Crisis Response

Crisis Response in Addiction Care

The Three Critical Emergencies

In addiction medicine, three situations require immediate response:

Overdose
Suicidal Ideation
Acute Withdrawal

Every healthcare provider working with this population must be prepared to respond.

1. Opioid Overdose

Recognition

The Opioid Overdose Triad:

Pinpoint pupils (miosis)
Unconsciousness/unresponsiveness
Respiratory depression (slow, shallow, or absent breathing)

Other Signs:

Blue/gray lips and fingertips (cyanosis)
Gurgling or snoring sounds
Limp body
Pale, clammy skin

Response Protocol

Step 1: Assess and Call for Help

Check responsiveness (sternal rub)
Call emergency services (108 in India)
If available, call additional help

Step 2: Administer Naloxone

Naloxone (Narcan) reverses opioid overdose
Intranasal: One spray in one nostril
Intramuscular: 0.4mg injection
Repeat every 2-3 minutes if no response

Step 3: Support Breathing

Rescue breathing if trained
Recovery position if breathing resumes
Stay with person until help arrives

Step 4: Post-Naloxone Care

Person may wake up in withdrawal
May be confused, agitated
Naloxone wears off in 30-90 minutes
Risk of re-overdose if long-acting opioid

Naloxone Access in India

Available at government hospitals
OST centers stock naloxone
Community distribution programs emerging
Harm reduction organizations provide training

2. Suicidal Ideation

Risk Factors in Addiction

Active substance use
Early recovery (first 90 days)
Co-occurring depression/anxiety
Recent loss (relationship, job, housing)
Previous suicide attempts
Access to lethal means
Chronic pain

Assessment: The Columbia Protocol

Ask directly:

"Have you wished you were dead or wished you could go to sleep and not wake up?"
"Have you actually had thoughts of killing yourself?"
"Have you thought about how you would do this?"
"Have you had any intention of acting on these thoughts?"
"Have you done anything, started to do anything, or prepared to do anything to end your life?"

Response Protocol

Immediate Risk (plan + intent + means):

Do not leave person alone
Remove access to means
Emergency psychiatric evaluation
Call crisis line: iCall (9152987821)

Elevated Risk (thoughts, no immediate plan):

Safety planning
Increase support contact
Reduce access to means
Mental health referral
Follow up within 24-48 hours

Lower Risk (passive thoughts):

Validate feelings
Explore protective factors
Safety plan
Schedule follow-up
Provide crisis resources

Safety Planning

Warning signs (triggers)
Internal coping strategies
Social contacts for distraction
Family/friends who can help
Professional contacts
Means restriction plan

3. Acute Withdrawal

Opioid Withdrawal Timeline

| Timeframe | Symptoms | |-----------|----------| | 6-12 hours | Anxiety, cravings, muscle aches | | 12-24 hours | Sweating, runny nose, yawning, dilated pupils | | 24-48 hours | Nausea, vomiting, diarrhea, goosebumps | | 48-72 hours | Peak symptoms, insomnia, fever | | 5-7 days | Symptoms subside |

Medical Management

Buprenorphine Induction (preferred):

Wait for moderate withdrawal (COWS ≥ 8)
Start 2-4mg, titrate to comfort
Transition to maintenance

Symptomatic Treatment:

Clonidine for autonomic symptoms
NSAIDs for pain
Loperamide for diarrhea
Ondansetron for nausea
Sleep aids as needed

When Withdrawal is Dangerous

Benzodiazepine/Alcohol Withdrawal CAN BE FATAL:

Seizures
Delirium tremens
Requires medical supervision
May need inpatient detox

Opioid withdrawal is miserable but rarely fatal:

Dehydration risk
Aspiration risk if vomiting
Risk of return to use
Support and comfort measures

AI in Crisis Response

What AI Should Do

✅ Immediately recognize crisis keywords ✅ Provide emergency contact numbers ✅ Give basic safety instructions ✅ Alert human staff urgently ✅ Stay calm and supportive

What AI Should NOT Do

❌ Attempt to handle crisis alone ❌ Delay escalation to gather more information ❌ Provide specific medication dosing ❌ Dismiss or minimize concerns ❌ End conversation abruptly

📚 Learn More