Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid dependence. It is used to treat chronic pain, and it is also used to treat addiction to heroin or other opioids. Prescribed for daily use, the medicine relieves cravings and removes withdrawal symptoms. Detoxification using methadone can be accomplished in less than a month, or it may be done gradually over as long as for the rest of the patient’s life. While a single dose has a rapid effect, maximum effect can take up to five days of use. After long-term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.
Naloxone, sold under the brand name Narcan among others, is a medication used to reverse or reduce the effects of opioids. It is used to counter decreased breathing in opioid overdose. Effects begin within two minutes when given intravenously, and within five minutes when injected into a muscle. The medicine can also be administered by spraying it into a person's nose. Naloxone blocks the effects of opioids for 30 to 90 minutes. Multiple doses may be required, as the duration of action of some opioids is greater than that of naloxone. Emergency medical services data from Massachusetts found that 93.5% of people given naloxone survived their overdose.
A pharmacist, also known as a chemist or a druggist, is a healthcare professional who dispenses medications and who provides advice on their effective use, with the aim of preventing disease and promoting public health. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.
A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. Opioids can cause death and have been used for executions in the United States.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of OUD.
Sufentanil, sold under the brand names Dsuvia and Sufenta, is a synthetic opioid analgesic drug approximately 5 to 10 times as potent as its parent drug, fentanyl, and 500 times as potent as morphine. Structurally, sufentanil differs from fentanyl through the addition of a methoxymethyl group on the piperidine ring, and the replacement of the phenyl ring by thiophene. Sufentanil first was synthesized at Janssen Pharmaceutica in 1974.
A methadone clinic, or substance use disorder services clinic (SUDS), is a clinic which has been established for the dispensing of medications used in the treatment of opiate dependence —historically and most commonly methadone, although buprenorphine is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence. Methadone is a schedule II (USA) opioid analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the opioid withdrawal symptoms that patients experience from taking short-acting opioids, like heroin, and allow time for detoxification. In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through an opioid treatment program certified by the Substance Abuse and Mental Health Services Administration and registered with the Drug Enforcement Administration.
An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils, and unconsciousness, however its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.
A coma cocktail is a combination of substances administered in an emergency to comatose individuals when the cause of the coma has not yet been determined. The intention is to work against various causes of a coma seen in an emergency setting including drug overdoses and hypoglycemia. The coma cocktail is sometimes colloquially referred to as a “party pack” by professionals in the pre-hospital emergency medical services field.
In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, depending on state requirements, other potentially abusable prescription drugs. PMPs are meant to help prevent adverse drug-related events such as opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing, and by identifying those patients who are obtaining prescriptions from multiple providers or those physicians overprescribing opioids.
The history of pharmacy in the United States is the story of a melting pot of new pharmaceutical ideas and innovations drawn from advancements that Europeans shared, Native American medicine and newly discovered medicinal plants in the New World. American pharmacy grew from this fertile mixture, and has impacted U.S. history, and the global course of pharmacy.
In the United States, the opioid epidemic is an extensive ongoing overuse of opioid medications, both from medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The great majority of Americans who use prescription opioids do not believe that they are misusing them.
The New Jersey “Opioid Antidote Prescription” bill is legislation sponsored in the New Jersey State Senate. The bill, numbered NJ S. 2323, requires a co-prescription of an opioid overdose agent, such as naloxone, with prescriptions for opioid medications for patients who have a high risk of overdosing and tightens restrictions on the dispensing of opioid medications in New Jersey.
The Illinois “Opioids-Covid-19-Naloxone” Resolution is legislation sponsored in the Illinois State Senate. The bill, numbered IL SR 1184, prompts the state of Illinois to examine the rise in opioid overdoses due to the COVID-19 pandemic. The bill also urges the state to improve and increase access to naloxone, an opioid overdose reversal drug.
The New York mandatory opioid antagonist prescription bill is legislation sponsored in the New York State Senate and Assembly. The Senate bill, numbered NY S. 5150-B, sponsored by state Senator Pete Harckham, will require prescribers to co-prescribe an opioid antagonist with the first opioid prescription of the year for certain high-risk patients to combat accidental overdoses.
The South Carolina opioid overdose prevention bill is legislation sponsored in the South Carolina state legislature. The bill, numbered SC H.B. 4711 and sponsored by state Representative Russell Fry, would require prescribers to offer a prescription for naloxone to patients at high risk of an opioid overdose.
The California naloxone requirement bill is legislation passed by the California legislature and signed into law in 2018. The bill, numbered AB 2760, and sponsored by state Assembly member Jim Wood, requires medical prescribers to offer a prescription for naloxone to certain populations at higher risk of overdosing from opiate drugs.
Over a period of six months, Colorado legislation HB 20–1065, the Colorado Harm Reduction Substance Use Disorders Law, passed through both houses of the state legislature with bipartisan sponsorship and was signed into law by Governor Jared Polis (D). The law provides support mechanisms and medications to individuals with substance abuse disorder. It also provides protection to pharmacists and ordinary Good Samaritans who are attempting to assist those with the potential of drug overdose and its subsequent consequences.
New Jersey's most recent revised policy was issued September 7, 2022 pursuant to P.L.2021, c.152 which authorized opioid antidotes to be dispensed without a prescription or fee. Its goal is to make opioid antidotes widely available, reducing mortality from overdose while decreasing morbidity in conjunction with sterile needle access, fentanyl test strips, and substance use treatment programs. A $67 million grant provided by the Department of Health and Human Services provides funding for naloxone as well as recovery services. This policy enables any person to distribute an opioid antidote to someone they deem at risk of an opioid overdose, alongside information regarding: opioid overdose prevention and recognition, the administration of naloxone, circumstances that warrant calling 911 for assistance with an opioid overdose, and contraindications of naloxone. Instructions on how to perform resuscitation and the appropriate care of an overdose victim after the administration of an opioid antidote should also be included. Community first aid squads, professional organizations, police departments, and emergency departments are required to "leave-behind" naloxone and information with every person who overdosed or is at risk of overdosing.
