Healthy Streets Outreach Program a program of Northeast Behavioral Health 280 Union Street Lynn, ma 781-592-0243
Jan 17, 2016
Healthy Streets Outreach Programa program of Northeast Behavioral Health
280 Union StreetLynn, ma
781-592-0243
First things first…slang Jammed, jambox, jam sandwich: really high
Falling out: overdosing
Fell out: overdosed
Dope: heroin
Narcon or Narcain: Narcan pronounced incorrectly
Beaned out: on a lot of benzos
Opioid OD Stats:Two people die from opioid overdoses every day in
Massachusetts.
More people are killed by opioid overdoses in Massachusetts
than by car accidents.
In 2007, there were over 6 times more deaths due to opioid-
related overdoses than in 1990.
For every death due to an opioid overdose in 2007, there
were 47 people who were treated for an overdose and lived. *Sources: “Opioids: Trends and Current Status in Massachusetts,” Massachusetts Department of Public HealthBureau of
Health Information, Statistics, Research, and Evaluation and the Bureau of Substance Abuse Services, 2009 DAWN data “Massachusetts Oxycontin Commission: Final Report” 2009
MDPH Pilot Details: Standing order authorizes Approved Opioid Overdose Trainers to
possess nasal naloxone and to distribute it to Approved Opioid
Overdose Responders.
Trainers and Responders are authorized to administer naloxone
to person experiencing a drug overdose.
Approved by MDPH Drug Control Program and the Commissioner
of DPH, overseen by medical director Dr. Alexander Walley.
DPH General Counsel’s Office determined the legality of the pilot
programs. Once efficacy of the pilots has been established, Public
Health Council will be asked to pass regulation to make the
program permanent.
Expanded AccessCurrently providing OD
prevention in additional venues:
DetoxMethadone clinicsSuboxone programsHomeless sheltersOther HIV P&E
programs Parent support groupsCorrections
Opportunity for Family InterventionMajority of ODs occur in the presence of others
ODs can be reversed by rescue breathing and/or Narcan
(Naloxone) administration
Many younger drug users are still living at home or are still
allowed to visit the home.
Treatment options can be discussed at the hospital with
family present in the case of an overdose.
Realistic and useful education for families.
Narcan Training Components20-minute session (or longer)
Enrollment form (used for data collection, risk
assessment, risk reduction)
Review of overdose risks, prevention, response,
calling 911, rescue breathing, refill procedure
Participant repeats information back,
demonstrates ability to assemble Narcan
What is an Opioid Overdose?
The brain has many, many receptors for opioids. Too much opioid fitting in too many receptors slow and stop the breathing.
Opioid fits exactly in receptor
Opioid receptor on brain
Narcan reversing an OD
Narcan has a stronger affinity to the opioid receptors than the heroin, so it knocks the heroin off the receptors for a short time and lets the person breathe again.
Opioid receptor
Narcan
Heroin
Opioid ODs, continued
ODs are rarely instantaneous!
ODs happen as a process- someone slowly stops
breathing
They usually happen 1-3 hours after the drug was used
Someone “found dead with a needle in their arm” is a rare
event that is sensationalized
What are the Signs/Symptoms of an OD?
Blue skin tinge- usually lips and
fingertips show first
Body very limp
Face very pale
Pulse (heartbeat) is slow, erratic, or not
there at all
Throwing up
Passing out
Choking sounds or a gurgling/snoring
noise
Breathing is very slow, irregular, or has
stopped
Awake, but unable to respond
REALLY HIGH OVERDOSE
Muscles become relaxed
Deep snoring or gurgling (death rattle)
Speech is slowed/slurred
Very infrequent or no breathing
Sleepy looking Pale, clammy skin
Nodding Heavy nod, not responsive to stimulation
Will respond to stimulation like yelling, sternal rub, pinching, etc.
Slow heart beat/pulse
Slow heart beat/pulse
What puts people at risk for ODs?
Mixing Drugs
Variation in strength and content of ‘street’ drugs (purity)
Tolerance changes (coming out of jail/TX)
Using alone
Physical Health (liver functioning, weight loss, etc.)
Transient living – new dealers/new product
Thinking you “know everything”
Switching from sniffing/eating to injection.
How can you avoid an opioid overdose?Know your tolerance
Know your supply
Control Your Own High
Be Aware of the Risks of Mixing Drugs
Try not to use alone
Make a plan
Talk with other users
Stop Using
Prevention Messages for FamiliesI want to remind you that (BECAUSE OF) your
tolerance is very low, you are at high risk for an
overdose.
Do you have an overdose plan? Do you and your
friends know about Narcan?
I love you but not what you do and I do not want
anything to happen to you.
If you relapse please do not do it alone.
A few words about benzos: They are long acting (at least a day, usually)
They impair your short-term memory. So you can actually forget how
many benzos or how much heroin you have used in the last 24 hours-
this could put someone in danger for an OD!!
Very common and easy to find on the street
Cheaper than heroin
They are frequently necessary for mental health reasons- there is a
high comorbidity between substance abuse disorders and mental
illness like anxiety, depression, and post-traumatic stress disorder
Make people who are in withdrawal feel better
People use benzos to get jammed- enhances the effects of heroin (or
methadone, etc)
Drugs could be cut or enhanced with benzos without the user knowing
Responding to an Overdose“Are you alright? You ok?”
No response try a STERNUM RUB
Call 9-1-1
Give the person AIR using rescue breathing
Give 2 or 3 breaths and set-up the Narcan
Spray the Narcan
Continue rescue breathing
Spray second dose if necessary
Continue rescue breathing
If an OD happens…Recovery Position
Overdose Prevention Using Nasal Narcan
Simple device, medication and nasal spray
Narcan is a pure opiate antagonist
No physiological effect other than blocking opiates
No adverse reactions
No potential for abuse or potential for OD
Narcan Kit components
What are barriers to calling 911 from the perspective of a substance user?
Fear of legal risk (outstanding warrants, DSS
involvement, loss of public housing)
Fear of judgment from family/ community
Personal embarrassment/shame
Other punitive measures (students loose federal
financial aid)
Manslaughter charges if someone dies on the scene
What about families?Are there fears about calling 9-1-1 among
families?
How will YOU handle this discussion if it
comes up without judging the person in front
of you?
Street Methods now have safer alternatives 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 throw up
Don’t put ice down their pants- it’ll make their pants wet! Cooling down the core
body temperature of someone who is ODing is dangerous because it will slow down
their body function even more than just the OD.
Don’t try to stimulate them in a way that could cause harm- slapping too hard,
kicking in the testicles, burning the bottom of the feet, etc. can cause long-term
damage
Don’t inject them with anything (saltwater, cocaine, milk)--it won’t work any more
than physical stimulation and can waste time or make things worse depending on
what you inject; a salt injection, for instance, could cause someone to go into
cardiac arrest if they already have high sodium levels in their system. Also, every
injection brings a risk of bacterial infection, abscesses, endocarditis, cellulitis, etc.
Does Speedballing balance you out?“Speedballing” refers to any combination of a stimulant
(upper) and a depressant (downer) taken together, esp.
a mixture of heroin and cocaine or heroin and
methamphetamine injected into the bloodstream.
No- speedballing does not cancel out OD risk
The more different drugs someone’s body has to
process, the harder it is on their body
People who speedball usually use much more frequently
that people who use only heroin- this increases OD risk
Will using Narcan help someone give a clean urine?No
Narcan knocks opiates off the opiate
receptors, but the drug is still floating around
in the body (AND urine!)
Can you use Suboxone to reverse an OD?Not a good idea, probably not enough Naloxone in a Suboxone
to reverse and overdose, will not act fast enough
Suboxone is a drug that contains both Buprenorphine (a partial
agonist) and Naloxone (antagonists, same thing as Narcan)
Suboxone is supposed to be taken sublingually, and if taken
this way, the Naloxone has no effect
If crushed and snorted, or injected, the Naloxone is “activated”
and acts as an antagonist
EnrollmentsBLUE or BLACK Pen
Non-users do not get asked any questions below the lot number.
Must fill in all information
If you do not have an answer use X’s or a zero
Use leading zeroes
If someone is not sure they are enrolled please fill out another
enrollment
DO NOT FORGET THE BSAS CODE
All codes are on the back of the enrollment
RefillsNever give a kit without doing the refill form.
Only answer all the questions if they are
reporting an overdose.
ALWAYS write comments, especially if it is a
reversal.
I used the Narcan.Trauma associated with witnessing an OD
may not manifest immediately.
Be open to hearing the details but never ask
for the details.
Positively reinforce all actions performed by
the responder.
Refill Narcan
Mary WheelerProgram Director – Healthy Streets Outreach
Program a program of Northeast Behavioral Health