Transcript Brant County Public Health Unit – Naloxone Training Slide Deck

COPE – BRANT
Community Overdose
Prevention
and
Education
Shawna Wilson
Public Health Nurse
Sexual Health and Infectious Disease
“In less than 3 minutes he came back to life”
After entering the brain, the drug binds to the body’s opioid receptors
with an attraction so strong that it can remain locked in place for hours.
Some of these receptors switch on the brain’s reward circuits – they
generate feelings of pleasure, some are involved in pain transmission –
heroin causes the receptors to dampen down pain signals entering the
brain from the spinal cord.
There are also opioid receptors on neurons that control breathing.
Take too much heroin, and these neurons will dangerously slow down
respiration. Starved of oxygen, the lips and fingers turn blue, the person
falls unconscious and stops breathing. Death can occur within minutes.
Naloxone reverses the process, by shoving the opiate out of the way
and binding to the receptor itself. This sends the user into immediate
withdrawal.
What is Naloxone (Narcan)?
•
•
•
Naloxone is a safe antidote to opioid overdose
Naloxone takes 1-5 minutes to work
Naloxone displaces or “kicks out” the opioids from the
receptors, then blocks those receptors and the effects of
the opiate for approximately 30-90 minutes
Why is it used?
•
•
Opioid overdose is the leading cause of accidental
death
Opioids are a family of pain management drugs with a
high potential for addiction and subsequent misuse
Naloxone Kits
• Contents of Naloxone Kit:
• 2 – ampules of 1cc (.4mg)
Naloxone Hydrochloride
• 2 -1cc 25g 1 inch,1-3cc
25g safety engineered
syringes
• Alcohol swabs
• Naloxone identifier card
• Non-latex gloves
• Naloxone Step by Step
instructions
• Mouth barrier
Drug Categories
Depressant Drugs: slow down the brain and nervous
system activity
Stimulant Drugs: will speed up the communication
between the brain and the nervous system
Hallucinogens: Interferes with the brain and results in
hallucinations
Drug Categories …continued
Depressants
Opioids:
Buprenorphine, Codeine,
Demerol, Fentanyl, Heroin,
Hydrocodone (Vicodin),
Hydromorphone (Dilaudid),
Oxycodone (Oxycontin,
OxyNEO, Percodan,
Percocet) Pentazocine
*Benzodiazepines:
Ativan, Halcion, Restoril,
Rohypnol, Serax, Valium,
Xanax
*Barbituates:
Amytal, Nembutal, Seconal
*Zopiclone
*Alcohol
*GHB
Stimulants
Cocaine
Crack Cocaine
Amphetamine (speed,
crystal meth)
Methylphenidate (Ritalin)
Khat
Hallucinogens
LSD
Magic Mushrooms
PCP
MDMA
DMT
GHB
Drug Categories…continued
• *Naloxone only reverses the effects of opioids such as heroin,
methadone, morphine, opium, codeine, or hydrocodone.
• It does not counter the effect of other types of drugs, such as
benzodiazepines (as above), antihistamines, alcohol, or other
sedatives (drugs such as phenobarbital) or stimulants such as
cocaine and amphetamines.
• But if the person is not breathing it will not hurt to administer
naloxone. If there is an opioid involved they will likely start
breathing again–though they will still be sedated from the other
drugs.
• Many overdoses happen due to mixing opioids with other drugs,
which is common practice.
In the worst case scenario, naloxone will simply do nothing,
but in the best case scenario it will save a life.
What is an overdose?
• An Overdose can occur when a person has used
too much of one drug or multiple drugs and the body
is not able to withstand the substance and/or the
amount used.
• Overdose causes a depression of the respiratory
system that can lead to death.
• Over dose can occur suddenly or over several hours
• Overdose can happen to anyone, there is no exact
formula to determine the amount or combination of
drugs that could lead to an overdose.
Who is at risk?
Those who may be at risk for an overdose include;
•
•
•
•
Individuals with a reduced tolerance to the drug: for example
those just released from jail, treatment facilities or hospital
Those who may be using a supply of drugs that has changed
from the norm; for example buying from a new dealer
Individuals who rely on someone else to inject them with a
drug
Those who use drugs alone
It’s a no-brainer - get these kits in to the people most
likely to be on the scene, which is other users.
How would I recognize an overdose?
STIMULANTS
• Seizures
• Sweating
• Difficulty breathing/chest tightness
• Foaming at mouth, Vomiting
• Sudden collapse, unconsciousness
• Racing pulse
• Headache, dizziness, ringing in ear
STIMULANTS
HALLUCINOGENS
OPIODS
• Psychosis
• Seizures
• Nausea, Vomiting
• Catatonic Syndrome (Trance-Like)
• Breathing is slow/absent
• Deep snoring or gurgling
• Finger nails look blue or purple
• Unresponsive to stimuli
• Vomiting
• Loss of consciousness
Responding to an opioid overdose
• STIMULATION
• CALL 911
• GIVE NALOXONE
• CHEST COMPRESSIONS
• CHECK
• REASSESS
1. Stimulation
• Try to wake the
person
• Shout their name,
shake their shoulders
2. Call 911
When speaking with the 911 dispatcher:
•
•
•
•
•
•
Remain quiet, speak calmly and
quietly.
Tell them the victim is unresponsive
Tell them the address, if you can,
have someone wait outside
Never leave the victim alone
When help arrives, tell them as much
as you know about the situation
Tell them that NALOXONE was given
3. Give Naloxone
How to administer Naloxone:
•
•
•
•
•
Look at the Naloxone vial, if there is liquid in the top of the vial gently tap
with your finger until the liquid drops below the neck of the vial
Break open the Naloxone vial (you may use an alcohol swab to protect your
fingers)
Insert a new syringe into the ampule and slowly draw up ALL of the
Naloxone into the syringe
Inject ALL of the Naloxone into the upper arm muscle or thigh muscle at a
90 degree angle
If you cannot remove the clothing, the needle is long enough to go through
light clothing.
4. Start Chest Compressions
• Make sure to lay the person on a hard
flat surface
• Find the middle of the person’s chest
• Hands one on top of the other, elbows locked, push down
hard and fast with heels of hands
• Push at least 2 inches with each compression
• Continue until EMS arrives
• If you are able to switch with another person, change every
few minutes in order to rest between
5. Check… is it working?
• Naloxone should work in 3-5 minutes
• When Naloxone starts working the person may:
o Wake up suddenly
o Wake up slowly
o Be confused
o Be angry and agitated and combative
o Want to use more drugs
WARNING!
Naloxone may cause MILD to SEVERE withdrawal
symptoms that could include; nausea, vomiting, sweating,
muscle aches, anxiety and agitation.
6. Reassess
• If the person has not started breathing on their own in
3-5 minutes, give a SECOND dose of NALOXONE
• Continue chest compressions until EMS arrives
• If the person wakes, explain to them that they have
overdosed and should NOT use more drugs as this will
increase their chance of having another overdose when
the Naloxone wears off.
• WATCH for signs of the OVERDOSE returning
Place the person in the recovery position which allows the mouth
and nose to drain, keeps tongue from blocking the airway.
What not to do!
Do not leave the person alone
They could stop breathing
Do not put them in a bath or
shower
They could drown
Do not inject them with anything It could seriously harm them and
besides NALOXONE
it will not help them
Do not slap, kick, punch or burn
the person or use ice.
It will not wake them up and it
could harm them
Do not try to give them a drink
They could vomit and choke
Do not try to induce vomiting
They could choke
FOLLOW UP!
After an overdose…
It can be a traumatic event for everyone involved in an
overdose.
• Talk with the people around you who support you, like
family or a friend, a health professional that you may have
connected with, share your experience.
• Ensure that everyone in your life knows that you carry a
Naloxone kit
• Seek support
• Please contact us at the Brant County Health Unit and we
will provide you with new supplies and a refill of Naloxone
Naloxone Kit Care
•
Store Naloxone in a cool dark place
•
Check the expiry date on the ampoules of
Naloxone, if it has expired or is near to the
expiry; take it back for a refill.
•
Check your kit supplies regularly
Adapted with permission from materials produced by
City of Hamilton Health Services Department
September 2015
www.bchu.org
519-753-4937
@BrantHealthUnit
Brant Health Unit
Naloxone nasal spray – Jan 2017
www.bchu.org
519-753-4937
@BrantHealthUnit
Brant Health Unit