TITLE:
Commentary: New Complications Make Treatment of “Opioid” Overdose Challenging
AUTHORS:
John F. Peppin, Joseph V. Pergolizzi Jr., Albert Dahan, Robert B. Raffa
KEYWORDS:
Opioid Overdose, Fentanoid, Naloxone, Polysubstance Abuse, Respiratory Stimulant
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.11 No.12,
December
29,
2020
ABSTRACT: The “opioid
crisis” has had
a tremendous impact not only on its victims, but also on the practice of
medicine, pain patients, and society in general. Unfortunately, efforts to
“stem the tide” have not been successful at reducing overdose deaths.
Counterbalancing the many ardent efforts to eliminate overdose deaths (such as
the current widespread availability and use of opioid-receptor antagonists such
as naloxone) is influx of the illicit fentanoids (i.e., fentanyl and analogs). In addition to their high-potency, the
fentanoids differ in surprising ways from more “traditional” opioids such as
morphine and heroin. This uniqueness contributes to a reduced effectiveness of
opioid receptor antagonists in the treatment of opioid overdose. Further
greatly complicating overdose treatment is polysubstance abuse (e.g., an opioid
plus a benzodiazepine). The non-opioid in
the combination is not responsive to an opioid-recep- tor antagonist, which
imparts additional challenges. Thus, the new reality introduces complications that negatively impact efforts to reverse “opioid” overdose. New approaches to improve outcomes in individuals who
experience respiratory depression due to
fentanoid-induced or polysubstance-induced over- dose are needed. Approaches that harmonize with the
new reality, perhaps something like a non-opioid “agnostic” pharmacologic ventilatory stimulant, would provide a welcome addition to
the current choices.