Naloxone as Part of Managing Opiate Overdose

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• Naloxone as Part of Managing Opiate Overdose
• Group Training

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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

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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

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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

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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

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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.

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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

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Background 2 Drug-related deaths in England
and Wales 1997 2002
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Effect Of Naloxone

• Short acting
• Blocks and reverses the effects of opiates

NALOXONE
OPIATES
Effect Effect
Stops withdrawals Withdrawals Pain
relief Feel pain Reduces cough reflex
Cough reflex Slows breathing Increases
breathing Lowers blood pressure Raises
blood pressure Sedation/coma
Awake/responsive NO OPIATE NO EFFECT
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Individual Response To Naloxone
10 minutes 4 hours
Duration Of Effect
Depends on

• What opiate used
• How much
• Any other drugs or alcohol taken

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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

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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

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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.

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Giving Naloxone
Injection Site Time To Take Effect

• Vein (intravenous) 1-2 mins
• Muscle (intramuscular) 2-5 mins
• Under skin (subcutaneous) 2-5 mins

Quicker and easier to inject into muscle and
effects may last longer
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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

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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

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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.

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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 its kept
• Keep away from strong light
• KEEP OUT OF REACH OF CHILDREN

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Summary

• Try to wake person
• Ambulance (call 999)
• Breathing and Airways
• reCovery Position
• NALOXONE

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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