Sofia 2009 Overdose prevention and management

Overview of the topics - Overdose risk factors - Methods of overdose prevention - Symptoms of overdoses - Safer help! - How to call the ambulance and talk to the paramedics - How to do rescue breathing / heart massage - When and how to use Naloxone - After the overdose - Overdose emergency plan

Overdose risk factors -Periods of abstinence -Low expierence in drug use and wrong technics -Unknown drugs -Mix of different drugs /alcohol -Health condition

Methods of overdose prevention - Check the quality of the drugs (?!) - Testing small amount - Use slowly / Take your time - Split into two or more servings - Don‘t mix up to many drugs / alcohol /benzos - Don‘t use drugs alone and talk to your partners before using - Learn safer use technics

Preventing Overdose - Know your dealer, know your stuff - Inject with OD prevention technics (tourniquet off after hit, several slow pushes to taste...)

Symptoms of overdose - Breathing problems (no or slow) - Skin colour, fingernails and pintpoint pupils - Onconsciousness, no response to pain - Loose muscles - No heartbeat or slow heartbeat (<50) -Epileptic attack -Psychiatric signs - Hyperventilation

Safer help! - Keep cool, you are the expert! - Use hand cloves! - Check out the place/person for harms like needles, blood, violence or any other risk! - Tell the others what you do and how they could help you

Calling for ambulance - Your name and organisation - Where you are - What happened and what you allready did - Wait for questions or advice

If drug users calling for help - Call ambulance - “My friend is unconscious/not breathing” - Give location - No need to say heroin or overdose - Police may come

How does opiate overdose kill? - cyanosis... (breathing is too slow), progressing to apnea... breathing stops - cardiac arrest... the heart stops because it ’ s not getting oxygen - circulatory collapse... circulation of blood to the brain stops

How to do rescue breathing / heart massage

Can you wake him? yes watch No No breathing? Turning blue? ou watch Yes Breath him, check pulse Call the ambulance! no pulse breath & start CPR Yes pulse Continue rescue breathing Give information to the ambulance and maybe assist them. Evaluate. Diagram without Naloxone

PRACTICE

Rescue breathing for peers Teach mouth to mouth using a dummy for practicing

Heart massage (1 person)

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Naloxone - Is also called Narcan or Narcanti. - Is a pure antidote to opiates including heroin - it reverses the effects of heroin for about an hour. - Has no effects of its own - using it without having opiates in you is like injecting water. - Is NOT a Drug - it has no potential for abuse. - Can cause withdrawal in a person with a habit. Withdrawal can harm someone.

Available forms of Naloxone - Nasal spray - Pre-loaded single-dose syringe - One-dose glass ampules - Multi-dose 10 mg bottle

Administration - Inject intravenous (fast response) or into muscle or subcutaneous (easier to inject) - Acts in 2-8 minutes - If no response in 2-5 minutes, repeat - Lasts minutes

SCARE ME Protocol S timulation unsuccessful in arousing person C all for help A irway clear R escue breathing E valuate M uscular administration of narcan E valuate and support

Can you wake him? yes watch No Breathing to low? Turning blue? nono give NLX Yes 3 quick breaths, give NLX Is he breathing on his own? yes watch No Continue rescue breathing until he’s breathing One hour later, is he getting sleepy again? no watch Yes Consider another dose of NLX

After the overdose - Don‘t leave the person alone - Tell the overdoser (and his partners) what happened with him - Talk to the paramedics - Evaluation and relaxing!

Recovery Position If you must leave the overdoser even for a few minutes put him into the recovery position so he won’t choke on vomit

Evaluation

7. Verhalten bei Drogennotfällen im Druckraum und auf der Straße a) im Druckraum: -Sofort die restlichen MitarbeiterInnen der Schicht informieren! -1-2 MitarbeiterInnen zur Unterstützung in den Konsumraum holen! -Die MitarbeiterInnen im Vorraum schließen sofort die Eingangstür! -Es herrscht absoluter Betriebsstillstand, d.h. die Einrichtung ist für die Dauer des Notfalls geschlossen! -Die MitarbeiterInnen im Konsumraum leiten sofort die nötigen Erste-Hilfe-Maßnahmen ein! -Sichtkontakt zu den KollegInnen halten und gegebenenfalls Unterstützung bzw. Ablösung anfordern. -Bei einem Notfall sind immer Handschuhe zu tragen!

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