1. YOU Can Help Someone Overdosing on an Opiate HHCLA Overdose Prevention and Response Program

2. The Goal of this Project: To keep opiate users alive.

3. Purpose of Training TO LEARN:  Facts About Opiates  Facts About Opiate Overdose  When to Use Naloxone  How to Use Naloxone  How to Give Rescue Breathing  How to Get the Necessary Help

4. All Opiates  Are made from the opium poppy  Affect the same part of the brain  Cause you to stop breathing if you overdose

5. Effects of Some Opiates OPIATEDURATION INTENSITY OPIATEDURATION INTENSITY Methadone24 hours++++ Methadone24 hours++++ Heroin 6 to 8 hours +++++ Heroin 6 to 8 hours +++++ Oxycontin 3 to 6 hours++++ Oxycontin 3 to 6 hours++++ Codeine 3 to 6 hours+ Codeine 3 to 6 hours+ Demerol2 to 4 hours++ Demerol2 to 4 hours++ Morphine 3 to 6 hours+++ Morphine 3 to 6 hours+++ OPIATEDURATION INTENSITY OPIATEDURATION INTENSITY Methadone24 hours++++ Methadone24 hours++++ Heroin 6 to 8 hours +++++ Heroin 6 to 8 hours +++++ Oxycontin 3 to 6 hours++++ Oxycontin 3 to 6 hours++++ Codeine 3 to 6 hours+ Codeine 3 to 6 hours+ Demerol2 to 4 hours++ Demerol2 to 4 hours++ Morphine 3 to 6 hours+++ Morphine 3 to 6 hours+++

6. Did you know… More injection drug users die from heroin overdose than from any other cause including AIDS, hepatitis or homicide. Overdosing is an occupational hazard for heroin injectors. It is just as common among seasoned injectors as new injectors. It is just as common among men as women. Overdoses are rarely suicide attempts. People who have overdosed, say “I didn’t mean to do it; I just wanted to get high.”

7. Have you ever overdosed? Have you ever seen someone OD?

8. From Overdose to Death Breathing stops Breathing stops Heart stops Brain stops

9. Signs of Overdose 1. Can’t be awakened - Unresponsive Test: Call name, sternum or upper lip rub - do they respond? Test: Call name, sternum or upper lip rub - do they respond? 2. Very slow or no breathing Test: Ear to mouth - can you feel breath? Test: Ear to mouth - can you feel breath? 3. Change in color of lips or fingers Test: Nails or lips are blue, purple, or ashy Test: Nails or lips are blue, purple, or ashy - or -

10. Preventing Overdose 1.Don’t mix alcohol or sedatives with heroin 2.Don’t inject alone 3.Start with smaller doses after a period of abstinenceafter a period of abstinence (e.g., after getting out of jail or drug treatment, or after taking a break) with heroin from a new sourcewith heroin from a new source

11. What Do You Know About Naloxone (Narcan)?

12. Naxolone temporarily reverses an opiate OD by kicking out the heroin from the brain’s opiate receptors to allow breathing to be restored. Naloxone (Narcan) The effect lasts for 30 – 60 minutes

13. Effects of Naloxone  Naloxone usually takes effect in 1 to 2 minutes  It could take up to five minutes  Naloxone lasts about 30 to 60 minutes, then the overdose effects can return  Naloxone puts the OD’r into withdrawal  Don’t let someone who you treat with Naloxone use again - the OD can come back!

14. Storage of Naloxone  Naloxone must be stored out of direct sunlight and be kept as cool as possible.  Keep it in its box and in the bag it’s given to you in.  You do not need to refrigerate it.  Naloxone expires  Check the expiration date and ask for a new dose if it’s close to the date.  Don’t store ANY drugs or paraphernalia in the bag with your Naloxone!!!  The police in the Skid Row area are aware of the HHCLA program

15. Naloxone Does Not Work for Overdoses of:  Valium  Xanax  Alcohol  Clonopin  Ativvan  Clonidine  Elavil 2. Stimulants  Cocaine  Amphetamines 1. Non-opioid Sedatives

16. Other uses for Naloxone Naloxone has NO other uses!  It cannot be used to get high  If the person is not overdosing on an opiate it will have no effect

17. The SCARE ME Technique Is s/he breathing on own? Is another dose of Naxolone needed? Seek help and stay. E valuate & Support Inject 1cc of Naloxone into a muscle – Upper arm, thigh or buttock M uscular injection Is s/he any better? Can you get Naloxone prepared quick enough so they don’t go too long with a breath. E valuate If s/he is not breathing, breath for him/her – 2 slow breaths R escue Breathing Make sure there is nothing in the throat and the airway is clear of blockage A irway Call 911 and say ”my friend is not breathing” Call 911 and say ”my friend is not breathing” C all for help Call their name and shake him/her Rub sternum or upper lip S timulation

18.  Call his/her name loudly  Rub your knuckles on his/her sternum (breastbone)  Don’t  Hit, slap or punch  Rub with ice or put in a cold shower  Inject with water, milk, or salt  These things won’t get the heroin out of his/her system, and might cause injury

19. Call 911 for help Avoiding Police Involvement  Speak clearly and concisely  Keep room quiet  Try not to lie, if asked, tell them you think the person took something, but you’re not sure what it was. “My friend has stopped breathing”

20. Airway Check for gum, food, the tongue, or anything else that might be blocking the airway. Check to see if there’s anything blocking the person’s airway - can air get through?

21. Rescue Breathing Tilt the head back and listen for breathing. Tilt the head back and listen for breathing. breathing If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 slow breaths. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 slow breaths. Each breath should take 1 second. BLOW

22. Evaluate Has anything changed? Is person breathing on their own? If not:  get the Naloxone ready  continue rescue breathing

23. Muscular Injection If the person is still not breathing Give 1cc of Naloxone into a muscle (one shot from the pre-filled syringe = 1cc) Keep giving rescue breathing

24. Evaluate Is person breathing on their own? If not:  Give 5 more breaths, one breath every 5 seconds  Inject another vial of Naloxone with a new needle  Continue rescue breathing until the paramedics arrive

25. Recovery Position If you must leave the overdoser alone and he is breathing normally, place him on his side in the recovery position  Mouth down, head turned so vomit cannot block airway;  Brain at same level of/lower than heart Picture available at: Picture available at: http://www.justoneshot.org.uk/help.htm We always recommend that you stay until the paramedics arrive.

26. Don’t Leave! Even if the person wakes up and starts breathing, the OD could come back. The effects of heroin last much longer than Narcan. The person who OD’d needs to go to the hospital to be observed. S/he will probably feel dope sick - don’t let him/her use again - the heroin is still there.

27. Wait for EMS When they arrive:  If you know, tell them what the person took  Tell them how much Naloxone you administered  Encourage overdoser to go to hospital

28. Addressing your concerns about responding to an OD  Could I catch something (e.g., HIV or HCV)?  Will I be able to remember how to do it right?  Could I get arrested?  What are the side effects of Naloxone?  Side effects could include: Allergic reactions, Palpitations, Arrhythmia, Seizure

29. Talk with your friends Who do you use with? they have Naloxone and know how to use it? Do they have Naloxone and know how to use it?  Talk with your friends about getting trained to use Naloxone  Show them the Naloxone video  Make a plan - tell them where you keep your Naloxone and what you want them to do if you OD

30. Your Turn - Demonstration and Practice

31. Review We created this training with the help of others. Thank you to: The Chicago Recovery Alliance (developers of the SCARE ME technique) The DOPE Project