Sofia 2009Sofia 2009

Overdose prevention Overdose prevention

and managementand management

Overview of the topics

- Overdose risk factors- Methods of overdose prevention- Symptoms of overdoses- Safer help!- How to call the ambulance and talk

to the paramedics- How to do rescue breathing / heart

massage - When and how to use Naloxone- After the overdose- Overdose emergency plan

Overdose risk factorsOverdose risk factors

- Periods of abstinencePeriods of abstinence- Low expierence in drug use and Low expierence in drug use and wrong technicswrong technics

- Unknown drugsUnknown drugs- Mix of different drugs /alcoholMix of different drugs /alcohol- Health conditionHealth condition

Methods of overdose Methods of overdose preventionprevention

- Check the quality of the drugs (?!)Check the quality of the drugs (?!)- Testing small amountTesting small amount- Use slowly / Take your timeUse slowly / Take your time- Split into two or more servings Split into two or more servings - Don‘t mix up to many drugs / alcohol Don‘t mix up to many drugs / alcohol /benzos/benzos

- Don‘t use drugs alone and talk to Don‘t use drugs alone and talk to your partners before usingyour partners before using

- Learn safer use technicsLearn safer use technics

Preventing OverdosePreventing Overdose

- Know your dealer, know your - Know your dealer, know your stuff stuff

- Inject with OD prevention - Inject with OD prevention technics (tourniquet off technics (tourniquet off after hit, several slow after hit, several slow pushes to taste...)pushes to taste...)

Symptoms of overdoseSymptoms of overdose

- - Breathing problems (no or slow)Breathing problems (no or slow)- Skin colour, fingernails and - Skin colour, fingernails and pintpoint pupilspintpoint pupils- Onconsciousness, no response to pain- Onconsciousness, no response to pain- Loose muscles- Loose muscles- No heartbeat or slow heartbeat - No heartbeat or slow heartbeat (<50) (<50)

-- Epileptic attackEpileptic attack-- Psychiatric signsPsychiatric signs- Hyperventilation- Hyperventilation

Safer help!Safer help!

- Keep cool, you are the expert!Keep cool, you are the expert!- Use hand cloves!Use hand cloves!- Check out the place/person for harms Check out the place/person for harms like needles, blood, violence or any like needles, blood, violence or any other risk!other risk!

- Tell the others what you do and how Tell the others what you do and how they could help youthey could help you

Calling for ambulanceCalling for ambulance

- Your name and organisationYour name and organisation- Where you areWhere you are- What happened and what you What happened and what you allready didallready did

- Wait for questions or adviceWait for questions or advice

If drug users calling for If drug users calling for helphelp

- Call ambulance - “My friend is - Call ambulance - “My friend is unconscious/not breathing” - unconscious/not breathing” - Give locationGive location

- No need to say heroin No need to say heroin

or overdoseor overdose

- Police may come- Police may come

How does opiate How does opiate overdose kill?overdose kill?

-- cyanosis cyanosis . . . . . . (breathing is too (breathing is too slow), progressing toslow), progressing to apnea apnea . . . . . . breathing stopsbreathing stops

-- cardiac arrest cardiac arrest . . . the heart . . . the heart stops because itstops because it’’s not getting oxygen s not getting oxygen   

-- circulatory collapse circulatory collapse . . . . . . circulation of blood to the brain circulation of blood to the brain stopsstops

How to do rescue How to do rescue breathing / heart breathing / heart

massagemassage

Can you wake him?

yes watch No

No breathing? Turning blue?

ouwatchYe

sBreath him, check pulseCall the ambulance!

no pulse breath& startCPR

Yes pulse

Continue rescue breathing

Give information to the ambulance and maybe assist them. Evaluate.

Diagram without NaloxoneDiagram without Naloxone

PRACTICE

Rescue breathing for peersRescue breathing for peers

Teach mouth to mouthTeach mouth to mouth

using a dummy for using a dummy for

practicingpracticing

Heart massage (1 Heart massage (1 person)person)

20

Naloxone

- Is also called Narcan or Narcanti.

- Is a pure antidote to opiates including heroin - it reverses the effects of heroin for about an hour.

- Has no effects of its own - using it without having opiates in you is like injecting water.

- Is NOT a Drug - it has no potential for abuse.

- Can cause withdrawal in a person with a habit. Withdrawal can harm someone.

Available forms of Available forms of NaloxoneNaloxone

- Nasal spray - Nasal spray

- Pre-loaded single-dose syringe- Pre-loaded single-dose syringe

- One-dose glass ampules- One-dose glass ampules

- Multi-dose 10 mg bottle- Multi-dose 10 mg bottle

AdministrationAdministration

- Inject intravenous (fast - Inject intravenous (fast response) or into muscle or response) or into muscle or subcutaneous (easier to inject)subcutaneous (easier to inject)

- Acts in 2-8 minutes- Acts in 2-8 minutes

- If no response in 2-5 minutes, - If no response in 2-5 minutes, repeatrepeat

- Lasts 30-90 minutes- Lasts 30-90 minutes

SCARE ME Protocol Stimulation unsuccessful in arousing person

Call for help

Airway clear

Rescue breathingEvaluate

Muscular administration of narcanEvaluate and support

Can you wake him?

yes watch No

Breathing to low? Turning blue?

no give NLXYes

3 quick breaths, give NLXIs he breathing on his own?

yes watchNo

Continue rescue breathing until he’s breathing

One hour later, is he getting sleepy again?

no watchYes

Consider another dose of NLX

After the overdoseAfter the overdose

- Don‘t leave the person aloneDon‘t leave the person alone- Tell the overdoser (and his Tell the overdoser (and his partners)partners)

what happened with himwhat happened with him- Talk to the paramedicsTalk to the paramedics- Evaluation and relaxing!Evaluation and relaxing!

Recovery PositionRecovery Position

If you must leave the overdoser If you must leave the overdoser even for even for

a few minutes put him into thea few minutes put him into the

recovery position so recovery position so

he won’the won’t

choke on vomitchoke on vomit

Evaluation

7. Verhalten bei Drogennotfällen im Druckraum und auf der Straßea) im Druckraum:-Sofort die restlichen MitarbeiterInnen der Schicht informieren!-1-2 MitarbeiterInnen zur Unterstützung in den Konsumraum holen!-Die MitarbeiterInnen im Vorraum schließen sofort die Eingangstür!-Es herrscht absoluter Betriebsstillstand, d.h. die Einrichtung ist für die Dauer des Notfalls geschlossen!-Die MitarbeiterInnen im Konsumraum leiten sofort die nötigen Erste-Hilfe-Maßnahmen ein!-Sichtkontakt zu den KollegInnen halten und gegebenenfalls Unterstützung bzw. Ablösung anfordern.-Bei einem Notfall sind immer Handschuhe zu tragen!

Thank you!Thank you! for more useful information look at:for more useful information look at:

www.anypositivechange.orgwww.harmreduction.orgwww.goingover.org.ukwww.goingover.org.uk

www.fixpunkt.orgwww.fixpunkt.org

Questions Questions ??