Opioid Overdose Responder Training

1. Opioid Overdose Responder Training NYC DOHMH Bureau of Alcohol and Drug Use Prevention, Care and Treatment

2. What is an overdose? The ingestion of a legal or illegal substance in more than the usual dose either intentionally or unintentionally.

3. What is an overdose? The ingestion of a legal or illegal substance in more than the usual dose either intentionally or unintentionally. Ingestion = �taking in.� You can overdose by ingesting in a number of ways (not just injecting)� sniffing, smoking, snorting, swallowing pills, etc. Legal or illegal substances = just because something is legal doesn�t mean it�s safe. Examples: alcohol, methadone, prescription pills.

4. Most overdose deaths in NYC are due to opioids Which drugs are opioids? How many opioids can you name?

5. Opioids include Heroin Morphine Codeine Methadone Demerol Oxycodone OxyContin Percodan Percocet Hydrocodone Vicodin Fentanyl Hydromorphone Dilaudid

6. Opioids and cocaine are most common in overdose deaths in NYCMentions on Death Certificates; Overdose Deaths, NYC, 2009 Mentions are mutually INCLUSIVE � Polydrug use is common in NYCMentions are mutually INCLUSIVE � Polydrug use is common in NYC

8. What does an opioid overdose do to the body? Generally happens over 1 to 3 hours The stereotypical �needle in the arm� death is NOT common (only about 15%). Most take much longer, and happen over time. Opioids suppress the urge to breathe Decrease response to carbon dioxide, leading to slowed breathing and death

9. What does an opioid overdose do to the body? Slow breathing ? Breathing stops ? Heart stops ? Circulation of blood to the brain stops

10. What factors could put you at risk of an overdose?

11. What factors could put you at risk of an overdose? Reduced Tolerance Illness Depression Unstable housing Using alone- more likely to be fatal Mixing Drugs Changes in the Drug Supply History of previous overdose Using in a new environment

12. What factors could put you at risk of an overdose? Reduced tolerance: using after a period of clean time, such as after release from jail or prison, hospitalization, or drug treatment. Mixing drugs: almost all overdoses that resulted in death in NYC were due to more than one substance, such as methadone and xanax. Using alone: Because overdose can take

13. What does an opioid overdose look like?

14. Signs of an opioid overdose Not responsive. Blue lips and nail beds Slow or no breathing, gurgling, snoring, �death rattle�

15. Is the person overdosing?To find out, stimulate the person Shake them, call their name loudly. Sternal Rub: rub your knuckles up and down breast bone Ice can work but this is easier Pain can stimulate someone to wake up but you don�t want to cause injury If the person does NOT respond, they may be overdosing. Take action!

16. Common mistakes Salt, milk or cocaine shots are falsely believed to reverse overdoses Ice on genitals- may rouse someone but the sternal rub is easier Cold shower Excessive hitting or burning feet or fingertips

17. What is Naloxone? Naloxone is also known as �Narcan.� Naloxone is a medication which reverses the effects of opioids, preventing fatal overdose. Naloxone restores breathing and consciousness. Naloxone can be given as a shot or as a nasal spray.

18. Naloxone reverses the effects of opioids. It does NOT work for substances that are NOT opioids, such as: NOT OPIOIDS: Alcohol Benzodiazepines Xanax, Valium, Klonopin Tricyclics Elavil (amitriptylene) GBH Cocaine Amphetamines Methamphetamine Ecstasy Ketamine

19. Mixing Drugs But: If someone is using an opioid in combination with another drug, naloxone will work. If you think someone MAY have used an opioid, even if you are not sure, use the naloxone. It won�t hurt and could help.

20. Overdose rescue kits Naloxone comes in two forms: Injectable (intramuscular injection) Intranasal (nasal spray)

21. A naloxone kit includes: INTRA-NASAL A face mask for rescue breathing 2 doses of naloxone 2 intranasal devices A brochure reviewing OD and rescue steps

22. Legality It is completely legal for a Trained Overdose Responder to carry and use naloxone in NYS. You can use naloxone even if you don�t have the card with you.

24. �Opioid Overdose Prevention Program�NYS Public Health Laweffective April 1, 2006 �the purchase, acquisition, possession or use of an opioid antagonist pursuant to this section shall not constitute the unlawful practice of a profession. Use of an opioid antagonist pursuant to this section shall be considered first aid or emergency treatment for the purpose of any statute relating to liability��

25. So what do you do when someone is overdosing?

26. Step 1: Get Help Call 911 Tell them you have a friend who is not breathing. Make sure EMS has a clear path to get to you, and doors are unlocked. Give clear directions.

27. Step 2: Rescue breathing

28. Instructions for rescue breathing Put the facemask, found in your rescue kit, on the victim�s face Tilt victim�s head back, make sure nothing is blocking the airway, and pinch nose Give 2 quick breaths and count to 5 Give 1 long breath Continue giving 1 breath every 5 seconds

29. If you are trained to give CPR, do it. Do not give rescue breathing If you are trained to give CPR, for Step 2, give CPR instead of rescue breathing. Remember: 1 round of CPR = 2 breaths 30 compressions

30. Rescue breathing or CPR Sometimes, the victim may wake up just from the oxygen alone. If so, do not continue to Step 3.

31. Step 3: Administer naloxone

32. Administering naloxone Nasal: Spray half of the vial of naloxone into each nostril Injectable: Inject the entire vial into the upper arm or thigh Continue rescue breathing (or CPR, if you�re trained) as needed If the person doesn�t respond to 1st vial of naloxone, wait 2-5 minutes and give the 2nd vial

33. Naloxone (Narcan) Reverses temporarily opiate effect of sedation and respiratory depression Takes effect within 2 - 8 minutes Causes sudden withdrawal in the opioid dependent person � an unpleasant experience Can�t get high from it Has no effect if an opiate is not present Routinely used by EMS (but in larger doses)

34. After naloxone is given: Awake and breathing Naloxone/Narcan wears off in 30-90 minutes Reassure the victim if s/he is feeling dope-sick � the naloxone will wear off. Using more drugs won�t have any effect while naloxone present. Instruct victim to go to the hospital with EMS for monitoring.

35. If the victim starts breathing place her/him in the recovery position to prevent choking on vomit. Recovery Position

36. Next Steps Report the use of Naloxone to NYS DOH NYS Overdose Reversal form Replenish the stock of Naloxone, even if just one dose was used If naloxone is reaching the expiration date

37. Questions? Contact the DOHMH Bureau of Alcohol and Drug Use (212) 219-5525 asiegler@health.nyc.gov Contact the Harm Reduction Coalition (212) 213-6376 x39 Stancliff@harmreduction.org