Transcript Responding to an Opiate Overdose

Responding to an Opiate
Overdose
BIOLOGY OF TOXINS SPRING 2012
MARY MURPHY, SARAH COOK, AND GILBERT
ORNELAS
Introduction
 More than 70 people die a day in the United States
from drug overdoses. New Mexico has the highest
overdose death rates* of any state, with Bernalillo
and Rio Arriba counties’ overdose death rates
exceeding that of both Los Angeles and New York.
Many of these deaths resulted from opiate use. It is
an epidemic of unnecessary tragic deaths but there is
an antidote…
*Death rate is defined as deaths per 100,000 people over a year period.
What is an opiate?
 the term opiate describes any of the narcotic opioid
alkaloids found as natural products in the opium
poppy plant
 a drug containing opium or its derivatives, used in
medicine for inducing sleep and relieving pain
 any sedative, soporific, or narcotic with morphine
like effects
 anything that causes dullness or inaction or that
soothes the feelings
What are
Opiate
Receptors?
They are a group of Gprotein coupled
receptors with opioids
as ligands. The
endogenous opioids
include: dynorphins,
enkephalins,
endorphins and
nociceptin. These
receptors are found
primarily in the brain
but also in the spinal
chord and the digestive
tract.
Examples of Common Opiates
 Heroin “chiva”
 Oxycontin (oxycodone) “oxys”
 Percocet (oxycodone) “perks”
 Demerol (mepiridine)
 Vicodin (hydrocodone) “hydros”
 morphine
 codiene
 Fentanyl
 Methadone
The risks associated with
opiate use apply to
medications prescribed
legally by a physician as well
as illicit drugs. Heroin was
invented by Bayer as a
painkiller and was a
treatment for morphine
addiction. Many of the legal
opiates available now are
considered as addictive as
Heroin. Legal does not
equal safe.
What is an Overdose?
 when a person has a greater effect than anticipated
from a substance they have taken into their system
 getting the jitters from too much coffee or energy
drinks
 chewing tobacco for the first time and feeling
nauseated
 in the case of opiates this could mean getting “too
high” or even stopping breathing
Common Symptoms of Opiate Overdose
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Unconscious/ passed out
Unresponsive
Shallow or no breathing
Skin turning pale or blue
Making choking and gasping sounds
Snoring
Limp body or lack of muscle tone
Cold to the touch
Awake but unable to speak
Vomiting
(This is not intended to be a comprehensive list and a person
experiencing an opiate overdose may not exhibit every one of
these symptoms.)
What Causes an Opiate Overdose?
1. Mixing Drugs
2. Lowered
Tolerance
3. Changing Drug
Concentration
4. “Solo Drugs”
1. Mixing Drugs
 Mixing drugs is the most common cause of death by
opiate overdose – the fewer drugs someone takes the
less likely they are to die of an overdose. Mixing
drugs with alcohol as another way that people can
have an overdose. If a person uses drugs and they
are unprepared to stop, perhaps they can consider
only using one or two drugs.
2.Lowered Tolerance
 Lowered tolerance can be caused by:
 If a person who uses opiates has not been using for even a day
tolerance can decrease.
 Opiate users exiting rehab, hospitalization and jail are at much
higher risk for overdose if they relapse.
 Lowered tolerance can also be the result of not taking in
enough food or water, having an illness, or not having enough
sleep.
 An inexperienced (new) drug user will have a low tolerance.
3.Changing Drug Concentration
 Illicit drugs do not always come in standardized
strengths. A person can have a opiate overdose as a
result of acquiring Heroin from a new dealer or a
dealer getting a new batch. A person should use
caution if trying a drug for the first time or trying a
new batch of drug for the first time. For example:
the 'China White' type of Heroin is a great deal more
potent than the ‘Black Tar' typically found in New
Mexico. When 'China White' appears in New Mexico
it is always followed by an increase in opiate
overdoses.
4. “Solo Drugs”
 Using opiates alone is a cause on unnecessary opiate
overdose death. If a person is using opiates when no
one is around, there is nobody there to rescue them if
they stop breathing.
Even Though Overdoses are Scary:
 Do not hit the person who overdosing
 Do not inject them with drugs or breath drugs into
their lungs
 Do not abandon the person who is overdosing
 Try not to panic
Other Potentially Dangerous Responses Are:
 Placing ice or bags of frozen green chili on the groin
 Putting the person in a shower or in the river
 Electrocuting the person
What Can you do?
 Help them walk around if they are conscious
 Ask the person to breathe more deeply
If they are unconscious:
Do a sternal rub (rub knuckles on bone in chest –
will cause pain, not injury)
2. Call 911
3. Breathe for the person (opiate overdose deaths
result from oxygen starvation)
4. Administer the antidote (naloxone)
1.
1. Sternal Rub
 A sternum rub can sometimes help to revive an
overdose victim.
 Making a fist, you rub your knuckles into the
sternum and the center of the person's chest. It is
intended to be painful and can cause bruising.
However, it is an excellent alternative to hitting the
person because it is less harmful and may achieve
the purpose of getting the person to respond.
2. Calling 911
 Try to stay calm
 Try to keep the background of the phone call sounding calm
 Tell 911 that someone is unconscious and not breathing (you
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don't have to mention drugs)
Give 911 good directions to where you are
Stay with the person and breathe for them as long as you can
Stay long enough to make sure the ambulance is headed to the
right place
If you have to leave the person for some reason, leave them in
the rescue position and leave the door open to where you were
If you administer naloxone, and you have to go, leave the vial
nearby so the EMTs will see that you already gave some
The Rescue
Position
If you have to leave
someone who is
unresponsive alone
to go for help,
leave them in The
Rescue Position.
The Rescue
Position decreases
the likelihood that
they will choke if
they vomit.
•Lay the person on their side with one arm supporting the
head.
•The other arm should be in front with their elbow and
forearm bearing a bit of upper body weight.
•Follow the same pattern with the legs – lower leg
straight, upper leg bent to bear some weight.
•This position may prevent choking if the victim vomits.
3. How to administer rescue breathing ONE
BREATH EVERY FOUR SECONDS
 A person has to breathe one breath every four seconds to keep their brain
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alive
Count seconds between the overdose victim's breaths
If there is more that 4 seconds between the person's breaths they will need
you to breathe for them
Check for a pulse, if no pulse, administer CPR
If the heart is still beating but they are not breathing enough tilt the head
back a bit, pinch the nose shut and give the person one regular-sized breath
every four seconds
Giving someone large breaths may cause air to go into the stomach and
may end up in vomiting
Keep giving rescue breathing until the person wakes up, or someone takes
over for you, or the emergency personnel arrive
Do not give up! If you cannot call 911, or you do not have naloxone, you
may be able to keep the person alive by breathing for them as their body
processes the opiates
3. How to administer rescue breathing ONE
BREATH EVERY FOUR SECONDS
4. Administer the Antidote (naloxone)
What is naloxone (Narcan)?
 Naloxone causes a rapid blockade of μ-opioid
receptors stopping the opioid overdose and often
producing rapid onset of withdrawal symptoms
 It is a synthetic drug, similar to morphine, that
blocks opiate receptors acting as a opioid antagonist
in the nervous system
 It was developed by Sankyo (global pharmaceutical
company) in the 1960s
 Naloxone has an exceptionally high affinity for μopioid receptors in the brain and spinal cord making
it a μ-opioid receptor competitive antagonist
How to Administer naloxone (Narcan)
1. Naloxone can be administered as a nasal spray.
2. Remove the caps (red and yellow plastic corks) from the vial of naloxone and the syringe
barrel.
3.Insert the vial into the barrel & turn the vial 3 times – slowly and gently – until it stops.
4. Screw the nasal atomizer onto the tip of the syringe. The naloxone is now ready to use.
5. Place the assembled naloxone atomizer in one of the overdose victim’s nostrils.
6. Press firmly on the base of the glass vial or plunger, spraying half of the naloxone deep
into the overdose victim’s nasal cavity.
7. Spray the remainder into the other nostril.
8. If the person does not regain consciousness in a minute or two, administer a second dose.
Where to Get naloxone (Narcan)
Stanford Public Health
Office (near UNM)
1111 Stanford Drive NE
Albuquerque, NM 87106
(505) 841-4100
Casa de Salud/Just
Healthcare
1608 Isleta Blvd. NW
Albuquerque, NM 87501
(505) 907-8311
Conclusion
 There are few experiences in life that can cause such
suffering as drug addiction. Until drug addicted
people are ready to attempt sobriety, incarcerating
them or allowing them to die lacks compassion and
is poor public health policy. New Mexicans finally
have tools to help keep our loved ones alive until
they are ready to seek help. If you or someone you
know use heroin or other opiates, avail yourself of
naloxone.
Resources
http://www.odgame.org/ (Click to play the
overdose game)
http://www.drugpolicy.org/new-mexico
http://harmreduction.org/
http://www.thegooddrugsguide.com/
http://www.thebody.com/content/art38411.ml
Literature Cited:

Enteen, L., Bauer, J., McLean, R., Wheeler, E., and Huriaux, E.(2010),Overdose Prevention and Naloxone
Prescription for Opioid Users in San Francisco. Journal of Urban Health, Volume 87, Number 6, Pages 931941.

Joen-Rong, S., Yen-Mei, L., Ling-Wen, L., Hsiang-Ning, L., & Mao-Hsiung, Y. (1998). INHIBITORY
MECHANISMS OF NALOXONE ON HUMAN PLATELETS.Clinical & Experimental Pharmacology &
Physiology, 25(7/8), 585.

New Mexico Department of Public Health. Harm Reduction Program. Overdose Prevention Short
Curriculum. Santa Fe, NM: New Mexico Harm Reduction Program, 2012. Print.
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Strang, J., Darke, S., Hall, W., Farrell, M., and Ali, R. (1996) Heroin overdose: the case for take-home
naloxone - home based supplies of naloxone would save lives. British Medical Journal, 312 7044: 1435-1436.

Strang, J., Manning, V., Mayet, S., Best, D., Titherington, E., Santana, L., Offor, E. and Semmler, C. (2008),
Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge
and attitudes and subsequent management of overdoses. Addiction, 103: 1648–1657.
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Weckman, Michelle. Use of a Continuous Subcutaneous Naloxone (Narcan) Infusion to Treat MethadoneInduced Respiratory Depression (414-A). (2009).Journal of Pain & Symptom Management, 37(3), 500.

Wheeler, E., Davidson, P. J., Jones, T., & Irwin, K. S. (2012). Community-Based Opioid Overdose Prevention
Programs Providing Naloxone -- United States, 2010. MMWR: Morbidity & Mortality Weekly Report, 61(6),
101-105.
Thank You