OPIOID OVERDOSE AVERTED: NALOXONE-FRIENDLY ZONES SAVE LIVES. Carl Scroggins, CADC, QHEIC, EMT

Transcription

1 OPIOID OVERDOSE AVERTED: NALOXONE-FRIENDLY ZONES SAVE LIVES Carl Scroggins, CADC, QHEIC, EMT

2 For the audio portion of this webinar, you have two options. 1. Listen through your computer speakers. Just make sure your volume is on. 2. Call in by phone: Phone: Participant Pin: #

3 Who is Gateway Alcohol & Drug Treatment? Largest Provider of Substance Abuse Treatment in Illinois Locations throughout Illinois and the St. Louis Metro East area. Treatment for Adults and Adolescents. Outpatient, Day Treatment Residential Treatment, and Aftercare.

4 Outpatient Services offered at 7 locations including: River North, Pekin and Swansea (St. Louis Metro East) As well as Residential services at 6 locations. Chicago River North Pekin Swansea

5 How to Communicate with the Presenter: Raise Your Hand Agree Disagree I need assistance

6 Please send us any questions you may have as we go along. Simply type your questions into the CHAT box on your webinar screen. Technical questions may be answered via chat. Questions related to the content of today s presentation will be answered by Carl Scroggins at the end of the one hour training.

7 Download a copy of today s presentation by clicking the download button in the Shared Files section.

8 Survey There is a brief survey at the end of the presentation. Help us understand what you thought of our webinar. CEU Each person who requested a CEU and logged into webinar for 60+ minutes will receive a certificate for 1 CEU. IMPORTANT: A continuing education credit is only available to individuals who register and log on to the webinar for 60 minutes. Credits cannot be provided to members of a group sharing the same login and/or computer

9 Carl S. Scroggins, CADC, QHEIC, EMT Overdose Prevention Program Supervisor, Gateway Treatment Centers More than 24 years of industry know-how including counseling clients and supervising programs Developed numerous trainings to enhance the knowledge of Gateway s clinical professionals on a variety of topics, such as cooccurring disorders, enhancing counseling skills and teamwork development Holds an AAS degree in Mental Health: Alcohol and Other Drug Abuse Counseling from Harold Washington College in Chicago.

10 In this training we will be focused on opioid overdose. Which drugs are opioids? Identify symptoms of overdose for depressants and stimulants. How they affect the body. How to manage an opioid overdose. How many opioids can you name?

11 Heroin Morphine Codeine Methadone Demerol Oxycodone OxyContin Percodan Percocet Hydrocodone Vicodin Fentanyl Hydromorphone Dilaudid

12 What is an overdose? The ingestion of a legal or illegal substance in more than the usual dose either intentionally or unintentionally. Ingestion: Taking in. You can overdose by ingesting in a number of ways (not just injecting) sniffing, snorting, smoking, swallowing pills, etc. Legal or illegal substances: Just because something is legal doesn t mean it is safe. Examples: alcohol, methadone, prescription pills.

13 The Illinois Consortium on Drug Policy Concluded: The Chicago Area has the most severe heroin problem as measured by emergency room visits. The trouble is most acute in the suburbs. Overdose deaths have spiked since 2007 In 2010, Chicago metropolitan hospitals recorded 24,360 admissions Heroin related Second place New York 12,226 Heroin related

14 Illinois is one of the sixteen states that has a higher fatality rate from drug overdoses than car accidents. From 2006 to 2008 Will and McHenry counties alone experienced a 100% increase in heroin related deaths

15 In 2009, Illinois enacted the Overdose Prevention Law The law allows trained individuals to administer lifesaving drugs in the event of an overdose. The Public Act (20 ILCS301/5-23) The Act further saves lives by protecting friends and family who seek medical help from arrest or prosecution for possession of a small amount of drugs.

16 As of August 15, States have laws protecting people who use naloxone NM, NY, WA, CA, MA, NC, OR, CO, VA, KY, MD, VT, UT, TN, ME, GA, WI, MN, OH, & DE. 26 with Washington D.C* * See The Network for Public Health Law August 2014 for a complete list of state laws and naloxone.

17 What does an opioid overdose do to the body? Generally happens over minutes to 3 hours The stereotypical needle in the arm death NOT common (only about 15%). Most take much longer, and happen over time. Opioids suppress the urge to breath Decreased response to carbon dioxide, leading to slowed breathing and death.

18 What does an overdose do to the body? Slow breathing Breathing stops Heart stops Circulation of blood to the brain stops

19 Audience Poll: What can increase your risk of overdose? a) mixing drugs b) mixing drugs and alcohol c) using after a period of non-use d) all of the above

20 Substances Individual Characteristics Route Mixing Quantity Potency Quality/Cut Age Tolerance Health Status Genetic Factors Other Medications Injection Inhalation Ingestion Snorting Inserting Overdose Risk

21 Depressants Alcohol, GHB, Benzodiazepines, Opioids: Morphine, Dilaudid, Heroin, Methadone Person can t stay awake, walk, or talk Slow or absent pulse Slow or absent breathing, snoring or gurgling. Less than breathes per minute (a breathe every 5 seconds is normal Skin looks pale or blue, especially nail beds and lips, feels cold Pupils are pinpoint or eyes rolled back Vomiting No response to noise or knuckles being rubbed hard on the breast bone Unresponsiveness Stimulants (uppers) Cocaine, Crack, Ritalin, Methamphetamine, Ecstasy Fast pulse or no pulse Short of breathe Body is hot/sweaty, or hot/dry Confusion, hallucinations, unconscious Clenched jaw Shaky Chest pain Seizures Vomiting Cannot walk or talk Rigid or jerking limbs

22 Reduced Tolerance Route Illness Depression Unstable housing Using alone-more likely to be fatal Mixing drugs Changes drug supply Health Status (Liver) History of previous overdose Using in a new environment not engaging in normal drug taking routine.

23 Reduced tolerance: using after a period of clean time, such as release from jail or prison, hospitalization, or drug treatment Mixing drugs: Such as methadone and Xanax (other benzodiazepines) Using alone: overdose can take effect over a long period of time

24 Pulmonary (lungs) Breathing is very slow and shallow or has stopped Passing out Throwing up Blueish tint to face, lips, fingernails Loose muscles Cold or clammy skin Choking sounds, gurgling noises, snoring Awake, but unable to talk Body is very limp Face is very pale

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26 To find out, stimulate the person Shake them, call their name loudly. Sternal Rub: rub your knuckles up and down the breast bone. Discomfort can cause someone to wake-up but you do not want to cause injury If the person wakes up: Ensure their airway is clear Call ambulance Contact medical department Stay with them until help arrives

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28 If the person CANNOT BE ROUSED: Call ambulance (911) Have someone contact the Medical Department Check that their airway is not blocked Check their breathing Look, listen, for breath and then pulse. If no pulse begin CPR. If not breathing begin basic life support, If breathing, place in RECOVERY POSITION Wait with them until the ambulance arrives Retrieve Naloxone Kit/Administer Naloxone

29 If you ve assessed the individual and they have symptoms of overdose, and you have reason to believe that the individual has overdosed follow the S.A.V.E. M.E. Protocol. Factors to take into consideration: The person has a history of opioid abuse/use.

30 The person tells you they ve taken an opioid and they are exhibiting signs of overdose and request naloxone or help for their overdose. If they are alert enough let them know that they have the option of naloxone. Someone tells you they witnessed the individual use a drug before the overdose symptoms began. You are informed by a family member, other staff, or anyone that reports that the individual told them they had used a drug(s) before the overdose symptoms occurred.

31 How to use Rescue Breathing on adults: 1. First, tilt the victim's head back and lift the chin up, then pinch the nose shut. 2. Give 2 slow breaths into the mouth (see next slide for rescue breathing mask). Blow until the chest gently rises. 3. Check for a pulse to make sure the heart is still beating. - If a pulse is present but victim is still not breathing...call 911 if you already haven t done so. 4. Give 1 slow breath about every 5 seconds. Do this for about a minute, 12 breaths. 5. Recheck pulse and breathing about every minute.

32 A rescue breathing mask similar to this one will be in the overdose kit. Instructions on how to use the mask will be on the mask packaging

33 The recovery position is designed to prevent suffocation through obstruction of the airway. Step One Step Two Step Three Recovery Position

34 1. Should be as near true lateral (on the side) as possible with the head dependent to allow free drainage of fluid. 2. The position should be stable 3. Any pressure that impairs breathing should be avoided. 4. It should be possible to turn the person onto the side and return to the back easily and safely. 5. Good observation of and access to the airway should be possible. 6. The position should not give rise to any injury

35 What is Naloxone? Naloxone is also known as Narcan Naloxone is a medication which reverses the effects of opioids, preventing fatal overdose Naloxone restores breathing and consciousness Naloxone can be given as a shot or as a nasal spray

36 Narcan /Naloxone has been used in the medical field, such as in emergency rooms, in emergency medical services for the last thirty to forty years as an antidote for opiate reversals.

37 Naloxone reverses the effects of opioids. It will not work for other substances such as: Alcohol Cocaine Benzodiazepines Amphetamines Xanax Valium Methamphetamines Klonopin Ecstasy Tricyclics Ketamine GHB

38 If someone is using an opioid in combination with another drug, naloxone will still counter- act the effects of the opioid. If you think the person has used an opioid and has overdosed, use the naloxone. It won t hurt and could help. Naloxone has no potential for abuse & has no mind altering effects.

39 Evzio Intramuscular auto-injector 0.4 Several hundred Dollars Talks to you Intramuscular injection Manual Inexpensive $ $40.00 Lay people may be hesitant to use

40 Intranasal naloxone packaged as: prefilled vials, syringes, and nasal cones must be kept from light must check expiration date on a regular basis NOTE: Always identify, look to see that the vial is a naloxone vial.

41 Works quickly since the nose has a large area for absorbing drugs directly into the blood stream.

42 Squirting the liquid drug as a fine mist covering more of the surface, increasing entry into the bloodstream.

43 Audience Poll: When administering nasal naloxone you should administer it into the following manor: a) Spray the full vial of naloxone into one nostril b) Spray 1ml into each nostril c) Spray half of the vial of naloxone into one nostril and if no response spray the other half into the other nostril

44 Note the luer-jet syringe contains a premeasured naloxone amount of 2mg per 2mL and the expiration date

45 1 Naloxone (Narcan) 1mg/mL 2mL Luer-Jet Luer-Lock Prefilled Syringe 1 LMA MAD300 Nasal Intranasal Mucosal Atomization Device without Syringe 1 Pair of Large Medstorm TritonGrip TE Black Nitrile Exam Gloves Conveniently Packaged In a 5 x 7 Zipper Bag Breathing Mask A brochure reviewing OD and rescue steps

46 The Overdose Responder Kit Also Contains: Quick Reference Guide: Will show S.A.V.E. M.E. protocol Rescue Breathing instructions Intranasal naloxone administration instructions Overdose Reversal and Naloxone Administration Form.

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52 If the second dose of naloxone does not revive them, something else maybe wrong either it has been too long and the heart has already stopped, there are no opioids in their system, or the opioids are unusually strong and require more naloxone (can happen with Fentanyl, for example) Naloxone only lasts between minutes.

53 The effects of opioids may last much longer Naloxone may wear off and overdose recur Someone should always remain with the person during the risk period just in case another dose of naloxone is required Inform EMTs/Paramedics about the number, frequency and timing of doses administered. 30 TO 90 MINUTES

54 S.A.V.E. M.E. Stimulation: Try to wake them up Call: If they don t respond to noise or pain, call 911. If you have to leave put in recovery position. Airway: Make sure nothing is blocking their airway. Check for breathing. Ventilate (Rescue Breathing): If they aren t breathing at least 1x every 5 seconds give rescue breaths.

55 Evaluate: Are they any better? Naloxone: Can you get to naloxone and prepare it quickly enough, if they aren t breathing? (MIST) Naloxone Intranasal Spray: Prepare naloxone and spray 1ml into each nostril. If one nostril is blocked spray into the open nostril. Keep breathing for them, if necessary, until naloxone kicks in. Ventilate (Rescue Breathing): If they aren t breathing at least 1x every 5 seconds give rescue breaths.

56 Evaluate & Support Are they breathing on their own? If the first spray/mist doesn t kick in after four minutes, give them a second dose Comfort the person he/she will be in withdrawal and may be very agitated.

57 Identify the scope of the overdose problem in your community/treatment Center (what drugs, who, where, etc.) Find a medical director or licensed physician that is willing to prescribe naloxone (cite research, enabling laws and put in touch with currently prescribing doctors and medical directors). Purchase naloxone (with MD s license number, through pharmacy or health department) and other supplies for kits.

58 Given your agency's facilities, policies, and staff, what are the potential barriers to developing an overdose prevention plan? What training would your agency need in order to put your plan into action? What resources do you already have (space, staff, time, photocopier, etc.)? And what do you need?

59 - Opioid overdose kills thousands of Americans Every year - Many of these deaths can be prevented by a cheap, effective and safe drug - Overdose programs can be implemented at minimal cost

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