1. Overdose Prevention & Response
Shoshanna Scholar & Adam Butler
LA Community Health Project

2. US Programs
CDC MMWR, 2012: Over 50,000 drug users (and their friends/ family) trained between Over 10,000 reversals reported.
60 programs distributing or prescribing naloxone, with approximately 240 individual sites, in 18 US states.*
*unpublished results of 2013 US naloxone programs survey, completed by the Harm Reduction Coalition

3. It’s legal & it’s safe
In California it’s legal to prescribe naloxone & it’s legal to use naloxone to save someone’s life (see slides at the end of this presentation for details on legal status) Naloxone is very safe and very effective pdf

4. What is an opioid overdose?
The brain has many opioid receptors.
Too much heroin in too many receptors slows down and sometimes stop breathing.
Heroin fits exactly in receptor
Opioid receptor on brain

5. Opioid overdoses Opioid overdoses are rarely instantaneous!
Overdoses happen as a process: someone slowly stops breathing
They usually happen 1-3 hours after the drug was used
Someone “found dead with a needle in their arm” is a rare event that is sensationalized

6. Examples of opioids Heroin Codeine Demerol Morphine Darvocet Fentanyl
Dilaudid
Methadone
Opium
Hydrocodone
Oxycodone
Vicodin
OxyContin
Tylenol 3
Tylox
Levorphanol
Percocet
Percodan

7. Are all opioids equal?

8. A few words about benzodiazepines
Long acting
Impair short-term memory
Common, cheap, and easily obtained
Diverted pills as low as $0.50
Often prescribed for mental health reasons
People often use “benzos” to manage withdrawal
Enhance the effects of opiates
Often used as “cut”
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!!
They are really really common and easy to find on the street
They are cheaper than heroin
They 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 disorder
People use benzos to get well- makes people who are in withdrawal feel better
People 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

9. A few words about Cocaine & Heroin
Slang: Speedballing: Any combination of a stimulant (upper) and a depressant (downer) taken together and injected into the bloodstream
Speedballing does not cancel out overdose risk.
The more drugs the body has to process, the harder it is to process which increases the chances of overdosing
People who speedball often use more frequently than people who use only heroin which increases the chances of overdosing

10. What puts people at risk?
Tolerance
Mixing drugs
Physical health
Variation in strength and content of ‘street’ drugs
Using alone

11. How can you avoid an overdose?
Know your tolerance
Know your supplier
Control your own high
Injection techniques
Be aware of the risks of mixing drugs
Try not to use alone
Make a plan
Talk with other users

12. Signs & symptoms of an overdose
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

13. Being really high vs. overdosing
OVERDOSE
Muscles become relaxed
Deep snoring or gurgling (death rattle)
Speech is slowed/slurred
Very infrequent or no breathing
Sleepy looking
Pale, clammy skin
Nodding
Heavy nod, not responsive to stimulation
Will respond to stimulation like yelling, sternal rub, pinching, etc.
Slow heart beat/pulse

14. How Naloxone reverses an overdose
Heroin
Naloxone has a stronger affinity to the opioid receptors than the heroin, so it knocks the heroin off the receptors for a period of time allowing the person breathe again.
Naloxone
Opioid receptor

15. How to use Naloxone . Pop off caps from Naloxone and syringe
. Insert syringe into Naloxone bottle
. Pull back plunger until Naloxone bottle is empty. Make sure at least 1cc is in syringe
. Grab a pinch of flesh on the shoulder and insert syringe fully
5. Depress plunger

16. What to do in the event of an overdose
Call 911
Perform rescue breathing
Administer Naloxone

17. Rescue Breathing chin-lift method to open the airway
hand under chin bone and lift
2 slow breaths
Blow enough air into their lungs to make chest rise
Turn head after each breath to ensure the chest is rising and falling
If it doesn’t work, tilt the head back more

18. Rescue Breathing
Breathe again. Count one-one thousand, two- one thousand, three-one thousand, four-one thousand…
Breathe every 5 seconds
Continue until:
The person starts to breathe on their own
An ambulance comes
Someone else can take over for you
You are too exhausted to continue

19. Barriers to calling 911 from user’s perspective
Fear of legal risk (outstanding warrants, DCFS involvement, loss of public housing)
Fear of judgment from family/community
Personal embarrassment/shame
Other punitive measures (students lose federal financial aid)
Urban legends (homicide charge, deportation…)

20. Recovery position

21. Street methods: debunking the myths
1. Don’t leave the person alone—they could stop breathing! 2. Don’t put them in a bath—they could drown! 3. Don’t induce vomiting—they could choke! 4. Don’t give them something to drink—they could throw up!

22. Street methods: debunking the myths
5. Don’t try to stimulate them in a way that could cause harm!
6. Don’t put ice down their pants- it’ll make their pants wet!
7. Don’t inject them with anything (saltwater, cocaine, milk)!
5. harm- slapping too hard, kicking in the testicles, burning the bottom of the feet, etc. can cause long-term damage
6. 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
7. 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.

23. It’s legal to save a life! Good Samaritan Law AB472
CA’s 911 Good Samaritan Law provides limited protection from arrest, charge, and prosecution for people who seek emergency medical assistance at the scene of a suspected drug overdose
Does not affect laws that prohibit selling, giving, or exchanging drugs
AB472 seeks to encourage people to QUICKLY seek medical care for a person who is overdosing
According to CDPH, more Californians die from accidental overdose death than motor vehicle accidents

24. California Law:   AB635, Jan 2014
Designed to encourage CA healthcare providers and community programs to widely distribute naloxone
Expands previous naloxone legislation in CA:
Allows for prescription & distribution throughout the state.
Protects licensed health care professionals from civil & criminal liability when they prescribe, dispense, or oversee distribution via a standing order of naloxone via an overdose prevention program or standard medical practice.
Permits individuals to possess and administer naloxone in an emergency and protects these individuals from civil or criminal prosecution for practicing medicine without a license.
Clarifies that licensed prescribers are encouraged to prescribe naloxone to individual patients on chronic opioid pain medications to address prescription drug overdose.

25. Resources
Videos about naloxone, opioid safety/overdose, and how to respond in emergencies:
best- practices/overdose-videos/
How to find a community-based naloxone distribution program (for parents and drug users who do not have access through the health care system):
prevention-program- locator.html

26. Resources for Families
Learn to Cope: online discussion forum for parents of drug users:
Grief Recovery from a Substance Passing (GRASP), for people who have lost a loved one to overdose:
Broken No More, a support group and advocacy organization for parents interested in advocating for drug policy reform:
Al-anon and Nar-anon, 12 step recovery groups for families and friends affected by another person’s drinking or drug use.

27. Questions?
Shoshanna S. Scholar Executive Director LA Community Health Project
Adam Butler
Training & Healthcare Access
LA Community Health
Project