CBNAP Naloxone training - PowerPoint Presentation

1. CBNAP Naloxone trainingTrainer Namelocation AND DATE

2. Learning objectivesBy the end of the presentation, participants will:Understand requirements of the Community-Based Naloxone Access Program Standing OrderKnow what naloxone is and how to store, track and administer itBe able to recognize and respond to an opioid overdose Be equipped to train others to administer naloxone

3. Community-Based Naloxone Access Program Standing Orderhttps://www.dhss.delaware.gov/dhss/dph/standingorders.html

4. Community-Based Naloxone Access Program (CBNAP) A program approved by Delaware Health and Social Services, Division of Public Health (DPH) to provide overdose response education and access to naloxone distribution services in accordance with these standing orders and program agreements.

5. Community-Based Naloxone Access Program Opioid Overdose Responder TrainingThis training may be provided by:Community-based classes conducted by a certified trainer;Point of distribution training conducted by a certified trainer;Online videos;Direct instruction from a pharmacist or other healthcare provider. Available classes, online videos and documentation forms can be found at:http://www.helpisherede.com/Get-Help/Overdose-Response

6. Naloxone Mythshttp://www.yourtrainingedge.com/top-10-training-myths/

7. Naloxone MythsMYTH: Naloxone encourages opioid users to take more drugs.

8. Naloxone MythsMYTH: Naloxone encourages opioid users to take more drugs.FACT: Research has shown that naloxone does not lead to more or riskier drug use (1).In fact, some studies have shown that naloxone use results in a decrease in opioid use (2).(1) Jones JD, Campbell A, Metz VE, Comer SD. No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone. Addictive Behaviors. 2017;71:104-106. doi:10.1016/j.addbeh.2017.03.008. (2) Wagner KD, Valente TW, Casanova M, et al. Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. International Journal of Drug Policy. 2010;21(3):186-193. doi:10.1016/j.drugpo.2009.01.003.

9. Naloxone MythsMYTH: Naloxone use prevents substance users from seeking treatment.

10. Naloxone MythsMYTH: Naloxone use prevents substance users from seeking treatment.FACT:There is no evidence to support the belief that the use of naloxone to prevent overdose death prevents opioid users from entering treatment.In fact, sometimes the near death experience can motivate an individual to seek treatment!Bazzari, AR, et.al. “Preventing Opiate Overdose Deaths: Examining Objections to Take-Home Naloxone.” Journal of Heath Care for the Poor and Underserved, vol.21, no.4, 2010

11. Naloxone MythsMYTH: Naloxone makes people violent.

12. Naloxone MythsMYTH: Naloxone makes people violent.FACT:It is rare for someone to wake up from an overdose and become combative (1).Dosing and process is designed to minimize hypoxic brain injury and allow the patient to wake up but not be in total opioid withdrawal. This keeps them safe and encourages engagement in treatment.(1) Fisher R, Odonnell D, Ray B, Rusyniak D. Police Officers Can Safely and Effectively Administer Intranasal Naloxone. Prehospital Emergency Care. 2016;20(6):675-680. doi:10.1080/10903127.2016.1182605.

13. NaloxoneGeneral informationNaloxone reverses all effects of opioids (i.e. morphine and heroin), such as respiratory depression and central and peripheral nervous system effects. Following intranasal administration the onset of naloxone action is 3-5 minutes (but can take up to 8 minutes) with a peak in 12-20 minutes and duration of approximately 30-60 minutes.

14. Naloxone mechanism of actionhttps://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/

15. Naloxone mechanism of actionhttps://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/What is an opioid?

16. Opioids -definitionsOpium: directly from the opium poppy Opiate: natural alkaloid product of opiummorphine, codeine, heroinOpioid: natural or synthetic pharmaceutical with affinity for the opioid receptorMethadone, buprenorphine, oxycodone, fentanyl, etc.Narcotic: Greek word meaning to numb or deadenOriginally used to describe opioids but now more widely used to describe any drug of abuse/addiction

17. Opioids - indicationsIn the U.S., opioids are indicated for the following uses:Analgesic to combat pain (morphine, hydrocodone, oxymorphone, etc.)Cough suppressant (dextromethorphan)Diarrhea (loperamide)Drug detoxification and maintenance treatment

18. Opioids - indicationsIn the U.S., opioids are indicated for the following uses:Analgesic to combat pain (morphine, hydrocodone, oxymorphone, etc.)Cough suppressant (dextromethorphan)Diarrhea (loperamide)Drug detoxification and maintenance treatment Withdrawal Management and Medications for Addiction Treatment (MAT)

19. Opioids - examplesBuprenorphineMethadoneCodeineFentanylHydrocodoneHydromophioneMeperidineMorphinOxycodoneOxymorphoneSuboxoneSubutexTylenol#3DuragesicVicodenNorcoDilaudidDemerolMethadoseMS ContinOxycopntinPercocetOpanaHeroin

20. Naloxone mechanism of actionhttps://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/NALOXONE ONLY WORKS IF THERE ARE OPIOIDS IN THE SYSTEM

21. naloxone Formulationshttps://openi.nlm.nih.gov/detailedresult.php?img=PMC4470965_40122_2015_35_Fig2_HTML&req=4http://choopersguide.com/content/intranasal-naloxone.htmlIntranasalAuto-injector

22. Naloxonestorage and expirationStore naloxone at room temperature (66-77oF)AVOID SUNLIGHT!DO NOT REFRIGERATE!DO NOT LEAVE IN THE GLOVEBOX!Naloxone has a shelf life of 12-18 monthsCheck the expiration date regularlyExpired naloxone kits should be replaced with a new kit

23. Naloxonestorage and expirationBe sure to store naloxone in a place that is easily accessible:First Aid KitWith AED In your handbag or backpack (provided you keep it at room temperature!)

24. Opioid overdose responder action stepshttp://www.russellwebster.com/naloxone-overdose-prevention-prisoners/

25. Opioid overdose responder action stepsRecognize signs and symptoms of opioid overdose Call for help – Dial 911 IF NOT BREATHING: perform rescue breathing to provide oxygen Administer naloxone to restore normal breathingIF NOT BREATHING OR SHALLOW BREATHING: continue rescue breathing If there is no change in 3-5 minutes, administer another dose of naloxone Stay with the person until help (medical professional) arrives

26. Recognize signs and symptoms of opioid overdose Very Intoxicated/HighOverdosedMuscles are relaxedPale, clammy skinSpeech is slowed or slurredBreathing is infrequent or has stoppedLooks sleepyDeep snoring or gurgling (“death rattle”)Responsive to shouting, ear lobe pinch, or sternal rubUnresponsive to any stimuliNormal heart rate and/or pulseSlowed or no heart rate and/or pulseNormal skin toneBlue lips and/or fingertips

27. Call for helpdial 911https://www.dcourier.com/news/2017/aug/12/column-when-should-you-call-911/

28. Call for helpdial 911https://www.auroragov.org/residents/public_safety/911_communications/when_to_call_911https://www.wibc.com/news/local-news/marion-co-sheriff-dont-call-911-fireworksDescribe exactly where you are with as much information as possible so they can more easily find you (i.e. 3rd floor, or in the bathroom).Describe what you see: “Not breathing, turning blue, unconscious, non-responsive, etc.”When the paramedics arrive, tell them what you know about what drugs the person may have been using—as much information as possible. Tell the dispatcher that you suspect an opioid overdose!!!!!This makes the call a priority.

29. Title 16 Chapter 47Criminal Immunity§ 4769 Criminal immunity for persons who suffer or report an alcohol or drug overdose or other life threatening medical emergency.A person who is experiencing an overdose or other life-threatening medical emergency and anyone (including the person experiencing the emergency) seeking medical attention for that person shall not be arrested, charged or prosecuted for an offense for which they have been granted immunity pursuant to subsection (c) and/or (d) of this section, or subject to the revocation or modification of the conditions of probation, if:The person seeking medical attention reports in good faith the emergency to law enforcement, the 9-1-1 system, a poison control center, or to a medical provider, or if the person in good faith assists someone so reporting; andThe person provides all relevant medical information as to the cause of the overdose or other life-threatening medical emergency that the person possesses at the scene of the event when a medical provider arrives, or when the person is at the facilities of the medical provider.

30. Title 16 Chapter 47Criminal ImmunityThe immunity granted shall apply to all offenses in this chapter that are not class A, B, or C felonies, including but not limited to the following offenses:Miscellaneous drug crimes as described in § 4757(a)(3), (6), and (7) of this title;Illegal possession and delivery of non-controlled prescription drugs as described in § 4761 of this title;Possession of controlled substances or counterfeit controlled substances, as described in § 4763 of this title;Possession of drug paraphernalia as described in §§ 4762(c) and 4771 of this title;Possession of marijuana as described in § 4764 of this title.http://delcode.delaware.gov/title16/c047/sc04/index.shtml

31. Check for breathingLook to see if the chest is rising and falling.Listen over the mouth and nose for breathing sounds.Feel for the breath against your cheek for 10 seconds.If not breathing, start rescue breaths.https://healthywa.wa.gov.au/Articles/A_E/DRSABCD-action-plan

32. IF NOT BREATHING: perform rescue breathing to provide oxygen https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/perform-rescue-breathing/

33. The Steps for Rescue BreathingPlace the person on their back.Tilt their chin up to open the airway.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.Plug 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.Breathe again. Give one breath every 5 seconds.

34. Mouth barriers are recommended when providing rescue breathsThese can be purchased online at the American Red Cross StoreIF NOT BREATHING: perform rescue breathing to provide oxygen https://www.redcross.org/store/first-aid-supplies

35. Administer Naloxone to restore breathinghttps://www.jems.com/articles/print/volume-41/issue-3/special-focus-resuscitation-recommendations/prehospital-naloxone-administration-for-opioid-related-emergencies.html

36. Administer Naloxone to restore breathingRemember, the goal of naloxone administration is to restore breathing.https://copd.net/clinical/breathing-treatments/

37. Administer Naloxone to restore breathingRemember, the goal of naloxone administration is to restore breathing.Because naloxone is reversing the effects of an opioid, some withdrawal effects may occur.However, the amount provided in the naloxone kit and the method with which it is administered should NOT cause severe withdrawal symptoms.

38. naloxone Formulationshttps://openi.nlm.nih.gov/detailedresult.php?img=PMC4470965_40122_2015_35_Fig2_HTML&req=4http://choopersguide.com/content/intranasal-naloxone.htmlIntranasalAuto-injector

39. Administration of nasal naloxoneAdminister nasal naloxone to a person suspected of an opioid overdose with respiratory depression or unresponsiveness as follows: Pop off the two caps from the delivery syringe and one cap from the naloxone vial. Screw the naloxone vial gently into the delivery syringe. Screw the mucosal atomizer device onto the top of the syringe. Spray half (1ml) of the naloxone in one nostril and the other half (1ml) in the other nostril.

40. Administration of nasal naloxone

41. Administration of injectable IM naloxoneAdminister injectable naloxone to a person suspected of an opioid overdose with respiratory depression or unresponsiveness as follows: Remove outer case from pre-filled single-use naloxone auto-injector device. Follow printed instructions on device label or the electronic voice instructions. Once (and only when) ready to use, remove red safety guard. Place the black end of the auto-injector against the outer thigh (through clothing if necessary). Press firmly for 5 seconds while the naloxone is administered via auto-injection. Injection will be intramuscular or subcutaneous depending on the patient’s characteristics such as body fat percentage.

42. IF NO BREATHING OR SHALLOW BREATHING: continue rescue breathinghttp://nhhrc.org/interview-overdose-prevention-response-with-makin-it-happen/

43. If there is no change in 3-5 minutes, administer another dose of naloxone

44. Stay with the person until help (medical professional) arrives

45. Recovery Positionhttps://www.healthnavigator.org.nz/health-a-z/r/recovery-position/

46. Recovery PositionIf you need to leave the patient for any reason (for example, to call 911) place the patient in the recovery position.Lay the person slightly on their side, their body supported by a bent knee, with their face turned to the side.This will help to keep their airway clear and prevent them from choking on their own vomit if they begin to throw-up.https://harmreduction.org/?s=recovery+position

47. What to expect after giving naloxoneWhile many people will react immediately, it may take up to eight (8) minutes for the naloxone to have an effect.Remember, the goal of administration of naloxone is to restore breathing.Because naloxone blocks opioids from acting, withdrawal symptoms may occur after someone is given naloxone, however, the dose provided and administration instructions should not lead to severe withdrawal symptoms.It is important that one does not use again until the naloxone wears off so that a re-overdose does not occur.

48. What to expect after giving naloxoneNaloxone’s effects last about 30-90 minutes.Many opioids last longer than this so if the naloxone wears off, it is possible that the person may go into overdose again.It is essential that the person be seen by a medical professional after an overdose (for example, EMT or a paramedic).If a person cannot walk or talk well after waking up, it is important that he or she is taken to a hospital.If he or she refuses to be taken to the hospital, stay with the person for several hours to keep them awake.https://www.addictionoc.com/signs-of-a-heroin-overdose/https://blog.credit.com/2013/10/consumer-rage-ambulance-ride-69734/

49. What if you don’t have naloxone?Call 911Start rescue breathing and continue until medical help arrives.If there is more than one person present, take turns as rescue breathing can be exhausting.https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/perform-rescue-breathing/

50. naloxone Kit

51. Tracking requirementsAll agencies or individuals providing community trainings must maintain a registry of persons trained Participants will be asked to provide this information during the training

52. Questions?https://www.huffpost.com/entry/asking-questions-is-really-hard_b_7052722