1. Recognition, Response and Administration of Naloxone (Narcan)

2.  Heroin  Codeine  Demerol  Morphine  Darvocet  Fentanyl  Dilaudid  Methadone  Opium  Hydrocodone  Oxycodone  Vicodin  OxyContin  Tylenol 3  Tylox  Levorphanol  Percocet  Percodan

3.  Methadone ++++  Heroin +++++  Oxycontin +++++  Codeine +  Demerol ++  Morphine +++  Fentanyl +++++ + Potency  24-32 Hours  6-8 Hours  3-6 Hours  3-4 Hours  2-4 Hours  3-6 Hours  2-4 Hours

4.  Natural opioids: contained in resin of opium poppy (morphine, codeine)  Semi-synthetic opioids: created from natural opioids such as hydromorphone, hydrocodone, oxycodone, heroin etc.,  Fully Synthetic Opioids: Methadone, Fentanyl

5.  Rarely instantaneous  Can happen 1-3 hours after use  Body has ingested more than it can handle  Opioids attack receptors that control breathing  Oxygen can’t get to the brain  Heart stops  Unconscious, Coma, Death  Long-term Brain/Nerve/Physical Damage

6.  Tolerance Shift  Mixing Drugs  Physical Health  Variation in strength/content  Switching from snorting/smoking to injection  Using alone

7.  Blue skin tinge- usually lips and fingertips show first  Body very limp  Face very pale  Pulse (heartbeat) is slow, erratic, or not there at all  Throwing up  Passing out  Choking sounds or a gurgling/snoring noise  Breathing is very slow, irregular, or has stopped  Awake, but unable to respond REALLY HIGHOVERDOSE Muscles become relaxed Deep snoring or gurgling (death rattle) Speech is slowed/slurred Very infrequent or no breathing Sleepy lookingPale, clammy skin NoddingHeavy nod, not responsive to stimulation Will respond to stimulation like yelling, sternal rub, pinching, etc. Slow heart beat/pulse

8.  Are you alright?  Are you ok?  Pain Stimulus  If no response call 9-1-1  Rescue Breathing  Naloxone  Rescue Breathing

9.  Salt Water  Suboxone  Ice On Body  Cold Shower  Cocaine  Milk  Burning Skin  Punching  Slapping

10.  Fear of legal risk (outstanding warrants, DSS involvement, loss of public housing)  Fear of judgment from family/ community  Personal embarrassment/shame  Other punitive measures (students loose federal financial aid)  Urban legends (homicide charge for being at an OD, being deported)

11.  Opioid Antagonist  Medication that reverses only OPIOID overdose  Can not get high on it  Can not abuse it  Stays active for 20-90 minutes depending on metabolism, amount of drug used  Liver Function  If they use before the Narcan wears off Narcan has a stronger affinity to the opioid receptors than the heroin, so it knocks the heroin off the receptors for a short time and lets the person breathe again. Heroin Narcan Opioid receptor

12.  Harm Reduction?  Know some street slang (does not mean YOU have to use it)  Know the street myths about response  Referrals to outside programs for Narcan  Not just people who inject are at risk for overdose.

13. Phone: (781) 592-0243 Thank You!!