1. Wilson, Christopher PT, DPT, DScPT

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Rehabilitation professionals are often consulted to assist with the management of patients who are experiencing acute or chronic pain, especially within the context of trauma or musculoskeletal dysfunctions. Many of these patients use opioid medications to assist with controlling pain in order to help them function in their daily lives. Although rehabilitation professionals do not prescribe or administer opioids, they are among frontline practitioners who are impacted by the opioid crisis.


Therapists' professional associations have addressed this public health crisis via policy and legislative advocacy efforts. In 2016, the American Physical Therapy Association's (APTA) House of Delegates officially joined the fight by endorsing campaigns of the White House and the Centers for Disease Control and Prevention to address the opioid crisis (APTA, 2016). This is reflected in the popular #ChoosePT campaign that has helped raise public awareness of the role of physical therapists (PTs) in nonopioid pain management. Concurrently, the American Occupational Therapy Association has actively advocated to the United States Congress to urge inclusion of occupational therapists in legislation to further address the myriad of issues related to opioid use, addiction, and abuse (Parsons, 2018). In February of 2019, the Surgeon General of the United States, Jerome Adams, MD, MPH, spoke to physical therapy leaders expressing his gratitude and appreciation for the collaborative efforts that the physical therapy profession has shown in helping to reduce opioid use in the United States (APTA, 2019). As the reported use and abuse of opioids continues to be a public health issue across the country, clearly more work is needed.


In June of 2019, the APTA endorsed PTs having naloxone available in the event that a PT or PT assistant encounters an individual in an opioid overdose crisis (APTA, 2019). Naloxone hydrochloride is most commonly administered via a nasal spray in an unconscious patient. It serves as an opioid receptor antagonist that works to almost instantaneously reverse the effects of systemic opioids including respiratory depression and central nervous system depression. According to the National Institute for Occupational Safety and Health (NIOSH), naloxone (also known as Narcan(R) or Evzio(R)) is very safe with no known adverse effects (NIOSH, 2018). If a patient is unconscious from another medical reason (i.e., myocardial infarction) and naloxone is administered, there are no harmful or negative effects from the naloxone (NIOSH). There is also an injectable form of naloxone that is generally less accessible to the general public as it requires puncturing the skin to administer and is often more expensive.


Based on the patient population that rehabilitation professionals care for, it is prudent clinical practice to prepare for an encounter with a patient or other individual in an opioid overdose emergency. The World Health Organization (2018) described key signs of the "opioid overdose triad" including pinpoint pupils, unconsciousness, and respiratory depression. Although there are no clear harms related to administering naloxone, administration in an opioid-dependent person may cause withdrawal symptoms that may require additional medical attention (NIOSH, 2018). In addition, "Naloxone will not reverse overdoses from other drugs, such as alcohol, benzodiazepines, cocaine, or amphetamines" (NIOSH). Finally, any opioid overdose situation, including those treated with naloxone, remains an emergency situation as the effects of naloxone may wear off in some cases and the victim will once again lose consciousness. Emergency services should always be called in the event of suspicion of any opioid overdose (NIOSH).


There has been some initial controversy related to therapists carrying or administering naloxone, as it is generally not historically within therapists' scope of practice to administer or prescribe medications. This emergency rescue medication is beginning to be perceived as an exception to this scope of practice issue due to its potential lifesaving action and minimal adverse risk profile. In addition, training in naloxone administration is being targeted toward nonhealthcare persons (i.e., police officers, municipal workers) as well as the general public (NIOSH, 2018). The administration of naloxone may also be permitted or restricted based on each therapist's individual jurisdictional practice act and Good Samaritan laws. It is recommended that therapists consult with their state licensing board or state professional association to determine their individual practice implications before choosing to carry or administer naloxone. Finally, although nasally administered naloxone is easy to use, training is recommended in the proper use and administration of naloxone. This training is often available at healthcare systems or public health departments at low or no cost.


Professional clinical practice for therapists has historically included training in first aid, cardiopulmonary resuscitation, and use of an automatic external defibrillator, among other emergency interventions. It may be beneficial to consider having naloxone available as an essential component of a therapist's emergency preparedness kit. Naloxone is often available without a prescription at some pharmacies, healthcare systems, or local community health departments. In addition, there are a growing number of healthcare institutions and rehabilitation clinics that are placing naloxone nasal spray in department emergency kits or with their automated external defibrillator.


For healthcare professionals wishing to learn more about the use and administration of naloxone, visit


For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life. BE PREPARED. GET NALOXONE. SAVE A LIFE (Office of the Surgeon General, 2018).




American Physical Therapy Association. (2016, June 7). APTA's House of Delegates endorses CDC and White House efforts to put a lid on opioid abuse. Retrieved from[Context Link]


American Physical Therapy Association. (2019, January 24). 'No Bigger Fan': US Surgeon General believes the physical therapy profession is a key player in the fight against opioid misuse. Retrieved from[Context Link]


American Physical Therapy Association. (2019, June 14). Vision in Action: 2019 House of Delegates sees important role for APTA in host of professional, societal issues. Retrieved from[Context Link]


National Institute for Occupational Safety and Health. (2018, October). Using naloxone to reverse opioid overdose in the workplace: Information for employers and workers. HHS (NIOSH) Publication No. 2019-101. Retrieved from[Context Link]


Office of the Surgeon General. (2018, April 5). U.S. Surgeon General's advisory on naloxone and opioid overdose. Retrieved from[Context Link]


Parsons H. (2018, August 28). Congress, the opioid epidemic, pain management and OT. Retrieved from[Context Link]


World Health Organization. (2018, August). Information sheet on opioid overdose. Retrieved from[Context Link]