Working with Substance Use: Essential Overdose Prevention

93,000. That is the approximate number of overdose deaths that occurred in 2020, a nearly 30% increase in the US over 2019. According to Dr. Nora Volkow, director of the National Institute on Drug Abuse, it was the highest number of overdose deaths in recorded history. While a variety of substances contributed to the overdoses, 69,710 were attributed to opioids. And although there were a multitude of additional factors at play in 2020, fentanyl is largely responsible for the sharp increase in overdose deaths. 

The devastation from overdose deaths has swept across all corners of the country, and has impacted all fields of healthcare practice. Gone are the days where we can pretend that these issues are relegated to the few. As helping professionals, we can’t assume that handling substance use disorders falls solely to those who have actively sought out to support that population. In fact, most people who struggle with substance use disorders don’t receive treatment. 

Now is the time for all of us in the helping professions to learn to support and connect with people with substance use disorders and their loved ones. As grim as these numbers may be, the situation is by no means hopeless. 

Overdose Prevention Through Harm Reduction

Harm reduction is the practice of meeting clients where they are and respecting the rights of people who use drugs. The focus is on minimizing harmful consequences associated with drug use. Harm reduction prioritizes the safety of lives over compliance with abstinence. Although this perspective may make some providers uncomfortable, the reality is that people shouldn’t have to die because they make choices that don’t align with our own values.

Basic harm reduction interventions are easy and effective for providers, people actively using, and their loved ones. Here are five tips and resources to help reduce harm and hopefully, save a life

1. Have Narcan on hand

Naloxone (or Narcan) is an essential tool for overdose prevention—as essential as first-aid kits or CPR training. Narcan is easy to access, easy to use, and can rapidly reverse an opioid overdose. Narcan works by binding to opioid receptors and can both reverse and block the effects of opioids, including heroin, fentanyl, and oxycodone.

Narcan is easy to access in most states, and often can be obtained at your pharmacy and is often covered by insurance. Although it comes in several forms, most non-medical professionals prefer the nasal spray version for its ease of use. The National Harm Reduction Coalition has a Naloxone finder on their website showing where it can be obtained across the country, and often at no charge.

The National Institute of Health produced a brief video that demonstrates how to recognize the signs of an opioid overdose and how to use Narcan. Being prepared to act and having Narcan on hand has saved thousands of lives.

2. Test drugs for drugs

More and more, fentanyl and related analogues are being surreptitiously added to illicit drugs, even non-opioids such as MDMA or counterfeit benzodiazepines. The result is that people who never even intended to take an opioid are now overdosing on opioids.

Fentanyl testing strips are another tool for overdose prevention, and can be purchased online and can be used in the privacy of one’s home to test their supply. DanceSafe.org is considered a trusted supplier and the strips they sell have been verified to detect fentanyl and eleven other analogues. There also may be local harm reduction groups in your area where you or your clients can get fentanyl testing strips as well. 

Keep in mind that the testing strips can’t detect every single known synthetic opioid, so a negative result doesn’t necessarily mean that a supply is totally safe. While drug testing people tells us what they’ve already taken, drug testing drugs themselves is an overdose prevention effort that can save lives.

3. Provide safety strategies for people actively using

One of the most dangerous things people can do is use alone. If you know that someone is using illicit substances—or licit substances in a way that’s dangerous—sharing some safety strategies can go a long way. Encourage people to use with others, and if they’re already doing so, encourage them to stagger their use in case medical attention needs to be provided. If someone is isolated, you can refer them to Never Use Alone, an organization that will stay on the phone with people while they use and should they become unresponsive will notify emergency services.

Certain drug combinations greatly increase the chance of an overdose, especially taking more than one central nervous system depressant. (For example, taking opioids and benzodiazepines at the same time.) Encouraging people to use one drug at a time can be lifesaving guidance.

For people who have had a recent period of abstinence, their tolerance has decreased, putting them at a higher risk of overdose. In those instances, encourage people to use less and use more slowly.

4. Learn evidence-based treatment for opioid dependence

With opioid overdoses and deaths on the rise, knowing appropriate referrals for people managing opioid use disorder (OUD) can be critical. Although as a society we’re most familiar with inpatient treatment and 12-step programs as being the norm, these aren’t typically the most effective treatments for OUD. Medication assisted treatment (MAT), also referred to as medications for opioid use disorders (MOUD), includes buprenorphine and methadone, both of which are evidence based and support individuals’ safety and stability while providing some protection against both overdose and withdrawal. 

Learn more about MAT or find a provider in your area for methadone or buprenorphine. 

5. Understand your words have power

If someone trusts you enough to disclose their substance use, consider your words carefully. Words like “addict” and “alcoholic” are no longer considered professional or appropriate terms—and they make no appearance in the DSM-5. These words imply judgment and carry a stigma that promotes shame rather than connection. And  being in a shame state tends to induce feelings of wanting to use. 

An addict is a concept, whereas the client in your office is a person. When people feel connected and accepted, they often feel hope and are more likely to accept support.

Withhold Judgment, Offer Support

When a client reveals something about substance use, it can be tempting to immediately refer out, or make a logical—but ultimately useless—statement about how they should stop. For a client struggling, this can feel like the verbal equivalent of a door slamming in their face. 

Even if substance use is beyond your scope of knowledge and practice, we all have the capacity to listen. Rather than simply expressing your concerns, ask what concerns them about their use. Ask how you can help. Ask what they need. You may not be the person who can ultimately serve their needs, but you are the person they came to for help and support. 

We must open doors for people. We must work alongside people, and we must meet people where they are. If the first person they reach out to is kind, compassionate, and willing to listen, clients will be more likely to accept further help, resources, and referrals. And if we can do this, then we are doing our most important work—helping people be well.