Fentanyl Overdose: Hospital Treatment And Care

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. It is typically used to treat severe pain, such as acute traumatic pain and advanced cancer pain. When used appropriately, fentanyl is considered safe and preferred over similar pain medications. However, fentanyl-related deaths have surged in recent years, particularly among young people, due to the illegal use of the drug. When a person overdoses on fentanyl, it is crucial to call 911 immediately and administer naloxone if available. Hospitals play a vital role in treating fentanyl overdose by providing emergency medical services, detox, and follow-up care to prevent future overdoses and support recovery. This includes connecting patients to mental health services and substance use treatment programs.

Administer naloxone to reduce toxicity

Administering naloxone is a crucial step in reducing opioid toxicity in the event of a fentanyl overdose. Naloxone is a safe medication that can rapidly reverse an opioid overdose by blocking the effects of opioids in the body. It attaches to opioid receptors and works to counteract the impact of opioids, including fentanyl. It is important to act quickly as naloxone typically remains effective for only 30 to 90 minutes, while some opioids can stay in the system longer.

Naloxone is available in two FDA-approved formulations: injectable and nasal spray. The injectable form can be administered into the muscle, under the skin, or into a vein. It is typically delivered via a needle, with the proper dose drawn from a vial. Recently, the FDA approved ZimhiTM, a single-dose, prefilled syringe that simplifies the administration process. It can be injected into the muscle or under the skin.

The nasal spray formulation offers an alternative method of delivery, with prefilled devices designed to spray the medication into the nose. While there are improvised nasal spray kits that combine injectable naloxone with an attachment for nasal delivery, these are not FDA-approved and can be challenging to assemble during an emergency.

When administering naloxone, it is recommended to start with one dose and wait for approximately 2 to 3 minutes to observe its effectiveness. If breathing has not returned to normal, a second dose may be given. It is crucial to closely monitor the individual for at least 2 hours after the last dose of naloxone to ensure their breathing remains stable.

Naloxone is a life-saving medication that can be safely given to people of all ages, and it will not cause harm if administered to someone who is not experiencing an opioid overdose. It is always advisable to call 911 or seek immediate medical attention, even after administering naloxone, to ensure the individual receives further necessary care.

Intubate if the patient is in respiratory distress

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. It is often associated with fatal overdoses, especially when taken recreationally or in addition to other substances. When a person is suspected of overdosing on fentanyl, it is crucial to call 911 immediately. While waiting for emergency services to arrive, the CDC recommends keeping the person awake and breathing, turning them on their side to prevent choking, and administering naloxone if it is available. Naloxone is an opioid reversal agent that can help reduce morbidity and mortality in cases of opioid overdose.

Once the patient arrives at the hospital, they may require immediate medical attention, especially if they are experiencing respiratory distress. Respiratory depression is a life-threatening adverse effect of fentanyl overdose, leading to shallow breathing and potentially fatal outcomes. In such cases, healthcare providers must be prepared to intubate the patient. Intubation involves inserting a tube into the patient's trachea to establish and maintain an open airway. This procedure is typically performed by trained medical professionals in emergency situations when a patient cannot breathe on their own.

The decision to intubate a patient in respiratory distress due to a fentanyl overdose is a critical step in their treatment. Intubation ensures that the patient receives adequate oxygenation and ventilation, which are essential for stabilizing their condition. It allows medical professionals to secure the patient's airway, preventing further respiratory complications. Additionally, intubation can facilitate the administration of medications or interventions aimed at reversing the effects of fentanyl and supporting the patient's breathing.

The process of intubation requires careful monitoring and expertise. Healthcare providers must assess the patient's airway, ensuring that it is clear and unobstructed. They may use specialized equipment, such as a laryngoscope, to visualize the vocal cords and trachea, guiding the tube into the correct position. Once the tube is inserted, it is secured in place to maintain the patient's airway patency. Throughout the procedure, vital signs such as heart rate, blood pressure, and oxygen saturation levels are closely monitored to ensure the patient's stability.

While intubation is a crucial step in treating respiratory distress caused by a fentanyl overdose, it is just one aspect of the comprehensive care provided in hospitals. Patients may also receive supportive care, such as administering intravenous fluids, monitoring vital signs, and providing medications to counteract the effects of fentanyl. Additionally, mental health services and social support networks play a vital role in the patient's recovery, helping to prevent future overdoses and maintain substance use recovery. The goal of hospital treatment is not only to address the immediate physical needs but also to provide a continuum of care that supports the patient's overall well-being and long-term recovery.

Provide mental health services

Fentanyl is a powerful synthetic opioid that is extremely potent, even in small doses. It is primarily used to treat severe pain, especially after surgery, and is also used to treat patients with chronic pain who have developed a tolerance to other opioids. Fentanyl is highly addictive, and overdose rates have been rising, with many young people affected.

Fentanyl addiction is a mental health issue that requires treatment and support. Hospitals and emergency departments have a responsibility to provide effective care to patients with substance use disorders, including fentanyl addiction. This includes providing mental health services to address the underlying causes of addiction and to support long-term recovery.

Mental health services can include individual counselling and therapy, such as cognitive behavioural therapy (CBT), which helps patients modify their attitudes and behaviours related to drug use, increase healthy life skills, and adhere to medication regimens. Contingency management, which uses a voucher-based system to reward patients for negative drug tests, can also be effective. Additionally, motivational interviewing, a patient-centred counselling style that addresses a patient's mixed feelings about change, can be beneficial. These behavioural treatments have proven effective, especially when combined with medication.

In addition to individual counselling, family therapy can play a crucial role in recovery from substance use disorders. It can help family members understand the impact of addiction on their loved ones and provide them with tools to support their recovery.

To facilitate access to mental health services, hospitals can provide referrals to local treatment facilities, support groups, and community-based organisations. For example, the SAMHSA National Helpline (1-800-662-HELP) offers confidential, free referrals to treatment facilities and support groups for individuals and families facing mental health and substance use disorders.

Outreach, Screening, Assessment, and Referral (OSAR) providers also offer comprehensive services for fentanyl and other substance use disorders. Callers can speak with a trained counsellor who can assess their needs and refer them to in-person or telehealth treatment options.

By providing a range of mental health services, hospitals can help address the underlying causes of fentanyl addiction and support patients on their journey to recovery.

Treat underlying substance use disorder

Treating a fentanyl overdose patient for underlying substance use disorder involves a combination of pharmacological and non-pharmacological treatments.

Pharmacological treatments include medication-assisted treatments (MAT) such as opioid reversal agents like naloxone (Narcan), which can be administered to reduce morbidity and mortality. Naloxone can be administered as an extremely high-dose intravenous infusion for patients overdosing on potent fentanyl derivatives like 3-methylfentanyl. Repeat doses of 2 mg may be required every 3 to 4 minutes for a total of 10 mg. However, naloxone should not be administered if intubation is necessary. Clinicians must be prepared to intubate if the patient remains in respiratory distress.

Non-pharmacological treatments involve connecting the patient with mental health services in their community. A warm handoff approach can be used, where a nurse or first responder engages with the patient to build trust and connect them to mental health services. This relationship-building is crucial for developing a treatment plan to help the patient continue receiving care. Social support networks and culturally specific recovery supports are also essential for preventing opioid overdoses and maintaining substance use recovery. Mutual support groups, such as twelve-step programs, and peer recovery services that connect individuals with others who have experienced substance use and recovery can be beneficial.

Additionally, addressing housing instability is crucial in preventing substance use disorders. Developing sober housing, expanding in-patient treatment services, and improving access to housing can support individuals in maintaining their recovery from substance use following an overdose.

Ensure a smooth transition of care

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. It is typically used to treat severe pain, such as acute traumatic pain and advanced cancer pain. When administered appropriately, fentanyl is considered safe and preferred over similar pain medications. However, fentanyl-related deaths have surged in recent years, often due to illegally manufactured drugs or the addition of unknown quantities of fentanyl to other substances.

To ensure a smooth transition of care for individuals who have experienced a fentanyl overdose, it is crucial to address their physical, mental, and social needs. Here are some key aspects of ensuring a seamless transition:

• Detox and Medical Stabilization: After a fentanyl overdose, the individual may require medical detoxification to eliminate the drug from their system and stabilize their health. This process can be done in a hospital setting or a specialized detox facility. During detox, medical professionals will monitor the individual's vital signs, manage withdrawal symptoms, and provide any necessary medical interventions.
• Mental Health Support: Experiencing an overdose can be a traumatizing event. It is essential to provide access to mental health services, such as counselling, psychotherapy, or support groups, to help individuals process their experience and address any underlying mental health conditions that may have contributed to substance use.
• Substance Use Disorder Treatment: Fentanyl overdose often indicates a substance use disorder. Connecting individuals to appropriate treatment programs, such as medication-assisted treatment (MAT), can help them address their substance use and develop strategies for long-term recovery. These programs may include individual and group therapy, relapse prevention strategies, and support groups.
• Housing and Social Support: Stable housing is a significant factor in preventing future overdoses and maintaining recovery. Connecting individuals to housing resources, such as sober living homes or transitional housing, can provide a safe and supportive environment for their ongoing recovery. Additionally, encouraging engagement in mutual support groups, 12-step programs, or peer recovery services can offer ongoing social support and help prevent isolation.
• Follow-up Care and Monitoring: Regular follow-up appointments with healthcare providers or addiction specialists are crucial to monitor an individual's progress, adjust treatment plans, and address any emerging concerns. This ongoing care can help prevent relapse and support sustained recovery.
• Education and Harm Reduction: Providing individuals with accurate information about the risks of fentanyl, overdose prevention strategies, and harm reduction techniques can empower them to make informed choices and reduce the likelihood of future overdoses. This includes educating individuals about safe drug use practices, the dangers of mixing substances, and the availability of resources such as naloxone kits.

By addressing these key areas, healthcare providers can facilitate a smooth transition of care for individuals who have experienced a fentanyl overdose, improving their chances of successful recovery and reducing the risk of future overdose events.

Frequently asked questions