for nonmedical use obtained them from a friend or relative.
The CDC reports that individuals who are prescribed opioids prior to graduating high school are 33% more likely to misuse prescription opioids after graduating. Additionally, taking opioids after wisdom teeth removal also increases the odds of long-term use.
What is an Opioid Overdose?
An opioid overdose happens when someone has taken too much of an opioid. Synthetic opioids such as Fentanyl are especially dangerous due to its potency and can be added to illicit street drugs. A person may experience non-life-threatening effects such as nausea, vomiting, or sleepiness. A person may also experience life-threatening effects that may lead to death, including infrequent or absent breathing, slowed or irregular heartbeat, no response to stimuli, and severe allergic reaction.
Risk factors for an opioid overdose include:
- Mixing opioids with other substances including benzodiazepines or alcohol
- Using after a break in use due to decreased tolerance
- Taking too many opioids
- Other health conditions
- Previous overdose
- Using opioids not from a pharmacy because the strength is unknown
- Using alone (increases risk of dying from an overdose) Those who overdose rarely experience sudden breathing cessation. There is usually enough time to intervene before breathing completely stops and death occurs.
Overdose deaths among the general population have been on the rise for the past decade. But until now, young people were largely insulated from any increase. There has been a new jump in overdose deaths among youths, and the relative increase among those ages 14-18 is now the highest of any age group. In King County, the recent increase in overdose deaths is driven largely by fentanyl found in illicit pills and powders.
What is Naloxone?
Naloxone is a non-addictive, life-saving drug that can reverse the effects of an opioid overdose when administered in time. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. But naloxone has no effect on someone who does not have opioids in their system, and it is not a treatment for opioid use disorder.
Naloxone works to reverse opioid overdose in the body for only 30 to 90 minutes. But many opioids remain in the body longer than that. Because of this, it is possible for a person to still experience the effects of an overdose after a dose of naloxone wears off. Also, some opioids are stronger and might require multiple doses of naloxone. Therefore, one of the most important steps to take is to call 911 so the individual can receive immediate medical attention.
Per RCW 69.41.095, any person or “entity” (e.g., police department, homeless shelter) can obtain, possess, and administer naloxone. It also permits naloxone distribution under a prescriber’s standing order. Find naloxone near you
What is Washington State’s Good Samaritan Law?
In WA State, anyone (including people under 21) trying to help in a medical emergency is generally protected from civil liabilities by RCW 4.24.300. WA State’s 911 Good Samaritan Overdose Law RCW 69.50.315 gives additional, specific protections against drug possession charges:
- If you seek medical assistance in a drug-related overdose, you cannot be prosecuted for drug possession.
- The overdose victim is also protected from drug possession charges.
- Anyone in WA State who might have or witness an opioid overdose is allowed to carry and administer naloxone (RCW 69.41.095).
However, a student in possession of illegal drugs and/or controlled substances on school property may be subject to corrective action.
Prevention Strategies for Parents/Guardians
How do I talk about opioids with my child?
It’s never too late to start talking with your child about the risks of prescription opioid misuse. As children age, they make more decisions on their own and face greater temptation and peer pressure. Though it may not seem like it, children really do hear your concerns. It’s important you help them understand what prescription opioids are, why they shouldn’t misuse them. Read more about how to talk to your teen about opioids here:
SAMHSA Talking to Your Teen About Opioids
Youth Discussion Guide: Talking to Teens About Fentanyl
How do I safely store my medications?
- Don’t hang on to meds, dispose excess meds at “takeback” events. Or, as an alternative where no takeback opportunities exist — by mixing the medication with coffee grounds or other unpleasant garbage and throwing it out. Mail your expired or unwanted medications for free or drop them off at a participating kiosk, more info here: Safe Medication Return Program
- Store your medication in a safe place. You can read more about preventing accidental and intentional use of drugs by reducing access to substances in the home here: SPS Safe Storage of Substances Campaign
What if an opioid has been prescribed?
- Talk to your provider about the following if an opioid is recommended for your child:
- Is a prescription opioid necessary to treat my child’s pain? For chronic pain, can we explore alternative treatments such as physical therapy, acupuncture, biofeedback or massage?
- How many pills are being prescribed, and over how long a period? Is it necessary to prescribe this quantity of pills?
- Should my child be screened to determine their risk of substance use disorder (SUD) before this medication is prescribed? If not, why not?
- What are the risks of misuse?
- Supervise the dispensing of the medication, counting the pills in the bottle to be sure they are being taken as prescribed. Clearly document when the prescription was filled and when a refill will be needed -– and be suspicious of any missing medication.
- Communicate with your child about the risks of misuse and be very clear that the medication is not to be shared with others.
- Communicate regularly with your child about the level of pain they are feeling, making sure the pain is diminishing with time and staying alert for any signs that your child is growing dependent on the medication.
Where can I turn for help?
If you are concerned about your child’s substance use, there are agencies within Seattle and King County that can help. You can find those agencies here: Behavioral Health Agencies
Seattle Public Schools Overdose Prevention Strategies
When are students taught about opioids and overdose?
Students receive mandatory drug prevention education, including information on opioids and overdose, in grades 7 and 9. High schools also administer health promotion campaigns like One Pill Can Kill, and Laced & Lethal.
How do school staff respond to on-campus overdose?
Multiple trainings have been provided to key staff, such as nurses and security, so they are able to recognize an overdose and provide appropriate response. All school sites are stocked with doses of the overdose reversal drug Narcan. Additional trainings are planned for the beginning of the 22-23 school year to increase the number of school staff who can respond to overdose on campus.
Does SPS have established policies or procedures for overdose response?
SPS Board Policy No. 3424 recognizes that the opioid epidemic is a public health crisis and access to opioid-related overdose reversal medication can be lifesaving. Superintendent Procedure 3424SP Opioid-Related Overdose Response provides guidance to administrators on how to implement this policy.