Overdose is an ever present issue in substance use disorder treatment, yet it is rarely directly addressed. Engagement in substance use disorder treatment represents a potential paradox- while it can help individuals eliminate or reduce drug use, which can decrease overdose risk; it is also a tolerance changing event that can actually increase risk for overdose death.
In March 2015, SAMHSA updated Opioid Treatment Program guidelines, including new guidance on discussing overdose:
Overdose prevention, including prescribing or dispensing naloxone, is an essential complement to both detoxification services as well as medically supervised withdrawal. Patients should be advised of the risks of relapse following detoxification and offered a relapse prevention program that includes counseling, naloxone and opioid antagonist therapy.
Similarly, in June 2015, the American Society of Addiction Medicine (ASAM) developed National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, including guidance on discussing overdose:
The Guideline Committee, based on consensus opinion, recommends that patients who are being treated for opioid use disorder and their family members/significant others be given prescriptions for naloxone. Patients and family members/significant others should be trained in the use of naloxone in overdose.
We provide some sample documents that may facilitate the process. Those desiring in-depth technical assistance can contact us for rates and availability at PrescribeToPrevent@gmail.com.
Opportunities to Address Overdose in Substance Use Disorder Treatment
- Intake assessment
- Trauma screening
- Induction or orientation phase
- Individual or group counseling
- Group counseling
- Routinely upon positive drug screen results
- At discharge
- When client overdoses
- International Overdose Awareness Day (August 31- the day before Recovery Month)
- Consider developing an on-site emergency overdose response policy and provide staff training
(see Section 46.0 Overdose Prevention and Education on pg. 140)
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