Opiate Overdose Prevention

Harm Reduction and Naloxone Administration Training

Purpose of Training

This training is designed to offer a brief education on opiate addiction and opiate overdose in relation to it’s effects on the brain.

This training program will teach you possible actions that you can take to prevent overdose and fatal overdose, such as Naloxone administration.

This training will not qualify you as a medical professional, but you will leave with a better understanding of the opiate epidemic and the life-saving actions your capable of performing.

Training OverviewPre-testPresentation

-Drug use, Addiction, Overdose statistics-Addiction and Overdose and the Brain-Naloxone and the Brain

Live VideoNaloxone Administration Demonstration Paperwork/Follow upQuestions

Is this training Necessary?Drug use, Addiction, and Overdose Facts

Everyday in the U.S. 100 people die of overdose

Is this training necessary?Nationally

Drug Overdose has become the leading cause of injury death

Opioids, such as heroin, account for about 80% of those deaths.

Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes

Drug overdose death rates have been rising steadily since 1992 with a 102% increase from 1999 to 2010 alone

According to the Center For Disease Control

and Prevention

Is this training Necessary?State of Illinois

In Illinois, more people die from overdose, then the national leading cause of death, Car Accidents. Heroin is the most commonly citeddrug among primary drug treatment admissions in Illinois.

Is this training necessary?

According to “Heroin Use in Illinois: A Ten-year Multiple Indicator Analysis” by the Illinois Consortium on Drug Policy at Roosevelt University 1998-2008

Regional Level

Chicago metropolitan area was ranked among the worst nationally for heroin-related problems

It ranked first in the number of individuals admitted to the emergency room for heroin abuse and first in percentage of arrests testing positive for heroin

Cook County“Heroin Hub”

In 2012, nearly 25,000 people were admitted to Cook County emergency rooms for heroin-related incidents.

That same year 533 people died from Opiate Overdose.

1996 1997 1998 1999 2000 20120

100200300400500600

Opiate Overdose Deaths

DuPage County46 Heroin related deaths in 201315 people in 17 days in July 2013 aloneBoth males and femalesAges 15-64

2010 2011 2012 201301020304050

2923

3846

Heroin Deaths

McHenry County

122 drug overdose deaths occurred from 2009 to 2012 in McHenry County

McHenry County had 16 heroin deaths in 2012, the highest total since 2008

A study found a large increase in deaths from heroin overdoses in the collar counties, including a 150% increase in McHenry County in a 3-year period.

Lake County2008 2009 2010 2011 2012

020406080

HeroinTotal Overdoses

Drug Related Death Yearly Comparisons

52

44

66

52

65

GenderMale Female

8 14

2012 Opioid Overdoses Age Range21-30 631-40 141-50 951-60 7Ages 0-20 and 61+ did not see any overdoses this year (2012)

All that said….Yes, this training is necessary!

Not all first responders are trained and equipped with Narcan or Naloxone

Opiate overdose deaths are on the rise, especially in the suburbs.

Its anticipated that this epidemic will get worse before it starts to get better.

YOU can save a life!

YOU have the ability to save a life

Opiates, Addiction, and the Brain

Opioids All categories have overdose risk.

Opioids

Natural Semi-Synthetic Fully Synthetic

Opiates

OpiumMorphineCodeine

HeroinHydrocodoneOxycodone

FentanylMethadoneDemerol

Opiate Similarities and Differences

Similarities DifferencesCome from the opium

poppy or are chemically created to be like a drug that comes from the opium poppy

Effect the same part of the brain

Can cause overdose in the same way

(when breathing stops)

Have different concentrations or strengths

Have varying durations of action

“Opiates are like beef, you can have steak or you can have hamburger, but either way you are eating beef. Same with opiates.”

Opiate Comparisons

Drug Duration Potency

Methadone 24hr ++++

Heroin 6-8hrs +++++

Oxycotin 3-6hrs +++++

Codeine 3-4hrs +

Demerol 2-4hrs ++

Morphine 3-6hrs +++

Fentanyl 2-4hrs ++++++++++++++++++++++

To be more specific…

Street namesHeroin: Smack, H, Tar, Junk, Dope

Hydrocodone: norcos, vikes, vic, watson

Oxycodone: oxy, percs, OC, cets

Brain Stem

Memory

Pleasure

Drive

Prefrontal Cortex Critical

impulse control(The Brake)

Gas pedal

Steering Wheel

Not fully developed in women until 21yrs and25 yrs for men

Vitals(Breathing)

We are wired for addiction

Our Pleasure line

SteakDinner

Heroin Use

“dope sick”

Let’s Talk PreventionWhat message do we want our loved ones to hear

Overdose Risk FactorsUsing aloneLow tolerance(treatment/lock-up)Mixing drugs is a recipe for overdoseSilence kills

Don’t use!

Tips for safe usingDon’t use alongStart low, go slowBe intentional/ don’t mixTalk, be honest have a user contract and a plan

Let’s talk Preventing Fatal Overdose

Recognize and Respond

Have an overdose plan Be trained to carry and administer Naloxone, have family and friends trained, people who use with you trained and know about the Good Samaritan

Signs to Recognize OverdoseSigns of being

really high

Pupils pinned Nodding (but arousable) Sleepy, intoxicated, but

breathing (8 or more time per minute)

Slurred speech

Stimulate & Observe

Signs of Overdose

Pupils pinned Not arousable (Sommolence)

(does not respond to sternal rub or painful stimuli)

Breathing slow or stopped(Respiratory Depression/Apnea)-chocking/gurgling/ snoring sounds

Slow Heartbeat (Bradycardia) Cold or Clammy Skin Blue lips or nails

Rescue Breathe & Naloxone

StimulateCan you wake the individual?

If they are not responsive

Call for HelpLay them

in the recovery position

Head turnedMouth down

Brain at same level as heart

The Good Samaritan Act

Calling for helpIllinois Public Act 097-0678

You & the overdose victim cannot be charged with possession for small amounts of illegal drugs when calling 911 or taking someone to an emergency room for an overdose.

For more information visit: www.stopoverdoseil.org

The A & B of LifeAirway and Breathing

Airway

Rescue Breathing

Make sure the air way is clear and nothing is preventing the person from breathing by checking their mouth.

Breathe for them.Two quick breathes every five seconds

EvaluateAre they any better? Can you get and prepare Naloxone quick enough that they won’t go too long without you breathing for them?

How does Naloxone work?

What is Naloxone?

The opiate antagonist

Opiate overdose antidote

Opiate Reversal

Naloxone

Breathing restored!

Naloxone has stronger affinity for opioid receptor

How do opioids affect breathing?Opioids are depressants that at high levels can repress the urge to breath

Naloxone

Illinois Public Act 096-0361 allows individuals to administer naloxone in the event of an overdose

Also known as Narcan

Works in 1-3 minutes

Non-scheduled drug

Cannot be abused

Benign substance that has not shown any adverse side effects in a healthy person

Temporarily takes away high, allowing the person the chance to breathe

Too much can cause withdrawal symptoms

Naloxone Administration

1ml-2ml or cc (equals 100units)

Repeat the dose every 2-3 minutes until they’re waking up

If they aren’t responding after 3 doses, it’s probably not an opiate overdose

(If you haven’t already, call for help and continue CPR until help arrives)

Naloxone Administration

There are different forms of Naloxone(Nasal spray, one-dose glass ampoules, pre-loaded single-dose syringe, multi-dose 10mg bottle)

Intramuscular injection (with 1-1½ inch needle) Into the muscle Needle goes all the way inGoes through clothes

May take a few minutes to work

Muscular Injection

Drug DurationMethadone 24hrs

Heroin 6-8hrsOxycotin 3-6hrsCodeine 3-4hrsDemerol 2-4hrsMorphine 3-6hrsFentanyl 2-4hrs

Naloxone 30-40minutes

Does not last in system as long as other drugs. High can return, overdose can occur again. Therefore, it is important to stay with individual for TWO hours to make sure they don’t overdose again or try to get high.

Evaluate & SupportAre they breathing on their own? Is another dose needed?

Evaluate and SupportComing off Naloxone

Emergency Rooms administer 2mg through IV

IV/Intravenous injection is fastest route of administration(You are NOT trained for this)

This results in SEVERE withdrawalsSupport is needed!

Using again will make the OD worse when the naloxone wears off.

If you can support the person as they deal with the discomfort, the naloxone will wear off and the withdrawal will fade.

Find out what they took. Opiates that last longer have longer lasting overdoses. (i.e.. Methodone may last 6-8hours)

Live!The live demonstration

Questions?Regarding the material we’ve gone over….

So Naloxone will save lives!

Great! Now I can use.

Yes, Naloxone will save your life.

However, there is no saying what state the overdose will leave you in.

Overdose obstructs oxygen from getting to your brainPhysically you may

come to, paralyzed

Jazzmin’s Journey: Directed by God

Overdose can lead to Hypoxic brain injury .These brain injuries can cause coma, seizures and, in worst case scenarios, brain death

A brain injury can result in mild to severe impairment of:•movement, balance and co-ordination•senses such as hearing or vision•spoken and written communication•thinking, concentration and memory.

In severe cases, brain injuries from overdoses can leave people in a vegetative state.

It is not naloxone that leaves these unfortunate

consequencesIt is the overdose!

Silence Kills

“There's not enough being done. There's no state action plan.

People are always going to talk about the cost of things. Well it costs about $30,000 every time someone overdoses, but it costs $25 for a Naloxone kit. It costs

more to not do something that to do

something."

It cost 7 times more to imprison an

individual for their disease than to

treat them for it.

To put that in perspective, in Illinois it cost

nearly $38,258.00 per inmate in 2010

to house an individual.

Illinois is in the top ten states to have

the highest population of inmates and

highest cost per year per inmate.

It cost each tax payer $1,743.20 a

year.

We spent nearly 1.2 billion in prison expenditures

$566.1 million in prison related cost outside the budget

“I could pay $10,000 for

treatment or I could pay that

much for a funeral”

Break the StigmaThe word “addict”

ConfidentialityPeople first languageUser friendlySomeone’s loved one

Break the StigmaAddiction is not a matter of will power.

Addiction is a mental illness

Addiction is a brain disease

Addiction is a chemical rewiring of the brain and the way in which we respond to pleasure

Addiction has little to nothing to do with will power

Those with an addiction cannot just stop. They need professional and medical treatment.

What is being done to fight this epidemic

Illinois’ Good Samaritan Act Illinois law, 20 ILCS 301/5-23

You & the overdose victim cannot be charged with possession for small amounts of illegal drugs when calling 911 or taking someone to an emergency room for an overdose.

For more information visit: www.stopoverdoseil.org

Illinois’ Naloxone Expansion Act

This act explains the expansion of naloxone to lay people with proper Training through overdosePrevention programs suchas this one .

Illinois public Act 096-0361

GRASPLTM

Foundation

Take A Stand

Find SupportDon’t Roll the Dice-Ja2Soon

StopOverdose

IL

High on Life

Chicago Recovery Alliance

Live4Lali

New Directions Addiction Recovery Services

The Other Side

H.E.R.O.

Together we are One Loud Voice

Serenity Family

Outreach

Open Hearts

open eyes

PATH

Refer your friends and family to usSpeak up! Carry NaloxoneEducate othersTalk to your kids, your parents, your peersWrite a letter to your school or your child’s schoolWrite a letter to your local police station or a government official/politicianFind local take back days

-Addiction can stem from prescription drugs-Monitor your drug cabinet

Thank you!

Credits:Wake the NationMassachusetts Department of Public HealthDr. WalleyMA Harm Reduction CoalitionDr. Celeste NapierCenter for Disease Control and PreventionKathie Kane-Willis and Illinois Consortium on Drug Policy Roosevelt UniversityDan Bigg and the Chicago Recovery allianceDuPage County Health Department DuPage Coalition Against HeroinMcHenry County Public Health DepartmentWanereye CommunicationISTOCK images