By: Dr. Geoffrey Modest
The World Health Organization published their “community management of opioid overdose“, which basically makes the following recommendations:
1) People likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose. strong recommendation, very low quality of evidence [basis of this recommendation is that most overdoses happen in private homes and most are witnessed — eg close friends, partner, family members]
2) Naloxone is effective when delivered by intravenous, intramuscular, subcutaneous and intranasal routes of administration. Persons using naloxone should select a route of administration based on the formulation available, their skills in administration, the setting and local context. conditional recommendation, very low quality of evidence
3) In suspected opioid overdose, first responders should focus on airway management, assisting ventilation and administering naloxone. strong recommendation, very low quality of evidence
4) After successful resuscitation following the administration of naloxone, the level of consciousness and breathing of the affected person should be closely observed until full recovery has been achieved. Strong recommendation, very low quality of evidence of note there have been approx. 69K world-wide deaths from opioid overdose each year (with 16651 in the US from prescription opioids in 2010). these guidelines acknowledge upfront that these recommendations, though important and should reduce opioid deaths, do not address the underlying issues (monitoring opioid prescribing practices, curbing inappropriate prescribing, increasing the rate of treatment for opioid dependence including prescription opioids). Unfortunately, the guidelines do not comment on the bigger social issues underlying opioid abuse: the importance of societies that value people/spur on motivation, empowerment and self-esteem; provide the necessary social framework for that, including good quality education, access to healthy diets/lifestyle, housing, etc.; and in general create real hope for the future and not increase income disparities, as is happening in many societies, industrialized and nonindustrialized.