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First Responder Overdose Response Training In collaboration with the Massachusetts Department of Public Health, Bureau of Substance Abuse Services and.

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Presentation on theme: "First Responder Overdose Response Training In collaboration with the Massachusetts Department of Public Health, Bureau of Substance Abuse Services and."— Presentation transcript:

1 First Responder Overdose Response Training In collaboration with the Massachusetts Department of Public Health, Bureau of Substance Abuse Services and Office of HIV/AIDS

2 Go to for an online module for first responders (EMTs, firefighters, and law enforcement officers) with post-test

3 The Overdose Problem

4 National & regional drug threat

5 National Vital Statistics System, ; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), ; Treatment Episode Data Set, Prescription opioid sales, deaths and treatment:

6 6 By 2010, drug overdose deaths outnumbered motor vehicle traffic deaths in 31 states CDC NVSS, MCOD More deaths from drug overdose In 2012, 13 Massachusetts residents died each week from drug overdoses

7 Learning Objectives 1.Understand the overdose crisis 2.Know how opioids work and overdose risk factors 3.Recognize an opioid overdose 4.Respond to opioid overdose 5.Review Good Samaritan/Naloxone Law  Passed August Comply with the emergency regulations  Passed March 2014

8 8


10 Police and Fire naloxone rescues in Massachusetts July 2014 TownRescues Quincy Police start Revere Fire start Gloucester Police + Fire start Weymouth Fire start Saugus Fire start New Bedford Police start April New Bedford Fire start April Total554 Why does Gloucester have so few rescues? Their EMS is fire department-based and has short response times. EMS usually arrives first

11 First Responder Pilot Data: Response to NaloxoneTotal Responsive and alert182 (45%) Responsive but sedated162 (40%) No response to naloxone61 (15%) Post-Naloxone Withdrawal SymptomsTotal None47 (40%) “Dope Sick”27 (23%) Irritable or Angry33 (28%) Physically Combative6 (5%) Vomiting16 (14%) Other14 (12%)

12 DPH Overdose Education & Naloxone Distribution Program Sites AIDS Action Committee AIDS Project Worcester AIDS Support Group of Cape Cod Brockton Area Multi-Services Inc. (BAMSI) Boston Public Health Commission Greater Lawrence Family Health Center Holyoke Health Center Learn to Cope Lowell House/ Lowell Community Health Center Manet Community Health Center MAPS/ Health Innovations North Suffolk Mental Health Seven Hills Behavioral Health Tapestry Health Learn to Cope Site Coming Soon

13 March 27, 2014 The Governor’s Public Health Emergency declaration provided emergency powers to DPH Commissioner Cheryl Bartlett, RN. At the Governor’s direction, the Public Health Council passed a regulation that: “Universally permits first responders to carry and administer Naloxone (Narcan), a safe and effective opioid antagonist that, when timely administered, can reverse an overdose and save a life.”

14 Why Police Officers? First to the scene of an overdose Frequent interaction with high risk populations With the right tools, police can make a public health impact Builds bridges to active users and their social networks Overdose is a true crisis and police can help

15 How Opioids Work and Overdose Risk Factors

16 16 There were ads in papers and journals for Bayer’s many products, including aspirin and heroin.

17 What are opioids/opiates? Medications that relieve pain Attach to the opioid receptors in the brain and reduce the intensity of pain signals reaching the brain.

18 Opioids Natural Opiates opium morphine codeine Semi-Synthetic Opiates heroin hydromorphone hydrocodone oxycodone Fully Synthetic Opioids fentanyl methadone The term opiate is often used as a synonym for opioid, however the term opiate refers to just those opioids derived from the poppy plant either natural or semi- synthetic All categories have overdose risk

19 opium morphine codeine heroin hydrocodone oxycodone fentanyl methadone Demerol opium morphine codeine hydrocodone oxycodone heroin Demerol methadone fentanyl hoursdays

20 How do opioids affect breathing? Opioid Receptors Opioid

21 How Overdose Occurs Slow BreathingBreathing StopsLack of oxygen may cause brain damageHeart StopsDeath

22 What is Narcan® (naloxone)? Narcan knocks the opioid off the opiate receptor, blocking opiate receptors from the opiate Temporarily takes away the “high,” giving the person the chance to breathe Narcan works in 1 to 3 minutes and lasts 30 to 90 minutes Narcan can neither be abused nor cause overdose only contraindication is known sensitivity, which is very rare Too much Narcan can cause withdrawal symptoms such as: nausea/vomiting diarrhea chills muscle discomfort disorientation combativeness

23 How does Narcan affect overdose?

24 What is an Opioid OD?

25 Naloxone Reversing Overdose



28 Mixing Opioids with Benzos Combining opioids with benzodiazepines or alcohol leads to a worse outcome Benzos are psychoactive drugs prescribed for sedation, anxiety, sleep and seizures The most commonly used benzos are: Klonopin, Valium, Ativan, Librium, and Xanax

29 Medications for Opioid Overdose and Treatment Narcan® = naloxone Reverses opioid overdose Short and fast-acting opioid blocker Vivitrol® = naltrexone Treatment for opioid and alcohol addiction Long-acting opioid blocker Suboxone® = buprenorphine + naloxone Treatment for opioid addiction The naloxone is added to discourage injecting or sniffing Subutex® = buprenorphine only Treatment for opioid addiction in pregnant women Methadone aka dolophine and methadose Treatment for opioid addiction or pain Street value because they can relieve withdrawal symptoms Street value because they can relieve withdrawal symptoms No street value because they cause withdrawal symptoms

30 Revolving door??? As it is for tobacco and weight loss, it takes multiple attempts before achieving success – By definition, addiction is a chronic condition where people make risky choices despite negative consequences With time, treatment works - people get better With treatment, crime is less common and therefore they interact with police less often – Law enforcement because its law enforcement is more likely to see the relapses than recovery

31 Administering Naloxone

32 First responders are authorized to administer nasal naloxone as a standing order, under Statewide Treatment Protocol 2.14 Office of Emergency Medical Services

33 Scene Safety and Potential Hazards Hazardous materials Other dangers at crash or rescue scenes Crime scenes NEEDLES PEOPLE Oncoming traffic Unstable surfaces Leaking gasoline Downed electrical lines Potential for violence Fire or smoke WEAR GLOVES: Assume all body fluids present a possible risk for infection

34 Recognize Overdose If a person is not breathing or is struggling to breath: call out name and rub knuckles of a closed fist over the sternum (Sternum Rub) Signs of drug use? – Pills, drugs, needles, cookers Look for overdose – Slow or absent breathing Gasping for breath or a snoring sound – Pinpoint pupils – Blue/gray lips and nails Ensure EMS is activated

35 Just high/overmedicated Small pupils Drowsy, but arousable – Responds to sternal rub Speech is slurred Drowsy, but breathing – 8 or more times per minute Overdose Small pupils Not arousable – No response to sternal rub Not speaking Breathing slow or stopped – < 8 times per minute – May hear choking sounds or a gurgling/snoring noise – Blue/gray lips and fingertips Just high/overmedicated vs. overdose >> Stimulate and observe >> Rescue breathe + give naloxone



38 Remember “Four Rights” for medication administration Massachusetts Office of Emergency Medical Services Minimum Standards for First Responder Training in First Aid, Epinephrine Auto-Injector and Naloxone Use AR Right Patient (opioid overdose) Right Medication (Naloxone-check for clarity) Right Date (check expiration) Right Dose (spray half (1ml) in each nostril)

39 Naloxone formulations Intranasal Auto-injector

40 Intranasal naloxone needs to be dispensed with the mucosal atomization device If there is nasal trauma or bleeding, do not administer naloxone Benefits of Intranasal Naloxone Nose is an easy access point Painless Eliminates risk of contaminated needle sticks and needle dispensing Intranasal Naloxone

41 1.Remove both yellow caps from the ends of the syringe 2.Twist the nasal atomizer onto the tip of the syringe 3.Remove the purple cap from the naloxone 4.Twist the naloxone on the other side of the syringe Give Naloxone: Intranasal

42 Push 1ml (1mg) of naloxone into each nostril Administer the entire contents of the 2ml syringe with approximately one half (1ml) administered in each nostril Administering one half in each nostril maximizes absorption Give Naloxone: Intranasal


44 Each auto-injector contains only 1 dose Inject into muscle or skin of the outer thigh Can be injected through clothing if needed Device injects intramuscularly or subcutaneously, delivers the naloxone, and retracts the needle fully into its housing Needle not visible before, during, or after Auto-injector Naloxone

45 Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency The Trainer does not contain a needle or medicine It can be reused to practice your injection The red safety guard can be removed and replaced on the Trainer Auto-injector Naloxone

46 Give Naloxone: Auto-injector





51 How does a person respond to Naloxone? Scenarios: 1.Gradually improves breathing and becomes responsive within 3 – 5 minutes 2.Immediately improves breathing, responsive, and is in withdrawal 3.Starts breathing within 3 – 5 minutes but remains unresponsive 4.Does not respond to first dose and naloxone must be repeated in 3 – 5 minutes (keep rescue breathing)

52 Reactions to Naloxone

53 Continue rescue breathing with 1 breath every 5 seconds until emergency responders arrive After 3-5 minutes, if the patient is still unresponsive with slow or no breathing, administer another dose of naloxone After Administering Naloxone

54 If victim is breathing, but unresponsive place in recovery position

55 Naloxone Storage Intranasal: Storage between 59 degrees to 86 degrees. – Avoid extremes in temperatures for long periods of time – Replace every 6-12 months, before expiration date Auto-injector: 59°F to 77°F (15°C to 25°C) – Temperature excursions are permitted between 39°F and 104°F – Keep in outer case until needed – If solution through viewing window is discolored, cloudy, then replace – Replace before expiration date

56 Naloxone Deployment Options Vehicles, front desk, booking area, holding area Vehicle glove compartment Vehicle pelican case Attached to AED case in passenger compartment First in bag Issued per shift Issued per officer

57 Questions and Answers Will Naloxone work on an alcohol overdose? – No. Naloxone only works on opioids What if it is a crack/cocaine or speed/methamphetamine overdose? – No. Naloxone only works on opioids What is the risk period for an overdose to reoccur after giving Naloxone? – Depends on how long acting the opioid is and how much they took If the person isn’t overdosing and I give them Naloxone will it hurt them? – No. If in doubt give naloxone.

58 What if a person refuses care and transport after Naloxone is administered? Inform the person of the risk of re-overdosing Inform the person naloxone is only temporary If person still refuses consider the mechanism of injury or Illness Do you believe he/she can refuse treatment with a sound mind and clear understanding of the circumstances? Remember they just overdosed! If no, the person can not refuse treatment

59 Reminder Naloxone is not a controlled substance but is a regulated substance (a prescription medication) that requires a licensed prescriber

60 Good Samaritan & Naloxone Law Passed August 2012

61 OEND program rescues: Program data

62 Encouraging people to call for help First responders play a key role Bystanders not calling is one of the reasons people are dying – Fear of public safety reduces 911 call rates Interactions at overdose scenes with people who use drugs can reduce fear of public safety

63 Acts of 2012, Chapter 192, Sections 11 & 32

64 (d) Naloxone or other opioid antagonist may lawfully be prescribed and dispensed to a person at risk of experiencing an opiate-related overdose or a family member, friend or other person in a position to assist a person at risk of experiencing an opiate-related overdose. (emphasis added)

65 (a) A person who, in good faith, seeks medical assistance for someone experiencing a drug-related overdose shall not be charged or prosecuted for possession of a controlled substance under sections 34 or 35 if the evidence for the charge of possession of a controlled substance was gained as a result of the seeking of medical assistance. (b) A person who experiences a drug-related overdose and is in need of medical assistance and, in good faith, seeks such medical assistance, or is the subject of such a good faith request for medical assistance, shall not be charged or prosecuted for possession of a controlled substance under said sections 34 or 35 if the evidence for the charge of possession of a controlled substance was gained as a result of the overdose and the need for medical assistance.

66 (c) The act of seeking medical assistance for someone who is experiencing a drug-related overdose may be used as a mitigating factor in a criminal prosecution under the Controlled Substance Act,1970 P.L , 21 U.S.C. section 801, et seq. (d) Nothing contained in this section shall prevent anyone from being charged with trafficking, distribution or possession of a controlled substance with intent to distribute. (e) A person acting in good faith may receive a naloxone prescription, possess naloxone and administer naloxone to an individual appearing to experience an opiate-related overdose.

67 Thank You

68 Go to for an online module for first responders (EMTs, firefighters, and law enforcement officers) with post-test

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