Overdose Prevention and Harm Reduction: Just like with any behavior that carries risk, the only way to completely prevent an overdose is by not consuming any opioids, but that is not always realistic. However, we can learn specific techniques to reduce the risk of overdose (see here). These techniques are overdose prevention strategies and fall under the broad heading of a harm reduction approach to drug use.
Information provided on this site is not intended to cover everything –there are many places to find helpful information about overdose prevention and harm reduction.
For information on opioid overdose prevention and education:
Medication Assisted Treatment (MAT) in combination with behavioral therapies to treat opioid use disorders helps reduce rates of illicit use and overdose by reestablishing normal brain functioning, reducing drug cravings, and preventing relapse (Kampman et al., 2015). MAT also lowers the risk of contracting infectious diseases (Tsui et al., 2014; Metzger et al., 1993). Research supports the perspective that opioid addiction is a chronic medical disorder that can be treated effectively with medications and supportive services such as psychosocial counseling, treatment for co-occurring disorders, motivational counseling, and vocational rehabilitation (SAMHSA, 2005).
*Information provided on this site is not intended to cover everything –there are many places to find helpful information about opioid use disorder treatment. To learn more, we suggest visiting the following sites:
For information on available drug treatment:
Visit the SAMHSA Treatment Locator or call the National Helpline 1-800-662-HELP or 1-800-487-4889 (TDD-for hearing impaired)
Providing overdose education and naloxone distribution (OEND) in various settings (i.e., emergency departments, primary care, prisons/jail, treatment facilities, community centers, etc.) has been strongly recommended by the CDC , World Health Organization , and the American Society of Addiction Medicine based on empirical evidence. This page is not intended to cover everything, but is designed to connect you with some of the research literature and data related to opioid overdose mortality and morbidity, prevention and intervention initiatives, policy impact, and more.
For systematic reviews of Overdose Education and Naloxone Distribution Programs, Legal Research and literature on opioid overdose prevention, visit:
In an emergency, calling 911 is often the first reaction people have. In the instance where 911 is called in response to an opioid related overdose, it is critical that emergency responders be trained and equipped to administer naloxone. Simply put, when emergency responders have naloxone on hand, they are able to save lives.
What is naloxone?
Naloxone is a medication that quickly reverses the effects of an opioid overdose, usually within 1-3 minutes. It can be injected under the skin or into muscle or a vein. A nasal spray version of naloxone is also available. Naloxone does not have harmful side effects, get people “high,” or reverse overdoses caused by substances other than opioids.
Naloxone has been in use in the medical field for decades, but as of August 2014 it is available to all emergency responders in Missouri.
What to do when you report to the scene of an overdose: (For complete information about respond at the scene of an overdose and administer naloxone, request a MO-HOPE Emergency Responder training *here*)
Assess the individual – look for signs and symptoms of an opioid/heroin overdose
Once you have identified that you are responding to an opioid/heroin overdose, begin rescue response (while waiting for EMS to arrive):
1. Administer 1 dose of naloxone
2. Administer rescue breathing (if pulse); Administer chest compressions (if no pulse)
3. Place person in recovery position if you stop administering rescue breaths or leave the person’s side
4. Give 2nd dose of naloxone if after 2-3 minutes the first dose was not successful* Prepare: In some cases, naloxone can precipitate withdrawals among those with physical dependence.
What to do after an overdose:
Remember to avoid guilt, stigma, and shame – this is not a moral issue or right vs wrong
Lean toward offering support, empathy, and resources for treatment rather than punishment
Encourage the person to seek medical treatment and care coordination at a hospital, but know they have the right to refuse this
SB 501 (effective August, 2017) also requires police officers who respond to a drug or alcohol overdose to provide appropriate treatment-related resources. MO-HOPE has created 2 versions of printable resource cards meeting these requirements:
Resources *Information provided on this site is not intended to cover everything–there are many places to find helpful information about naloxone and overdose prevention programs. To learn more, we suggest the following sites:
Missouri Law Enforcement and Public Safety Officers
Law Enforcement and Public Safety departments across Missouri received an email from the Missouri Department of Public Safety regarding the MO-HOPE opioid overdose reporting system (field reports). Many of the departments have expressed similar questions and concerns, which are addressed below:
Is the overdose reporting system mandatory?
Although field reports are not yet mandatory, their use has been requested by the Missouri Department of Public Safety. Tracking these incidents will inform state-wide prevention and intervention efforts and allow us to most effectively support our law enforcement and first responders. As such, each police department will have different protocols regarding filling out the MO-HOPE field report.
Why did the email state that these reports must be submitted within 12 hours of the overdose event?
We strongly recommend entering the field report as soon as possible to avoid forgetting and to ensure accurate information regarding the overdose event. Within 12 hours is ideal, but we understand that that may not always be possible/plausible to do so, therefore personnel can still fill out the field report after 12 hours has passed.
What is being done with the data collected through the field reports?
The data collected through the MO-HOPE field report will help us better understand overdoses are occurring, naloxone administration patterns, and success rates of overdose reversal attempts.
The data will be utilized in a few ways. Primarily, the MO-HOPE project will use these numbers to ensure we are training and equipping those most likely to respond to opioid overdose events to the best of our abilities. Additionally, this information will be used to help develop future programs and obtain funding for grants. Aggregated information is available to the public on our website (under ‘Results’) to help other programs and departments gain insight to how opioid overdoses have impacted communities across Missouri, and to use that information to implement or strengthen efforts to combat the opioid crisis.
Is the field report confidential?
The field reports are submitted through REDCap, which is a secure database that is only accessible to the MO-HOPE evaluation team. No personal information is collected and all reports will remain confidential.
The primary goal of the MO-HOPE Project is to create system level changes that will result in fewer opioid overdose deaths. A key component of that effort is to offer those who are at highest risk of experiencing or encountering an opioid overdose with the tools and knowledge to act.
MO-HOPE currently offers overdose education and response trainings for emergency responders and substance use treatment providers. Over the coming months, trainings will expand to other professional groups and the general public. A brief description of the emergency responder and substance use treatment provider trainings are provided below:
Overdose Response and Naloxone Training Program for Emergency Responders:
Opioid Overdose Background: Learn about substance use disorder and opioid overdose causes and trends
Opioid Overdose Recognition and Response: Learn how to correctly identify and respond to an overdose event, including how to properly administer naloxone
Managing Overdose Situations: Learn how to effectively and compassionately work with individuals who have just experienced or witnessed an overdose
MO-HOPE Evaluation: Learn how to participate in MO-HOPE evaluation protocols, including the completion of “Overdose Field Reports” when naloxone is used to reverse an overdose
*A supply of naloxone (AdaptPharma Narcan nasal spray) will be given to participating agencies for use in the field.
Overdose Education and Naloxone Distribution (OEND) Training for Substance Use Treatment Providers:
Opioid Overdose Background: Learn about opioid overdose causes and trends, including existing efforts to combat the opioid crisis and legislative protections for naloxone use and dispensing
Opioid Overdose Prevention, Recognition, and Response: Learn how to correctly identify and respond to an overdose event, including how to administer naloxone
OEND programming: Learn about the empirical basis for OEND programming and how to conduct OEND with your clients/patients at risk of experiencing or witnessing an overdose
*A supply of naloxone (AdaptPharma Narcan nasal spray) will be available for participating agencies and organizations if eligible. For more information on eligibility (e.g., non-profit status, presence of a facility standing order), please complete the “Request a Training” form and a MO-HOPE staff member will contact you.
Statute Section 190.255.1, HB 2040, enacted August 28th, 2014. Relevant topics covered by this bill:
– Distribution to first responders
– First Responder administration immunity
House Bill No. 1568. Enacted August 28, 2016. Relevant topics covered by this bill:
– Pharmacy availability (without a prescription)
– Pharmacist criminal and civil immunity
– Criminal and civil immunity for any person administering naloxone “in good faith”
– Immunity from disciplinary action from licensing boards
– Right to store/dispense for free if acting under a standing order from a health care professional
St. Louis City – Board Bill 40
– A 911 Good Samaritan Law passed in the city of St.Louis providing limited immunity to those who call 911 for someone experiencing an overdose. * A statewide Good Samaritan law has not yet passed.
Missouri does not currently have a statewide Prescription Drug Monitoring Program (PDMP), though a municipality-level PDMP was created by St. Louis County Department of Public Health. – Since March, 2016, six jurisdictions ( Louis City, St. Charles County, Ste. Genevieve County, Jackson County, Kansas City, City of Independence) have adopted legislation to join County’s PDMP. Numerous other jurisdictions across Missouri are currently pursuing or considering legislation as well.
* For more information, visit: http://www.stlouisco.com/HealthandWellness/PDMP
Incorporating overdose education and naloxone distribution (OEND) into clinical practice has been strongly recommended by the CDC , World Health Organization , and the American Society of Addiction Medicine. This page is designed to provide treatment providers with brief pieces of information and available resources to help them establish OEND within substance use, mental health, and medical settings.
After an overdose, use the first meeting as an opportunity to:
– Start the OEND conversation about use patterns and fluctuations in risk
– Acknowledge the patient’s struggle with substance use
– Discuss a harm reduction approach to drug use and recovery
– Highlight naloxone as a way to keep the patient alive to pursue treatment
– Emphasize this as standard practice; not a personal judgement * Educate families & friends when possible – remember, if people are unresponsive due to an overdose, they will not be able to administer naloxone to themselves!
What to include in the OEND conversation: (For complete information about how to conduct OEND with patients, request a MO-HOPE provider training *here*)
Talk with the person about what makes them at risk of experiencing an overdose- both in general and on any given day
Explain what an overdose looks like and provide specific signs/”what to look for” (e.g, unresponsiveness, shallow breathing)
Discuss reversal myths (e.g., injecting cocaine, placing in a bath of ice)
Emphasize that the only method to reverse an opioid overdose that has proven to be safe and effective is to administer naloxone.
Outline a specific rescue response:
1. Administer 1 dose of naloxone
2. Call 911 (review 911 Good Samaritan laws)
3. Administer rescue breaths
4. Place person in recovery position if you stop administering rescue breaths or leave the person’s side
5. Give 2nddose of naloxone after 2-3 minutes if 1st dose is not successful
6. Stay with the person until medical help arrives ( Naloxone has an effective time of 30 minutes to an hour, and after that time elapses, the individual can go back into an overdose state.)
Explain how naloxone can be obtained
Discuss keeping naloxone readily available and how to store it appropriately
Prevention StrategiesUse the harm reduction approach to discuss overdose prevention
Use phrases like “If you choose to use…” followed by prevention strategies
– For example: If you choose to use, always have naloxone nearby (and someone who knows how to use it)
Resources *Information provided on this site is not intended to cover everything. There are many places to find helpful information about naloxone and overdose prevention programs.
For additional information on opioid overdose prevention and education:
Access StopOverdose for additional information specific to treatment providers including talking about overdose, overdose prevention, naloxone, and treatment
Review the Opioid Overdose Basics including recognizing an opioid overdose, responding to an opioid overdose, and risks and prevention strategies
Access patient education and training materials here
Access the Healthcare Professional Toolbox for additional information on understanding overdose and addition, professional development, and patient education resources
For Buprenorphine Waiver- Medication-Assisted Treatment Trainings offered throughout the state of Missouri, visit here.
For clinical support (provided by the American Academy of Addiction Psychiatry in collaboration with others with support from SAMHSA) and training related to opioid use disorder, visit the Provider’s Clinical Support System
For free Continuing Medical Education courses funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), visit here