Overdose Prevention and Intervention Strategies

Prevention:

  • Reach out for help
  • Maintain social support (family & friends)
  • Be supportive (not judgmental) if someone has a problem.
  • Carry naloxone and be trained on how to use it.
  • Talk about substance use with medical terminology instead of stigmatizing language.
  • Understand pain. Talk to a health care provider about an individualized plan that is right for your pain.
  • Be safe. Only take medications as prescribed. Always store in a secure place. Dispose of unused medication properly (U.S. Department of Health and Human Services, 2018).

Interventions:

Naloxone

  • Use Naloxone to stop an opioid overdose
    • Naloxone is an antidote to opioid overdose. It is an opioid antagonist that is used to reverse the effects of opioids (U.S. Department of Health and Human Services, 2018).

Medication-Assisted Treatment

  • Consider Medication-Assisted Treatment
    • Medication-assisted treatment (MAT) includes medicines, counseling, and support from family and friends. MAT can help with stopping drug use, get through withdrawal, and cope with cravings (U.S. National Library of Medicine, 2018).

Counseling and Therapy

Utilize counseling and therapy services that meet the user’s needs

Various types of counseling such as individual, group, and family, can assist with creating goals, establishing social support, and developing coping skills. This can help with learning new strategies to deal with different situations as well as repair and improve relationships. Also, these consist of different therapies such as:

      • Cognitive-behavioral therapy (CBT) helps recognize and stops negative patterns of thinking and behavior. In turn, it can help manage stress and change thoughts that cause opioid misuse.
      • Motivational enhancement therapy helps build motivation to stick with a treatment plan.
      • Contingency management focuses on giving incentives for positive behaviors such as staying off the opioids (U.S. National Library of Medicine, 2018).
  • Pharmacotherapy
    • The “start low and go slow” dosing idea. In other words, start with low doses of medicine, and slowing increases as needed.
  • Relaxation therapy
    • Focuses on identifying and reducing tension within the mind and body through deep breathing, progressive muscle relaxation, or visualization.
  • Mindfulness-Based Therapy
    • Learning to be present and separate the experience of pain from negative thoughts and resultant emotional distress that serve to make the pain worse.
  • Operant Behavioral Therapy
    • Diminishes reinforcing responses to pain behaviors and increases the reinforcement of healthy behaviors.
  • Fear Avoidance
    • In vivo exposure techniques to assist individuals with physical activities to decrease the fears that are strongly associated with such activity.
  • Acceptance and Commitment Therapy
    • Develops awareness and nonjudgmental acceptance of all experiences, both negative and positive. Identifies directions toward life values. Motivates appropriate action toward goals that support values (Goodin, Bulls, & Herbert, 2019).

Cultural Approach to Prevention & Interventions

Cultural history, connection, social support, and inclusion decrease risks of an opioid overdose. To elaborate, ohana (love, inclusion, purpose), culture & tradition (identity, power, attachment), and community & land (stability, relationships, autonomy) will lead to healing, joy, bonding, and peace which is connected to connection. All these factors seem to decrease someone’s risk of addiction and drug overdose (Maxera, 2020).

A literature review of 4,518 articles with a range of sample sizes being 11 to 2,685 clients revealed that the use of cultural interventions showed benefits of all areas of wellness (spiritual, behavioral, mental, social, and emotional) by reducing or eliminating substance use problems in 74% of studies (Rowan, Poole, Shea, et al., 2014).

  • Join programs that engage in cultural activities to reduce or eliminate opioid use. One of Native Hawaiian programs is Papa Ola Lokahi which has different bases on each Hawaiian island and offers different programs for spiritual, mental, social, emotional, and physical healing (Papa Ola Lokahi, 2020). Also, several activities to engage in to increase protective factors against opioid use are:
    • Lomi Lomi: Holistic Healing
    • ʻAi pono: Healthy Eating
    • Moʻokūʻauhau: Genealogy/Self & Cultural Identity development
    • Kūkākūkā: “Talk Story”
    • Establish Connection to Culture
    • Ho’oponopono: Improve family relationships (Yurow & Daniels, 2019).

References:

Goodin, B. R., Bulls, H. W., & Herbert, M. S. (2019). A Biopsychosocial Perspective on the Assessment and Treatment of Chronic Pain in Older Adults. Effective Treatments for Pain in Older Patients. 131-151. https://dl.uswr.ac.ir/bitstream/Hannan/32416/1/9781493988259.pdf#page=136.

Maxera L. (2020, May 4). Overdose Prevention, Recognition and Response. Hawaiʻi Health & Harm Reduction Center.

Papa Ola Lokahi. (2020). Vision, Mission and Guiding Principles. http://www.papaolalokahi.org/about-papa-ola-lokahi/vision-mission-guiding-principles.html

Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., Hopkins, C., Hall, L., Mushquash, C., & Dell, C. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance abuse treatment, prevention, and policy, 9, 34. https://doi.org/10.1186/1747-597X-9-34

U.S. Department of Health and Human Services (HHS). (2018, September). Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. https://www.addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf.

U.S. National Library of Medicine. (2018, August 27). Opioid Misuse and Addiction Treatment. MedlinePlus. https://medlineplus.gov/opioidmisuseandaddictiontreatment.html.

Yurow, J. & Daniels, S. (2019, June 5). State Approaches to Culturally Competent Services. 2019 CSAT/CSAP ANNUAL MEETING. Hyatt Regency Metro Center Bethesda, MD. https://nasadad.org/wp-content/uploads/2019/06/Day-2-session-4-Culturally-Competent-Services.pdf.