OPIOID OVERDOSE PREVENTION ORIENTATION WHAT ARE OPIOIDS AND HOW LONG DO THEY WORK? Duration of Action of Opioids

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1 OPIOID OVERDOSE PREVENTION ORIENTATION There has been an alarming increase in the incidence of deaths caused by opioid overdose (prescription and non- prescription) in the United States. Enhanced educational and hands- on training programs have been shown to decrease, if not eliminate, the dangers associated with opioid use and abuse. Death by opioid overdose is preventable and hopefully this information, which can literally save lives, will be beneficial to you and your loved ones. WHAT ARE OPIOIDS AND HOW LONG DO THEY WORK? Opioids are drugs that are effective for the use of pain. Different opioid medications have varying length of action on how long they work. Table below list opioids and the duration of action (how long they may work) DRUG (long acting) Methadone Buprenorphine (Suboxone) Morphine Oxycodone (Oxycontin) Heroin Dilaudid Codeine Demerol Fentanyl Duration of Action of Opioids DURATION (Hours) WHAT CIRCUMSTANCES INCREASE RISK OF DEATH BY OVERDOSE? Recent release from drug treatment or incarceration. Tolerance level changes and individuals assume they can use the same amount of the drug they were using before they went into treatment or were incarcerated. (suggestion to reduce risk: do a tester amount) Mixing or combining (ingesting them at roughly the same time period) drugs like alcohol and benzodiazepines is a DEADLY mix Being ill, especially with an active infection or having a suppressed immune system increases risk of overdose Using alone Assuming potency of drug is same as the last time you used OVERDOSE SIGNS Semi- awake but not able to talk Very slow breathing Loud gurgling or snoring sounds 1

2 Shallow breathing Lips and fingernails turn blue or purple or grayish ash color Non- responsive to outside stimulus such as sternal chest rub, pinching of ears or lips FACTS Death from an overdose can take anywhere from 1 to 3 hours to occur Opioids suppress the urge to breathe and decrease the brains response to the build- up of carbon dioxide. Rescue breathing alone can sustain someone until EMS arrives especially if started before the heart stops beating Oxygen administration is the cure for overdose DO s and DON Ts DO Stay with the person suffering overdose symptoms DO have a plan of action with your using partner in the event either of you overdoses DO put the person on their side (recovery position) if they are breathing independently (on their own) DO Rescue Breathing if the person is not breathing independently DO administer Naloxone if available DO call 911 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 as this could cause further injury DON T let the person immediately use again after administering naloxone WHAT TO DO IN CASE OF OVERDOSE Stimulate- - - Yell their name, shake them, rub sternum (rub middle of chest/sternum with knuckles), 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 Give 2 quick breaths then breath 1 slow breath every 5 seconds if the person is not breathing on their own. Evaluate- - - is the person improving? Administer Naloxone/Narcan (inject 1 cc with syringe in arm, thigh, or buttocks (muscle syringe 25g, 1- inch 3ml syringes are recommended- - any option is OK as long as the point is 1 inch long to reach the muscle). If using spray model Naloxone, spray once in each nostril. If using auto injector (Evzio brand), follow verbal prompts. Evaluate and Support- - - Are they breathing on their own? Remember to stay with person and seek help. Is more Naloxone needed? 2

3 Do not leave person unattended. If for any reason you are not able to directly observe the person, place them in recovery position laying them on their side, their body supported by a bent knee, with their face turned to the side. This can help keep airway cleared and preventing them from choking on their vomit. Perform Rescue Breathing Overdose Response For a person whose breathing is severely impaired, rescue breathing is one of the most important steps in preventing an overdose death. When someone has extremely shallow and intermittent breathing (around one breath every 5-10 seconds) or has stopped breathing and is unresponsive, rescue breathing should be done as soon as possible because it is the quickest way to get oxygen into someone who has stopped breathing. If you are performing rescue breathing, you are getting much needed air into someone s body who will die without it. The difference between survival and death in an opioid overdose depends on how quickly enough oxygen gets into the person s body. These are the steps for rescue breathing: 1. Place the person on their back. 2. Tilt their chin up to open the airway. 3. Check to see if there is anything in their mouth blocking their airway, such as gum, toothpick, undissolved pills, syringe cap, cheeked Fentanyl patch (these things have ALL been found in the mouths of overdosing people!). If so, remove it. 4. Pinch their nose with one hand, and give 2 even, regular-sized breaths. Blow enough air into their lungs to make their chest rise. If you don t see their chest rise out of the corner of your eye, tilt the head back more and make sure you re plugging their nose. 5. Breathe again. Give one breath every 5 seconds. 3

4 Photo: N.O.M.A.D (Not One More Anonymous Death) If you are alone with the overdosing person, follow these steps and give the person a few breaths and then put them in the Recovery Position and go get your Naloxone kit. If there is more than one of you there to respond to the overdose, DIVIDE DUTIES have one of you do rescue breathing and the other can go get the Naloxone kit. If you don t have a naloxone kit, continue rescue breathing until help (i.e. the ambulance) arrives. If there s more than one person present, take turns rescue breathing it can be exhausting. 4

5 RECOVERY POSITION 5

6 NALOXONE (NARCAN) Naloxone is an opioid antagonist used to counter the effects of an opioid overdose When used in a reasonable time frame, it takes about 3-5 minutes to work Naloxone only works if a person has opioids in their system and it has no effect if opioids are not present Naloxone comes in injectable form (1cc recommended) and also in nasal spray ( 1 spray in each nostril) Naloxone may only last minutes (in rare cases person may go back into overdose symptoms because the effect of most opioids last longer than effect of the naloxone) Naloxone will cause the person to go into sudden withdrawal and they will wake up unhappy. Routinely used by EMS and other first responders Reverses sedation and respiratory depression It is a prescription medication and is available over- the- counter in some places No adverse effects Links to Purchase Naloxone Spray Intranasal Mountainside Medical Equipment medical.com/naloxone- life- saving- drug- kit.html Injectable Naloxone (Hospira) (muscle syringe 25g, 1- inch 3ml syringes are recommended) Evzio Auto Injector (has visual and voice instructions) ign=brand&utm_content=gfrflo1b_dc pcrid pkw evzio pmt be 6

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8 How to Use EVZIO evzio/how- to- use- evzio.php Visual and voice instructions help guide the way EVZIO is designed to be easy to use for patients, their family members, and other caregivers. It contains the Intelliject Prompt System (IPS ) with visual and voice instructions that help guide the user through the injection process. You should use EVZIO exactly as prescribed by your healthcare provider. Each EVZIO auto-injector contains only one dose of medicine. Caregivers should pinch the thigh muscle when injecting EVZIO into a child under the age of one. Step 1. Pull EVZIO from the outer case. Do not go to Step 2 (Do not remove the red safety guard.) until you are ready to use EVZIO. If you are not ready to use EVZIO, put it back in the outer case for later use. Step 2. Pull off the red safety guard. To reduce the chance of an accidental injection, do not touch the black base of the auto-injector, which is where the needle comes out. If an accidental injection happens, get medical help right away. Note: The red safety guard is made to fit tightly. Pull firmly to remove. Do not replace the red safety guard after it is removed. Step 3. Place the black end against the middle of the outer thigh, through clothing (pants, jeans, etc) if necessary, then press firmly and hold in place for 5 seconds. 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 World Health Organization (WHO) Opioid overdose: preventing and reducing opioid overdose mortality Harm Reduction Coalition Opioid Overdose Basics prevention/overview/overdose- basics/ Naloxone Information VIDEOS RELATED TO OVERDOSE RESCUE WITH NALOXONE (NARCAN) (1 st video Video by Prevention Point Pittsburgh and Project Lazarus (11min17sec) Project Lazurus (20 min) families/videos Nasal =D5EBF44FF7084B0829D1D5EBF44FF7084B0829D1 Evzio ign=brand&utm_content=gfrflo1b_dc pcrid pkw evzio pmt be Harm Reduction website prevention/tools- best- practices/overdose- videos/ Rescue Breathing xdd- Lj30Ns&feature=youtu.be Staying alive on the outside (after incarceration or after treatment) alive- on- the- outside 9

10 Charles Thibodeaux B.A.A.S., LCDC DFPS Liaison/Oxford House Coordinator Mental Health and Substance Abuse Services Program Services Section/Substance Abuse Services P.O. Box Mail Code 2109 Austin, TX