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Trauma and Injury Prevention Section Summer 2015 Newsletter - Opioid Edition

Chair’s Corner

Ali RajaThanks to our outstanding Newsletter Editor, Dr. Elizabeth Johnson, we are introducing our first themed issue – and we’ve decided to focus on opioids. We have so many TIPS and ACEP members with expertise on this topic that choosing our first theme was a no-brainer. In this issue, you’re about to read about some of the amazing work that is being done by our emergency physician colleagues across the country, from Washington to Massachusetts, and there’s no reason why you can’t work to implement similar best practices in your ED as well.

Over the next few months, we’re going to be building on the work outlined in this Newsletter. We have submitted a related Section Grant, are putting together a webinar for the late summer, and will be making opioids one of the areas on which we’ll be focusing during our October Section Meeting in Boston. However, we’re looking for ideas for our next themed issue in the Fall, so please send me any suggestions via e-mail. Until then, have a fantastic – and injury free – summer!

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The True Characteristics of Emergency Department Opioid Prescribing: Synthesis of Recent Research

 Weiner-HoppeThe Emergency Department (ED) is at the convergence of the opioid abuse epidemic. Not only do emergency physicians (EPs) routinely care for patients with adverse effects from opioids (e.g. abuse, misuse, overdose, heroin use), but EDs also treat patients who present with moderate to severe acutely painful conditions that may benefit from opioids. EDs are increasingly called upon to determine whether patients have a painful condition that may warrant opioids or are attempting to obtain these medications for other purposes such as abuse or diversion. Further along this spectrum, as the “safety net” of the healthcare system, EDs are now becoming a source of naloxone for patients at high risk for opioid overdose.

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Washington ACEP Chapter Journal Club On Take-Home Naloxone

Hayes WongWhitesideAt the annual Summit to Sound Emergency Medicine conference, the Washington ACEP Chapter hosted a “Naloxone Programs in the Community” journal club. This session was attended by community and academic physicians, nurses, and other healthcare professionals from around Washington State, as well as from Alaska and Vancouver, BC. In total, they represented at least 25 different facilities. The primary objectives of the journal club were to explore current evidence of community naloxone programs in reducing opioid overdoses and promote discussion about prescribing naloxone from the ED. The two articles chosen for discussion were “Project Lazarus: Community-Based Overdose Prevention in Rural North Carolina” (Pain Medicine 2011) and “Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis” (BMJ 2013). Additionally, Caleb Banta-Green, PhD, MSW, MPH, principal investigator for a NIDA funded trial to determine the effectiveness of overdose education plus take-home naloxone for patients in the ED, was present and participated in the discussion.

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Prescription Drug Monitoring Programs (PDMPs)

The United States is currently facing an epidemic of opioid analgesic-related addiction, overdose, and death. Opioid prescriptions quadrupled between 1999 and 2013 with overdose deaths increasing in parallel.1,2 In response, states have implemented Prescription Drug Monitoring Programs (PDMPs) to track prescriptions of controlled substances. PDMPs are statewide electronic databases that collect data from pharmacies regarding dispensed controlled substances. While they were first designed for use by law enforcement and regulatory agencies, PDMPs have been identified as a critical tool in identifying patients at risk for opioid overdose, abuse or diversion. As such, all state PDMPs now allow authorized health care providers to access this database to evaluate a patient’s controlled substance prescription history. There is evidence to suggest that PDMPs are a useful tool in reducing opioid-related addiction, diversion, and overdose.3,4 The role of state PDMPs in addressing this epidemic has been highlighted in recent publications,5–7 including the White House Office of National Drug Control Policy’s Prescription Drug Abuse Prevention Plan.

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Opioid Facts

Opioid: Any chemical substance that resembles opiates 

  • Bind to opioid receptors in the central and peripheral nervous system and the gastrointestinal tract
  • Decrease the perception of pain leading to increased pain tolerance and decreased pain reaction
  • Side effects include drowsiness, sedation, constipation, euphoria, and respiratory depression


Opiate: Naturally occurring alkaloids found in Papaver somniferum (opium poppy) 

  • Belong to biosynthetic group benzylisquinoline alkaloids
  • Major opiates are morphine, codeine, and heroin
  • Used medically for sleep induction or pain control 


Naloxone: Opioid/opiate antagonist

  • Trade name is Narcan
  • Used as antidote for opioid overdose
  • Competitively bind to opioid receptors
  • Side effects include agitation, nausea, vomiting, and tachycardia
  • Onset of action is approximately 1 minute with duration of action 45 mins
  • Can administer IM/SC at dose of 0.01 mg/kg not to exceed 10 mg
  • Can be administered intranasally by basic EMS personnel

Naloxone. Medscape Drugs and Diseases. 
Prada, Adrian. Opioid Abuse. Medscape. Dec. 1, 2014

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Opioid Overdose Prevention and Response

Elizabeth Samuels

Since 1990, unintentional drug overdose deaths have more than tripled nationwide1,2 and since 2004, drug related emergency department (ED) visits increased by over 80%. Half of the 5.1 million drug related ED visits in 2011 were associated with drug misuse or abuse, evenly distributed between nonmedical pharmaceutical and illicit drug use.3 Prescription opioid overdose now results in more overdose deaths than heroin, cocaine, and psychostimulants combined, but heroin use is increasing.1,2 One in fifteen people who use prescription opioids will try heroin in their lifetime and more people with histories of opioid prescription misuse or abuse are starting to try heroin (5% in 2004 vs 13% in 2010).4

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The CDC Releases Report on the Need to Expand Naloxone Distribution


At the end of April, the Centers for Disease Control released a statement pushing for increased naloxone administration by EMS personnel in an effort to reduce deaths due to opioids. Currently all 50 states allow advanced EMS staff to administer naloxone but only 12 states allow basic EMS staff to administer naloxone. 

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Make a Difference: Write that Council Resolution!

Many College members introduce new ideas and current issues to ACEP through Council resolutions. This may sound daunting to our newer members, but the good news is that only takes two ACEP members to submit a resolution for Council consideration. In just a few months the ACEP Council will meet and consider numerous resolutions.

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