Incorporating Overdose Prevention, Recognition, and Response Education into Our Work with IDUs

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Incorporating Overdose Prevention, Recognition,
and Response Education into Our Work with IDUs

• Emalie Huriaux, MPH
• Harm Reduction Coalition
• dope_at_harmreduction.org
• 510.444.6969 x 16

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Who We Are

• The Drug Overdose Prevention Education (DOPE)
  Project
• Founded December 2001
• Team of overdose educators
• Mission to reduce the number of fatal ODs to zero

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What We Do

• Trainings for service providers law enforcement
• Trainings in SROs
• Trainings at syringe exchange sites
• Collaboration with SFDPH
• Rotate through 7 sites per month
• DOPE trainers pull folks from the line train
  them
• SFDPH providers give 2 free pre-filled units of
  naloxone

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naloxone (Narcan)

• An opiate antagonist that temporarily reverses
  the effects of an opiate (heroin) overdose
• Traditionally administered by paramedics
• Legal, nonscheduled, prescription medication

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naloxone prescriptions

• Since November 2003, over 700 people have
  received training and take-home naloxone.
• To date, over 180 of these participants have
  reversed an overdose using naloxone.

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Why We Are Here

• OD leading cause of death among IDUs
• Addressing OD is part of addressing IDUs overall
  health wellness
• Research shows the risk of OD closely associated
  with HIV risk
• HIV risk indicators may prove useful in
  determining OD risk, illuminating the need to
  include OD prevention alongside HIV risk
  reduction efforts. (Ochoa, et al, 2000)

• Share our model of OD prevention, recognition,
  and response education
• Possible venues for education include
• HIV test counseling
• Case management with HIV- and HIV clients
• Needle exchange

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What is an Overdose?

• Toxic amount of drug or combination that causes
  the body to shut down
• Heroin Other Downers (e.g., alcohol, benzos)
• Breathing slows and stops, then heart stops
• Stimulants (e.g., cocaine, speed)
• Heart speeds up, body temp rises, resulting in
  seizure, heart attack, stroke

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RISKS PREVENTION

• Mixing

• Use one drug at a time
• If mixing, reduce amounts of everything
• Dont mix alcohol with heroin/pills
• If drinking with heroin, do shot first

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RISKS PREVENTION

• Tolerance

• Use less after leaving detox, jail, or when sick
• HCV and HIV individuals may be at a higher risk
  for experiencing OD
• Do tester shot

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RISKS PREVENTION

• Quality

• Try to use the same dealer
• Do tester shot

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RISKS PREVENTION

• Using Alone

• Fix with a friend
• Leave door unlocked
• Call someone trusted

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Assessing Downer Overdose

• How do you tell if someone is
• really high vs. having an overdose?

HIGH the lineUNRESPONSIVE OVERDOSING
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Signs of Overdose

• Unresponsive (shouting, pain wont awaken)
• Unconscious
• Breathing slow or shallow (lt12/minute)
• Pale, clammy, loss of color
• Blue or gray (esp. lips or nails)
• Loud, uneven snoring/gurgling
• Not breathing
• Faint or no pulse

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Stimulation

• NOISE
• PAIN (sternum rub)
• Are they responsive?

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Call 911

• Quiet down the scene
• Be calm, speak clearly
• Dont argue
• Tell em
• Exact address
• Victim unconscious
• Victim not breathing or blue

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Call 911 (cont.)

• You DO NOT have to tell 911
• Your name (give an AKA if youre worried)
• That its an overdose
• That drugs are involved
• Do tell the paramedics, once they arrive,
  everything you know

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Airway

• Head Tilt / Chin Lift
• Look for chest rise/fall with your eyes
• Listen for breath with your ear
• Feel for air with your cheek

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Rescue Breathing

• Head Tilt / Chin Lift
• Pinch nose
• 2 slow breaths and check chest
• Keep at it
• 1 breath
• every 5 seconds

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If You Leave for Any Reason

• Put the person in the recovery position

Put the left arm across the chest, so that the
back of the hand rests against the cheek
Put the right hand by the head (as if they were
waving)
Hold the hand in place and lift up the left knee
Turn the person on their side by pushing down
on the knee
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If You Have Naloxone

• EVALUATE
• Has the person resumed breathing?
• Can you get to the naloxone?

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Naloxone IM Injection

• Assemble 1 dose
• Muscle shot, either
• Shoulder (deltoid)
• Butt (gluteus)
• Thigh (quads)
• KEEP BREATHING FOR THEM

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Evaluate Support

• Is a 2nd shot needed?
• Inform them what happened
• Stay with them (2-3 hours)

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How to Incorporate OD Information In Your Work

• Discussion

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THANK YOU

• Our amazing participants
• Rachel McLean, MPH, Founder, The DOPE Project
• Kristin Ochoa, MD, Los Angeles Overdose Taskforce
• Josh Bamberger, MD, S.F. Department of Public
  Health
• Peter Davidson, PhD (c), U.C. San Francisco
• Mary Howe, Homeless Youth Alliance/S.F. Needle
  Exchange
• Naloxone Advisory Group
• All the DOPE Project trainers and service
  providers weve worked with over the years!