Transcript Overdose Training slides

Drug Overdose:
Prevention, Recognition,
Response, and Naloxone
Training
Lydia H. Guterman, MPH
[email protected]
Title Slide
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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.
Thanks
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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
Training Outline
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Training Outline (cont.)
• 5. Stimulant Overdose: Recognition and
Response
• 6. Mixed Overdose
• 7. Practice Using Naloxone
• 8. Questions and Discussion
Training Outline 2
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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
What is an Overdose?
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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
and Upper
medical care. RespondingODtoisDowner
different
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Why People Overdose:
Risk Factors and Prevention
Strategies
Why people OD: Risk Factors and
Prevention Strategies
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RISKS & PREVENTION
Mixing
• Use one drug at a time
• If mixing, reduce amounts of
everything
• Don’t mix drugs with the same
effects (alcohol with opiates)
• If drinking with downers, do
shot first
Mixing
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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
Tolerance
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RISKS & PREVENTION
Quality
• Try to use the same dealer
• Do tester shot
Quality
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RISKS & PREVENTION
Using Alone
• Fix with a friend
• Leave door unlocked
• Call someone trusted
Using Alone
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Risks & Prevention
Administration
Route
• Snorting, smoking are
less direct than injecting
• Don’t 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
Opiate Overdose
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Assessing Downer Overdose
How do you tell if someone is
really high vs. having an overdose?
HIGH
“the line”=UNRESPONSIVE
OVERDOSING
Assessing the 'Line'
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Signs of Overdose
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Unresponsive (shouting, pain won’t awaken)
Unconscious
Breathing slow or shallow (<12/minute)
Pale, clammy, loss of color
Blue or gray (esp. lips or nails)
Loud, uneven snoring/gurgling
Not breathing
Faint or no pulse
Signs of an OD
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Stimulation
• NOISE
• PAIN (sternum rub)
• Are they responsive?
Stimulation
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RESPONSE
You have decided that the person is
overdosing and action needs to be
taken. How should you respond?
Response: What should you do?
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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
What to DO
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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.
What NOT to do
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Call Ambulance
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Quiet down the scene
Be calm, speak clearly
Don’t argue
Tell ‘em
– Exact address
– Victim unconscious
– Victim not breathing or blue
Call and Ambulance
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Call Ambulance (con’t.)
• You DO NOT have to tell the dispatcher
– Your name (give an AKA if you’re worried)
– That it’s an overdose
– That drugs are involved
• Do tell the paramedics, once they arrive,
everything you know
Call and ambulance
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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
Rescue Breathing: Open Airway
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Rescue Breathing
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Head Tilt / Chin Lift
Pinch nose
2 slow breaths and check chest
Keep at it
– 1 breath
every 5 seconds
Rescue Breathing: Give Breathes
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If You Leave for Any Reason
Put the person in the recovery position
Put the right hand by the head (as if they were waving)
Put the left arm across the chest, so that the back of
the hand rests against the cheek
Hold the hand in place and lift up the left knee
Recovery Position
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.
Naloxone: What is it?
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If You Have Naloxone
EVALUATE
• Has the person resumed breathing?
• Can you get to the naloxone?
If you have naloxone: Evaluate
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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
Giving a naloxone shot
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Evaluate & Support
• Is a 2nd shot needed?
• Inform them what happened
• Stay with them (2-3 hours)
Post shot- support and evaluate
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Stimulant Overdose
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.
Assessing stimulant overdose
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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.)
Response
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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.
Responding to a mixed OD
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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.
Get your script and kit and explain
about storage
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THANK YOU
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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 we’ve
worked with over the years!
thank you.
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