Canada leads the world in per capita consumption of opioids

Accidental overdose is the 3rd leading cause of unintentional death

Oxycontin delisting

In 1995, England and Germany became the first countries to distribute Naloxone to opiate users.

In Turin, Italy Naloxone is available over the counter.

In Scotland, Naloxone is prescribed by qualified nurses and pharmacists

Drug overdose is the leading cause of accidental death in the US

Started distributing naloxone in 1999Currently there are 183 Public Health

programs and they report 10 000 overdose reversals

Harm reduction saves lives

Edmonton street outreach program first to operate take home naloxone in Canada

August 31, 2011 Toronto Public Health became the first health unit in Canada to operate naloxone program

August 31, 2012 Ottawa Public Health and the BC CDC launched Naloxone programs

In January, a community wide Naloxone information session was held

Very well attended in person and via OTN at several sites across the region and province

Since that time, several potential prescribers have stepped forward in

Guelph and Waterloo Region

• Naloxone is an opiate antagonist which means that it binds to the same receptors in the brain that opiates do and temporarily removes the opioids and their harmful effects. This reverses the respiratory depression that can cause overdoses to be fatal.

• Naloxone is ONLY effective with OPIOID overdoses (i.e. heroin, oxycontin, morphine).

• The only known side-effect of Naloxone is withdrawal symptoms for someone with an opioid addiction, and skin sensitivity to the injection.

• When Naloxone is injected into a muscle or inhaled intra-nasally, it takes between 2-4 minutes to work.

• Naloxone lasts for up to 45 minutes.

• Since Naloxone only temporarily removes the opioids from the receptor sites in the brain, the opioids will return back to those receptors once the naloxone is gone, and the overdose symptoms can return

• It is therefore REALLY important to call 911 even if Naloxone is used!!!

A prescription medication 1 supplier in Canada – Sandoz Average cost: $11.35/ ampoule Not on the provincial formulary (ODB) Not covered by EAP (Exceptional

Access Program) Currently supplied by OHRDP (Ontario

Harm Reduction Distribution Program)

2 Ampoules of 1cc .4mg Naloxone Hydrochloride

3 – 1cc 25g 1-inch safety engineered intramuscular syringes (an extra syringe if one malfunctions)

Naloxone step-by-step pamphlet Alcohol Swabs (for opening ampoule) Prescription identifier Card

Goal: To provide take home Naloxone kits to

people who use opioids in order to prevent deaths caused by overdose

Sanguen discussed the proposed Naloxone program with: Guelph General Hospital ER and

Emergency Mental Health Unit EMS (Guelph-Wellington & Waterloo

Region) Police (Guelph & Waterloo Region) Cambridge Fire Department Public Health Department (Guelph-

Wellington & Waterloo Region)

Naloxone Medical Directive(Sanguen: Dr. Chris Steingart)

Sanguen Health Centre Staff (Registered Nurses, Social Workers, and Outreach Workers) trained and

certified to dispense Naloxone

Has a history of or is currently using opiates

Is at risk for overdoseWilling to take the overdose trainingWilling to complete the follow-up

evaluationsNo previous hypersensitivity to

Naloxone

Overdose risks and prevention tips Overdose myths – what not to do How to recognize opioid overdose 5 steps to intervening Debriefing / Evaluation

Mixing

•Avoid mixing drugs•Most overdose deaths occur because multiple drugs have been taken (i.e. alcohol, benzodiazepines + opioids)•Prevention: Use one drug at a time, or use less of each drug! Remember: You can always do more, but you can’t do less.

Tolerance

Tolerance is the body’s ability to increasingly withstand the effects of the substance•Develops over time so that the amount needed to feel the same effects increase•Can decrease rapidly when someone is not using•Prevention: use less drugs when tolerance lower (break from detox, prison)•

Inconsistent Drug Quality & Potency

•Drug quality is unpredictable. •Illegal drugs are unregulated, therefore their strengths unpredictable•Prevention: Inject a very small amount or snort the first bit to test the strength. Carefully check out a new product. Does it taste, smell, and look different?

Using Alone

•If you overdose, there will be no one to help you•Prevention: use with a friend (do not share needles), leave door unlocked, call someone.

Overdose Prevention

Opioids • Breathing is very slow, erratic or not at all

• Finger nails &/or lips blue or purple

• Body is limp• Deep snoring or gurgling

sound

• Vomiting• Loss of consciousness• Unresponsive• Pinpoint pupils

Stimulants • Seizures• Pressure/tightness in chest• Foaming at the mouth• Racing pulse• Perfuse sweating• Vomiting

• Headache, dizziness• Difficulty breathing• Sudden collapse• Loss of consciousness

Hallucinogens

• Psychosis• Catatonic syndrome

(person may sit in a trance-like state)

• Seizures• Nausea, vomiting

DO NOT Implications

Put the person in a bath/cold water

Person could drown or go into shock

Induce vomiting Person could choke

Inject them with anything (i.e. saltwater, cocaine, milk) other than naloxone

Does not help and can cause the person more harm. Wastes time.

Slap too hard, kick them in the groin, burn the bottom of their feet

Could cause the person serious harm

Let them sleep it off Person could stop breathing and die

DO NOT Implications

Give the person a shot of coke/speed or a Speedball (combination of a stimulant and depressant injected together in the bloodstream)

Giving a shot of cocaine increases overdose risk, because cocaine can numb the urge to breathe. Speedballing is dangerous because stimulants constrict blood vessels, and cause the heart to beat faster, which can depletes the body of much-needed oxygen, making the overdose worse.

Put ice down the pants / put the person in a cold shower

Likely won’t work. Also, these can slow down the respiratory system (worsening the OD) and cause shock/hypothermia.

Call 911

You do not have to tell them your name, that you suspect an overdose, or that drugs are involved

Once the paramedics arrive, tell them as much as you know about the drugs the person was using and what you did. This is to ensure that they can provide the best care and response.

1.) Stimulation

2.) Call 911

3.) Give Naloxone

4.) Rescue Breathing

5.) Is it Working? Give Naloxone Again

Toronto Public Health▪ POINT (Prevent Overdose in Toronto) Program

Preventing Overdose Waterloo Wellington

▪ http://www.preventingoverdose.ca/

Harm Reduction Coalition▪ www.harmreduction.org

29 Young Street EastWaterloo, ON

176 Wyndham St. NGuelph, ON

www.sanguen.com(519) 603- 0223(877) 351- 9857