Accidental overdose in the community

Risks for Accidental Opioid Overdose Seen in the Community

March 23, 2021

Joshua Lynch, DO, EMT-P, FAAEM, FACEP: I look at it 2 different ways. I think there is the unintended user, the pediatric family member or another family member who takes the wrong medication because the medication is lying around. Also, when does somebody who has been using opioids become at a higher risk to have an accidental overdose? I think that deserves a bit of discussion, specifically when in that point of the opiate user’s life are they at the highest risk? There are also patients who co-use other CNS (central nervous system) depressants such as alcohol, benzodiazepines or a combination of both; some people may use another drug that has fentanyl in it without realizing it contains fentanyl. In western New York and the greater Buffalo area as well as in many other cities and rural areas, fentanyl is in everything, and we are seeing a lot of fentanyl being mixed with cocaine. The average cocaine user may know nothing about opioids or may have believed that they have never used opioids. We see patients come in and they think they are in cocaine withdrawal and they are actually in opiate withdrawal; they are shocked when we tell them.

Patients who have lost their tolerance are in another group. This is probably one of the saddest situations: patients get out of rehab or they get out of an inpatient program where they are doing great, or they go through a period where they are not using at all. Sometimes, patients may step into a situation where they end up using again, and they do not take into account that they now have lost a significant tolerance to the opioids. They use the same amount as they did before—maybe they do it alone, which raises the risk for a fatal overdose exponentially. Those folks will proceed to have a higher risk of a fatal overdose. Oftentimes, we see this happen in residential programs or halfway houses; we see somebody doing great; they may have been doing very well for 6 months. Then they come out of the residential program or halfway house and within a few days they fatally overdose. It is the same for folks getting out of jail or other incarceration situations.