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Mitigating Overdose Risk

Mitigating Overdose Risk

Overdose remains a leading cause of death for Americans aged 18-44.1 In 2024, there were approximately 80,391 drug overdose deaths in the U.S., down almost 27% from 2023.2 This follows a dramatic increase of overdose deaths over the last two decades.3

Over two-thirds (68%; n=54,743) of overdose deaths in 2024 involved opioids, of which 88% (n=48,422) were fentanyl and other synthetic opioids.2 Recently, opioid overdose deaths have involved another substance(s), often unbeknownst to the user. For example, illegally manufactured fentanyl may contain other drugs such as stimulants, xylazine, or benzodiazepines.4 As with overall overdoses, opioid overdose deaths increased 10-fold from 1999 to 20225, and the rate of overdose deaths involving synthetic opioids other than methadone increased by 289% from 2011 to 2021.3

Rapid access to medications for OUD and carrying naloxone is an overdose mitigation strategy.

The clinical care team understands the risk of overdose among patients with OUD and has been trained on how to identify signs of an overdose and respond accordingly. Patients and their families are provided with education and other support, including naloxone.

Educate patients and families about factors that increase the risk of overdose so they can be prepared to respond if an overdose occurs.

People with OUD are most at risk of overdose when they use opioids following periods of abstinence or significantly diminished use.6 During these times, their opioid tolerance is likely to decrease so use of previous quantity of opioids can be enough to trigger an overdose. This increased risk of overdose is more common in the following situations:

  • After leaving a controlled environment such as inpatient or residential stay or release from prison or jail;
  • After discontinuing a medication for OUD or trying to remain opioid-free without medication;
  • When using opioids, such as illicit fentanyl, where the opioid dose and the other substances included are unknown;
  • When taking opioids in combination with other respiratory depressants (e.g., alcohol, benzodiazepines);7 and
  • In individuals experiencing suicidal thoughts, ideation, or planning.

Actively encourage patients and families to obtain and carry naloxone. Prompt administration of naloxone can reverse an overdose and save lives.

Naloxone is available without a prescription in all 50 states and the District of Columbia. It can be obtained free-of-charge from some public spaces such as libraries, community health centers, and vending machines, and it is also available at many stores and online. Ideally, hand a naloxone kit to each patient with OUD.

Learn more about state naloxone laws in the Naloxone Access Summary of State Laws (PDF - 6.4 MB).

Train providers, staff, patients, and families on how to recognize an opioid overdose and respond by administering naloxone. Keep naloxone available in the office, and ideally, provide it to patients and their families. See Resources section for patient education materials.

Signs and symptoms of an overdose include:8

  • Small or constricted pupils;
  • Loss of consciousness or inability to awaken;
  • Shallow breathing or slow heart rate;
  • Choking or gurgling sounds;
  • Limpness; and
  • Pale, blue, or cold skin.

Make sure all staff know what to do in the event of an overdose. Ensure staff are trained in naloxone administration including rescue breathing and that naloxone kits are readily available onsite. Consider printing and laminating a tip card such as the following: Preventing an Opioid Overdose: Know the Signs. Save a Life. | Overdose Resource Exchange (ORE) | CDC. If someone appears to be experiencing an overdose, take the following steps:8

  1. Administer naloxone.
  2. Call 911 immediately to enlist the help of first responders.
  3. Aim to keep the affected person awake and breathing. Provide rescue breathing as needed.
  4. Place the person on their side to avoid choking.
  5. Stay with the person until emergency personnel arrive.

If one of your patients has an overdose, review their treatment plan to determine whether changes and additional services are needed. This may mean transitioning them to a higher level of care.

Individuals who have survived an overdose may continue to experience intense emotions such as shame, guilt, or anger. Encourage them to find a network of support through family, friends, and community-based organizations.7 As discussed in the section on Suicidality, it is also important to recognize that an overdose may have been intentional.

Consider regularly checking your state's Prescription Drug Monitoring Practice to see if a patient is obtaining prescription opioids from another prescriber, as it may indicate a return to use.7

  • Don't create barriers to access of naloxone.

Non-prescription ('Over-the-Counter') Naloxone Frequently Asked Questions

The following questions and answers provide details about purchasing and using Narcan 4mg naloxone hydrochloride nasal spray specifically, health plan coverage, training resources, other formulations of naloxone available, and federal grant funding aimed toward increasing access to naloxone in communities across the country.
Source
Substance Abuse and Mental Health Services Administration (SAMHSA)
Year

Opioid Overdose Prevention Toolkit

Equips healthcare providers, communities, and local governments with material to develop practices and policies to help prevent opioid-related overdoses and deaths. Addresses issues for healthcare providers, first responders, treatment providers, and those recovering from opioid overdose.

Format
Toolkit
Audience
Behavioral Health Providers
Communities
Medical Providers
Policymakers and Payers
Source
Substance Abuse and Mental Health Services Administration
Year
File Size
.42 MB

1. Lippold KM. Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid—Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015-2017. MMWR Morb Mortal Wkly Rep. 2019;68. doi:10.15585/mmwr.mm6843a3

2. CDC, National Center for Health Statistics. U.S. Overdose Deaths Decrease Almost 27% in 2024. May 9, 2025. Accessed May 29, 2025. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250514.htm

3. Garnett MF, Minino AM. Drug Overdose Deaths in the United States, 2003-2023. National Center for Health Statistics. doi:10.15620/cdc/170565

4. CDC. Polysubstance Overdose. Overdose Prevention. September 6, 2024. Accessed May 29, 2025. https://www.cdc.gov/overdose-prevention/about/polysubstance-overdose.html

5. CDC. Understanding the Opioid Overdose Epidemic. Overdose Prevention. November 1, 2024. Accessed February 26, 2025. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

6. Biondi BE, Vander Wyk B, Schlossberg EF, Shaw A, Springer SA. Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community. Addiction Science & Clinical Practice. 2022;17(1):15. doi:10.1186/s13722-022-00299-1

7. Substance Abuse and Mental Health Services Administration. SAMHSA Overdose Prevention and Response Toolkit. SAMHSA; 2024. Accessed May 2, 2025. https://library.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf

8. CDC. Preventing an Opioid Overdose: Know the Signs. Save a Life. Overdose Resource Exchange (ORE). 2024. Accessed April 28, 2025. https://www.cdc.gov/overdose-resources/files/preventing-an-opioid-overdose-tipcard-a.html