Drug Overdose: Prevention, Recognition, Response, and Naloxone Training

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Drug Overdose Prevention, Recognition,
Response, and Naloxone Training

• Lydia H. Guterman, MPH
• lydiaguterman_at_gmail.com

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Thanks

• Many of these slides were originally developed by
  Emalie Huriaux at the DOPE Project, part of the
  Harm Reduction Coalition in Oakland, California.

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Training Outline

• 1. What is an overdose?
• 2. Discuss the different types of overdose.
• 3. Discuss factors that increase risk for
  overdose and how to reduce risk of overdose.
• 4. Opiate Overdose Recognition and Response

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Training Outline (cont.)

• 5. Stimulant Overdose Recognition and Response
• 6. Mixed Overdose
• 7. Practice Using Naloxone
• 8. Questions and Discussion

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Overdose The Basics
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What is an Overdose?

• Toxic amount of drug or combination that causes
  the body to shut down
• Opiates Other Downers (e.g. heroin, alcohol,
  benzos)
• Breathing slows and stops, then heart stops
• Blue lips or fingernails, extended nodding,
  labored breathing, nonresponsive
• Stimulants (e.g., Tina, speed)
• Heart speeds up, body temp rises, resulting in
  seizure, heart attack, stroke

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Overdose Response

• Stimulant and Downer overdoses are VERY DIFFERENT
  and should not be handled the same way.
• In the case of opiate overdose, perform rescue
  breathing, administer naloxone, and call
  emergency services
• In the case of a stimulant overdose (heart
  attack), perform CPR and get the victim to
  medical care.

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Why People OverdoseRisk Factors and Prevention
Strategies
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RISKS PREVENTION

• Mixing

• Use one drug at a time
• If mixing, reduce amounts of everything
• Dont mix drugs with the same effects (alcohol
  with opiates)
• If drinking with downers, 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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Risks Prevention

• Snorting, smoking are less direct than injecting
• Dont push shot in all at once. Instead, use
  multiple smaller pushes of the plunger to get the
  dose in.
• If change route, decrease dose.

• Administration
• Route

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Opiate Overdose
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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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RESPONSE

• You have decided that the person is overdosing
  and action needs to be taken. How should you
  respond?

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What Should You Do?

• Do
• Call an ambulance if possible
• Make sure the person is breathing. If not,
  perform rescue breathing.
• Administer naloxone if appropriate
• Stay with the victim

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What You should not do

• Do not
• Throw the person in an ice bath
• Inject them with salt water or milk
• Beat them up to try to get them to wake up
• All of these responses waste valuable time. It
  only takes a few minutes for the brain to have
  serious damage without oxygen. Use your time to
  help the person get oxygen/ breathe.

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Call Ambulance

• 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 Ambulance (cont.)

• You DO NOT have to tell the dispatcher
• 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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Make sure the person is getting Oxygen.RESCUE
BREATHING

• 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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NALOXONE

• An opiate antagonist that temporarily reverses
  the effects of an opiate overdose
• Traditionally administered by paramedics
• Legal, nonscheduled, prescription medication
• IDU can be trained to use it and carry it with
  them.
• Not harmful if given to someone who is not
  overdosing.

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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 Intermuscular Injection

• Crack open vial and draw up full contents
• 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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Stimulant Overdose
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Assessing a Stimulant Overdose

• The symptoms of stimulant overdose are VERY
  DIFFERENT than downer overdose.
• Symptoms include extreme sweating, seizure,
  foaming at the mouth, tightness in the chest, and
  heart attack/ heart failure.

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Response

• Immediately call ambulance.
• Perform rescue breathing/ CPR.
• Do not use naloxone. It will not help because
  opiates are not involved.
• Treat symptoms (for example, if the person is
  having a seizure make sure (s)he does not slam
  into anything.)

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Responding to a Mixed Overdose

• People often mix stimulants and downers.
• Assess the situation- is the person showing signs
  of a downer or stimulant overdose? React
  accordingly.
• In either case, perform rescue breathing if the
  person is not breathing and call ambulance.
• If opiate overdose, stimulate then give naloxone
  if necessary.

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Get Prescription from Doctor and get naloxone and
overdose kit from trainer if available.

• Explain that naloxone must be stored in the dark
  and expires in two years.
• Talk to clients about police and possible
  confiscation.
• Tell clients to report any reversals or if their
  naloxone was taken or if they need a re-fill.

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THANK YOU

• Amazing Overdose Prevention Advocates in the USA
• 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!