• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » How to Talk to Patients About the Risk of Opioid Overdose

How to Talk to Patients About the Risk of Opioid Overdose

February 11, 2020
From The Carlat Addiction Treatment Report
Issue Links: Learning Objectives | Editorial Information

There were 47,600 deaths due to opioid-related overdoses in 2017. Put another way, in the time it’ll take you to read this issue of CATR, almost 5 Americans will die from an opioid overdose (www.cdc.gov/drugoverdose/data/statedeaths.html). One important way to reduce risk is by empowering patients with the knowledge, skills, and tools to prevent and manage overdoses. This article will focus on how to talk to patients to do just that.

Preventing overdose
When addressing overdose risk, begin by having your patients tell you about how they use opioids. Your curiosity will help build an alliance with the patient; it’ll also allow you to point out strategies to reduce harm. Be sure to mention specific factors that increase risk, such as concurrent benzodiazepine, gabapentinoid, or alcohol use; the possibility of fentanyl contamination; using alone; and changing dealers. Another high-risk situation is when people come out of incarceration, a hospital, or a residential program. If patients haven’t used any opioids for even a few days and then start taking them again, they’ll be at increased risk of overdose, especially if they go back to their previous amount, because they will have lost their former tolerance (this is called “tolerance shift”). See the table below for discussion points on reducing the risk of overdose. For additional information about how to discuss overdose risk with patients in various settings, see www.prescribetoprevent.org.
Table: Preventing an Opioid Overdose

Table: Preventing an Opioid Overdose

(Click to view full-size PDF.)

Next, talk to your patients about naloxone. In 2018, the US Surgeon General issued a recommendation that more people, including family, friends, and those at risk for opioid overdoses, keep naloxone (Narcan, Evzio) on hand. Ask your patients if they have naloxone at home, if the prescription has been renewed within the last year, if they know how to administer it, and if they’ve instructed others around them on how to use it. Many states have standing orders from medical directors that enable patients and family members to get prescriptions from a pharmacy without seeing a provider.

Assessing for overdose
Be sure to tell your patients to watch for the classic signs of an opioid overdose using language they’ll understand (eg, “cold, clammy hands and bluish lips” instead of “poor perfusion and hypoxia”). If a patient experiences these symptoms, emergent action is required. See “Patient-Centered Guide to Managing an Opioid Overdose” on page 3. (Ed note: A great resource, published by ­SAMHSA, from which this section was drawn, is the Opioid Overdose Toolkit. It’s available at www.store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA18-4742.)

Good Samaritan laws
Patients engaged in illicit drug use may not want to get involved in a crisis due to fears of legal repercussions, such as arrest, loss of public housing, or loss of benefits. This means many lay responders don’t call 911. As of July 2017, 40 states have passed Good Samaritan laws safeguarding individuals who report an overdose from certain criminal sanctions (Watson DP et al, Harm Reduct J 2018;15(1):18). However, these protections vary by state, and you should know your state’s laws; begin by consulting www.tinyurl.com/wjbojlg.

Good Samaritan laws can include protection from arrest, charge, and prosecution for both controlled substance and paraphernalia possession. For example, New York law protects the individual who is overdosing AND the person who calls 911 from any prosecution for drug possession of alcohol (up to 8 oz; for underage drinkers) or marijuana (any amount), paraphernalia offenses, and sharing of drugs. The law may also provide protection for other crimes, such as probation or parole violations.

These regulations work. Persons with knowledge of Good Samaritan protections or those who have previously used naloxone are more likely to call 911 at the scene of an overdose (­Watson, 2018). Furthermore, states with Good Samaritan laws have a lower incidence of ­opioid-overdose mortality than those without such laws (McClellan C et al, Addict Behav 2018;86:90–95).

CATR Verdict: An important, patient-centered strategy for turning the tide of opioid-related overdose deaths is to talk to your patients about the risks of using opioids and what to do in an emergency. Use language they can understand and encourage patients to train those around them (friends, family, and peers) in the use of lifesaving measures like naloxone.
Addiction Treatment
KEYWORDS hepatitis hiv opioid-epidemic overdose prevention
    www.thecarlatreport.com
    Issue Date: February 12, 2020
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Harm Reduction, CATR, January/February 2020
    New Hope: CBT for Internet and Computer Game Addiction
    How to Talk to Patients About the Risk of Opioid Overdose
    The Clinician’s Role: Reducing Harm Among People Who Use Drugs
    Harm Reduction Strategies—A Primer
    Highlights From This Issue
    Welcoming Our New Editor-in-Chief
    Featured Book
    • OUDFB1e_Cover_Binding.png

      Treating Opioid Use Disorder—A Fact Book (2024)

      All the tools you need to assess and treat patients struggling with opioid use disorder. 
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.