YOU Can Help Someone Overdosing on an Opiate HHCLA Overdose Prevention and Response Program.

YOU Can Help Someone YOU Can Help Someone Overdosing on an OpiateOverdosing on an Opiate

HHCLA Overdose Prevention HHCLA Overdose Prevention and Response Programand Response Program

The Goal of this Project:The Goal of this Project:The Goal of this Project:The Goal of this Project:

To keep opiate users alive.To keep opiate users alive.

Purpose of TrainingPurpose of Training

TO LEARN:TO LEARN: Facts About OpiatesFacts About Opiates Facts About Opiate Facts About Opiate OverdoseOverdose

When to Use NaloxoneWhen to Use Naloxone How to Use NaloxoneHow to Use Naloxone How to Give Rescue How to Give Rescue Breathing Breathing

How to Get the Necessary How to Get the Necessary HelpHelp

All OpiatesAll Opiates

Are made from the opium Are made from the opium poppypoppy

Affect the same part of Affect the same part of the brainthe brain

Cause you to Cause you to stop stop breathingbreathing if you overdose if you overdoseQuickTime™ and a

TIFF (Uncompressed) decompressorare needed to see this picture.

Effects of Some OpiatesEffects of Some Opiates

OPIATEOPIATE DURATION DURATION INTENSITYINTENSITY

MethadoneMethadone 24 hours24 hours ++++++++

Heroin Heroin 6 to 8 hours 6 to 8 hours ++++++++++

Oxycontin Oxycontin 3 to 6 hours3 to 6 hours ++++++++

Codeine Codeine 3 to 6 hours3 to 6 hours ++

DemerolDemerol 2 to 4 hours2 to 4 hours ++++

Morphine Morphine 3 to 6 hours3 to 6 hours ++++++

OPIATEOPIATE DURATION DURATION INTENSITYINTENSITY

MethadoneMethadone 24 hours24 hours ++++++++

Heroin Heroin 6 to 8 hours 6 to 8 hours ++++++++++

Oxycontin Oxycontin 3 to 6 hours3 to 6 hours ++++++++

Codeine Codeine 3 to 6 hours3 to 6 hours ++

DemerolDemerol 2 to 4 hours2 to 4 hours ++++

Morphine Morphine 3 to 6 hours3 to 6 hours ++++++

Did you know…Did you know…

More injection drug users die from heroin More injection drug users die from heroin overdose than from any other cause overdose than from any other cause including AIDS, hepatitis or homicide.including AIDS, hepatitis or homicide.

Overdosing is an occupational Overdosing is an occupational hazard for heroin injectors.hazard for heroin injectors.

It is just as common among It is just as common among seasoned injectors as new seasoned injectors as new injectors.injectors.

It is just as common It is just as common among men as women.among men as women.

Overdoses are rarely suicide Overdoses are rarely suicide attempts. People who have attempts. People who have overdosed, say “I didn’t mean to do overdosed, say “I didn’t mean to do it; I just wanted to get high.”it; I just wanted to get high.”

Have you ever Have you ever overdosed?overdosed?

Have you ever Have you ever overdosed?overdosed?

Have you ever seen Have you ever seen someone OD?someone OD?

From Overdose to Death

Breathing stopsBreathing stops

Heart stopsHeart stops

Brain stopsBrain stops

Signs of OverdoseSigns of Overdose

1. Can’t be awakened - 1. Can’t be awakened - UnresponsiveUnresponsive

Test: Call name, Test: Call name, sternum or sternum or upper lip rub - do they respond?upper lip rub - do they respond?

2. Very slow or no breathing2. Very slow or no breathing Test: Test: Ear to mouth - can you feel Ear to mouth - can you feel

breath?breath?

3. Change in color of lips or 3. Change in color of lips or fingersfingers

Test: Test: Nails or lips are blue, Nails or lips are blue, purple, or ashypurple, or ashy

- or -- or -

- or -- or -

Preventing OverdosePreventing Overdose

1.1. Don’t mix alcohol or sedatives Don’t mix alcohol or sedatives with heroinwith heroin

2.2. Don’t inject aloneDon’t inject alone

3.3. Start with smaller dosesStart with smaller doses• after a period of abstinence after a period of abstinence

(e.g., after getting out of (e.g., after getting out of jail or drug treatment, or jail or drug treatment, or after taking a break)after taking a break)

• with heroin from a new with heroin from a new sourcesource

What Do You Know About What Do You Know About Naloxone (Narcan)?Naloxone (Narcan)?

Naxolone Naxolone temporarily temporarily reverses an opiate OD by reverses an opiate OD by kicking out the heroin kicking out the heroin from the brain’s opiate from the brain’s opiate receptors to allow receptors to allow breathing to be restored.breathing to be restored.

Naxolone Naxolone temporarily temporarily reverses an opiate OD by reverses an opiate OD by kicking out the heroin kicking out the heroin from the brain’s opiate from the brain’s opiate receptors to allow receptors to allow breathing to be restored.breathing to be restored.

Naloxone (Narcan)Naloxone (Narcan)

The effect lasts for 30 – 60 The effect lasts for 30 – 60 minutesminutes

Effects of NaloxoneEffects of Naloxone

Naloxone usually takes effect Naloxone usually takes effect in 1 to 2 minutesin 1 to 2 minutes

It could take up to five minutesIt could take up to five minutes

Naloxone lasts about 30 Naloxone lasts about 30 to 60 minutes, then the to 60 minutes, then the overdose effects can overdose effects can returnreturn

Naloxone puts the OD’r into Naloxone puts the OD’r into withdrawalwithdrawal Don’t let someone who you treat with Don’t let someone who you treat with

Naloxone use again - the OD can Naloxone use again - the OD can come back!come back!

Storage of Naloxone

Naloxone must be stored Naloxone must be stored out of direct out of direct sunlightsunlight and be kept as and be kept as coolcool as possible. as possible.

Keep it in its box and in the bag it’s given to you in.Keep it in its box and in the bag it’s given to you in. You do not need to refrigerate it.You do not need to refrigerate it.

Naloxone expiresNaloxone expires Check the expiration date and ask for a new Check the expiration date and ask for a new

dose if it’s close to the date.dose if it’s close to the date.

Don’t store ANY drugs or Don’t store ANY drugs or paraphernalia in the bag with paraphernalia in the bag with your Naloxone!!!your Naloxone!!! The police in the Skid Row area are aware of The police in the Skid Row area are aware of the HHCLA programthe HHCLA program

Naloxone Naloxone Does NotDoes Not Work for Work forNaloxone Naloxone Does NotDoes Not Work for Work for

Overdoses of:Overdoses of:

ValiumValium XanaxXanax AlcoholAlcohol

ClonopinClonopin AtivvanAtivvan

ClonidineClonidine

Elavil Elavil 2. 2. StimulantsStimulants CocaineCocaine

AmphetaminesAmphetamines

1. Non-opioid 1. Non-opioid SedativesSedatives

Other uses for NaloxoneOther uses for NaloxoneOther uses for NaloxoneOther uses for Naloxone

Naloxone has NO other uses!Naloxone has NO other uses!

It cannot be used to It cannot be used to get highget high

If the person is not If the person is not overdosing on an overdosing on an opiate it will have no opiate it will have no effecteffect

The The SCARE MESCARE ME Technique Technique

Is s/he breathing on own? Is Is s/he breathing on own? Is another dose of Naxolone needed? another dose of Naxolone needed? Seek help and stay.Seek help and stay.EEvaluatevaluate & Support& Support

Inject 1cc of Naloxone into a Inject 1cc of Naloxone into a muscle –muscle –Upper arm, thigh or buttockUpper arm, thigh or buttockMMuscularuscular injectioninjection

Is s/he any better? Can you get Is s/he any better? Can you get Naloxone prepared quick enough so Naloxone prepared quick enough so they don’t go too long with a they don’t go too long with a breath.breath.

EEvaluatevaluate

If s/he is not breathing, breath If s/he is not breathing, breath for him/her –for him/her –2 slow breaths2 slow breathsRRescueescue BreathingBreathing

Make sure there is nothing in the Make sure there is nothing in the throat and the airway is clear of throat and the airway is clear of blockageblockageAAirwayirway

Call 911 and say Call 911 and say ”my friend is not ”my friend is not breathing”breathing”CCallall for helpfor help

Call their name and shake him/herCall their name and shake him/herRub sternum or upper lipRub sternum or upper lipSStimulationtimulation

SStimulationtimulation

Call his/her name loudlyCall his/her name loudly

Rub your knuckles on his/her Rub your knuckles on his/her sternum (breastbone)sternum (breastbone)

Don’tDon’t

Hit, slap or punchHit, slap or punch

Rub with ice or put in a cold showerRub with ice or put in a cold shower

Inject with water, milk, or saltInject with water, milk, or salt

These things won’t get the heroin out These things won’t get the heroin out of his/her system, and might cause injuryof his/her system, and might cause injury

CCall 911 for helpall 911 for help

Avoiding Police Avoiding Police InvolvementInvolvement Speak clearly and Speak clearly and conciselyconcisely

Keep room quietKeep room quiet

Try not to lie, if Try not to lie, if asked, tell them you asked, tell them you think the person took think the person took something, but you’re something, but you’re not sure what it was.not sure what it was.

““My friend has stopped My friend has stopped breathing”breathing”

AirwayAirway

Check for gum, food, the tongue, or anything Check for gum, food, the tongue, or anything else that might be blocking the airway. else that might be blocking the airway.

Check to see if there’s anything blocking Check to see if there’s anything blocking the person’s airway - can air get through?the person’s airway - can air get through?

Rescue BreathingRescue Breathing

Tilt the head back and listen for Tilt the head back and listen for breathing. 

If not breathing normally, If not breathing normally, pinch nose pinch nose and cover the mouth with yours and blow and cover the mouth with yours and blow until you see the chest rise.until you see the chest rise. Give 2 Give 2 slow breaths.  slow breaths. 

Each breath should take 1 second.Each breath should take 1 second.

BLOWBLOW

EEvaluatevaluate

Has anything changed?Has anything changed?

Is person breathing on their own?Is person breathing on their own?

If not:If not: get the Naloxone readyget the Naloxone ready

continue rescue breathingcontinue rescue breathing

Muscular InjectionMuscular InjectionIf the person is still not breathingGive 1cc of Naloxone into a muscle

(one shot from the pre-filled syringe = 1cc)

Keep giving rescue breathing

Evaluate

Is person breathing on their own?Is person breathing on their own?

If not:If not: Give 5 more breaths, one breath Give 5 more breaths, one breath every 5 secondsevery 5 seconds

Inject another vial of Naloxone Inject another vial of Naloxone with a new needlewith a new needle

Continue rescue breathing until Continue rescue breathing until the paramedics arrivethe paramedics arrive

Recovery PositionRecovery Position

If you must leave the overdoser alone and he is If you must leave the overdoser alone and he is breathing normally, place him on his side in the breathing normally, place him on his side in the recovery positionrecovery position

Mouth down, head Mouth down, head turned so vomit cannot turned so vomit cannot block airway;block airway;

Brain at same level Brain at same level of/lower than heartof/lower than heart

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Picture available at: Picture available at: http://www.justoneshot.org.uk/help.htm

We always recommend that We always recommend that you stay until the you stay until the paramedics arrive.paramedics arrive.

Don’t Leave!

Even if the person wakes up Even if the person wakes up and starts breathing, the OD and starts breathing, the OD could come back. could come back.

The effects of heroin last much The effects of heroin last much longer than Narcan.longer than Narcan.

The person who OD’d needs to go to The person who OD’d needs to go to the hospital to be observed.the hospital to be observed.

S/he will probably feel dope sick - S/he will probably feel dope sick - don’t let him/her use again - the don’t let him/her use again - the heroin is still there.heroin is still there.

Wait for EMSWait for EMS

When they arrive:When they arrive:

If you know, tell them what If you know, tell them what the person tookthe person took

Tell them how much Naloxone Tell them how much Naloxone you administeredyou administered

Encourage overdoser to go to Encourage overdoser to go to hospitalhospital

Addressing your concerns about responding to an ODAddressing your concerns about responding to an OD

Could I catch something (e.g., HIV Could I catch something (e.g., HIV or HCV)?or HCV)?

Will I be able to remember how to Will I be able to remember how to do it right?do it right?

Could I get arrested?Could I get arrested?

What are the side effects of What are the side effects of Naloxone?Naloxone?

Side effects could include: Allergic Side effects could include: Allergic reactions, Palpitations, Arrhythmia, reactions, Palpitations, Arrhythmia, SeizureSeizure

Talk with your friendsTalk with your friends

Who do you use with?Who do you use with?Do they have Naloxone and know how to use it? they have Naloxone and know how to use it?

Talk with your friends about Talk with your friends about getting trained to use Naloxonegetting trained to use Naloxone

Show them the Naloxone videoShow them the Naloxone video

Make a plan - tell them where Make a plan - tell them where you keep your Naloxone and what you keep your Naloxone and what you want them to do if you ODyou want them to do if you OD

Your Turn - Demonstration Your Turn - Demonstration and Practiceand Practice

ReviewReview

We created this training with the help of others.We created this training with the help of others.

Thank you to:Thank you to:

The Chicago Recovery Alliance (developers of the SCARE ME technique)The Chicago Recovery Alliance (developers of the SCARE ME technique)

The DOPE ProjectThe DOPE Project