Overdose a Public Health Epidemic

Transcription

1 Overdose a Public Health Epidemic What Can We Do? Dr. Kerby Stewart Texas Dept. of State Health Services Kerby.stewart@dshs.state.tx.us Mark Kinzly, Harm Reduction Activist & Consultant markkinzly@yahoo.com Charles Thibodeaux, Texas Dept. of State Health Services Charles.thibodeaux@dshs.state.tx.us What Are We Talking About? Overdose in the United States Overdose in Texas What are Opioids? What is an Overdose? Signs of Opioid Overdose Naloxone Do s and Don t s What Can We Do? Overdose in the United States The Centers for Disease Control (CDC) and Prevention has classified prescription drug abuse as an epidemic. Deaths caused by drug overdose have steadily climbed throughout the last two decades in the United States. In 2010, more deaths resulted from overdose than from vehicle traffic crashes for people 25 to 64 years old. Of the 22,134 deaths related to prescription drug overdose in 2010, 75percent involved opioid analgesics. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Policy Impact: Prescription Painkiller Overdoses, November 2011, Available: Centers for Disease Control and Prevention, Prescription Drug Overdose in the United States: Fact Sheet, Available: 1

2 Overdose in Texas In Texas from 1999 to 2007, there was a 150 percent rise in deaths from drug overdose from legal and illegal drugs according to a report from the Drug Policy Alliance. The 150 percent increase since 2007 of fatal overdoses in Texas echoes national trends. Almost one third of all drug overdoses were adolescents and young adults in the age range with the majority of victims being in the year age range. In 2007, more people in Houston died from accidental overall drug overdose than from automobile accidents. Legal prescription drugs that contain opioid, such as hydrocodone and oxycodone, were identified in at least 50 percent of all accidental overdoses between 2005 and 2009 in Houston. When heroin is factored in to the picture, deaths from opioid overdoses hit 56 percent. Drug Policy Alliance, Overdose: A National Crisis Taking Root in Texas, Available: Texas Opioid Deaths by County 2009 Number of T40.2 Opioid Deaths per Year* Number of Deaths Year Texas deaths from poisoning by codeine, morphine, oxycodone, hydrocodone (T40.2) opioids other than opium (T40.0), heroin (T40.1), methadone (T40.3) and other synthetic narcotics (T40.4) DSHS Vital Statistics Year 2

3 DSHS Treatment Admissions Methadone "Other Opiates" Law Enforcement Response to Overdose Law Enforcement shuts down Pill Mills (increase in heroin use as result) Heroin Use on The Rise in Ohio use still on the risein ohio As Florida Shuts down Pill Mills, Heroin Fills Void florida shutsdown pill mills.html Law Enforcement Carrying Naloxone to Save Lives. North Carolina Harm Reduction enforcement usingnarcan naloxone save people who have overdosed lives Law Enforcement Quincy Mass. reversed 211 overdose deaths narcan to reverse heroin overdoses/ / Law Enforcement in Illinois Police using Narcan to Reduce Heroin Deaths usingnarcan to reduce heroin deaths/ Opiates and Opioids Opiates: Opium Morphine Codeine Heroin Opioids Hydrocodone (Vicodin, Lortab, Norco) Oxycodone (Oxycontin) Hydromorphone (Dilaudid) Fentanyl Meperidine (Demerol) 3

4 OPIOIDS DURATION OF ACTION PRODUCE DIFFERENT SPEED, LENGTH AND INTENSITY OF WITHDRAWAL DRUG METHADONE OXYCONTIN HEROIN DILAUDID CODEINE DEMEROL FENTANYL HOW LONG IT WORKS 24 HOURS 12 HOURS 6-8 HOURS 4-6 HOURS 3-4 HOURS 2-4 HOURS 1-2 HOURS What Are Contributing Factors of Opioid Overdose? Recently released from drug treatment or incarceration. Tolerance level changes and folks tend to think they can use the same amount as pre treatment or incarceration Return to use following Detoxification Mixing drugs ie alcohol/opioids and benzodiazepines, etc Supressed Immune system Infection Using alone Assuming potency of drug is same as last use Overdose Signs Non Responsive to outside stimulus such as sternal rub on chest, pinching of ears or lips Shallow or Irregular Breathing Lips and fingernails turn blue or purple or grayish ash color Loud gurgling or snoring sounds Very slow (apneic) breathing Semi awake but not able to talk 4

5 Physiology of Opioid Overdose The Overdose can take anywhere from 1 to 3 hours to occur before becoming fatal Normal respiration involves breathing in air with oxygen (O2) and breathing out carbon dioxide (CO2). The primary stimulus to take a breath is rising CO2 followed by decreasing O2. Opioids suppress the urge to breathe by decreasing the brain s response to rising CO2 and decreasing O2. (Giving this person oxygen, alone, or respirations through a mask, will not reverse this; though, it will prolong viability!) The OD victim will eventually need either reversal by naloxone or ventilation from a ventilator Do s and Don t s DO Stay with the person overdosing DO put the person on their side if they are breathing independently DO Rescue Breathing if person not breathing independently DO administer Naloxone if available DO call 911 if feasible DON T inject the person with salt water, or milk DON T give the person a cold shower DON T try to continue or forcefully wake the person up this could cause further injury S.C.A.R.E. M.E. Stimulation Yell their name, shake, and rub sternum, pinch ear or lip Call for Help Call 911 and say person is not breathing Airway Make sure the airway is clear of blockage. Lay person on their back and tilt head back Rescue Breathing Breath 2 slow breaths if person not breathing on their own. Thereafter one breath every 5 seconds. Does their chest rise with your breaths? if not they have a blocked airway Repeat head tilt and chin thrust maneuver until airway opens. If airway has foreign body blocking it this maneuver may open airway if it doesn t perform abdominal thrusts/back blows (TAKE A CPR COURSE!) Evaluate is the person improving? Muscular Injection Inject 1cc of Naloxone (or one spray in each nostril) into muscle thigh, upper arm, or buttock Evaluate and Support Are they breathing on their own? Stay with person and seek help. Is more Naloxone needed? 5

6 RESCUE BREATHING Oxygen prolongs viability during an overdose and rescue breathing alone can sustain someone until EMS arrives if started before the heart stops beating. RECOVERY POSITION Unless you are doing rescue breathing, put them into The Recovery Position on their side so they can clear secretions (ie so they don t choke on vomit). Naloxone (Narcan) Naloxone is an opioid antagonist used to counter the effects of an opioid overdose When used in a timely fashion, it takes about 3 5 minutes to work Naloxone only works if a person has opioids in their system and has no effect if opioids are not present Naloxone comes in injectable form (1 cc recommended) and also in nasal spray (1 spray in each nostril) Naloxone only lasts minutes (person may go back into respiratory suppression remember stay with person) Naloxone will cause the person to wake up dope sick (in acute severe withdrawal) and unhappy DO NOT let the person immediately use again 6

7 NALOXONE IN ACTION Reverses sedation, hypotension, and respiratory depression Causes sudden withdrawal in the opioid dependent person No psychoactive effects Over the counter in some countries, but not the US Routinely used by EMS ADMINISTRATION Inject into muscle but subcutaneous and intravenous are fine also Nasal spray once in each nostril Acts in 3-5 minutes If no response in 5 minutes repeat- and if 911 has not been called do it now!! Do not repeat naloxone more than twice Naloxone Lasts minutes Put Naloxone in the Hands of First Responders A Naloxone distribution program puts the antidote directly into the hands of those most likely to witness an overdose and respond first drug users, their families, outreach workers, and police There are a variety of settings where naloxone programs should be incorporated including: harm reduction services like needle exchange vans, methadone clinics, doctor s office s, drug treatment clinics, ambulances, and prison/jail release programs 7

8 Saving Lives is the Right Thing to Do! Many US States have passed laws to encourage naloxone distribution and use in emergencies. Recognizing that people may be reluctant to respond in an emergency if they fear prosecution, the laws aim to stop preventable deaths by encouraging trained laypeople to act in good faith to save a life, much as a bystander would do if they saw someone drowning or choking. GOOD SAMIRITAN LAWS ARE BEING IMPLEMENTED ALL OVER THE UNITED STATES Global Efforts In countries around the world, naloxone distribution programs have trained drug users, their families and friends to identify signs of overdose, administer naloxone, and ultimately save lives. These efforts have reversed tens of thousands of overdoses, and show that drug users and their communities can take positive steps to protect their health What about the US? In the US more than 53,000 people have been trained in overdose response and more than 10,000 rescues with naloxone have been reported! 8

9 Supports for Overdose Prevention SAMHSA Overdose Toolkit Overdose Prevention Toolkit/SMA Center for Disease Control (CDC) Prescription Drug Overdose in the United States: Fact Sheet ml World Health Organization (WHO) Opioid overdose: preventing and reducing opioid overdose mortality Harm Reduction Coalition Opioid Overdose Basics basics/ Naloxone Information Video s on Overdose Prevention Project Lazarus families/videos Chicago Recovery Alliance Dann Bigg +overdose+prevention+video&qpvt=chicago+recovery+alliance+ov erdose+prevention+video&form=vdre#view=detail&mid=66f3d72 CF47BC91FD21266F3D72CF47BC91FD212 Back From the Brink Staying Alive on The Outside (2 videos) Rhode Island Mark Kinzly LIVE: Using Injectable Naloxone to Reverse Opioid Overdose n&form=qbvr&pq=naloxone%20video%20&sc=0 0&sp= 1&sk=#view=detail&mid=3005B8088F22925B02E13005B8088F2292 5B02E1 Why Not Naloxone Having a life saving medication and not making it available is unethical at best. There is no evidence that suggests Naloxone access increases drug use. Though naloxone requires a prescription it is not a controlled substance. Open prescriptions can be written that allow for the dispensing of the medication to multiple recipients Write your legislative representative! 9

10 What Can We Do? Educate Clients Family Spouses Providers Neighbors Police Officers Anyone who works with Opioid Users 10