Harm Reduction and Overdose

AwarenessPresented by: Melissa Cade, LCDC, LBSW

Overdose

• What is Overdose? • Overdose (OD) happens when a toxic amount of a drug or

combination of drugs overwhelms the body. People can overdose on lots of things, including alcohol, Tylenol, opioids, or a mixture of drugs.

• Drug overdose is a nationwide epidemic that claims the lives of over 43,000 Americans every year. Over six hundred Texans were confirmed to have been killed by opioids in 2013, but recent reports suggest that this is a vast undercount, with nearly 800 prescription-drug related deaths reported by medical examiners in just 17 of the state’s 254 counties.

Opioid Overdose• Opioid overdose occurs when the level of opioids, or combination of opioids and

other drugs, in the body render a person unresponsive to stimulation or cause their breathing to become inadequate. This happens because opioids fit into the same receptors in the brain that signal the body to breathe. If someone cannot breathe or is not breathing enough, oxygen levels in the blood decrease causing the lips and fingers to turn blue, a process called cyanosis. Oxygen starvation will eventually stop vital organs like the heart, then the brain, and can lead to unconsciousness, coma, and possibly death. Within 3-5 minutes without oxygen, brain damage starts to occur, soon followed by death.

• Opioids include: heroin, morphine, codeine, methadone, oxycodone (Oxycontin, Percodan, Percocet), hydrocodone (Vicodin), fentanyl (Duragesic), and hydromorphone (Dilaudid).

Opioid Overdose • Feels And Looks Like:

• Person cannot stay awake• Can’t talk or walk• Slow or no pulse• Slow or no breathing, gurgling• Skin looks pale or blue, feels cold• Pupils are pinned or eyes rolled back• Vomiting• Body is limp• No response to noise or knuckles being rubbed hard on the breast bone

Opioid Overdose• Priority Groups and Risk Factors for Opioid Overdose

• Recent medical care for opioid poisoning/intoxication/overdose• Suspected or confirmed history of heroin or nonmedical opioid use• High-dose opioid prescription• Recent release from jail or prison• Recent release from mandatory abstinence program or drug detox program• Enrolled in methadone or buprenorphine detox/maintenance (for addiction or pain)• Remoteness from or difficulty accessing medical care• Any opioid prescription and known or suspected:

• Smoking, COPD, emphysema, asthma, sleep apnea, or other respiratory system disease• Alcohol use• Concurrent benzodiazepine use• Concurrent antidepressant prescription

Responding to Opioid Overdose• 1. Stimulation

• Call their name and shake• Sternal rub

• 2. Call for Help• Call 911 – be specific about symptoms and condition (example: “My friend

isn’t breathing, unresponsive when I try to wake them, and vomiting.”)• If leaving the person alone, place them in the recovery position. This will

help to keep the airway clear and prevent them from choking on vomit.

Responding to Opioid Overdose• 3. Ventilate

• Breathe for them. (Plug nose, tilt head back, and give 1 breathe every 5 seconds)• If the person was already breathing, or begins breathing but is unresponsive then the

responder should administer naloxone next.

• 4. Administer Naloxone• Inject 1cc of Naloxone into a large muscle such as the upper arm or thigh• If no response in 3-5 minutes, repeat with a new needle and vial – 1cc of Naloxone.

• 5. Evaluate and Support• Monitor the overdose survivor reassuring them that the drug withdrawal will decrease in

about one hour, and more drugs should not be used. • Inform EMS of what happened and how much Naloxone was given.

Naloxone

• Understanding Naloxone• Naloxone (Narcan) reverses an opiate overdose by blocking opioid

receptors in the brain. It wakes a person who is overdosing in 3-5 minutes and is active for about 30-90 minutes at which point the effect of opioids can return. Naloxone has no other effects and cannot be used to get high; it will cause no harm if the person is not having an overdose.

• Naloxone can precipitate withdrawal symptoms which bring a powerful urge to take more drugs. Because Naloxone has a half-life of 1-1.5 hours, considerably less than heroin and morphine, taking more opiates can bring on a second overdose.

Access to Naloxone• In 2015, Texas joined other states with the enactment of Senate Bill 1462, which contains a

number of provisions designed to make it more likely that naloxone will be available when and where it is needed. The law, which passed unanimously, went into effect September 1, 2015.

• New Provisions: • It permits any person otherwise authorized to prescribe naloxone to prescribe it not only to a person at risk

of overdose, but also to a family member, friend, or other person in a position to assist in such a person. This prescription can come in the form of a standing order. The law also states that a pharmacist is permitted to dispense naloxone under any prescription that is authorized under the law.

• It permits any person or organization acting under a standing order to store and distribute naloxone as long as they don’t seek or receive compensation for those actions.

• It permits any person to possess naloxone, even if they don’ have a prescription for it. • It permits emergency services personnel (firefighters, EMT, emergency room personnel, etc.) to administer

naloxone to any person who appears to be suffering an opioid-related overdose.

Access to Naloxone

Tolerance and Half-Life• Tolerance

• When a person uses a drug regularly they develop a tolerance to it. This means they need to use more to get the same effect. Similarly, if a person hasn’t been using regularly – or if they’ve not been able to get drugs – their tolerance will drop.

• Half-life• Refers to the time it takes for a drug to drop to half the strength of its original

dose. Some drugs have a long half-life, for example some benzodiazepines. If a person has used yesterday, they may still have enough in their system today to overdose if they use more. Diazepam (Valium) has one of about 24 hours, so if you took 20mg yesterday you would still have approximately 10mg of diazepam active in your system today.

Stimulant Overdose• Feelings and Looks Like:

• Fast pulse or no pulse• Short of breath• Body is hot/sweaty, or hot/dry• Confusion, hallucinations, unconscious• Clenched jaw• Shaky• Chest pain• Seizures• Vomiting• Cannot walk or talk

Responding to Stimulant Overdose

A: Mental Distress• Associated with: sleep

deprivation, crashing, anxiety, paranoia. If a person is conscious, and you are sure this is not medical in nature, they may just need support and rest.

B: Physical Distress• Medical attention is required

immediately if person has: jerking or rigid limbs, rapidly escalating body temperature and pulse, in/out of consciousness, severe headache/sweating/agitation, or chest pains

Responding to Stimulant Overdose

A. Mental Distress• Keep calm. Stay with person. Use their name.• Give water or fluid with electrolytes. Do not

overhydrate.• Place cool, wet cloths under armpits, back of

neck, or head• Open a window for fresh air• Get them comfortable. Move away from activity• Encourage person not to take any other

substance• If you are not comfortable with the

situation, call 911.

B. Physical Distress• Call 911. • Stay with the person.• Keep person conscious, hydrated, calm• If heart has stopped do ‘hands only’

CPR• Tell medical professionals as much as

possible so they can give the right treatment to prevent organ damage and death.

Risk Factors for Overdose• Loss of Tolerance: overdoses occur when people start to use again, following

a period of abstinence.• Mixing Drugs: mixing opioids with other drugs, especially depressants such

as benzodiazepines or alcohol. • Using Alone: when using alone there is no one present to see signs of

overdose. • Variation in Strength of Street Drugs: street drugs may vary in strength and

effect based on the purity of the substance and the amount of other ingredients used to cut the drug.

• Serious Illness: AIDS, liver disease, diabetes and heart disease

Harm Reduction• To prevent overdose:

• Know your health status and your tolerance.• Do not mix drugs and alcohol. If you do mix, choose to use drugs before alcohol.• Be aware: using drugs while on prescribed medications can increase overdose risk.• Don’t use alone. Leave the door unlocked or tell someone to check on you. • Do testers to check strength. Use less. Pace yourself.• Talk to an experienced person or a trusted healthcare provider about reducing risk.• Know CPR and get trained on giving naloxone.• Choose a safer route of taking drugs.

Harm Reduction

• Will overdose prevention and naloxone training support continued/more use?

• What kind of message does it send to people in treatment?

Harm Reduction – Prevention Tips

Mixing Drugs• Use one drug at a time• Use less of each drug• Try to avoid mixing alcohol with heroin/pills• If drinking or taking pills with heroin, do the

heroin first to better gauge how high you are – alcohol impairs judgement so you may not remember or care how much you’ve used

• Have a friend with you who knows what drugs you’ve taken and can respond in case of emergency

Tolerance• Use less after any period of abstinence or

decreased use• Go slow if you haven’t used recently• Use less when you are sick• Do a tester shot, or go slow to gauge how

the shot is hitting you• Use less risky methods• Be aware of new environment and new

people – this can change how you experience the effects of drugs

Harm Reduction – Prevention Tips

Quality• Test the strength of drug before you do

the whole amount• Try to buy from the same dealer• Talk to others who have the same dealer• Know which pills you’re taking and try to

learn about variations in similar pills• Be careful when switching from one type

of opioid pill to another since their strengths/dosage will vary.

Using Alone• Use with a friend• Develop an overdose plan with your

friends or partners• Leave the door unlocked • Call or text someone you trust to

have them check on you

Harm Reduction – Prevention Tips

Age and Physical Health• Stay hydrated. Drink plenty of water• Eat regularly• Get enough sleep and rest when you feel

worn down• Carry your inhaler if you have asthma• Try to find a good, nonjudgemental doctor

and get checked out for any health factors that may increase your risk of overdose.

Mode of Administration• Be mindful that injecting and smoking can

lead to increased risk• Consider snorting, especially in cases when

you’re using alone or may have decreased tolerance

• Be careful when changing modes of administration since you may not be able to handle the same amounts.

• Safer Routes: no use swallowed snorted/ smoked/inserted injected

Harm Reduction• Tips for Calling 911

• Tell the paramedics exactly where you and the overdosing person are. Example: 3rd floor of building, room 314, in the bathroom.

• When speaking with the dispatcher avoid using words like drugs or overdose – stick with what you see: “The person is not breathing, turning blue, unconscious, non-responsive, etc.” This makes the call priority because it will be identified as a life-threatening emergency.

• When calling, keep loud noises in background to a minimum – if it sounds chaotic they will surely dispatch police to secure the scene and protect the paramedics.

• Remove drugs and paraphernalia from immediate sight • When the paramedics arrive, tell them as much as you know about what drugs the person may

have taken, when they used them, and whether naloxone was administered. Remember paramedics main goal is to address the health of the individual and respond to the medical emergency.

Good Samaritan Law

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