1. Drug Overdose: Prevention, Recognition, Response, and Naloxone Training Lydia H. Guterman, MPH lydiaguterman@gmail.com 1Title Slide

2. Thanks Many of these slides were originally developed by Emalie Huriaux at the DOPE Project, part of the Harm Reduction Coalition in Oakland, California. 2Thanks

3. Training Outline 1. What is an overdose? 2. Discuss the different types of overdose. 3. Discuss factors that increase risk for overdose and how to reduce risk of overdose. 4. Opiate Overdose: Recognition and Response 3Training Outline

4. Training Outline (cont.) 5. Stimulant Overdose: Recognition and Response 6. Mixed Overdose 7. Practice Using Naloxone 8. Questions and Discussion 4Training Outline 2

5. Overdose: The Basics 5

6. What is an Overdose? Toxic amount of drug or combination that causes the body to shut down Opiates & Other Downers (e.g. heroin, alcohol, benzos) –Breathing slows and stops, then heart stops –Blue lips or fingernails, extended nodding, labored breathing, nonresponsive Stimulants (e.g., Tina, speed) –Heart speeds up, body temp rises, resulting in seizure, heart attack, stroke 6What is an Overdose?

7. Overdose Response Stimulant and Downer overdoses are VERY DIFFERENT and should not be handled the same way. In the case of opiate overdose, perform rescue breathing, administer naloxone, and call emergency services In the case of a stimulant overdose (heart attack), perform CPR and get the victim to medical care. 7 Responding to Downer and Upper OD is different

8. Why People Overdose: Risk Factors and Prevention Strategies 8 Why people OD: Risk Factors and Prevention Strategies

9. RISKS & PREVENTION Mixing Use one drug at a time If mixing, reduce amounts of everything Don’t mix drugs with the same effects (alcohol with opiates) If drinking with downers, do shot first 9Mixing

10. RISKS & PREVENTION Tolerance Use less after leaving detox, jail, or when sick –HCV+ and HIV+ individuals may be at a higher risk for experiencing OD Do tester shot 10Tolerance

11. RISKS & PREVENTION Quality Try to use the same dealer Do tester shot 11Quality

12. RISKS & PREVENTION Using Alone Fix with a friend Leave door unlocked Call someone trusted 12Using Alone

13. Risks & Prevention Administration Route Snorting, smoking are less direct than injecting Don’t push shot in all at once. Instead, use multiple smaller pushes of the plunger to get the dose in. If change route, decrease dose. 13Administration Route

14. Opiate Overdose 14Opiate Overdose

15. Assessing Downer Overdose How do you tell if someone is really high vs. having an overdose? HIGH “the line”=UNRESPONSIVE OVERDOSING 15Assessing the 'Line'

16. Signs of Overdose Unresponsive (shouting, pain won’t awaken) Unconscious Breathing slow or shallow (<12/minute) Pale, clammy, loss of color Blue or gray (esp. lips or nails) Loud, uneven snoring/gurgling Not breathing Faint or no pulse 16Signs of an OD

17. Stimulation NOISE PAIN (sternum rub) Are they responsive? 17Stimulation

18. RESPONSE You have decided that the person is overdosing and action needs to be taken. How should you respond? 18Response: What should you do?

19. What Should You Do? Do: –Call an ambulance if possible –Make sure the person is breathing. If not, perform rescue breathing. –Administer naloxone if appropriate –Stay with the victim 19What to DO

20. What You should not do: Do not: –Throw the person in an ice bath –Inject them with salt water or milk –Beat them up to try to get them to wake up **All of these responses waste valuable time. It only takes a few minutes for the brain to have serious damage without oxygen. Use your time to help the person get oxygen/ breathe. 20What NOT to do

21. Call Ambulance Quiet down the scene Be calm, speak clearly Don’t argue Tell ‘em –Exact address –Victim unconscious –Victim not breathing or blue 21Call and Ambulance

22. Call Ambulance (con’t.) You DO NOT have to tell the dispatcher –Your name (give an AKA if you’re worried) –That it’s an overdose –That drugs are involved Do tell the paramedics, once they arrive, everything you know 22Call and ambulance

23. Make sure the person is getting Oxygen. RESCUE BREATHING Head Tilt / Chin Lift Look for chest rise/fall with your eyes Listen for breath with your ear Feel for air with your cheek 23Rescue Breathing: Open Airway

24. Rescue Breathing Head Tilt / Chin Lift Pinch nose 2 slow breaths and check chest Keep at it –1 breath every 5 seconds 24Rescue Breathing: Give Breathes

25. If You Leave for Any Reason Put the person in the recovery position Put the right hand by the head (as if they were waving) Put the left arm across the chest, so that the back of the hand rests against the cheek Hold the hand in place and lift up the left knee Turn the person on their side by pushing down on the knee 25Recovery Position

26. NALOXONE An opiate antagonist that temporarily reverses the effects of an opiate overdose Traditionally administered by paramedics Legal, nonscheduled, prescription medication IDU can be trained to use it and carry it with them. Not harmful if given to someone who is not overdosing. 26Naloxone: What is it?

27. If You Have Naloxone EVALUATE Has the person resumed breathing? Can you get to the naloxone? 27If you have naloxone: Evaluate

28. Naloxone – Intermuscular Injection Crack open vial and draw up full contents Muscle shot, either –Shoulder (deltoid) –Butt (gluteus) –Thigh (quads) KEEP BREATHING FOR THEM 28Giving a naloxone shot

29. Evaluate & Support Is a 2 nd shot needed? Inform them what happened Stay with them (2-3 hours) 29Post shot- support and evaluate

30. Stimulant Overdose 30Stimulant Overdose

31. Assessing a Stimulant Overdose The symptoms of stimulant overdose are VERY DIFFERENT than downer overdose. Symptoms include extreme sweating, seizure, foaming at the mouth, tightness in the chest, and heart attack/ heart failure. 31Assessing stimulant overdose

32. Response Immediately call ambulance. Perform rescue breathing/ CPR. Do not use naloxone. It will not help because opiates are not involved. Treat symptoms (for example, if the person is having a seizure make sure (s)he does not slam into anything.) 32Response

33. Responding to a Mixed Overdose People often mix stimulants and downers. Assess the situation- is the person showing signs of a downer or stimulant overdose? React accordingly. In either case, perform rescue breathing if the person is not breathing and call ambulance. If opiate overdose, stimulate then give naloxone if necessary. 33Responding to a mixed OD

34. Get Prescription from Doctor and get naloxone and overdose kit from trainer if available. Explain that naloxone must be stored in the dark and expires in two years. Talk to clients about police and possible confiscation. Tell clients to report any reversals or if their naloxone was taken or if they need a re-fill. 34 Get your script and kit and explain about storage

35. THANK YOU Amazing Overdose Prevention Advocates in the USA Rachel McLean, MPH, Founder, The DOPE Project Kristin Ochoa, MD, Los Angeles Overdose Taskforce Josh Bamberger, MD, S.F. Department of Public Health Peter Davidson, PhD (c), U.C. San Francisco Mary Howe, Homeless Youth Alliance/S.F. Needle Exchange Naloxone Advisory Group All the DOPE Project trainers and service providers we’ve worked with over the years! 35thank you.