Opiate Overdose Prevention

1. Opiate Overdose Prevention Harm Reduction and Naloxone Administration Training

2. 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. Purpose of Training

3. Pre-test • Presentation -Drug use, Addiction, Overdose statistics -Addiction and Overdose and the Brain -Naloxone and the Brain • Live Video • Naloxone Administration Demonstration • Paperwork/Follow up • Questions Training Overview

4. Is this training Necessary? Everyday in the U.S. 100 people die of overdose Drug use, Addiction, and Overdose Facts

5. According to the Center For Disease Control and Prevention 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 Is this training necessary? Nationally

6. In Illinois, more people die from overdose, then the national leading cause of death, Car Accidents. Heroin is the most commonly cited drug among primary drug treatment admissions in Illinois. Is this training Necessary? State of Illinois

7. 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 Is this training necessary? Regional Level According to “Heroin Use in Illinois: A Ten-year Multiple Indicator Analysis” by the Illinois Consortium on Drug Policy at Roosevelt University 1998-2008

8. Cook County 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. “Heroin Hub”

9. 46 Heroin related deaths in 2013 15 people in 17 days in July 2013 alone Both males and females Ages 15-64 DuPage County

10. 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.

11. 2012 Opioid Overdoses Lake County Ages 0-20 and 61+ did not see any overdoses this year (2012)

12. 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! All that said….Yes, this training is necessary! YOU have the ability to save a life

13. Opiates, Addiction, and the Brain

14. Opioids All categories have overdose risk. Opioids Opiates Natural Semi-Synthetic Fully Synthetic Fentanyl MethadoneDemerol Heroin Hydrocodone Oxycodone Opium Morphine Codeine

15. Similarities Differences • Come 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 Opiate Similarities and Differences “Opiates are like beef, you can have steak or you can have hamburger, but either way you are eating beef. Same with opiates.”

16. Opiate Comparisons

17. To be more specific… Street names Heroin:Smack, H, Tar, Junk, Dope Hydrocodone:norcos, vikes, vic, watson Oxycodone: oxy, percs, OC, cets

18. We are wired for addiction Prefrontal Cortex Critical impulse control (The Brake) Not fully developed in women until 21yrs and 25 yrs for men Gas pedal Steering Wheel Drive Memory Brain Stem Pleasure Vitals (Breathing)

19. Heroin Use Steak Dinner “dope sick” Our Pleasure line

20. Don’t use! Let’s Talk Prevention • Overdose Risk Factors • Using alone • Low tolerance • (treatment/lock-up) • Mixing drugs is a recipe for overdose • Silence kills • Tips for safe using • Don’t use along • Start low, go slow • Be intentional/ don’t mix • Talk, be honest have a user contract and a plan What message do we want our loved ones to hear

21. 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

22. Signs 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 Signs to Recognize Overdose

23. Stimulate Can you wake the individual? If they are not responsive Call for Help Lay them in the recovery position Head turnedMouth down Brain at same level as heart

24. The Good Samaritan Act Calling for help Illinois Public Act 097-0678You & 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

25. Airway Make sure the air way is clear and nothing is preventing the person from breathing by checking their mouth. Rescue Breathing Breathe for them. Two quick breathes every five seconds The A & B of Life Airway and Breathing

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

27. What is Naloxone? The opiate antagonist Opiate overdose antidote Opiate Reversal Naloxone Breathing restored! How do opioids affect breathing? How does Naloxone work? Opioids are depressants that at high levels can repress the urge to breath Naloxone has stronger affinity for opioid receptor

28. 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

29. 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

30. 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 in • Goes through clothes • May take a few minutes to work Muscular Injection Naloxone Administration

31. 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 & Support Are they breathing on their own? Is another dose needed?

32. Emergency Rooms administer 2mg through IV IV/Intravenous injection is fastest route of administration (You are NOT trained for this) This results in SEVERE withdrawals Evaluate and Support Support 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) Coming off Naloxone

33. Live! The live demonstration

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

35. Great! Now I can use. Yes, Naloxone will save your life. However, there is no saying what state the overdose will leave you in. So Naloxone will save lives!

36. Physically 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. Overdose obstructs oxygen from getting to your brain

37. It is not naloxone that leaves these unfortunate consequences It is the overdose!

38. 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 Break the Stigma • The word “addict” • Confidentiality • People first language • User friendly • Someone’s loved one 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." Cost “I could pay $10,000 for treatment or I could pay that much for a funeral”

39. 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. Break the Stigma Addiction is not a matter of will power.

40. Illinois’ Naloxone Expansion Act Illinois’ Good Samaritan Act Illinoislaw, 20 ILCS 301/5-23You & 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 public Act 096-0361 This act explains the expansion of naloxone to lay people with proper Training through overdose Prevention programs such as this one . What is being done to fight this epidemic

41. Find Support Take A Stand Open Hearts open eyes Don’t Roll the Dice-Ja2Soon New Directions Addiction Recovery Services High on Life H.E.R.O. Live4Lali Serenity Family Outreach The Other Side Chicago Recovery Alliance LTM Foundation Stop Overdose IL GRASP PATH Together we are One Loud Voice

42. What can YOU do to Wake the Nation • Refer your friends and family to us • Speak up! • Carry Naloxone • Educate others • Talk to your kids, your parents, your peers • Write a letter to your school or your child’s school • Write a letter to your local police station or a government official/politician • Find local take back days • -Addiction can stem from prescription drugs • -Monitor your drug cabinet

43. Credits: Wake the Nation Massachusetts Department of Public Health Dr. Walley MA Harm Reduction Coalition Dr. Celeste Napier Center for Disease Control and Prevention Kathie Kane-Willis and Illinois Consortium on Drug Policy Roosevelt University Dan Bigg and the Chicago Recovery alliance DuPage County Health Department DuPage Coalition Against Heroin McHenry County Public Health Department Wanereye Communication ISTOCK images Thank you!