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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

On Overdose Awareness Day, Ninety People Could Die From Opioids

By Gary Evans, Medical Writer

The Centers for Disease Control and Prevention designates today — Aug. 31, 2017 — as “International Overdose Awareness Day.” When it's over, 90 people will likely have fatally overdosed. In treating them and trying to save their lives, first responders, safety officials, and even hospital workers are at risk of succumbing to the effects of powerful opioids.

Three Ohio hospital nurses recently had to be revived with an opioid antidote after collapsing after caring for a drugged patient, underscoring a new occupational threat to healthcare workers. The incident, which the healthcare workers survived, drives home the growing occupational risk of the national opioid epidemic. Though few details were being released, the life-threatening effect of the drug involved suggests exposure to carfentanil. It is estimated that carfentanil — a drug literally approved for tranquilizing elephants — is 100 times more potent than a similar synthetic opioid, fentanyl.

The opioid epidemic has hit the United States in three distinct waves, the CDC reports. Approximately 300,000 people — roughly the population of Pittsburgh — died of opioid overdoses from 1999 to 2015, when 33,000 died in one year alone. The estimated OD deaths in 1999 were 8,050.

“The first wave of deaths began in 1999 and included deaths involving prescription opioids,” the CDC states in an upcoming MMWR report. “It was followed by a second wave, beginning in 2010, and characterized by deaths involving heroin. A third wave started in 2013, with deaths involving synthetic opioids, particularly illicitly manufactured fentanyl (IMF).”

Drug products containing IMF now come in various guises, including counterfeit prescription pills, mixed with cocaine, or sold as powders to those seeking heroin with and without their knowledge that they are ingesting IMF, the CDC warns.

The National Institute of Drug Abuse estimates that 90 Americans die every day of an opioid overdose. How did we get here? Here is the institute’s explanation, posted on an NIH webpage :

“In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.”

To summarize the impact in one harrowing sentence, the drug institute estimates that 80% percent of people who use heroin in the United States first misused prescription opioids.

For more on the threat of the opioid epidemic to healthcare workers see the October 2017 issue of Hospital Employee Health.

Gary Evans has written about infectious diseases, occupational health, medical ethics, and a variety of other healthcare issues for more than 25 years. His writing has been honored with five awards for interpretative and analytical reporting by the National Press Club in Washington, DC.