Emergency Responder, train the trainer model - PowerPoint Presentation

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Emergency Responder, train the trainer model  

Missouri Overdoes Rescue and Education ProjectSlide2

Topics covered today:

Opioid Use Disorder & the brainOpioid overdose recognition & ResponseChanging legal landscape

MO-HOPE

field report

MORE ProjectSlide3

Opioid Use Disorder and the BrainSlide4

Preventable

Treatable

Recovery is possible

Addiction & substance use disorder Slide5

Brain disease

Symptoms

Progression

PrognosisSlide6

Risk factors for SUD

Victims of abuse

Easy availability

Poor self concept

Difficulties coping with stress

Weak family relationships Early experimentation

Behavior problems GeneticsSlide7

International Narcotics Control Board Report, 2008

The influence of prescription monitoring programs on chronic pain management,

Pain Physician

, 2009Slide8
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That’s why it feels good!Slide10

Why do people use opioids?

Alexander

Walley,MDSlide11

Medication Assisted Treatment (MAT)

Source: National Institute on Drug Abuse, Pew Charitable Trusts

Credit: Rebecca

Hersher

and Alyson Hurt/NPRSlide12

MAT for opioid dependence

Alexander Walley,MDSlide13

What are risk factors for an overdose?

Acute:Period of abstinence= Decreased tolerance (

Incarceration, detox, rehab, etc.)

A change in amount or purity

(e.g., fentanyl)

InjectingMixing opioids with other substances (CNS depressants)

Using aloneBeing physically ill/respiratory disease

Homeless in the past 90 days

Chronic:

Previous overdose

History of substance use or misuse

Previous suicide attempt

Access to prescription drugs

Witnessed a family member overdose

High Rx opioid dose and/or sustained actionSlide14

“A theory which suggests that people typically adjust their behavior in response to the perceived level of risk

, becoming more careful where they sense greater risk and less careful if they feel more protected”A familiar concern…

safe sex

edHIV prophylaxisneedle exchange

SeatbeltshelmetsSocietal public health

Cost vs. BenefitRisk compensationSlide15

Naloxone Antidote Administration for Suspected Opioid OverdoseSlide16
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Depressed mental status or coma

Ineffective or absent breathing

Pinpoint pupils

Bottom line on opioid overdose (narcotic

toxidrome

):Slide18

At least try to get breathing

restarted by giving the antidote via nasal sprayAdminister rescue breathing

(if pulse)

Administer chest compressions(if no pulse)

While waiting for EMS to arrive…Slide19

Naloxone (Narcan®): a drug that reverses opioid overdose effects

ADAPT Pharma antidote delivery system

NO assembly required

NO separate syringe

NO separate delivery device

While waiting for EMS to arrive…Slide20

Deploying the nasal spray kitSlide21

Deploying the nasal spray kitSlide22

Deploying the nasal spray kitSlide23

Deploying the nasal spray kitSlide24

BRISKLY

is the key concept here.

A feeble or slow push of the plunger

will just cause the medicine to

“dribble” ineffectively out of the kit.Slide25

If the first dose does not work, you can administer a 2nd doseIt takes approximately 2-5 minutes to take effect

Narcan stays in the system ~ one hourNarcan has a shorter half-life than heroin

Someone can go back into overdose after

Narcan wears off

Someone who overdosed should NOT use any type of depressant following the overdose

Important notes about naloxone (Narcan)Slide26

Opioid overdose = lack of oxygen to the brain. Even a little bit through rescue breathing can keep someone alive!Rescue breathing:

- Tilt head back and give 1 breath every 7 seconds

Feel for a pulse…

If pulse is present at all, start rescue breathingSlide27

Head-tilt/Chin-lift Maneuver often lifts the tongue out of the way

Airway tipsSlide28

If leaving their side, place patient in the recovery positionSlide29

Prepare!

About 50% of administrations result in no negative side effects.

Naloxone

can precipitate withdrawals among those with physical dependence. These may manifest as

:

Anger/Irritability (about 20%)“Dope Sick” (about 19%)Vomiting (about 7%)

Combative (about 4%)Other (about 5%)These initial reactions are medical (not criminal)Slide30

Nose

obstructions, active bleeding, structural defects

When NOT to use the spraySlide31

Patient does not show

opioid overdose symptomsIf the patient has no pulse, start CPRDon’t interrupt chest compressions for breathing or naloxone administration

Keep doing chest compressions until the AED arrives and it’s ready to deploy!

When NOT to use the spraySlide32

Eye ProtectionGlovesBreathing mask

Reminder: always use universal precautionsSlide33

What if I give naloxone to a patient who has a different kind of overdose or isn’t overdosing at all? Might the medicine cause harm?

F

A

Q

Frequently Asked QuestionsSlide34

No, not at all. Naloxone has very little,

if any, effect on people who are not experiencing an opioid overdose. It is an extremely safe (and effective) medication.

ANSWERSlide35

Do we need to write a report or tell anybody if we use the antidote on someone?

F

A

Q

Frequently Asked QuestionsSlide36

Yes. In addition to department protocols, this program will require officers to complete a field report on their smartphone

.

ANSWERSlide37

How should we safely store the Narcan

and how long does it last?

F

A

Q

Frequently Asked QuestionsSlide38

Keep Narcan

out of extreme temperatures and direct sunlight. Don’t leave it in your vehicle during hot summers and cold winters. Narcan shelf life is 24 months, but studies have found it lasts much longer if stored appropriately.

ANSWERSlide39

What now?

AFTER NALOXONE ADMINISTRATIONSlide40

addict

junkie

dope head

why

don’t you care?

rehab

loser

what’s the point?

aren’t you sick of this?

here we go again

get it together!

same old thing

Remember: avoid shame, guilt, stigma

What do I say? Things to avoidSlide41

empathic

offer hope

supportive

understanding

non-judgmental

compassionate patience

tolerance

Remember: this isn’t a moral issue or matter of right vs wrong

What do I say? Try these approaches: Slide42

There is treatment available and people do find recovery

There are resources and people to help

Is there someone we should call?

Because you may experience some withdrawal, this is a time people often want to use.

What do I say? Specific phrasesSlide43

Medication Assisted Treatment = most effective in reducing OD

In-Patient Treatment FacilitiesIntensive/Out Patient Treatment ProgramsHolistic/Nutritional/Alternative Approaches

Community Supports

Treatment options Slide44

Changing legal landscapeSlide45

Naloxone for General Public (2016)911 Good Samaritan (2017)

Changing legal landscapeSlide46

Naloxone laws in MO

RSMO 190.255, enacted August 28, 2014Distribution to first respondersFirst responder administration immunity

RSMO 195.206, RSMO 338.205, enacted August 28, 2016

Pharmacy availability (without an outside prescription)

Pharmacist criminal and civil immunityThird party access/right to possessAny person administering naloxone in good faith and with reasonable care has criminal and civil immunity and is immune from any disciplinary action from his/her professional licensing board

Any person or organization acting under a standing order issued by someone who is authorized to prescribe naloxone may store and dispense naloxone if the person does not collect a feeSlide47

(RSMO 195.205) A person who, in good faith, seeks or obtains medical assistance for someone who is experiencing a drug or alcohol overdose or other medical emergency or a person experiencing a drug or alcohol overdose or other medical emergency who seeks medical assistance for himself or herself or is the subject of a good faith request shall not be

ArrestedChargedProsecutedConvictedHave property subject to civil asset forfeiture

If the evidence … was gained as a result of seeking or obtaining medical assistance.

Missouri’s Good Samaritan LawSlide48

RSMO 579.015, 579.074, 579.078, 579.105Possession of a controlled substance or imitation controlled substance

Possession of paraphernaliaKeeping or maintaining a public nuisanceRSMO 311.310, 311.320, 311.325Alcohol sale to minorPossession of an altered ID

Purchase or possession of alcohol by a minor

Violating a restraining orderViolating probation or parole

What does immunity cover?Slide49

Outstanding warrants“an offense other than an offense under subsection 2 of this section, whether the offense arises from the same circumstances as the seeking of medical assistance. “

What is NOT covered?Slide50

Section 4:Any police officer who is in contact with any person or persons in need of emergency medical assistance under

this section shall provide appropriate information and resources for substance-related assistance.

What are responsibilities on a scene?Slide51

Reporting ProceduresSlide52

Currently no centralized figures in Missouri on overdose events and reversals – who, what, where, etc.

These figures = CRITICAL for better understanding overdose patterns and continuing to receive federal funding to provide more training and naloxone…

The rationale - Why project evaluation is important:Slide53

The

field report – what to expect:

1) Add this web link to your desktop:

mohopeproject.org/

ERreport

2) After responding to an overdose, click on

the

link and

complete the form

Agency, Zip, Sex, Age,

Drugs involved

, Use of

Naloxone, etc

.

3) Click “submit

”

and data will be sent

to

a secure database monitored by MIMHSlide54

Set up the web link on your phone:Mohopeproject.org/

ERreportComplete the Field Report for the following scenario:

The date is 01-03-17. You are a police officer for the “Test Agency,” who responded to a home in 63119 zip (Webster Groves, MO). The 22 year old individual appeared to be in an opioid overdose state so you administered one dose of

Narcan

nasal spray and he came out of the overdose. He appears to be a White non-Hispanic male, but you didn’t ask him directly. His friend who made the 911 call mentioned heroin being involved, but that friend is no longer at the scene and the individual says he’s “not sure” what he took. The individual states that he has been administered

Narcan before and he is feeling fine and does not want to go to the hospital.Practice Field ReportSlide55
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Your personal information and responses will not be shared with anyone outside of Evaluation project

personnel.Aggregated data will be reported and shared to inform project direction and

scope.

If you have any concerns about completing the Field Report, please contact your training liaison immediately, as timely completion is a critical piece of our partnership agreement.

The specifics – data protection and informed consent:Slide60

For questions about scheduling trainings, Narcan supply, or treatment resources, contact

DHSS:

Karen Wallace, M.Ed.

Karen.Wallace@health.mo

(573) 751-6839

For questions about evaluation (training surveys or OD Field Reports), contact MIMH:

Claire Ward, MSW Claire.ward@mimh.edu (

314) 516-8420

Questions?