The term 'drug overdose' is thrown around a lot, but new findings suggest that patients at risk for "overdose" may not like that term.
Dr. Phillip Coffin, Director of Substance Use Research at the San Francisco Department of Public Health, runs clinical trials and implementation science related to substance use. In response to high rates of drug overdose deaths from opiates, in 2003 San Francisco began distributing naloxone (an opioid antagonist that reverses the drugs' effects) to heroin users through syringe exchange programs and community outreach. Remarkably, heroin overdose death rates have plummeted to less than a dozen a year in a city with a population over 830,000. Like the rest of the country, however, San Francisco saw increased deaths related to prescription opiates.
Based on the success of giving naloxone to heroin users, providers in San Francisco decided to start prescribing the medication to patients receiving opiates for pain. Dr. Coffin oversees that program, encouraging medical providers to co-prescribe naloxone. The program has led to some interesting findings, particularly concerning the language we use when talking about drug overdose.
"The prescription opioid user population is different from the heroin user population," explains Dr. Coffin. "People who take prescribed medications often think that overdose only happens when people use illegal drugs or take 100 pain pills. They don't see themselves as at risk for drug overdose, even if they clearly are."
According to Dr. Coffin, the driving risk factors for an overdose are having had a prior overdose, genetic predispositions for respiratory depression, low tolerance for opioids due to periods of abstinence, and using other substances at the same time. All of these can occur even in people who are taking medications as prescribed.
"People may take their medicine after having a glass of wine, or they may be ill with pneumonia, or have sleep apnea, have just started a new medication, or they may have a genetic predisposition for respiratory depression when taking opioids," says Dr. Coffin. "All of these normal situations could put them at risk. As long as people associate the term 'drug overdose' with illicit substances or attempted suicide, they think that information on emergency medications like naloxone doesn't apply to them."
Because most people who are prescribed opioids do not see themselves as being at risk for overdose, they may decline naloxone even if it is offered by a medical provider. Additionally, explains Dr. Coffin, many people on pain medications are sensitive to losing access to those medications and may be reluctant to accept anything that might make them appear to be engaging in risky behavior with their pain pills.
Dr. Coffin recommends that instead of using the term 'drug overdose' when speaking to patients, physicians should talk about possible 'adverse effects.' For example, a physician could say, "We offer naloxone to all our patients on opioids to reverse the effects in case anything bad happens, like if you stopped breathing." Talking about not breathing as a possible side effect usually grabs patients' attention and will make them more open to information on naloxone.
"Opioids can be risky medications and patients should have something to mitigate those risks," says Dr. Coffin. "Just like we prescribe glucagon to anyone who has just started insulin, naloxone could be offered as standard protocol to anyone using opioids."
The lesson here is that language matters. And sometimes a simple change of phrase is all it takes to save lives.