Drug Overdose: Prevention, Recognition, Response, and Naloxone

Training

Lydia H. Guterman, MPH

lydiaguterman@gmail.com

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

Overdose: The Basics

5

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

Quality • Try to use the same dealer• Do tester shot

11Quality

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

Opiate Overdose

14Opiate Overdose

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

Stimulation

• NOISE

• PAIN (sternum rub)

• Are they responsive?

17Stimulation

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

Stimulant Overdose

30Stimulant Overdose

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.