Observing International Overdose Awareness Day

Each year, International Overdose Awareness Day is observed on August 31. This day raises awareness of those who have lost their lives to overdose, the people who grieve them, and ways overdose deaths can be prevented. This year’s theme¹, “Together we can,” encourages all those whose lives have been affected by overdose to find strength in coming together to share their stories and advocate for the changes needed to #EndOverdose.

According to the Centers for Disease Control and Prevention (CDC), an estimated 107,543 people died from overdoses in 2023.² Roughly half of overdose deaths in 2023 involved synthetic opioids, such as fentanyl. These staggering numbers call attention to the widespread impact of substance use and the importance of lowering the barriers to public health interventions that reduce harm and save lives.

Barriers to Substance Use Disorder Treatment

Some people who use substances may be in need of a treatment event of some kind but find appropriate care inaccessible. According to the CDC, of the 54.6 million people living with a substance use disorder (SUD) in 2022, only 13.1 million received treatment.³ The level of knowledge about SUD treatment among healthcare providers and attitudes among the public about drug use can get in the way of people seeking the treatment they need and, as a result, lead to more overdose deaths.

A recently published, whose co-authors included JBS's Dr. Melinda Campopiano von Klimo and Laura Nolan, explored physician reluctance to implement existing evidence-based practices to treat SUD.⁴ They found that a common reason for low rates of physicians addressing substance use in their patients is physicians’ perceived lack of skill and knowledge to treat the disorder.

Another major obstacle that people with a SUD face when trying to reach out for help is the stigma surrounding this experience. The National Institute on Drug Abuse (NIDA) emphasizes that words matter⁵, noting that “feeling stigmatized can make people with SUD less willing to seek treatment.” This can even impact access to evidence-based harm reduction services, including overdose education and naloxone distribution, that prevent overdose.⁶

Reversing Overdose

Findings from the systematic review noted the growing evidence that harm reduction practices “offer significant individual and public health benefits.⁴  The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2023 Overdose Prevention and Response Toolkit cites the importance of educating people who use drugs, as they have the  highest likelihood of witnessing an overdose. Health educators seek to provide information about overdose basics, how overdose occurs, risk considerations, and community context, as well as training on opioid overdose reversal medications (OORM).

Naloxone, commonly known by its brand name, Narcan, is an OORM approved by the Food and Drug Administration that effectively reverses opioid overdose. Narcan comes in the form of a nasal spray, while other OORMs are also available as injectables. According to SAMHSA’s toolkit, multiple studies have shown that making Narcan widely available can help reduce overdose death rates. Evidence-based harm reduction strategies involving naloxone include providing it to family and friends of people who use opioids or other drugs, prescribing an OORM when prescribing an opioid, and emergency medical services who respond to an overdose leaving behind a naloxone kit with the survivor.

“For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life. BE PREPARED. GET NALOXONE. SAVE A LIFE.”

-Former Surgeon General, VADM Jerome Adams

Preventing Overdose

A key approach to overdose prevention is education for people who use substances. Certain factors leading to low drug tolerance can increase people’s vulnerability to overdose.⁷ These include recent incarceration, having received opioid-blocking overdose reversal medication that has since worn off, or a period of abstinence while receiving OUD treatment. Another risk factor is using drugs alone without there being someone to respond if an overdose occurs. Overdose prevention education includes sharing the harm reduction basics: 1. Never use alone; 2. Go slow; and 3. Have naloxone and know how to use it. One life-saving resource applying the principles of harm reduction is Never Use Alone, the Overdose Prevention Lifeline. This toll-free national hotline provides overdose prevention, detection, crisis response and medical intervention services without stigma or judgment. They can be reached at 877-696-1996 and peer operators are available 24-hours a day, 7 days a week, 365 days a year. For more information, visit https://neverusealone.com/.

Medications for opioid use disorder (MOUD), opioid agonist medications designed to lessen withdrawal that have been shown to be beneficial in the recovery process, are also an important overdose prevention strategy. There is evidence that MOUD like buprenorphine are also effective in reducing post-nonfatal overdose mortality. A 2023 study⁸ found that buprenorphine treatment following a nonfatal overdose involving opioids was associated with a 62% reduction in the risk of subsequent overdose death involving opioids. Despite the known benefits, this and other studies cited continued issues with connecting people to buprenorphine treatment “after critical opioid-related events, particularly for vulnerable groups,” demonstrating that lowering barriers to opioid agonist medications is an important part of preventing overdose deaths.

How You Can Get Involved

We each have a role to play, individually and in our communities, to prevent overdose death and make appropriate care more accessible for people who use drugs. Equip yourself with information about the signs of an overdose, get trained in the use of naloxone, and find out more about harm reduction strategies that research has shown can help reduce fatal overdoses.⁹ For additional resources, check out:

• SAMHSA’s resource guide, “Overcoming Stigma, Ending Discrimination”
• CDC’s Preventing Opioid Overdose, including the naloxone trainings and fact sheets in the Naloxone Toolkit
• Campaign Resources - International Overdose Awareness Day (overdoseday.com)

References

¹Pennington Institute. (n.d.). Campaign resources. International Overdose Awareness Day.
² National Center for Health Statistics. (2024, May 15). U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. Centers for Disease Control. 
³ Centers for Disease Control. (2024, April 2). Stigma Reduction. 
⁴ Campopiano von Klimo M, Nolan L, Corbin M, et al. Physician Reluctance to Intervene in Addiction: A Systematic Review. JAMA Netw Open. 2024;7(7):e2420837. 
⁵ National Institute on Drug Abuse. (2021). Words matter: Preferred language for talking about addiction. 
⁶ Tsai, A. C. et al. (2019, Nov 26). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS medicine , 16(11), e1002969. 
⁷ Substance Abuse and Mental Health Services Administration. (2024). SAMHSA Overdose Prevention and Response Toolkit. Publications and Digital Products. 
⁸ Samples, H., Nowels, M. A., Williams, A. R., Olfson, M., & Crystal, S. (2023). Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries. American journal of preventive medicine , 65(1), 19–29. 
⁹ U.S. Department of Health and Human Services. (n.d.). Harm reduction.