Drug Overdose: Prevention, Recognition, Response, and Naloxone Training Lydia H. Guterman, MPH...
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Transcript of Drug Overdose: Prevention, Recognition, Response, and Naloxone Training Lydia H. Guterman, MPH...
Drug Overdose: Prevention, Recognition, Response, and Naloxone
Training
Lydia H. Guterman, MPH
1Title Slide
Thanks
• Many of these slides were originally developed by Emalie Huriaux at the DOPE Project, part of the Harm Reduction Coalition in Oakland, California.
2Thanks
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
3Training Outline
Training Outline (cont.)
• 5. Stimulant Overdose: Recognition and Response
• 6. Mixed Overdose
• 7. Practice Using Naloxone
• 8. Questions and Discussion
4Training Outline 2
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
6What is an Overdose?
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.
7Responding to Downer and Upper
OD is different
Why People Overdose:Risk Factors and Prevention
Strategies
8Why people OD: Risk Factors and
Prevention Strategies
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
9Mixing
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
10Tolerance
RISKS & PREVENTION
Using Alone• Fix with a friend• Leave door unlocked• Call someone trusted
12Using Alone
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.
13Administration Route
Assessing Downer Overdose
How do you tell if someone is
really high vs. having an overdose?
HIGH“the line”=UNRESPONSIVE
OVERDOSING
15Assessing the 'Line'
Signs of Overdose
• 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
16Signs of an OD
RESPONSE
You have decided that the person is overdosing and action needs to be taken. How should you respond?
18Response: What should you do?
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
19What to DO
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.
20What NOT to do
Call Ambulance
• Quiet down the scene
• Be calm, speak clearly
• Don’t argue
• Tell ‘em– Exact address– Victim unconscious– Victim not breathing or blue
21Call and Ambulance
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
22Call and ambulance
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
23Rescue Breathing: Open Airway
Rescue Breathing
• Head Tilt / Chin Lift
• Pinch nose
• 2 slow breaths and check chest
• Keep at it
– 1 breath
every 5 seconds
24Rescue Breathing: Give Breathes
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 kneeTurn the person on their side by pushing down onthe knee 25Recovery Position
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.
26Naloxone: What is it?
If You Have Naloxone
EVALUATE
• Has the person resumed breathing?
• Can you get to the naloxone?
27If you have naloxone: Evaluate
Naloxone – Intermuscular Injection
• Crack open vial and draw up full contents
• Muscle shot, either– Shoulder (deltoid)– Butt (gluteus)– Thigh (quads)
KEEP BREATHING FOR THEM28Giving a naloxone shot
Evaluate & Support
• Is a 2nd shot needed?
• Inform them what happened
• Stay with them (2-3 hours)
29Post shot- support and evaluate
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.
31Assessing stimulant overdose
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.)
32Response
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.
33Responding to a mixed OD
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.
34Get your script and kit and explain
about storage
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 we’ve
worked with over the years!
35thank you.