1. Just Plain Killers SYMPOISUM
Fairfield Behavioral Health Services Response

2. What is an Opioid? Jeremy Purnell, Certified Prevention Specialist, Fairfield Behavioral Heath Services
Powerful, highly addictive narcotics commonly prescribed to treat pain. Well known opioids include:
Oxycodone
Oxycontin
Percocet
Vicodin
Codeine
Demerol
Fentanyl
Medical Uses: Opioids are use to treat pain or relieve coughs or diarrhea.
Medications that are artificially made rather than extracted from opium unlike opiates. Opioids are among the world oldest known drugs.

3. Putting Opioids in Perspective
More people died from drug overdoses in than the entirety of the Vietnam War
U.S. consumes 80% of global opioid supply
Between 2011 & 2015, overdose deaths in the US tripled from opioids
Americans are more likely to die from an opioid overdose than from a car accident
More than 72,000 people in the US died from drug overdoses; nearly 200 a day. That’s up from 2016, which held the previous record of roughly 64,000. 2/3rds were linked to opioids. It will have killed more people than guns, car crashes, or HIV/Aids in a single year.
Around 58,000 US troops died in the Vietnam War between More than 4,500 have died so far in the Iraq War since Adds up to more than 62,700…..still less than the 72,000 who died in 2016.
While the U.S. makes up 4.6% of the world’s populations it consumes 81% of the world supply of oxycodone. We know that 4 out of 5 heroin users started just with a Rx-it could be for wisdom teeth, sports or other injury so this is why it is so important to focus on our youth as well.

4. So…What Could Have Caused This Drug Crisis?
Heroin-prescription pills cycle started current crisis
Illicit drug use in U.S. has historically increased
In 2017…25 million+ Americans abuse drugs
User demand for more and stronger drugs only continues to increase
Synthetic opioids such as fentanyl are the latest and growing drug demand
Also known as an “opioid use disorder”
Characterized by compulsive, difficult-to-control drug use

5. Fairfield County Stats - 2018
1 total drug overdose deaths
46 NALOXONE administrations via EMS
13 opioid-related overdoses
35 patients with an opioid use disorder
64% inmates in SCDC custody who have indicated opioid use
835 opioid prescriptions were dispensed

6. The US consumes what percentage of the global opioid supply?
Brain Spark Question
The US consumes what percentage of the global opioid supply?

7. When did Governor McMaster declare an opioid epidemic?
Brain Spark Question
When did Governor McMaster declare an opioid epidemic?

8. Signs Someone IS Abusing Prescriptions Drugs
Get a prescription for the same medicine from two different doctors.
Fill a prescription for the same medicine at two different pharmacies.
Take more of a medicine than they used to or take more than is instructed on the label.
Take the medicine at different times or more often than is instructed on the label.
Become more withdrawn or angry.
Symptoms of prescription drug abuse can be hard to recognize in older adults. This is because they are similar to symptoms of aging. For instance, confusion and memory loss are symptoms of both.
If you care for or spend time with an older adult, be aware of their medicines and behavior. The following are warning signs that someone may be abusing prescription drugs. If they:
Appear confused or forgetful.
Often talk about a medicine.
Are afraid to go somewhere without taking a medicine.
Are defensive when you ask about a medicine.
Make excuses for why they need a medicine.
Store “extra” pills in their purse or in their pocket.
Sneak or hide medicine.
Have been treated for alcohol, drug, or prescription drug abuse in the past.

9. Symptoms of someone “REALLY HIGH”
Muscles become relaxed; slow movement and reactions
Speech is slurred/slowed
Sleepy looking but will respond to stimulation
Nodding

10. Where do our children get pills from?
Their parents and grandparents medicine cabinet
Friends/peers
Wisdom Teeth Surgeries
Sports Injuries

11. 75% of heroin users got started with prescription opioids
Opioids  Heroin
75% of heroin users got started with prescription opioids
Cheaper
Easier to access
The cost of heroin continues to drop, while potency levels rise.
A “baggie” (or small, single-use bag) of heroin typically costs between $5 and $20. In 2016, the United Nations Office on Drugs and Crime (UNODC) reported the average price of heroin in the U.S. was $152 per gram (which is usually divided into 20 bags).
People with severe heroin addictions have described purchasing 10 to 15 bags of the drug per day. Following this model of use, an individual would spend between $438 and $1,750 per week
Vicodin costs about $126 for 100 pills without insurance (or $1.26 per tablet). The same, single pill costs $5 on the street (almost 4 times more). High prescription and street prices for these types of pills often lead people to search for cheaper alternatives like heroin and fentanyl.
Because opioid addiction requires higher and higher amounts to get the same effect, an individual will need to take progressively higher numbers of pills each day

12. Fentanyl Used to treat severe pain
times more powerful than morphine
Cutting heroin with fentanyl
Threat to anyone who comes in contact with it, not just users
0.25 mg can kill you
Prescribed often after other opioids don’t work
Sourced from China and Mexico
May require several doses of naloxone for it to actually work due to how strong it is
Not diverted from hospitals
Use grain of sand example:
1 gran of sand =carfentanyl
10-15 grains of sand =fentanyl
Fatal doses

13. Fentanyl Video

14. Name one symptom that someone is abusing prescription drugs.
Brain Spark Question
Name one symptom that someone is abusing prescription drugs.

15. Name three well-known opioids
Brain Spark Question
Name three well-known opioids

16. Name a symptom of someone overdosing on opioids
Brain Spark Question
Name a symptom of someone overdosing on opioids

17. Safe Storage Tips: 1 2 3 4 5 Lock them up
Keep opioids in the pharmacy bottle 2
Always secure after use 3
Keep track of quantities 4
Remove unwanted drugs from your home 5

18. How many of you brought unused or expired pain pills today for the drug take-back program?

19. What are some risk factors for overdose
Using an opioid (Heroin, fentanyl, methadone, etc.) with alcohol, benzodiazepines, crack, cocaine or other substances increased the risk for an overdose.
Mixing drugs
Repeated use of the same drug leads to an increased tolerance of its effects on your body.
If you take a break from a drug, your tolerance is lowered. Reason you might take a break includes:
Prison
Compulsory Drug Treatment Center
Voluntary treatment
Sickness/hospitalization
Reduce tolerance

20. What are some risk factors for overdose
Unfamiliar supply/changes in quality
Using a new dealer, your dealer gets a new supply, it may be of a different strength than what your body is used to. It may also be “cut” and mixed with other drugs.
Having someone else inject you. If you are relying on someone else to inject you, then they are in control of your dose.
Physical Health (liver functioning, weight loss, asthma, immune system problems, dehydration, malnutrition, etc.)
Using Alone
Though using alone doesn’t increase the potential for overdose, it means that no one is around to help you if something does happen.
What are some risk factors for overdose

22. Symptoms of Overdose
Slow heartbeat/pulse; pale clammy skin; fingers or lips turning blue
Deep snoring or gurgling
Extreme sleepiness, inability to awaken verbally or upon eternal rub (rubbing knuckles on center of rib cage)
Heavy nod, not responsive to stimulation

23. Naloxone (Narcan) Medication used to block the effects of opioids
8,102 naloxone administrations to reverse opioid overdose in % increase from 2017.
748 opioid-related overdose deaths in SC in 2017
33 overdose reversals in Fairfield County
If you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone. Naloxone is a medicine that can treat an opioid overdose when given right away. It rapidly restores normal respiration to a person who has stopped breathing as a result of overdose on prescription opioids or heroin. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. Naloxone is available as an injectable (needle) solution, a hand-held auto-injector (EVZIO®), and a nasal spray (NARCAN® Nasal Spray).
Some states have passed laws that allow pharmacists to dispense naloxone without a personal prescription. This allows friends, family, and others in the community to use the auto-injector and nasal spray versions of naloxone to save someone who is overdosing.
Fairfield Behavioral Health now offers this medication to patients / caregivers in case their love one overdoses on different drugs.
*DAODAS Opioid Fact Sheet

24. Visit this site for more information on efforts to combat opioid use.

25. Part 2 Narcan distribution training Douglas Johnson, Opioid Education & Narcan Distribution (OEND) Trainer Fairfield Behavioral Heath Services

26. Naloxone

27. What is Naloxone, and how Does it save lives?
Naloxone is an overdose reversal drug used by first responders across the country to save lives when someone overdoes on opioids like heroin or prescription pills.
Naloxone works by knocking the opioids out the receptors in the brain and blocking them from returning. It can be sprayed in the nose or injected into a muscle. This reverses all of the effects of the opioids taken. When enough naloxone is given, breathing returns to normal.
Naloxone is not treatment for addiction.
When people only use naloxone after an overdose without treatment, they are very likely to continue using opioids, and are at high risk of overdosing again.
100% safe and a person cannot overdose or get high off of it.
What is Naloxone, and how Does it save lives?

28. How to Recognize and Respond to an Opioid Overdose

29. How to Recognize an Overdose
Might not happen right away – could happen hours after use. (NOTE: Synthetic opioids, like fentanyl, often cause sign of overdoses MINUTES after use, or less)
Telltale signs:
blue lips and nails
slow, shallow, gurgling breathing
Pinpoint pupils
Unresponsive when you call their name, shake them, or rub their sternum (rub your knuckles hard up and down their breastbone)

30. Rescue Breaths
For a person whose breathing is severely impaired, rescue breathing is one of the most important steps in preventing an overdose death. When someone has extremely shallow breathing (around one breath every 5-10 seconds) or has stopped breathing and is unresponsive, rescue breathing should be done as soon as possible because it is the quickest way to get oxygen into someone who has stopped breathing. If you are performing rescue breathing, you are getting much needed air into someone’s body who will die without it. The difference between survival and death in an opioid overdose depends on how quickly enough oxygen gets into the person’s body.

31. Steps for Rescue Breathing
Place the person on their back
Tilt their chin up to open the airway.
Check to see if there is anything in their mouth blocking their airway if so remove it.
Plug their nose with one hand, and give 2 even, regular-sized breaths. Blow enough air into their lungs to make their chest rise. If you don’t see their chest rise out of the corner of your eye, tilt the head back more and make sure you’re plugging their nose.
Breathe again. Give one breath every 5 seconds.

32. REVIVE! – Responding to an Opioid Overdose Emergency
How to respond to a suspected opioid overdose emergency:
Five Essential Steps for Lay Responders
Check for responsiveness and administer initial rescue breaths if person is not breathing.
Call 911
Administer Naloxone.
Continue rescue breathing if person is not breathing on their own.
Stay with the person and monitor their response until EMS arrive.
REVIVE! – Responding to an Opioid Overdose Emergency

33. The Recovery Position Recovery position
If you have to leave the person for any reason, put the person in the recovery position
This will help keep their airway open and prevent them from choking on fluids

34. Brain Spark:
Someone you know is experiencing an overdose and there is evidence of heroin usage. The person is unconscious and unresponsive. What is the first thing you should you do?
Check for responsiveness and administer initial rescue breaths if person is not breathing.
Call 911
Administer Naloxone.
Continue rescue breathing if person is not breathing on their own.
Stay with the person and monitor their response until EMS arrive.

35. Brain Spark: Once you have Administered naloxone and the individual has awakened, what should you do?
Call 911

36. Don’t leave the person alone – they could stop breathing
Don’t put them in a bath – they could drown
Don’t induce vomiting – they could choke
Don’t give them something to drink – they could vomit
Don’t inject them with anything besides naloxone (such as saltwater, other drugs, or milk) – it wont work any more than physical stimulation, and can waste time or make things worse depending on what you inject
What NOT to do

37. Where to obtain Naloxone
Community Distributor
Pharmacy
Can be a public or private organization
Provides services to individuals at risk for opioid overdose.
Naloxone is available from pharmacies choosing to participate in its dispensing without a prescription pursuant to the Joint Protocol.

38. Storing Naloxone Store Do not freeze Keep Replace
· Store NARCAN Nasal Spray at room temperature between 59oF to 77oF (15oC to 25oC). NARCAN Nasal Spray may be stored for short periods up to 104°F (40°C).
Store
· Do not freeze NARCAN Nasal Spray.
Do not freeze
· Keep NARCAN Nasal Spray in its box until ready to use. Protect from light.
Keep
· Replace NARCAN Nasal Spray before the expiration date on the box.
Replace

39. Brain Spark Question
Which 2 medications do Fairfield Behavioral Health Services prescribe for opioid use disorder?

40. Brain Spark Question
Which drug are opioid users turning to when they can’t get prescription drugs?

41. South Carolina Law: S.C. Overdose Prevention Act SC Code Section 44-130-60
The Act seeks to grant immunity from both civil and criminal prosecution, to doctors, pharmacists, caregivers, and first responders, who are engaged in the prescription, dispensation and administration of Narcan in an opioid- overdose suspected case.
S.C. Code Section The Immunity
A Caregiver may in an emergency administer an opioid antidote to a person whom a caregiver believes in good faith is experiencing an opioid overdose if the caregiver has received the opioid overdose information.
A caregiver who administers an opioid antidote in accordance with the provisions of this section is not subject to civil or criminal liability.

42. The Good Samaritan Law: Enacted into law end of 2017 session
Provides criminal immunity to a person who calls the police or 911 to assist someone who is overdosing in an effort to save their life. _________________________ The joint protocol authorizes any pharmacist practicing in the State of South Carolina and licensed by the South Carolina Board of Pharmacy to dispense Naloxone-Hydrochloride (naloxone) products to persons without a prescription, pursuant to of the South Carolina Code of Law

43. Narcan ADAPT training video: https://www. youtube. com/watch