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The challenges of surviving an overdose: Opinion

A recent article published in Psychology Today and authored by Dr. Mark S. Gold discusses the challenges, both acute and long-term, faced by individuals who have survived an overdose. In addition, the article discusses some addiction treatments that have been demonstrated to be effective, including medication-assisted treatment (MAT), as well as some of the most common reasons for refusing treatment or MAT.

For acute effects of drug overdose, neurological damage can be quite common, but is seldom medically evaluated the same way as traumatic brain injury or stroke. “For example, opioid overdose with loss of consciousness and depressed respiration can mean severe oxygen deprivation (hypoxia). This can result in cognitive impairments, memory problems, or permanent brain injury-related disability,” wrote Dr. Gold. Other negative health consequences of overdose include respiratory dysfunction, as well as cardiovascular damage and disease. In addition, overdoses of certain drugs can also result in kidney and liver failure.

Common long-term effects of overdose include injuries such as fractures, which can lead to disability and chronic pain. In addition, many people who survived overdoses also suffer from chronic health issues including depression and post-traumatic stress disorder (PTSD). Furthermore, heavy drug use and overdoses have a significant negative impact on brain and nervous system function, often leading to cognitive impairments and decline.

In addition, experiencing an overdose is also linked to the risk of having more overdoses. “One study showed that five years later, up to 40% of individuals who overdosed experienced one or more overdoses. Each subsequent overdose has a higher likelihood of being fatal. Individuals who began medication-assisted treatment with buprenorphine, methadone, or naltrexone have significantly better outcomes,” said Dr. Gold. “However, only 20-50% of the patients continue MAT treatment. Relapses are common without continuous support and treatment, especially the first year after an overdose.”

In terms of treatments, Dr. Gold highlighted methadone maintenance, as well as using long-acting injectable forms of MAT, such as buprenorphine (Sublocade, Brixadi), some of which can be administered on a monthly basis. Monthly injections of such medications (as opposed to daily administrations) simplify treatments and also decrease withdrawal symptoms and cravings, improving individuals’ adherence to treatment programs. However, in the U.S., MAT cost can be prohibitively expensive, totaling $1,600-$2,000 per monthly dose. Moreover, insurance reimbursement can be another important hurdle faced by patients seeking MAT treatment.

“Surviving an overdose is a critical time for intervention, whether the patient is 18 or 70. It is an emergency and teachable moment ideal for an organized intervention, education, and treatment initiation ASAP. I recommend giving patients and their loved ones take-home naloxone or nalmefene to prevent future opioid overdose fatalities and also to start the patient on MAT treatment,” concluded Dr. Gold.