Naloxone as Part of Managing Opiate Overdose Group Training

1. Naloxone as Part of Managing Opiate Overdose Group Training

2. Opiate Overdose Overdose causes respiratory depression and can lead to death NAC study - from a sample of 155 drug-using clients 46% had overdosed, while 82% had witnessed overdose. In total the sample witnessed over 700 overdoses, 121 of which were fatal Sydney (1994) - in a sample of 320 users over 60% had overdosed, over 30% of whom had done so in past year. 80% had witnessed an overdose. Most OD occurs in the presence of others who could potentially prevent death from OD if they had been trained

3. How to Recognise Opiate Overdose Person unconscious, and cannot be woken – UNROUSABLE CYANOSIS – BLUE lips or tongue Not breathing at all or breathing slowly – deep snoring. Pin point pupils

4. Risk Factors In Overdose Reduced tolerance - especially on release from prison or relapse following detox - risk of fatal OD 8x higher in first 2 weeks than in following 10 weeks Injecting – Puts person more at risk than smoking/chasing Polydrug use – particularly when mixing sedative drugs (alcohol, benzodiazepines, other opiates). Fatalities can occur up to 3 hours following injection in up to 50% of cases Using alone Increase in purity of street drugs, changing dealer. Using in unfamiliar surroundings - not engaging in normal drug-taking routine, Using with unfamiliar people – who may not help in an overdose situation

5. Overdose Myths –Things NOT to do Putting person in a cold bath or shower Injecting salt solution ‘Pulp Fiction’ - injecting adrenalin into the heart Giving stimulants, amphetamines, cocaine, black coffee etc

6. Naloxone A pure opiate antagonist ‘antidote to heroin’ Temporarily reverses the effects of an opiate overdose No effect on overdoses resulting from the use of other drugs Short acting - wears off quickly Overdose can last for 8 hours or more (especially with methadone) Naloxone can begin to wear off in 20 mins So only for use with continued medical support No potential for abuse Naloxone precipitates WITHDRAWAL – the individual may want to use again straight away/ become aggressive.

7. Background 1: Naloxone is a long established a drug used in emergencies to counter the effects of overdosing on opiates/opioids such as Heroin Methadone It is marketed under trade names including; Narcan

8. Background 2: Drug-related deaths in England and Wales 1997 – 2002 

9. Effect Of Naloxone Short acting Blocks and reverses the effects of opiates:

10. Individual Response To Naloxone What opiate used How much Any other drugs or alcohol taken

11.  Actions on Discovering Overdose 1 Check that the environment is safe. Try to ROUSE the person by: Slapping / shaking the person Rub STERNUM (centre of chest) or UPPER LIP firmly with knuckles If the person wakes up; Ensure their airway is clear Call ambulance Stay with them until paramedics arrive If the person CANNOT BE ROUSED; Call ambulance Check their airway is not blocked – (tongue, vomit) Check their breathing – look, listen and feel for breath (If not breathing begin basic life support, if breathing, place in RECOVERY POSITION and in either case wait with them until the ambulance arrives) Administer Naloxone

12. Actions on Discovering Overdose 2 CALL AMBULANCE Check Airway – clear if blocked, Check breathing. If breathing, place in recovery position – if not breathing, begin basic life support or place in recovery position to maintain a good airway and prevent them from choking Administer naloxone

13. Calling An Ambulance Call 999 and ask for ambulance Give information on where the person is, what they have taken, and the exact address, whether drowsy or unconscious Wait for the person to arrive, and stay with the person, who should be kept in the recovery position If naloxone has been administered, dispose of used needle safely in paramedics sharps bin.

14. Giving Naloxone Vein (intravenous) 1-2 mins Muscle (intramuscular) 2-5 mins Under skin (subcutaneous) 2-5 mins

15. Naloxone Administration Quickest route of injection is intravenous However INTRAMUSCULAR injection recommended as easier. Inject into a muscle Upper outer buttock, thigh area or upper arm. Hold needle 90 degree above skin Insert needle into muscle Slowly and Steadily push plunger all the way down

16. Important Points I A single injection of naloxone buys time for an ambulance to arrive –its effects may wear off in as little as 20 mins. Naloxone has a short duration of action; therefore… Continued medical treatment is ESSENTIAL

17. Important Points II Used needle should be disposed of in sharps bin (paramedics will have one) If bleeding appears after naloxone administration, apply pressure. Naloxone as a shelf life and should be replaced after the expiry date.

18. Where To Keep Your Naloxone Carry on your person, OR A specific place at home or the place you use Let other people know where it’s kept Keep away from strong light KEEP OUT OF REACH OF CHILDREN

19. Summary Try to wake person Ambulance (call 999) Breathing and Airways reCovery Position NALOXONE

20. Useful Links www.exchangesupplies.org - Going over DVD and suggested overdose training. www.anypositivechange.org - Naloxone DVD and harm reduction materials www.lifeline.org.uk - publications and leaflets