In recognition of International Overdose Awareness Day, the Season 1 finale of ASAM Practice Pearls explores recent trends in overdoses. Drs. Stephen Taylor and Alexander Walley discuss the increase of fentanyl and other contaminants in the drug supply, the impact of racial and geographic disparities, and the importance of community-specific responses. They highlight the value of compassionate overdose care, data-driven interventions, and strategies to help individuals post-overdose. Together, they discuss the need to lower barriers to treatment and foster future leaders in addiction medicine.

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Host

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM’s President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. 

Expert

Alexander Y. Walley, MD, MSc, DFASAM 

Dr. Alexander Y. Walley is Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine, primary care physician and addiction specialist at Boston Medical Center focused on the medical complications of substance use, specifically HIV and overdose. He leads research studies on overdose prevention and the integration of addiction specialty care and general medical care. He is a founder of Boston Medical Center’s inpatient addiction consult service and walk-in substance use care bridge clinic. Dr. Walley was a founding director of the Grayken Addiction Medicine Fellowship and is the president of the American College of Academic Addiction Medicine. He serves as the medical director for the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services, the Overdose Prevention Program, and the SafeSpot Overdose Prevention Hotline. 

📖 Show Segments

• 00:05 – Introduction 
• 00:17 – Epidemiology and Geographical Areas of Concern 
• 07:15 – Racial, Geographic, and Socioeconomic Disparities
• 08:58 – Contaminants in the Drug Supply Affect Overdose Response
• 13:03 – Engaging Patients with Post-Overdose Care
• 18:18 – Approaching Conversations About Overdose Risk
• 23:42 – Tools for Overdose Prevention
• 26:19 – Policy, Protocols, and Treatment Innovationsr
• 30:41 – Training the Next Generation
• 33:23 – Final Thoughts on the Overdose Crisis
• 34:05 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Understand the Evolving Nature of the Opioid Epidemic: The overdose crisis has progressed through distinct waves, from prescription opioids, to heroin, to fentanyl, and now to increasingly complex combinations with stimulants and synthetic substances. 
• Address Racial, Ethnic, and Geographic Disparities: Marginalized populations and rural communities often face greater risk and reduced access to prevention, harm reduction, and treatment resources, requiring intentional, equity-focused interventions. 
• Respond to Emerging Drug Supply Contaminants: The presence of non-opioid substances like xylazine complicates overdose response, as naloxone may not reverse all effects, requiring expanded training and protocols for responders. 
• Promote Compassionate Overdose Response: In the event of an overdose, the priority is to restore breathing quickly and safely. Use only the amount of naloxone necessary and offer supportive, nonjudgmental care throughout the recovery process. 
• Encourage Practical Overdose Prevention Strategies: Most fatal overdoses occur when people use alone. Help patients develop practical safety plans, such as not using alone, developing safety plans, using drug checking tools, and maintaining access to naloxone to reduce overdose risk.  
• Leverage Real-Time Data for Community Action: Tools like OD Map and CDC dashboards provide real-time insights that can help inform timely, targeted community responses to emerging overdose patterns. 
• Lower Barriers to Evidence-Based Treatment: Expanding access to care through same-day treatment, low-barrier programs, and integrated support services, such as housing, education, and employment, helps improve outcomes and reduce overdose deaths. 
• Remove Barriers to Treatment and Support Systems: Expanding access to care, integrating social supports, and investing in workforce development, including training future addiction medicine leaders, are important for sustainable progress. 

🔗 Resources

• The ASAM Principles of Addiction Medicine (Seventh Edition): 
  • The Harm Reduction Approach to Caring for People Who Use Substances: Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529. 
• A Call for Compassionate Opioid Overdose Response: Russell E, Hawk M, Neale J, Bennett AS, Davis C, Hill LG, Winograd R, Kestner L, Lieberman A, Bell A, Santamour T, Murray S, Schneider KE, Walley AY, Jones TS.  Int J Drug Policy. 2024 Nov;133:104587. doi: 10.1016/j.drugpo.2024.104587. Epub 2024 Sep 18. PMID: 39299143.   
• Understanding and Addressing Widening Racial Inequalities in Drug Overdose: Friedman JR, Nguemeni Tiako MJ, Hansen H.  Am J Psychiatry. 2024 May 1;181(5):381-390. doi: 10.1176/appi.ajp.20230917. PMID: 38706336; PMCID: PMC11076008. 
• National Syndromic Surveillance Program (NSSP): Provides expertise and technical assistance to support public health professionals. 
• Safe Spot (1-800-972-0590): A toll-free, 24/7 confidential service that provides overdose safety planning and response to people using drugs alone. 
• State Unintentional Drug Overdose Reporting System (SUDORS): Provides detailed information on the characteristics and circumstances of overdose deaths to inform drug overdose prevention and response efforts. 

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