Dual Diagnosis Assignment Paper

According to epidemiological research on opioid overdose deaths, data indicates that accidental opioid overdose continues to increase in the United States, Australia, Canada, and other countries across the globe. In Australia, it is estimated that opioid overdose contributes to an average of 1.5 of daily deaths.  In the United States, opioid overdose deaths are hitting a treble. Increased mortality rates over recent years are setting the alarm on the need for increased supply and use of naloxone drugs, which are useful in reversing opioid overdose (Chimbar, L., & Moleta, Y. (2018).Dual Diagnosis Assignment Paper.  The trend has also initiated naloxone distribution programs and training on administration patterns to reduce opioid overdose deaths. This essay, therefore, details mechanism of naloxone in reversing opioid overdose while deeply reviewing the historical emergence of the drug. The second part gives an account of the effectiveness of home naloxone, and the third part evaluates whether there is a role for taking home naloxone.

Part One

Mechanism of naloxone in reversing overdose

Opioid drugs overdose leads to significant brain damage due to compromised opioid receptors leading to drug accumulation. When an opioid overdose occurs, care of timely administration of naloxone should be considered. Naloxone is a particular opioid antagonist drug that correctly reverses opioid overdose through its mode of action.  It is also used to counter pain associated with general or local anesthetic procedures. The drug is effective in reversing opioid overdose because of its competitive nature at the opioid receptors. Precisely, naloxone has a fast onset of action with a short half-life; therefore, it exerts its effects on the receptors faster compared to opioid. When administered during an opioid overdose, naloxone displaces the opioid drug at the receptor, thus reversing its impact on the site of action. It is also important because it reverses respiratory depression which leads to increased mortality rates among affected persons.  Heroin, morphine, oxycodone are examples of opioid drugs displaced from receptors.  It can be given both intravenously and intramuscularly.  In Australia, subcutaneous use is also allowed, and the drug is approved to be provided in an ambulance by paramedic staff alongside other traineda medical professionals. The treatment of opioid overdosed in Australia using naloxone has been practiced for over 40 years, showing a marked improvement in reducing opioid overdose mortality (Chimbar, L., & Moleta, 2018).

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Naloxone administration should coincide with signs and symptoms of opioid overdose for effective reversal of overdose effects.  In case opioid drugs are taken with alcohol, cases of overdose are doubled requiring timely administration of naloxone drug. Dual Diagnosis Assignment Paper.  Brain damage and related effects occur when signs and symptoms of the disease are not timely detected.

Naloxone drug has broad bio-availability hence making it an effective overdose reversal drug. Notably, the drug has a short shelf-life; therefore it is easily absorbed by opioid receptors and thus displacing opioids from binding to receptors.  Naloxone is also available in other form known as ‘take-home naloxone’ because the drug has few adverse effects. The  take-home drug is thus suitable for use since it can  be administered by people beyond the health profession as long as necessary training or skills are imparted to the responsible individuals for drug administration.

Training on naloxone use is useful because the drug is administered in different alternatives, with the recent one being the ‘take-home naloxone.’ According to pharmacology research, most opioid overdoses involve patients with chronic pain. The patients do not have a comprehensive understanding of overdose. As a result, they become victims of central nervous system depressants overdose such as alcohol and benzodiazepines. Such victims and their families should be taught on how to intervene in case problems of opioid overdose effectively are detected.  The General Practitioners and pharmacists are therefore tasked with the responsibility of offering comprehensive guides to users of naloxone to prevent further complications in affected persons that would lead to death. The training is useful because it champions for early pre-hospital intervention. According to public health survey in Australia, most patients prescribed for opioids would appreciate having naloxone alongside to act as a remedy in case of overdose instances, this aspect presents a valuable opportunity for naloxone supply to a broader population, especially to those at risk of an opioid overdose. Dual Diagnosis Assignment Paper. The World Health Organization now recommends ‘take-home naloxone’ drug use to reduce overdose deaths through reversal mechanisms. Notably, the WHO conclusion came after research on ‘take-home naloxone’ proved feasible, safe, and cost-effective. The health professionals are required to timely identify those patients that require naloxone use and administer safe medication. They should also offer guidelines and train patients on how to reverse opioid addiction by naloxone use. Naloxone drugs are available over the counter for supply efficiency. Notably,  it may also be prescribed to anyone who is at risk of experiencing overdose but offered at a reduced cost through PBS. Research indicates that individual training takes less time, usually 5 to 10 minutes on how to identify opioid overdose, and intervening appropriately and timely. The practice may be combined with learning critical steps in dealing with patients, involving positioning the inappropriate positions facilitating express breathing. Additionally, the training consists of an algorithm of calling an ambulance because the duration of opioid action may exceed that of naloxone leading to complications.

Historical emergence and challenges of naloxone as “take-home” medication

The history of opioid drug traces back to 1961 when it was first patented in New York by scientists who were interested in treating constipation related to chronic opioid use. Scientists discovered that naloxone was safe with minimal side effects, the only problem manifested in victims of opioid overdose manifesting withdrawal symptoms. Naloxone was later approved for treating opioid overdoses by the Food and Drug Administration.Dual Diagnosis Assignment Paper.  The main routes were intravenous and intramuscular injections; hence there was a faster drug absorption and related drug efficacy, the trend created an opportunity for medical professionals to explore different ways of effectively administering the drug under hospital and non-hospital settings, with significant emphasis made on the latter.

The clinical trials practiced in New York and Washington, D.C, created a new program scheme of random piloting take-home naloxone. According to CDC reports, ‘take-home naloxone’ produced more than 26,000 opioid overdose reversion, from 1996 to 2014. Consequently, the opioid overdose mortality cases were reduced. The positive report indicated that home-based care is of naloxone administration by non-medical personnel was effective in reducing opioid overdose and related emergencies.

One of the challenges created by naloxone introduction is moral hazards that have considerably increased mortality rates due to opioid overdose. The increasing availability of naloxone drug creates a  tendency for people to abuse opioid prescriptions, with the pacification of naloxone presence as a remedy to reverse the overdose and associated effects. As a result, more opioid overdose deaths have been realized over the last ten years. Another challenge is the dual diagnosis. In this case, a patient presents with complex problems that require an in-depth assessment to decide on the drug to give and related coping strategies.  Dual Diagnosis Assignment Paper. When naloxone is administered in such cases in isolation, its effectiveness may be reduced, leading to partial treatment of a patient. Research indicates that patients with dual diagnosis and substance abuse are reported to recover less (Dwyer, Fraser & Dietze, 2016). Notably, in case of dual diagnosis, proper clinical assessment is needed before settling on a treatment plan for a client; in this case, prescription alone does not solve the patient’s clinical problems.  Additionally, naloxone administration may be a challenge when dealing with patients of opioid overdose and substance abuse because they develop related issues such as withdrawal symptoms, stress, and sometimes suicidal ideations. In this case, proper training of naloxone givers is needed, which goes beyond dealing with an opioid overdose but extends to coping induction of coping strategies to the client. Dual Diagnosis Assignment Paper.

Part 2: Effectiveness of Naloxone in reversing Opioid overdose

Naloxone is effective in reversing opioid overdose if timely administered. It has a short short-half-life hence easily binds to the opioid receptors, displacing opioid drugs. Notably, a time frame of three hours or less is allowed for the efficacy of naloxone to be realized.  Traditionally, only medical staffs were allowed to administer naloxone drug in case of an opioid overdose. However, such a trend has manifested gaps in timely administration because as some patients may experience overdose in remote areas hence impeding appropriate administration of naloxone. In such cases, patients develop a complex problem and brain damage due to lack of oxygen supply; they later die before medical personnel arrives with naloxone (Dwyer, Fraser & Dietze, 2016). To increase naloxone effectiveness, the health ministries through relevant bodies have increased the drug’s scope of bioavailability, which is significantly improving the efficacy of the drug. The critical activity introduced is a training of both medical and non-medical staff on the timely and safe administration of naloxone during an opioid overdose (Clark, Wilder & Winstanley, 2014). Dual Diagnosis Assignment Paper. More emphasis is made on the non-medical individuals who may be close relatives of friends to a victim. The training also empowers them on how to deal with dual diagnosis cases, for instance, family members of patient are trained on the safe administration of naloxone as well as inducing coping strategies to the patient to deal with stress and minimize suicidal ideations.

Brief Literature Review on the efficacy of take-home naloxone programs

‘Take-home’ naloxone (TNH) programs were introduced by governments in Europe to facilitate broad scope availability of naloxone drug to combat opioid overdose cases.  Notably, the death toll related to opioid overdose shown a significant increase over the last decade. Research indicates that many of those who died of an opioid overdose were not alone during the time of death. The research further shows that the majority of victims suffered opioid overdose in the presence of witnesses, friends, witnesses, and family members.  The study concludes that a gap was realized in the inability of people to detect and recognize the seriousness of opioid overdose. Others were in remote areas making medical access difficult, while the majority feared legal repercussions while at the same time did not have access to naloxone (Clark, Wilder & Winstanley, 2014). THN programs have therefore bridged this gap by ensuring a good supply of take-home naloxone to prevent opioid overdose death recurrences.  To maximize efficacy, the TNH program support team are training non-medical personnel on timely detection of overdose situations, proper reporting, and effective administration of naloxone drugs (Jauncey & Nielsen, 2017). Through the program, there is increased availability of naloxone as an over the counter medicine; in this case, the pharmacist dispensing drug must reinstate instructions for taking the medication. Dual Diagnosis Assignment Paper.

According to (McDonald & Strang, 2016), take-home naloxone program has significantly reduced mortality rates due to opioid overdose. According to the systematic research conducted and clinical trials, only one death was reported among 123 overdose victims administered TNH, indicating greater efficacy of TNH ((McDonald & Strang, 2016).  Additionally, the study verified that take-home naloxone did not confer any harmful effect on the clients, hence making it safe for timely administration and appropriate follow-up. (Langham, Wright, Kenworthy, Grieve & Dunlop, 2018) Indicate in their research study that THN is cost-effective hence benefit a more extensive community use of naloxone. According to the British National Formulary List price, the costs for THN was relative, creating a distribution balance, useful for community use of naloxone.  Death cases in remote areas due to the inaccessibility of medical services was significantly low.

Part 3:  Analysis of role for take-home naloxone in those who use/abuse opiates prescription

Opiate overdose is a frequent public health problem and a growing concern because of premature death it results in. Notably, the opioid overdose mortality rates indicate a significant increase due to home or resident-based deaths Witnesses or bystanders interviewed in various surveys confess to having witnessed deaths of victims without taking steps. One reason for this is legal implication fear while the other is oblivion on how to detect drug overdose case. This indicates that take-home naloxone plays a vital role in preventing such death (Langham, Wright, Kenworthy, Grieve & Dunlop, 2018). If there were a supply of the drug, then the deaths would be significantly minimized.

People living in remote areas experience difficulty in accessing timely medical attention. In such cases, if they experience opioid overdose problems, they will develop brain failure due to prolonged exposure to the condition without receiving medical assistance. Dual Diagnosis Assignment Paper. As a result, the death toll rises (Jauncey & Nielsen, 2017).  Take-home naloxone program ensures that naloxone is available to the patients at tier home, which is useful in overdose reversal before referral for further medical assessment.

The take-home naloxone has a significant role in the community because it can be presently administered by non-medical personnel, mostly known as laypeople. The THN programs through its comprehensive training on naloxone administration have created awareness on detection of overdose cases, timely reporting and proper administration of naloxone drug as further medical attention awaits (Shaw, L. V., Moe, Purssell, Buxton, Godwin, Doyle-Waters & Hohl, 2019). This is an essential reviving process that is facilitating more meaningful use of take-home naloxone. More emphasis on educating naloxone givers is required for continuous quality improvement of naloxone administration to minimize opioid overdose deaths significantly.

Conclusion

Naloxone is an active antagonist of opioid drug actions. Its role in opioid overdose reversal has most importantly reduced associated deaths by a more significant percentage. The use of THN programs is improving bioavailability scope of the drug, benefit community users. There is also an enhanced legal and ethical considerations evaluation regarding naloxone use, making it easier for people to report opioid overdose cases, do comprehensive follow-ups on victims, and seek further guidance on naloxone use as overdose reversal drug. Dual Diagnosis Assignment Paper.

References

Chimbar, L., & Moleta, Y. (2018). Naloxone Effectiveness: A Systematic Review. Journal of addictions nursing, 29(3), 167-171.

Clark, A. K., Wilder, C. M., & Winstanley, E. L. (2014). A systematic review of community opioid overdose prevention and naloxone distribution programs. Journal of addiction medicine, 8(3), 153-163.

Davis, C. S., Carr, D., Southwell, J. K., & Beletsky, L. (2015). Engaging law enforcement in overdose reversal initiatives: authorization and liability for naloxone administration. American journal of public health, 105(8), 1530-1537.

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Dwyer, R., Fraser, S., & Dietze, P. (2016). Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers. Drugs: Education, Prevention, and Policy, 23(5), 388-396.

Jauncey, M. E., & Nielsen, S. (2017). Community use of naloxone for opioid overdose — Australian prescriber, 40(4), 137.

Langham, S., Wright, A., Kenworthy, J., Grieve, R., & Dunlop, W. C. (2018). Cost-effectiveness of take-home naloxone for the prevention of overdose fatalities among heroin users in the United Kingdom. Value in health, 21(4), 407-415. Dual Diagnosis Assignment Paper.

McDonald, R., & Strang, J. (2016). Are take‐home naloxone programs effective? Systematic review utilizing the application of the Bradford Hill criteria. Addiction, 111(7), 1177-1187.

Shaw, L. V., Moe, J., Purssell, R., Buxton, J. A., Godwin, J., Doyle-Waters, M. M., … & Hohl, C. M. (2019). Naloxone interventions in opioid overdoses: a systematic review protocol. Systematic reviews, 8(1), 138.

Strang, J. S., & McDonald, R. (Eds.). (2016). Preventing opioid overdose deaths with take-home naloxone. Publications Office.

US Department of Health and Human Services. (2019). Naloxone: the opioid reversal drug that saves lives—how healthcare providers and patients can better utilize this life-saving drug.

Weiner, J., Murphy, S. M., & Behrends, C. (2019). Expanding Access to Naloxone: A Review of Distribution Strategies.

Wermeling, D. P. (2015). Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Therapeutic advances in drug safety, 6(1), 20-31.

World Health Organization. (2014). Community management of opioid overdose. Dual Diagnosis Assignment Paper.