Presentation on theme: "Opioid Overdose Prevention and Reversal via Peer-Administered Narcan"— Presentation transcript:
1Opioid Overdose Prevention and Reversal via Peer-Administered Narcan Healthy Streets Outreach Programa program of Northeast Behavioral Health280 Union StreetLynn, ma
2First things first…slang Jammed, jambox, jam sandwich: really highFalling out: overdosingFell out: overdosedDope: heroinNarcon or Narcain: Narcan pronounced incorrectlyBeaned out: on a lot of benzos
3Opioid OD Stats:Two people die from opioid overdoses every day in Massachusetts.More people are killed by opioid overdoses in Massachusetts than by car accidents.In 2007, there were over 6 times more deaths due to opioid-related overdoses than in 1990.For every death due to an opioid overdose in 2007, there were 47 people who were treated for an overdose and lived.*Sources: “Opioids: Trends and Current Status in Massachusetts,” Massachusetts Department of Public HealthBureau of Health Information, Statistics, Research, and Evaluation and the Bureau of Substance Abuse Services, 2009DAWN data “Massachusetts Oxycontin Commission: Final Report” 2009
4MDPH Pilot Details:Standing order authorizes Approved Opioid Overdose Trainers to possess nasal naloxone and to distribute it to Approved Opioid Overdose Responders.Trainers and Responders are authorized to administer naloxone to person experiencing a drug overdose.Approved by MDPH Drug Control Program and the Commissioner of DPH, overseen by medical director Dr. Alexander Walley.DPH General Counsel’s Office determined the legality of the pilot programs. Once efficacy of the pilots has been established, Public Health Council will be asked to pass regulation to make the program permanent.
5Expanded AccessCurrently providing OD prevention in additional venues:DetoxMethadone clinicsSuboxone programsHomeless sheltersOther HIV P&E programsParent support groupsCorrections
6Opportunity for Family Intervention Majority of ODs occur in the presence of othersODs can be reversed by rescue breathing and/or Narcan (Naloxone) administrationMany younger drug users are still living at home or are still allowed to visit the home.Treatment options can be discussed at the hospital with family present in the case of an overdose.Realistic and useful education for families.
7Narcan Training Components 20-minute session (or longer)Enrollment form (used for data collection, risk assessment, risk reduction)Review of overdose risks, prevention, response, calling 911, rescue breathing, refill procedureParticipant repeats information back, demonstrates ability to assemble Narcan
9What is an Opioid Overdose? Opioid fits exactly in receptorThe brain has many, many receptors for opioids. Too much opioid fitting in too many receptors slow and stop the breathing.Opioid receptor on brain
10Narcan reversing an OD Heroin 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.NarcanOpioid receptor
11Opioid ODs, continued ODs are rarely instantaneous! ODs happen as a process- someone slowly stops breathingThey usually happen 1-3 hours after the drug was usedSomeone “found dead with a needle in their arm” is a rare event that is sensationalized
13What are the Signs/Symptoms of an OD? REALLY HIGHOVERDOSEMuscles become relaxedDeep snoring or gurgling (death rattle)Speech is slowed/slurredVery infrequent or no breathingSleepy lookingPale, clammy skinNoddingHeavy nod, not responsive to stimulationWill respond to stimulation like yelling, sternal rub, pinching, etc.Slow heart beat/pulseBlue skin tinge- usually lips and fingertips show firstBody very limpFace very palePulse (heartbeat) is slow, erratic, or not there at allThrowing upPassing outChoking sounds or a gurgling/snoring noiseBreathing is very slow, irregular, or has stoppedAwake, but unable to respond
14What puts people at risk for ODs? Mixing DrugsVariation in strength and content of ‘street’ drugs (purity)Tolerance changes (coming out of jail/TX)Using alonePhysical Health (liver functioning, weight loss, etc.)Transient living – new dealers/new productThinking you “know everything”Switching from sniffing/eating to injection.
15How can you avoid an opioid overdose? Know your toleranceKnow your supplyControl Your Own HighBe Aware of the Risks of Mixing DrugsTry not to use aloneMake a planTalk with other usersStop Using
16Prevention Messages for Families I want to remind you that (BECAUSE OF) your tolerance is very low, you are at high risk for an overdose.Do you have an overdose plan? Do you and your friends know about Narcan?I love you but not what you do and I do not want anything to happen to you.If you relapse please do not do it alone.
17A few words about benzos: They are long acting (at least a day, usually)They impair your short-term memory. So you can actually forget how many benzos or how much heroin you have used in the last 24 hours- this could put someone in danger for an OD!!Very common and easy to find on the streetCheaper than heroinThey are frequently necessary for mental health reasons- there is a high comorbidity between substance abuse disorders and mental illness like anxiety, depression, and post-traumatic stress disorderMake people who are in withdrawal feel betterPeople use benzos to get jammed- enhances the effects of heroin (or methadone, etc)Drugs could be cut or enhanced with benzos without the user knowing
18Responding to an Overdose “Are you alright? You ok?”No response try a STERNUM RUBCall 9-1-1Give the person AIR using rescue breathingGive 2 or 3 breaths and set-up the NarcanSpray the NarcanContinue rescue breathingSpray second dose if necessary
20Overdose Prevention Using Nasal Narcan Simple device, medication and nasal sprayNarcan is a pure opiate antagonistNo physiological effect other than blocking opiatesNo adverse reactionsNo potential for abuse or potential for OD
22What are barriers to calling 911 from the perspective of a substance user? Fear of legal risk (outstanding warrants, DSS involvement, loss of public housing)Fear of judgment from family/ communityPersonal embarrassment/shameOther punitive measures (students loose federal financial aid)Manslaughter charges if someone dies on the scene
23What about families?Are there fears about calling among families?How will YOU handle this discussion if it comes up without judging the person in front of you?
24Frequently Asked Questions and Street Myths about ODs
25Street Methods now have safer alternatives Don’t leave the person alone--they could stop breathingDon’t put them in a bath--they could drownDon’t induce vomiting--they could chokeDon’t give them something to drink--they could throw upDon’t put ice down their pants- it’ll make their pants wet! Cooling down the core body temperature of someone who is ODing is dangerous because it will slow down their body function even more than just the OD.Don’t try to stimulate them in a way that could cause harm- slapping too hard, kicking in the testicles, burning the bottom of the feet, etc. can cause long-term damageDon’t inject them with anything (saltwater, cocaine, milk)--it won’t work any more than physical stimulation and can waste time or make things worse depending on what you inject; a salt injection, for instance, could cause someone to go into cardiac arrest if they already have high sodium levels in their system. Also, every injection brings a risk of bacterial infection, abscesses, endocarditis, cellulitis, etc.
26Does Speedballing balance you out? “Speedballing” refers to any combination of a stimulant (upper) and a depressant (downer) taken together, esp. a mixture of heroin and cocaine or heroin and methamphetamine injected into the bloodstream.No- speedballing does not cancel out OD riskThe more different drugs someone’s body has to process, the harder it is on their bodyPeople who speedball usually use much more frequently that people who use only heroin- this increases OD risk
27Will using Narcan help someone give a clean urine? NoNarcan knocks opiates off the opiate receptors, but the drug is still floating around in the body (AND urine!)
28Can you use Suboxone to reverse an OD? Not a good idea, probably not enough Naloxone in a Suboxone to reverse and overdose, will not act fast enoughSuboxone is a drug that contains both Buprenorphine (a partial agonist) and Naloxone (antagonists, same thing as Narcan)Suboxone is supposed to be taken sublingually, and if taken this way, the Naloxone has no effectIf crushed and snorted, or injected, the Naloxone is “activated” and acts as an antagonist
30Enrollments BLUE or BLACK Pen Non-users do not get asked any questions below the lot number.Must fill in all informationIf you do not have an answer use X’s or a zeroUse leading zeroesIf someone is not sure they are enrolled please fill out another enrollmentDO NOT FORGET THE BSAS CODEAll codes are on the back of the enrollment
31Refills Never give a kit without doing the refill form. Only answer all the questions if they are reporting an overdose.ALWAYS write comments, especially if it is a reversal.
33I used the Narcan.Trauma associated with witnessing an OD may not manifest immediately.Be open to hearing the details but never ask for the details.Positively reinforce all actions performed by the responder.Refill Narcan
34Contact InformationMary WheelerProgram Director – Healthy Streets Outreach Programa program of Northeast Behavioral Health