A Questionable Solution to Maryland’s Opioid Crisis

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In 2015, over 1,000 Marylanders died due to opioid-related overdoses. This week, in response to increasing opioid-related deaths, Senate Bill 868 will be heard. This bill increases the scope of the Overdose Response Program (ORP), which provides education and reduces overdose by certifying and training Marylanders to assist overdose victims.

The bill allows healthcare professionals to dispense naloxone to individuals without any of the previously required education. The intent is remove the barrier of attending an educational session for obtaining naloxone, with the hope of curbing the opioid-overdose epidemic.

While naloxone is not difficult to administer, an overdose cannot be treated by just administering naloxone once. Naloxone wears off quickly, and it is critical to call emergency medical services and understand how to initiate CPR. Allowing access to the drug without education may not improve outcomes, and may become a financial burden to those trying to help.

Naloxone-instructions-SQUARE-768x859_harmreductioncoalition.jpg

Image Credit: The Harm Reduction Coalition

While the Department of Hygiene and Mental Health, the Institute for Emergency Medical Services System, and The American Pharmacists Association are invested in this bill, other associations have yet to make formal statements. The American Medical Association has a task force increasing access to naloxone, the American Society of Addiction Medicine, and the Substance Abuse and Mental Health Services Administration recommend and encourage individuals who carry naloxone to receive a comprehensive overdose-related education.

While the bill’s intention is noble, removing education is not the right way forward. There are other possibilities, including requiring healthcare professionals to provide a standardized pamphlet each time they provide or dispense naloxone – which would please all stakeholders.

Nelson Mandela said, “Education is the most powerful weapon which [we] can use to change the world.” In our attempt to save lives, Maryland should be cautious in skipping education.

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3 Responses to “A Questionable Solution to Maryland’s Opioid Crisis”

  1. mliaoblog Says:

    Thank you for an interesting blog. Being an emergency physician myself this certainly seems to be a very short-sighted policy. As you’ve mentioned already Naloxone is notoriously short acting and in my experience, is not usually an absolute must for a successful resuscitation by trained health professionals. While I see by increasing its access may buy some time for the overdosed individual to reach professional care in a non-hospital setting, there are too many uncontrolled variables. Also, while education is an absolute must in conjunction with this policy, it also has its shortcomings. In the medical profession one is often reminded that you “lose what you don’t use” i.e. information retention is poor unless it is something that you use on a daily basis so the expectation of training random individuals and expecting them to respond appropriately when it is not their usual line of profession seems unreasonable. The logical solution would be for a policy further upstream to control the indiscriminate access to opiates in the first place but I can understand that that too has significant challenges in implementation.

  2. tomoyok Says:

    As a healthcare professional in a city, we faces in the situation related to your topic. Thank you for raising the issue and making the point of the importance of the education. Since the Naloxone administration in public became a news, many parents and family members of patients suffering drug addiction have been approaching us to prescribe naloxone as a part of discharge medication. Their requests are based on the news report, not from the proper education from qualified healthcare professionals. As you mentioned in your blog post, Naloxone is not the miracle drug to treat opioid overdose; it is a temporal measure to initiate management and resuscitation process for people who overdosed opiate medications. I have witnessed many people who survived the opioid overdose by proper first response and CPR effort in community. As you stated, I agree, that the basic education of how to handle opioid overdose and other medical emergency very important and naloxone use should be a part of the education, not the isolated solution.

  3. mujanvk Says:

    Thank you for this very informative post. I agree with you that education is important along with making Naloxone available to the public, and I like the idea of accompanying the drug with a pamphlet. However, I believe that the point of minimizing the barriers to gain access to Naloxone was to save the lives that would have been lost otherwise. Even if one less life is lost as a result of this injection, that is one life saved from overdose, and I believe that that is very noble especially that the drug has minimal side effects. I also know that Dr. Leana Wen along with others have designed an online training module for Naloxone that people who are interested could complete the module online and get certified in how to apply Naloxone (http://health.baltimorecity.gov/news/press-releases/2016-02-17-baltimore-health-officials-announce-new-online-training-lifesaving). The website is: http://dontdie.org. In my opinion, this is a positive step towards a less troublesome path to receive training for the time of emergency. Moreover, TV ads could also be another way to inform people of how to help a person who is overdosing. Overall, I see the positive aspects of both opinions and despite supporting the removal of barriers of obtaining naloxone, I believe that in the case that the bill is passed, this should not be an excuse for the state not to inform individuals of how to do the injection and what steps need to be taken the application of the drug.

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