Drug Overdose Prevention Program Training Module Illinois Department of Human Services - PowerPoint Presentation

Drug Overdose Prevention Program Training Module Illinois Department of Human Services Division of Alcoholism and Substance Abuse Dr. Seth Eisenberg, MD Rosie Gianforte , LCSW

Overview of the Heroin/Opiate Problem Identifying Opioid OverdosesHow to Respond to an OverdoseUse of NaloxoneAfter Naloxone – Outreach Efforts/Treatment Referrals TOPICS

Opioids Opioids are a type of drugs in both legal (prescription medications such as oxycodone, hydrocodone, morphine, fentanyl) and illegal(heroin) forms. Opioids are natural or synthetic substances that act on the brainOpioids dull pain and relieve anxiety. People may misuse opioids because they are in pain (physical and emotional) and opioids produce a relaxed feeling.

A NATIONAL EPIDEMIC Between 2000 – 2013, Deaths from prescription opioid overdose death more than tripled. In 2014, 52 people died every day as a result of an overdose from a prescription painkiller.In 2014, almost 2 million Americans abused or were dependent on prescription opioids Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids.

According to the Centers for Disease Control : Since 2010, Heroin-related overdose deaths have more than quadrupled.More than 9 in 10 people who used heroin also used at least one other drug.Among new heroin users, approximately three out of four report having abused prescription opioids prior to using heroin.

IN ILLINOIS – the Opiate crisis 2013 - 2015 Illinois was one of 14 states with the highest increases in overall drug overdose deaths between 2013 and 2014.Opioid drug overdoses killed 45% more people than homicidesThe Chicago Metropolitan area ranks first nationwide in emergency department mentions for heroin use. Cook County ranks first in the nation for percentage of arrestees testing positive for opiates.Illinois is one of 16 states in which more people die of dug overdose than car crashes. Source: Illinois Department of Public Health

Who is at risk of an overdose? Switching between prescriptions Mixing opioids with other prescriptions People with chronic medical conditions (HIV, cardiovascular or respiratory disease, mental illnesses) Recently released from incarceration and in-patient tx programs. Recently completing a mandatory opioid detoxification or having abstained from use for a period of time Discharge from emergency medical care after opioid intoxication

Strategies to prevent overdose death Talk to people and caregivers about ways to avoid an accidental overdose, especially at discharge: Do not adjust prescribed dosage, skip doses, or take any extra doses Do not mix with other dugs and/or alcohol (i.e. anti-anxiety drugs like benzodiazepines, antidepressants, or cocaine) Abstain from use of opioids unless prescribed, and attempt abstinence from heroin. Opioid Overdose Prevention Toolkit – 2014

WHY naloxone? Naloxone works by reversing effects of an overdose The only purpose is to reverse overdose; there is no abuse potential and this medication cannot produce a “high” Naloxone is safe. It is as nontoxic as water and has no potential for addiction. If a person has not taken opioids, naloxone will not hurt them. Naloxone is cost effective. In Illinois anyone can be trained to administer naloxone.

Naloxone Facts Onset of action is about 2-3 minuteDuration of action is 30-120 minutes depending on method of administrationIt will not reverse an overdose caused by other drugs, only opioidsMay be used in children and pregnant womenNaloxone should be stored in its original packaging, while avoiding light, at room temperature. It can be left in the car glove box overnight, but not as a permanent storage optionPay attention to the expiration date for any naloxone product. Most have an expiration date of about 12-18 months. Expired naloxone can still be administered if there is no other alternative available. However, it may not be as effective and a second dose may be required.

Naloxone Kit Contents: 2 doses Naloxone (nasal or intramuscular) Syringes for intramuscular Gloves Alcohol Wipes Information about rescue steps, naloxone administration, and follow up resources

2 Ways to Administer NaloxoneNasal (intranasal – IN) Injectable (intramuscular – IM)

How to Give nasal spray Naloxone In the case of a known or suspected opioid overdose:Peel back the tab to remove NARCAN® Nasal Spray from its package.Place the device into one nostril.Press the device plunger firmly.Get emergency help right away.

Where to find Naloxone Funded programs near you:Contact DHS/DASA DHS.DOPP.coordinator@illinois.gov Ask your medical provider or pharmacyGo to www.getnaloxonenow.org or www.naloxoneinfo.org Ideally, naloxone should be available in these settings: Syringe Exchange Programs Jails Hospital Emergency Departments Free Clinics First Responders Friends and Family members Methadone, Suboxone and Other Treatment Programs

Overdose Overdose is a condition that usually occurs over 1-3 hoursMay be caused by: Excess intake of opioidsCombination of opioid and a depressant Opioid use in someone with a medical condition When in doubt, call 911! REALLY HIGH OVERDOSE Muscles becomes relaxed Pale, clammy skin Speech is slowed or slurred Breathing is infrequent or has stopped Sleepy looking Deep snoring or gurgling Responsive to sternal rub, shouting, earlobe pinch Unresponsive to any stimuli Normal heart rate and/or pulse Slow or no heart rate/pulse Normal skin tone Blue lips and/or face

How Overdose Works

Reversing Overdose Try to wake them up Shake them and shout If no response, grind your knuckles into the breast bone for 5 to 10 seconds Call 911 Administer Naloxone Check for breathing/ give rescue breathing Stay with the person until help arrives

ACTION PLAN STEPS

TIPS for Calling 9-1-1 & Naloxone Whichever you can do the quickest – DO FIRST! Tell the dispatcher the person has stopped breathing The dispatcher may give instructions on rescue breathing or chest compressionsHave the address and location ready The dispatcher may connect you with the paramedics who will ask you the same questions – this is a normal process.

Rescue Breathing Please review the steps below to perfect your rescue breathing technique: 1. Be sure the person’s airway is clear (check that nothing inside the person’s mouth or throat is blocking the airway 2. Place one hand on the person’s chin, tilt the head back. 3. Pinch the nose closed. 4. Place your mouth over the person’s mouth to make a seal and give 2 slow breaths. 5. The person’s chest should rise (but not the stomach). 6. Follow up with one breath every 5 seconds until the person can breath on their own

While you’re waiting for naloxone to kick in… Start rescue breathing again until you see the person start to breathe on their own. Wait 2-3 minutes (longer if administering IN naloxone) to give the medication a chance to work.If no response after 2-3 minutes, give a second dose of naloxone and begin rescue breathing again.If still no response, continue rescue breathing until paramedics arrive and let them take over. Note: naloxone will only work if the individual has taken an opioid. If they overdosed on a non-opioid, naloxone will not have an effect on them.

What to expect after administration of naloxone… Stay with the person for as long as you can or until help arrivesIf the person is still unresponsive, make sure to lay them in the recovery position to prevent choking and wait for help. If the person is responsive, they will be confused about what is happening and will probably not remember overdosing. Explain what has happenedComfort the person; withdrawal symptoms triggered by naloxone can feel unpleasant. Some people may become agitated or combative and will need help remaining calm. Don’t allow the person to take more opioids, as they can overdose again.

Summary – Do’s and Don’tsDO support the person’s breathing by administering naloxone or performing rescue breathing DO administer naloxoneDO put the person in the “recovery position” on the side, if the person is breathing independentlyDO stay with the person and keep him/her warmDON’T slap or try to forcefully stimulate the personDON’T put the person into a cold bath or showerDON’T inject the person with any substanceDON’T make the person vomit what he/she may have swallowed

Medicated Assisted Treatment (MAT) After testing different treatments for over 25 years, M.A.T. was the one that showed the most success. There are 3 forms: Methadone, Combination Buprenorphine/Naloxone, Vivitrol. They are all affective and the treatment center will decide which is best. SAMSHA Treatment Locator: Convenient and Easy to use Behavioral Health and Substance Abuse Treatment locator: https://findtreatment.samhsa.gov/locator

RESOURCES VideosAnatomy of an Overdosehttps://www.youtube.com/watch?v=DhS9M2ni2yE Administering Nasal Atomizer Naloxone http://adaptpharma.com/news-events/press-kitAdministering injectable naloxone https://vimeo.com/197652566/ce41306803 https://vimeo.com/197650414/4916741e17 (Spanish) Recognizing & Reversing an overdose https://www.youtube.com/watch?v=FZpgjRBby_M M.A.T. Treatment https://youtu.be/ht7EpK2UF4I Websites News + research on overdose prevention Prescribetoprevent.org GetNaloxoneNow.org preventionalliance.org Opioid overdose prevention education Stopoverdose.org Family support GRASP : Grief Recovery After a Substance Passing Grasphelp.org Learn2cope.org

Contact Information Drug Overdose Prevention Program email:DHS.DOPP.coordinator@illinois.govSeth Eisenberg, M.D.Seth.Eisenberg@illinois.govRosie Gianforte Rosie.m.gianforte@illinois.gov312-814-2136