Uncovering all the factors that could lead to opioid-induced respiratory depression is difficult which is why anyone using opioids may be at risk of having an accidental opioid poisoning.1 There are several factors that can increase a person’s risk for an accidental opioid poisoning, even with proper prescription use, including:
- Accidently taking too much2,3
Issues such as forgetfulness, drowsiness, dementia, or other cognition problems can lead to patients accidentally taking too much of their prescription opioid.
- Mixing opioids with alcohol2
Some patients may simply forget that they can’t mix their prescribed opioids with alcohol or other medications such as sedatives, putting them at risk for an accidental opioid poisoning.
- Having other health issues2
Health issues such as hepatic, renal or lung disease may increase a person’s likelihood of experiencing an accidental opioid poisoning.
- Splitting extended-release tablets2,4
Patients may consider ways to make their prescription last longer, including breaking their pills in half. This can be especially dangerous when splitting extended-release tablets.
- Improper storage5,7
A study conducted in 2017 showed that only 11% of Canadian households with potentially harmful drugs keep them in a safe place. This can put young children at risk for unintentional opioid poisonings. Teens are also at risk, as opioids are the most recreationally used prescription drug by this age group. In Ontario, over 1 in 10 high school students (Grades 7-12) used an opioid recreationally at least once between 2018-2019. About half of these teens said they got them from their home.
- Loss of tolerance8,9
Some patients may not be aware that their opioid tolerance can decrease in as little as 2-3 days after stopping their treatment. For example, if a patient suddenly feels better, they may choose to interrupt their treatment for a few days, then start it again when the pain returns. However, stopping their therapy for only a few days may increase their chances of experiencing an overdose once they resume their opioid treatment.
While prescription opioids offer benefits, they also come with some risks.10 Counselling patients on the factors discussed above can help mitigate many of the risks associated with prescription opioids. However, uncovering all the factors that could lead to an accidental opioid poisoning can be difficult.1 As an added safety precaution, provide a take-home naloxone kit–available as either a nasal spray, like NARCAN® Nasal Spray, or an injection–to all patients receiving an opioid prescription.1,8
References: 1. Tsuyuki R et al. Canadian national consensus guidelines for naloxone prescribing by pharmacists. Canadian Pharmacists Journal. 2020;153(6):347-351. 2. Government of Canada. Opioid overdose. Available at: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/overdose.html(Open in a new window). Accessed July 27, 2021. 3. American Addiction Centers. Opioid epidemic coming for the elderly. Available at: https://drugabuse.com/opioids/prescription/elderly-opioid-epidemic/(Open in a new window). Accessed July 27, 2021. 4. Canadian Agency for Drugs and Technologies in Health. Pill splitting: a review of clinical effectiveness, cost-effectiveness, and guidelines. Available at: https://cadth.ca/sites/default/files/pdf/htis/june-2015/RC0663%20Pill%20Splitting%20Final.pdf(Open in a new window). Accessed July 27, 2021. 5. Drug Free Kids Canada. Help your teens before they help themselves. Available at: https://www.drugfreekidscanada.org/prevention/drug-info/prescription-drugs/(Open in a new window). Accessed July 27, 2021. 6. Finkelstein Y et al. Overdose risk in young children of women prescribed opioids. Pediatrics. 2017;139(3): e20162887. 7. Ontario Student Drug Use and Health Survey. Drug use among Ontario Students. Available at: https://www.camh.ca/-/media/files/pdf---osduhs/drugusereport_2019osduhs-pdf.pdf(Open in a new window). Accessed July 27, 2021. 8. Ontario Pharmacists Association. Pharmacist clinical tool for initiating naloxone discussions. Available at: https://opatoday.com/wp-content/uploads/Practice/Tools/Naloxone/Pharmacist-Clinical-Tool-for-Initiating-Naloxone-Discussions.pdf(Open in a new window). Accessed July 27, 2021. 9. Government of Canada. About Opioids. Available at: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/about.html(Open in a new window). Accessed July 27, 2021. 10. Government of Canada. Canada’s Opioid Crisis. Available at: https://www.canada.ca/content/dam/hc-sc/documents/services/publications/healthy-living/canada-opioid-crisis.pdf(Open in a new window). Accessed July 27, 2021.