The recent overdose epidemic has brought the issue of substance use front and center as a mainstream problem. That means now is the time to harness our collective efforts to devise mainstream solutions. As we celebrate International Overdose Awareness Day, it’s essential that we recognize the hidden impacts of this tragic trend and implement programs that save lives and help reduce the burden on families, first responders and communities.
Where substance use disorder (SUD) and overdose were once largely considered to be problems that only affected those living on the fringe of society, we now recognize they affect all walks of life and people of every socioeconomic class, race, gender and lifestyle. With over 106,000 overdose deaths in 2021 alone (the most recent year for which data is available)—not to mention the untold number of overdose survivors—odds are that almost everyone has been directly affected by this tragic trend.
If loss of life isn’t heartbreaking enough, unless you’ve been directly impacted by an overdose, few realize that every overdose has far greater implications beyond the acute situation. The impact doesn’t end when naloxone is administered, a person is taken to the hospital for treatment, or to the morgue. In fact, every incident has a ripple effect on the individual, their family, first responders and the community at large.
Future Health Implications
Overdose deaths get most of the attention, but surviving one is not a clean slate. Roughly a million nonfatal overdoses are treated in emergency departments each year, and the ill effects can cause irreversible brain damage, long-term impairment of motor skills, coordination and memory, and lifelong muscle spasms or a staggering gait. Even nonfatal doses can have a severe impact on internal organs, causing damage to heart valves, pulmonary edema, irreversible kidney damage and hypertension. If a person collapses in a slumped-over position, it could cut off circulation to the lower extremities, potentially requiring amputation.
In fact, one JAMA study showed that the most common causes of death during the first year following a nonfatal opioid overdose were substance use-associated disease like HIV, chronic respiratory diseases and viral hepatitis, along with circulatory disease and cancer. Increased rates of depression, impulsivity and suicidal ideation are also common with the highest rates of suicide among females.
Addiction is a Family Disease
SUD affects far more people than just the afflicted individual; it can destroy the entire family. Similarly, those who are close to someone who overdoses can feel immense loss, guilt and anger that their loved one didn’t receive or accept help in time to prevent the incident.
Loved ones may also feel shame due to the stigma of SUD, and they may not get the same level of sympathy or support as those who lose loved ones to any other kind of tragic accident or natural cause. This combination of emotions can cause family members to withdraw or internalize their emotions, further complicating their grief and creating fertile ground for mental health issues—and even their own SUD—to take root.
The Toll on Frontline Responders
Some of the most “invisible” victims of the overdose epidemic are the paramedics, public safety and medical professionals who are charged with first response in overdose events. As if these individuals didn’t already suffer PTSD from the ordinary emergencies they treat every day, seeing an overwhelming number of overdose incidents day after day takes a tremendous emotional toll, creating feelings of burnout, exhaustion and helplessness.
Many are also frustrated with barriers to treatment that perpetuate the overdose cycle, which often leaves them treating the same individual multiple times—sometimes within the same 24 hour period. Considering the burden these individuals carry, it’s no wonder many suffer from compassion fatigue, which can put lives at risk.
The cumulative effect of these impacts can be severely detrimental for communities. The added demand on healthcare facilities strains an already overwhelmed system, and the frequency of overdose events makes it difficult for first responders to attend to other emergencies in a timely manner. Not to mention the stress forces many providers to leave their jobs and is a deterrent for new people entering those fields. The economic impact of the lives lost, loss of workforce due to addiction, lost productivity due to the emotional strain on loved ones is hard to quantify but is undeniable.
That’s why none of us have the luxury of considering addiction and overdose to be someone else’s problem. We all bear the burden and therefore all have a role to play in the solution.
Steps for Making a Positive Impact
First, raising awareness is essential. Days like International Overdose Awareness Day send a strong message to those who are struggling with addiction and those left behind that help is available. It’s important that we remember those we’ve lost without the stigma and instead focus on the disease, treatment options and hope, just as we would for cancer or any other chronic illness.
It’s also an opportunity to remind people what to do in the event of an overdose: always call 911 first, administer naloxone if available, administer rescue breaths if needed, and stay until help arrives. These simple steps could save a life.
We must also prioritize education about the dangers of hidden substances, such as fentanyl. It, along with fentanyl analogs and other adulterants, can be mixed with other substances without the user’s knowledge, putting them at much greater risk of overdose. Being aware of that risk can encourage those with SUD to be more mindful and cautious.
Harm reduction strategies like making naloxone readily available, needle exchange programs and supervised consumption sites can help, but we also must make SUD treatment more accessible and include referrals to treatment as part of every OD-first response encounter. Evidence-based treatment can reduce SUD, health harms and overdose deaths, and the longevity and quality of treatment directly relates to lower mortality rates. We should also prioritize medication-assisted treatment to help individuals achieve and maintain sobriety.
For first responders, professional counseling, and having informal conversations with colleagues and friends about the stress of the job can help reduce the impact of PTSD from frequent overdose response. Organizations should also implement role switching to minimize time in the field, reduce burnout and give responders a mental and emotional break from the trauma.
Finally, we must find ways to make community mental health resources more readily available through walk-in clinics and telehealth, and to expand the number providers, especially in areas most impacted by the overdose epidemic. Not only is SUD itself often driven by underlying mental health issues, but the impact of SUD and overdoses on families and communities is creating a secondary mental health crisis that must be addressed before it turns deadly.
Dr. Lawrence Weinstein is Chief Medical Officer at American Addiction Centers. In addition to nearly 20 years of experience in managed behavior healthcare and senior leadership, he has also been in private practice, providing individual and group diagnostic psychotherapeutic services, family therapy and addiction psychiatry.