and response recognition, prevention, overdose...statewide overdose prevention and naloxone...

Overdose Prevention, Recognition, and Response

MISSIONCentering harm reduction in Arizona through participant-driven advocacy, education, and outreach

● Statewide Overdose Prevention and Naloxone Distribution Program

● Comprehensive Harm Reduction Education and Outreach Program● In-depth Trainings on HIV/HCV, Stimulants, Needlestick Prevention,

Stigma, & more● Local and Legislative Advocacy

HOW WE DO IT

OVERVIEW• Harm Reduction & Stigma• National and State Overdose Trends• The Drugs• Overdose Prevention, Recognition &

Response• Next Steps

HARM REDUCTION

19.3 Milliondid not receive substance use treatment at a specialty facility

18.3 Milliondid not perceive a need for treatment

STIGMAHARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

WHAT IS HARM REDUCTION?

A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

https://harmreduction.org/about-us/principles-of-harm-reduction/


https://harmreduction.org/about-us/principles-of-harm-reduction/

WHAT DOES HARM REDUCTION DO?Centers people who use drugs as more than their drug use and as experts on their own care.

Recognizes that drug use and recovery is complex and exists along a continuum. For some, drugs meet important needs so drug-related harm cannot be assumed and abstinence can be just one of many possible goals.

Aims to meet people “where they’re at” by supporting ANY positive change.

Harm reduction does not aim to minimize real harm related to substance use.


HARM REDUCTION IN ACTION

DRUG USE

● Needle exchanges

● Wound care● Take-home

Naloxone● Fentanyl testing

strips● MAT● Supervised

consumption sites

SEX WORK

● Screening clients● Peer-education● Safe sex supplies● Condom

negotiating skills● The buddy system● Knowing

boundaries

HIV/HCV

● Access to testing● Not sharing

equipment ● Or only sharing

with others who have the same status

● Reducing alcohol consumption for HCV

● PEP, PrEP, Antiretrovirals

● Bleach kits


STIGMA

WHAT IS STIGMAStereotype: a negative belief about a group (dangerousness, laziness, moral weakness)

Prejudice: Agreement with belief + negative emotional reaction (fear, anger)

Discrimination: Behavior response to prejudice (avoidance, withhold access to basic needs/help)

Stigma permeates every aspect of a marginalized person’s life – relationships, health care, housing, employment, and education.


• Stigma from individuals– “Junkies”

• Institutional stigma– HCV tx excluding current users

• Self-stigma (internalized)– “I don’t deserve anything good”

• Stigma by association– Married to a person who uses drugs

WHAT IS STIGMA


Hepatitis C – 33% of young PWID, 70-90% of older & former PWID (CDC)HIV – Global prevalence among PWID 28x higher• 50-90% of PWUD living with HIV also have HCV

Trauma - In surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposureNutrition - Lower average weight than controlsArrest - 1,488,707 drug arrests in 2015 (84% possession)Incarceration - 2,224,400 in 2014Education – Financial aid denied for students w/ drug convictionshttp://www.drugpolicy.org/press-release/2017/09/new-fbi-report-shows-drug-arrests-increased-2016-drug-war-rages

HEALTH DISPARITIES


http://www.drugpolicy.org/press-release/2017/09/new-fbi-report-shows-drug-arrests-increased-2016-drug-war-rages

http://www.drugpolicy.org/press-release/2017/09/new-fbi-report-shows-drug-arrests-increased-2016-drug-war-rages

TRENDS

NATIONAL TRENDS

• Overdose > motor vehicle accidents• 70,000+ deaths in 2017

• Rural, veterans

• Death most likely in first 28 days after leaving inpatient

https://www.dea.gov/press-releases/2018/11/02/dea-releases-2018-national-drug-threat-assessment-0https://www.cdc.gov/drugoverdose/data/statedeaths.htmlhttps://www.mdedge.com/emergencymedicine/article/132735/toxicology/who-overdoses-opioids-va-emergency-departmenthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/


https://www.dea.gov/press-releases/2018/11/02/dea-releases-2018-national-drug-threat-assessment-0

https://www.cdc.gov/drugoverdose/data/statedeaths.html

https://www.mdedge.com/emergencymedicine/article/132735/toxicology/who-overdoses-opioids-va-emergency-department

https://www.mdedge.com/emergencymedicine/article/132735/toxicology/who-overdoses-opioids-va-emergency-department

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/

TRENDSHARM REDUCTION STIGMA DRUGS OVERDOSE NALOXONE

• 2017 – 949 opioid related deaths• Age group – 42% 25-44 y.o.• Over 51,000 opioid-related encounters costing

$431 million• 4 Arizonans a day die of OD• Mohave, Pima, Graham, Gila

https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-opioid-emergency-response-report.pdfhttps://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioids/index.php#dashboard

ARIZONA TRENDS


https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-opioid-emergency-response-report.pdf

https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-opioid-emergency-response-report.pdf

https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioids/index.php#dashboard

https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioids/index.php#dashboard

• A DSM V recognized mental health disorder

• Can be mild, moderate, or severe

• Does not occur in every person who uses drugs, or even every person who becomes physically dependent

• Often related to social determinants of health, past or current abuse and trauma

• Can be a coping mechanism for some people


WHAT IS SUBSTANCE USE DISORDER?



Types• Heroin• Prescription opioids (licit and illicit use)

– Hydrocodone (Vicodin), Oxycodone (Oxycontin, Percocet), Hydromorphone (Dilaudid), Morphine, Methadone, Fentanyl, Codeine

• Methadone used in opioid replacement therapyEffects• Chronic and acute pain relief; cancer and non-cancer

pain• Cough suppression (often codeine)• Sleep• Euphoric feelings• Relaxation

OPIOIDS


Facts• Most fentanyl found in street drugs is produced illegally• Fentanyl is usually added to the drug supply before it

enters the US• The CDC reports a 200% increase (between 2000 and

2014) in the rate of overdose deaths involving opioids, including an 80% increase in fatal overdoses involving fentanyl and other synthetic opioids in only one year

• It is often impossible to tell if a drug is laced with fentanyl unless you test it

FENTANYL

http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf


Myths• You can overdose and die from touching

fentanyl• People who know there is fentanyl in their

drugs do not care and will not change their behavior

• Naloxone can’t save you from a fentanyl overdose

• Fentanyl overdoses are different from other opioid overdoses

FENTANYL

http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf


FENTANYL


Types• Benzodiazepines – Klonopin, Xanax, Valium, Ativan• Sleep Aids – Ambien, Lunesta• Muscle Relaxers – Somas, Flexeril

Effects• Sedative, sleep-inducing, anti-anxiety, anticonvulsant,

muscle relaxing properties. • Useful in treating anxiety, insomnia, agitation, seizures,

muscle spasms, alcohol & opioid withdrawal• Enhance the effects of heroin, alcohol, and marijuana

NON-OPIOID DEPRESSANTS


Types• Cocaine – powdered and crack• Meth/Speed• Prescription stimulants – Ritalin, Adderall

Effects• Historically used to treat asthma & other respiratory

problems, obesity, neurological disorders• Prescribed for the treatment of narcolepsy, ADHD, and

depression that has not responded to other treatments• Increased alertness, attention, & energy, elevate blood

pressure, increase heart rate and respiration, constrict blood vessels, increase blood glucose

STIMULANTS


OVERDOSE

• Also known as “overamping” • Not as cut and dry as an opioid overdose,

more unpredictable & harder to define• Can be physical, psychological, or both• Likelihood of stimulant OD often tied to a

person’s physical health – pre-existing high blood pressure or heart disease, lack of sleep, nutrition, hydration

https://harmreduction.org/issues/overdose-prevention/overview/stimulant-overamping-basics/

WHAT IS A STIMULANT OVERDOSE?


https://harmreduction.org/issues/overdose-prevention/overview/stimulant-overamping-basics/

• First, figure out what is needed, medical assistance, or support and rest?

• There is no “antidote” to a stimulant OD, like Naloxone.

• A stimulant OD can result in serious medical emergencies like seizure, stroke, overheating or heart attack.

HOW TO RESPOND TO A STIMULANT OVERDOSE


WHAT IS AN OPIOID OVERDOSE?


LOCATION OF SUSPECTED OVERDOSE

http://azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioid-report.pdf




High Overdosed

Muscles become relaxed Pale or gray, clammy skin

Speech is slowed or slurred Breathing is infrequent or has stopped

Sleepy looking Deep snoring, gurgling, or rattling

Responsive to shouting, sternal rub, or earlobe pinch

Unresponsive to any stimuli

Normal heart rate and/or pulse Slow or no heart rate and/or pulse

Normal skin tone Blue or gray lips and/or fingertips


RISK FACTORS FOR OVERDOSE

• Mixing drugs

• Variation in purity

• Tolerance changes

• Using alone

• Physical health


NALOXONE/NARCAN

RESPONDING: NARCAN/NALOXONE


ARIZONA NALOXONE LAWS• HB 2489 (2015), HB 2355 (2016), HB 2493 (2017)

A.R.S. 36-2266 & 36-2267• Protects prescribers from certain liabilities• Allows for standing order• Allows for 3rd party prescription• Protects person who administers medication

A.R.S. 32-1979• OTC pharmacy sale• Pharmacy board must create rule


NALOXONE MYTHS

• “Naloxone encourages drug use.”

• “It sends the wrong message!”

• “It could hurt somebody not overdosing.”

• “Reversal requires medical professional.”

• “But in Pulp Fiction…”

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htmhttps://prescribetoprevent.org/wp2015/wp-content/uploads/PHLRKnowledgeAsset_Naloxone_FINALfull_8June15.pdf


https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm

https://prescribetoprevent.org/wp2015/wp-content/uploads/PHLRKnowledgeAsset_Naloxone_FINALfull_8June15.pdf

https://prescribetoprevent.org/wp2015/wp-content/uploads/PHLRKnowledgeAsset_Naloxone_FINALfull_8June15.pdf

RESPONDING TO AN OPIOID OVERDOSE

• 1. Sternum rub• 2. Call 911• 3. Administer naloxone, if on

hand• 4. Rescue breathe


RESPONDING: NARCAN• Administer one dose • Return to rescue breathing• Should work within 2 minutes; if it doesn’t,

give 2nd dose• Narcan can wear off within 45-90 minutes –

overdose could reoccur• Transfer care to EMS, otherwise stay with

person and observe 3 hours• 911 should always be called first!!


RESPONDING: RESCUE BREATHING• One hand tilting forehead back and plugging nose• Other hand on chin opening mouth• Create a seal with your mouth around their mouth


RECOVERY POSITION


INTRAMUSCULAR NARCAN INTRANASAL NARCAN


WHO SHOULD HAVE NALOXONE?• CDC: 83% of people who administered

naloxone were people who use drugs (2015)

• Friends and family• Law enforcement• Jails, prisons, probation• Treatment centers, sober living• Homeless shelters & services




AFTER THE OVERDOSE• “Ungrateful that I saved their life”• ONE person communicating, explain what

happened• Prevention messages – what happened

this time and how can we keep it from happening again?

• Get OD survivor and their family Naloxone• Could be a good time to talk treatment and

support options


WHERE?WHERE TO INCORPORATE?• Street-based outreach• Peer distribution• Co-prescribing• Treatment centers, jails distribute upon

release• Probation/Parole Officers distribute to clients• EMS and hospital distribution/prescription• Pharmacist-initiated distribution

SPW NUMBERS

Sep 2016-May 2019

233,192 Doses of Naloxone

7,251 Overdose Reversals


RESOURCES● Harm Reduction Coalition -

http://harmreduction.org/issues/overdose-prevention/

● Drug Policy Alliance - http://www.drugpolicy.org/drug-overdose

● Overdose Prevention Alliance - http://overdoseprevention.blogspot.com/

● Prescribe to Prevent - http://prescribetoprevent.org/



http://www.drugpolicy.org/drug-overdose

http://www.getnaloxonenow.org/

http://prescribetoprevent.org/

Thank youSTAFF NAME

Overdose Prevention Coordinator

STAFF CONTACT INFO

www.spwaz.org

http://www.spwaz.org

and response recognition, prevention, overdose...statewide overdose prevention and naloxone...

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