Grampian Naloxone Programme “Train the trainer” Answers to Quiz

1. Approximately how many drug related deaths were there in Grampian in 2017? B. 85 Drug related deaths fluctuate on an annual basis and can appear to vary depending on the report read. On an average year Grampian generally accounts for around 10% of all Scottish deaths. There were 934 deaths in 2017. That means a potential of 934 lives that might have been saved if somebody present had access to a supply of naloxone.

2. Other people/witnesses are not normally present at overdoses. B. FALSE It is more common that other people will be present at the scene when a person overdoses. This means that there is the perfect opportunity for people to intervene to save a life.

3. Older drug users are at higher risk of overdose. A. TRUE Around 70% of drug deaths involved experienced drug users who were 35 years or older which in Scotland is classified as an “older drug user”. In addition people who have a history of non-fatal overdose are at increased risk of fatal overdose

4. Which individuals are eligible to receive BLS/naloxone training? D. All of these people There should be no exclusion criteria to anyone receiving Basic Life Support and naloxone training. Anybody at risk of overdose or in contact with those at risk of overdose may be trained. This includes those prescribed methadone or Suboxone/Subutex etc at any stage in their treatment. (Remember post-detoxification is one of the high risk times for overdose.) Significant others may also receive a supply. Services in contact with those at risk may also hold a supply for staff use.

5. What is the main body function affected by opioid overdose? B. RESPIRATION CNS depressants such as opioid drugs severely depress the respiratory system. For this reason rescue breaths are recommended for opioid overdose in order to try and get some oxygen back into the blood.

6. List the four drugs most commonly involved in overdose METHADONE HEROIN DIAZEPAM (BENZODIAZEPINES) ALCOHOL Each of these drugs is classed as a depressant drug. Mixing combinations of these drugs is one of the most common causes of overdose. Naloxone will only reverse the effects of opioid drugs such methadone and heroin.

7. List 3 potential signs that somebody is experiencing an overdose Unresponsive/unconscious Laboured/reduced breathing Blue lips Pale, clammy skin NB: Pinpoint pupils may be present however this is merely a sign that opioids have been ingested and are not classed as a clear sign of overdose.

8. Name the two main risk factors for overdose Reduced tolerance Poly-drug use

9. Name two high risk times for overdose Any 3 of the following: On release from prison On leaving residential rehabilitation or hospital On recent detoxification During period of relapse After a recent life event (bereavement, relationship breakdown etc) During festive periods, weekends & holidays Any others?

10. List 3 ‘myths’ for dealing with an overdose casualty Any 3 of the following: Walking the casualty around (risk of further injury) Inflicting pain (will not work on someone unconscious or who has taken a strong painkiller such as heroin) Injecting stimulant drugs (stimulant drugs cannot counteract or reverse effects of opioid overdose) Injecting salty water (there is sometimes (client) confusion that this is similar to a hospital saline drip) Throwing water or put casualty in bath / shower (trigger shock or accidental drowning) Putting the casualty outside (risk of hypothermia) Any others?

11. Cocaine use increases the risk of fatal overdose TRUE Using stimulants will put additional pressure on the heart by increasing heart rate, therefore increasing the risk of cardiac arrest

12. Name the group of drugs which can be reversed by naloxone OPIOID DRUGS Naloxone will not reverse the effects of benzodiazepines or alcohol however if the issue is poly drug use and one of the drugs is an opioid, giving naloxone may be enough to temporarily reverse the symptoms of overdose.

13. When naloxone is administered to someone they will always experience withdrawals FALSE Severity of symptoms of withdrawal can be linked to the dose of naloxone administered. By giving one dose of naloxone at a time the risk of severe withdrawal may be less.

14. How many doses of naloxone are in the pre-filled syringe used in Scotland? There are 5 x 0.4mL doses in each pre-filled syringe. This equates to 0.4mg naloxone per dose

15. Into which area of the body should clients be advised to administer naloxone a. THIGH Clients should be advised to administer the injection into the muscle of the outer thigh – the upper arm is also a licensed site however the muscle on the thigh is bigger. It is not necessary to remove clothing but do check for any obstructions such as coins, a phone or a wallet. There are 2 needles contained in each kit. The second is provided should the first needle become damaged or bent. It is not necessary to change it between every dose administered.

16. How long before the effects of naloxone start to wear off? b. 30 minutes The effects of naloxone are short lived and begin to wear off after around 30 minutes. Opioids will begin to reattach to receptors. This poses a danger to people who have been given naloxone and go on to use further drugs to combat any symptoms of withdrawal. Clients should be made aware of the dangers of topping up with additional drugs and reinforce this with clients.

17. Who can administer naloxone? e. Anybody Legislation is in place which allows anybody to administer naloxone for the purposes of saving a life.

18. You should never administer naloxone to a pregnant woman FALSE Administering naloxone may cause distress to the unborn baby due to potential for withdrawal however not giving naloxone may cause both the mother or baby to die.

19. What is the ratio of chest compressions to breaths for Cardio Pulmonary Resuscitation? The ratio is 30 chest compressions followed by 2 breaths. Breaths are still encouraged due to the depleted oxygen stores in the blood as this is a respiratory event. Naloxone should be administered after the first cycle then every 3 cycles thereafter until all doses are used or the ambulance has arrived and paramedics have taken over.

Questions?