1. INTRODUCTION TO OPIOID OVERDOSE PREVENTIONPRESENTATION TO WGDSC HARM REDUCTION FORUM MARCH 2013 Presentation property of Preventing Overdose Waterloo Wellington

2. WHAT WE WILL COVER What is an opioid overdose? Who is at risk for an opioid overdose? How to recognize an opioid overdose Myths and Facts about overdose How to respond to an opioid overdose 3. WHAT IS AN OPIOID OVERDOSE? The Central Nervous System and the effectsof psychoactive drugs Depressants Overdose Defined Types of Overdose 4. The Central Nervous SystemConsciousness,Memory, andEmotion. Three main effects:Breath,Movement, and 1.depressant, Balance.2.stimulantHearingSight,3.hallucinogen Smell, Taste, and Touch 5. DepressantsDepressants cause the central nervous system to slow down - breathing and heartbeat are affected.Desired depressant effects Relaxation, a sense of calm and drowsiness Pain relief Lowering of inhibitionExamples of depressants Opioid drugs (heroin, morphine, pethidine, codeine,methadone, dilaudid, fentanyl, hydromorphone) Alcohol Benzodiazepines or benzos (diazepam/valium) Cannabis (grass, weed, dope) Inhalants (aerosols, cleaning agents, solvents and gases) 6. Uppers (Stimulants) Stimulants cause breathing and heartbeat to speed up.Desired upper effects: Increased energy and alertness Increased confidence Ability to stay awake over long periods of timeExamples of uppers Amphetamine (speed) and methamphetamine (ice), Cocaine, Ecstasy (MDMA), Nicotine ( tobacco) Caffeine (tea, coffee, cola drinks) 7. Hallucinogens (psychedelics) These drugs distort what people hear, think and see.Desired hallucinogenic effectsAn altered sense of the world, time, the body, other people, thoughts, and emotionsExamples of hallucinogensMagic mushroomsLSD (acid, trips)Ketamine (Special K)Cannabis (grass, weed, dope) 8. Overdose DefinedOverdose is the use of a drug (or drugs) in an amount or way that causes acute harmfulmental or physical effects.Overdose may produceshort-lived or lasting effects,and can sometimes be fatal. 9. TYPES OF OVERDOSE Depressant overdose: slows the central nervous systemdown to the point where several systems may stop working. Stimulant overdose: speeds the central nervous system upto the point of overworking certain functions leading tofailure. Toxic overdose: organ damage or failure (heart, lungs,kidneys etc.) from taking an excessive amount of a drug.For today, we will be focusing on opioid overdoses, which fallinto the depressant category 10. After-effects of Non-Fatal Overdoses:After an overdose a person can be left with serious, sometimespermanent, health problems as a result of the overdose itself brain damage due to lack of oxygen as a result of seizure, strokeor heart attack lung damage or pneumonia resulting from vomit/ fluid enteringthe lungs during a period of unconsciousness muscle damage due to a long period of unconsciousnessespecially if a limb is trapped under the body reducing its bloodsupply. Serious complications can include paralysis, limb amputation orkidney failure, broken bones due to falls, burns from exposure toheaters or cigarettes, or physical assaults. 11. WHO IS AT RISK FOR AN OPIOID OVERDOSE?Overdose doesnt discriminate, but there are somekey factors and patterns of use that have anincreased risk; Demographics Prescription Patterns Mixing Drugs Patterns of Use 12. OD RISK: DEMOGRAPHICSA B.C. Review of Coronor Data from 2006-2011 allowed them to pulltogether a profile of risk factors for overdose related death.Most overdose deaths:Are accidental versus suicide (86%),occur in persons under the age of 60 (87%),have a documented source of chronic pain (82%),almost half have a documented co-morbid mental health diagnosis(45%).are the result of taking at least one other non-opioid class ofmedications(93%),Are not the result of multi-doctoring - almost all are taking medicationsprescribed by a single doctor or clinic.Happen everywhere no geographical or population density correlation 13. OD RISK: PRESCRIBING PATTERNS a 2009 Ontario study in the Canadian Medical Association Journallinked the 850% rise in oxycodone prescribing with a quintupling inoxycodone-related fatalities. Among the highlights: 66.4% had visited a physician in the month before death; 56.1% had filled a prescription for an opioid in the month beforedeath. Approximately 50,000 Ontarians are addicted to opioids and manymore are dependent Canada has the highest per capita rates of opioid consumption inthe world. A 2009 CAMH study indicated that more youth in Waterloo-Wellington had consumed opioids for non-medicinal purposesthan tobacco (20%), the highest rate in Ontario. Most of them gotit from home. 14. OD RISK: PATTERNS OF USEOverdose doesnt discriminate, but there are somekey factors and patterns of use that have anincreased risk; Mixing Drugs The Way a Drug is Taken Low or Reduced Tolerance Using Alone Long-term use 15. OD Major Risk Factors: Mixing DrugsDifferent drugs take different amounts of time to leave the body.New drugs can combine with drugs that may have been used hours earlier.Drugs may still be in the body long after a person cant feel their effects.The majority of overdoses involve the use of a combination of drugs. 16. The way a drug is taken:How you take a drug can effect how fast and how strong the effect is. The quicker the drug enters the bloodstream, the higher the risk of overdose.Injection into a vein: Very fast absorptionInjection into a muscle or under the skin: Fast absorptionSmoking: Very fast absorptionSnorting, shafting: Fast absorptionHooping: Slower absorptionSwallowing: Slowest absorption 17. Major Risk Factors: Reduced toleranceTolerance can take some time to develop -weeks or months - but will reduce far more quickly.As little as three or four days without certain drugs can be long enough to lower tolerance to the point where there is a higher risk of overdose. The risk of overdose is high when individuals do nottake into account that their tolerance may belower than usual.Changes in how strong/pure a drug is could leadto a person using more of a drug than they cantolerate by accident. 18. Major Risk Factors: Reduced ToleranceTimes when tolerance will be low or reduced After drug detox or a rehabilitation program; After being in custody or jail; After a period when the drug of choice was notavailable; Being a new or casual user; Following a period when use of a drug has reducedor ceased for any reason Just because a persons tolerance for one drug is highdoesnt mean that it will be high for a different drug! 19. Major Risk Factors: Using aloneFor a person using alone an overdose could be fatal,as the situation might not be noticed. Using withothers does not guarantee that an overdose will behandled well though. 20. Major Risk Factors:Being an experienced, long-term user It is not just new users who overdose - in fact experienced orolder users are at greater risk. Long-term users are more likely to mix drugs; Cycles of abstinence and return to drug use result in morefrequent periods of reduced tolerance; The law of averages - the more a person uses the greater thelikelihood of overdose; A belief that It wont happen to me. If a person has useddrugs over several years and not suffered an overdose, theycould become over confident and take more risks. 21. How to Recognize an Overdose :Is it an Overdose, or are they just really high?If someone is extremely high, and they are using depressants, they may: have contracted/small pupils; have slack and droopy muscles; be nodding out; scratch a lot due to itchy skin; have slurred speech and/or be out of it However, they will respond to outside stimulus 22. How To Recognize an Opioid Overdose: Signs and SymptomsPerson may be awake, but unable to talkBody is very limpFace is very pale or clammyFingernails and lips turn blue or purpleBreathing is very slow and shallow, irregular, or hasstoppedheartbeat is slow, strange, or not there at allChoking sounds, or a gurgling noise (death rattle);Loud, uneven snoringVomiting/throwing upLoss of consciousness/passing outPerson does not respond to noise or pain 23. OVERDOSE MYTHS ANDFACTS 24. Overdose: The Myths and FactsMythPeople collapse (drop) immediately after injecting.FactSome do. However, overdose can take placeover one to three hours. 25. Overdose: The Myths and FactsMyth:Purity and/or taking too much of the drug are the main causes of overdose.Fact:They are factors but definitely not the mainreasons. The main reasons are mixing with otherdrugs and using when tolerance is low or absent. 26. Overdose: The Myths and FactsMyth: It is young, inexperienced users who mostlyoverdose.Fact: It is more likely to be an older user, someone in hisor her early 30s who has been using for a longwhile. 27. Overdose: The Myths and FactsMyth:Being on methadone means its impossible to overdose.Fact:Being on a methadone program will reduce therisk of overdose in the longer term, however, in thefirst few days the risk is higher (the body is stilldeveloping a tolerance to the methadone). Evenafter being on a methadone program for a longtime it is still possible to overdose. 28. Overdose: The Myths and FactsMyth:If the person doesnt die, theyll be alright.Fact:Even when an overdose is not fatal, there can beserious health effects. 29. Overdose: The Myths and FactsMyth:Injecting Cocaine or Crack will stop an ODFact:Injecting crack will make the OD happen fasterCrack speeds up your heart rate so the bodyneeds more oxygenHeroin slows down breathing 30. OVERDOSE: THE MYTHS AND FACTSMyth:Most overdoses happen when someone is aloneFact:A UK report showed that over 50 out of 100overdoses happen with another person in theroom 31. Overdose: The Myths And FactsMythIf someone ODs you should walk them aroundFact:This is a waste of timeThere is a chance that the person will fall over,bang their head and cause a head injuryThen theyll be suffering from an overdose anda head injury 32. Overdose: The Myths And FactsMythInjecting salt water will stop an ODFact:NO it wont!NOR will injecting milk, water, orangejuiceAll will only add to the problem 33. Overdose: The Myths And FactsMyth:If someone is snoring theyre okFact:If someone has been using depressantsand they are snoring it is a sign thatthey are struggling to breathe 34. Overdose: The Myths And FactsMythIf a friend ODs, you should put them in thebathFactYou can change the body temperature reallyfast and put them into shockThey could drownIt can be a slippery and wet nightmare tryingto get an unconscious person out of a bathtub 35. Overdose: The Myths And FactsMythMaking someone vomit will slow down an ODfrom DownFactThis will just increase the chances of themchoking to deathDepressants stop the gag reflex which makesit more likely that youll choke 36. HOW TO RESPOND TO AN OPIOIDOVERDOSE Call 911 Ensure safety andinfection control CPR Naloxone 37. Responding to an Opioid Overdose: Calling an AmbulanceIf the person is conscious:try to keep them awake and talking as much as possible while you call 911. Moving them around could risk a fall.If the person is unconscious:Put them in the recovery position and call 911 for an ambulance.The Recovery Position:Places the person securely on their sideto ensure that they cannot choke onVomit or other fluids 38. Responding to an Opioid Overdose: The Recovery PositionOnce in the Recovery Position: Call 911 if you havent already done so Ensure Safety: check the scene Use stimulation to check if they respond Check for breathing Begin CPR if the person is not breathing 39. CALLING 911 If there is someone else in the room have them call 911. Ask theperson who calls 911to come back and tell you they havecalled the ambulance. That way you are sure that ambulancehas been called. If no one else is there, make the call yourself. In most communities, police will be dispatched at the sametime. Police will attend with an ambulance. For many this is thereason they will not call 911, however saving lives always has tobe the first priority. When you call the ambulance they will ask a series of questions.This is to brief paramedics on the situation before arrival. Stayon the phone if you can. 40. Ensuring Safety: First Steps You cant help someone if you need help yourselfIn the event of any emergency, including an overdose, make suresafety comes first. Check the scene for anything that could be of danger to you, otherpeople or the person experiencing the overdose. Respond to any other emergencies and ensure the safety of theenvironment. When ANY bodily fluid is present, such as blood, vomit, or saliva,always put a barrier between the fluid/victim and yourself such asgloves, or a face mask. Always avoid contact with the fluid(s) andwash hands thoroughly immediately after giving first aid. 41. CPR : COMPRESSIONS, AIRWAY, BREATHING Remember:Opioids slow the central nervous system down. The person needs to be breathing to bring in oxygen, and theheart needs to be pumping to circulate the oxygen to the brain.In many communities, 6-8 minutes is anaverage response timeonce 911 is called. 42. CPR: COMPRESSIONS, AIRWAY, BREATHINGChest Compressions:CPR involves chest compressions at least 5 cm deep and at a rate of atleast 100 per minute in an effort to create artificial circulation bymanually pumping blood through the heart.Rescue Breathing:The rescuer may also provide breaths by either exhaling into the subjectsmouth or nose or using a device that pushes air into the subjects lungs.This will only be effective if the airway is clear. Current recommendations place emphasis on high-quality chestcompressions over artificial respiration; a simplified CPR methodinvolving chest compressions only is recommended for untrainedrescuers. Chest compressions alone can at least circulate existing oxygen inthe blood. A full first aid response to an opioid overdose includeschest compressions and rescue breathing. 43. Responding To An Overdose:Opioid Overdose Reversal IF you are trained in the administration ofNaloxone (Narcan) and have it available toyou, administer the recommended dosage byinjection or intra-nasally and continue CPR. If the person is still not breathing on their ownafter 5 minutes, re-administer the dose andcontinue CPR. If the second administration does not stimulatebreathing independently, it is not likely anopiate overdose. Continue CPR.Naloxone does not Continue CPR and wait for paramedics toreplace medicalarrive. intervention, but Always dispose of needles in the closest it does buy biohazard box. life-saving time! 44. Questions? Comments?Preventing Overdose Waterloo Wellington http://www.preventingoverdose.ca/ preventingoverdose@gmail.comFind us on Facebook and Twitter