OVERDOSE MANAGEMENT

• COMBINING OPIATES WITH OTHER DRUGS, ESPECIALLY ALCOHOL AND OTHER DOWNERS, IS MUCH MORE LIKELY TO LEAD TO AN OVERDOSE.

ARE ALL OPIATES CREATED EQUAL?

IN SOME WAYS ALL OPIATES ARE THE SAME AND IN OTHER WAYS THEY ARE DIFFERENT:

ALL OPIATES ARE THE SAME IN THAT THEY…• COME FROM THE OPIUM POPPY OR ARE CHEMICALLY CREATED TO

BE LIKE A DRUG WHICH COME FROM THE POPPY;

• HAVE THEIR EFFECT ON THE SAME PART OF THE BRAIN

• CAUSE OVERDOSE IN THE SAME WAY IF TOO MUCH IS USED--THIS OVERDOSE COMES IN THE FORM OF STOPPED BREATHING

ARE ALL OPIATES CREATED EQUAL?

IN SOME WAYS ALL OPIATES ARE THE SAME AND IN OTHER WAYS THEY ARE DIFFERENT:

OPIATES ARE DIFFERENT IN THAT THEY:

• HAVE DIFFERENT CONCENTRATIONS OR STRENGTHS

• HAVE VARYING DURATIONS OF ACTION SUCH AS……..

DURATION OF ACTION“PRODUCE DIFFERENT SPEED, LENGTH AND INTENSITY OF WITHDRAWAL”

DRUG• METHADONE• HEROIN• DILAUDID• CODEINE• DEMEROL• FENTANYL

HOW LONG IT WORKS

• 24 HOURS• 6-8 HOURS• 4-6 HOURS• 3-4 HOURS• 2-4 HOURS• 1-2 HOURS

OVERDOSE PREVENTION

SOME THINGS YOU CAN DO TO PREVENT OD:

• KNOW YOUR STUFF

• TESTING SMALL AMOUNT

• PURIFICATION

• PURITY TESTING

WHAT CAUSES A SEVERE OVERDOSE?

• CARDIAC ARREST

• APNEA

• CIRCULATORY COLLAPSE

• WHEN SOMEONE’S HEART STOPS

• WHEN SOMEONE CAN NO LONGER BREATH

• WHEN THERE IS NO CICULATION OF BLOOD

RECOGNIZING OD VS. GOOD HIGH

• SOME SIGNS OF A SERIOUS OVERDOSE WITH OPIATES, WHICH MAY LEAD TO DEATH, ARE:

• RESPIRATORY DEPRESSION… Very slow and ultimately no breathing

• CYANOSIS… Turning blue on the lips and fingertips first

• EXTREME SOMNOLENCE…Hard to awaken; sleepiness

• PROGRESSING TO STUPOR OR COMA…Falling out

• SKELETAL MUSCLE FLACCIDITY…Loose muscles

• COLD OR CLAMMY SKIN

• BRADYCARDIA… Slowness of the heartbeat

• HYPOTENSION… Low blood pressure

WHAT TO DO : UNDERSTANDING HEROIN OVERDOSE

THE PRIMARY BARRIER TO SEEKING HELP DURING AN OVERDOSE IS FEAR OF POLICE INVOLVEMENT. REAL OR PERCEIVED, THE THREAT OF ARREST GREATLY IMPACTS DECISION-MAKING AT THE SCENE OF AN OVERDOSE.

WHAT TO DO?“ONCE YOU HAVE DETERMINED SOMEONE HAS TAKEN TOO MUCH”

FIRST CALL 911

WHATEVER IS GOING ON WITH THEM-- THE MORE HELP THE BETTER. CPR IS HARD TO KEEP UP FOR LONG!!!!!!!!!

WHAT TO DO?“IF YOU DECIDE TO CALL 911”

FIRST CHECK THE PERSON CAREFULLY FOR ANY DRUGS ON THEIR PERSON. IT WOULD SUCK TO BE RESUSCITATED, ONLY TO BE

ARRESTED!!!!!!!!!!!!!!!!!!!!

STEP 1: CHECK RESPONSIVENESS

1. FIRST, TAP THEN SHAKE THE PERSON’S SHOULDER. IF THAT DOESN’T WORK TRY PINCHING AN EARLOBE OR FINGERTIP.

2. ASK “ARE YOU OK?” SHOUT THE PERSON’S NAME; SHOUT “WAKE UP!” IF NO RESPONSE, CONTINUE.

STEP 2: CALL 911“GET EMS IN MOTION”

• 1. ASK SOMEONE TO CALL 911.

• 2. IF ALONE, YELL FOR HELP. IF NO ONE COMES, CALL 911 AND QUICKLY RETURN. SECONDS COUNT!

STEP 3: ROLL PERSON ONTO BACK

1. DO THIS AS GENTLY AS POSSIBLE TO AVOID INJURY.

STEP 4: OPEN AIRWAYS“USE HEAD-TILT/ CHINLIFT METHOD”

1. TILT HEAD BACK WITH YOUR NEAREST HAND BY APPLYING BACKWARD PRESSURE TO PERSON’S FOREHEAD.

2. PLACE FINGERS OF OTHER HAND UNDER CHIN BONE AND LIFT. DO NOT USE YOUR THUMB TO LIFT THE CHIN.

3. TILT HEAD BACK WITHOUT CLOSING MOUTH.

STEP 5: CHECK FOR BREATHING“TAKE 3-5 SECONDS”

1. PLACE EAR OVER PERSON’S MOUTH AND NOSE WHILE KEEPING AIRWAY OPEN.

2. LOOK AT CHEST TO CHECK RISE AND FALL: LISTEN AND FEEL FOR BREATHING

STEP 6: GIVE 2 SLOW BREATHS

1. WITH HEAD STILL TITLED BACK, PINCH NOSE SHUT

2. TAKE A DEEP BREATH; SEAL LIPS AROUND PERSON’S MOUTH.

3. GIVE 2 SLOW BREATHS, EACH LASTING 1 1/2 TO 2 SECONDS

4. WATCH CHEST TO SEE IF BREATHS GO IN.

5. ALLOW CHEST TO DEFLATE AFTER EACH BREATH

6. IF NEITHER BREATH WENT IN, TRY AGAIN

7. IF THE SECOND ATTEMPT FAILS, CHECK FOR WINDPIPE BLOCKAGE, USUALLY CAUSED BY VOMIT OBSTRUCTING THE AIRWAY

8. ATTEMPT TO CLEAR AIRWAY

STEP 7: NEXT CHECK FOR PULSE

1. DO NOT USE THUMB--IT HAS ITS OWN PULSE.

2. MAINTAIN HEAD TILT

3. FEEL ON NECK FOR PULSE USING 2 OR 3 FINGERS USING HAND NEAREST PERSON’S FEET.

4. TAKE 5-10 SECONDS TO FEEL FOR PULSE

IF THERE IS A PULSE BUT NO BREATHING1. GIVE 1 RESCUE BREATH EVERY 5-6 SECONDS, 10-12 A MINUTE. USE

SAME METHODS AS STEP 6, BUT ONLY GIVE 1 BREATH AT A TIME.

2. CHECK TO SEE IF THERE IS A PULSE

3. CONTINUE UNTIL PERSON REVIVES OR TRAINED HELP ARRIVES

MAKE A PLAN“TALK TO YOUR RUNNING PARTNER ABOUT WHAT YOUR PLAN IS

IF ONE OF YOU OVERDOSES”

• WHEN SHOULD SOMEONE TAKE ACTION

• WHAT’S PREFERED REGARDING 911 (SHOULD THEY BE CALLED IMMEDIATELY OR SHOULD RESUSCITATION BE TRIED)

• WHAT SHOULD BE DONE AFTER THE PERSON RESUMES BREATHING IE. WILL PERSON GO TO ER

• WHAT SHOULD BE DONE AFTER THE PERSON RESUMES BREATHING IE. WILL PERSON GO TO ER

• IS IT OK TO REMOVE YOUR PARTNER’S IDENTIFICATION IN CASE HE OR SHE HAS OUTSTANDING WARRANTS?

• THE MORE YOU PLAN OUT IN ADVANCE THE LESS ROOM THERE IS FOR ERROR AND PANIC IN THE EVENT OF OD

THE CURE FOR A HEROIN

OVERDOSE IS OXYGEN,

BREATHING SUPPORT AND

AIRWAY CONTROL.

OVERDOSE

OVERDOSE“WHAT IS AN OVERDOSE”

OVERDOSE HAPPENS WHEN YOU TAKE TOO MUCH OF A DRUG (OR A COMBINATION OF DRUGS), AND IT OVERWHELMS YOUR BODY----ESPECIALLY YOUR BRAIN AND OTHER IMPORTANT ORGANS SUCH AS THE LIVER, HEART, AND LUNGS AND KIDNEYS. WHEN THIS HAPPENS YOUR BODY LOSES THE ABILITY TO COPE WITH THE DRUG: YOU MAY PASS OUT, STOP BREATHING, HAVE HEART FAILURE OR HAVE SEIZURES. ALL OF THESE CAN KILL YOU.

BUT OVERDOSES DON’T HAVE

TO BE FATAL!!!

OVERDOSE“WHAT IS AN OVERDOSE”

ANYONE WHO USES DRUGS CAN OVERDOSE -

FROM FIRST TIME USERS TO THE VETERAN.

THERE ARE MANY RISK FACTORS FOR OVERDOSE: SOME AREN’T EVEN DRUG RELATED. PROBLEMS CAUSED BY POOR HEALTH, DEPRESSION/LOW SELF-ESTEEM, HOMELESSNESS, DRUG PROHIBITION/ SCARCITY AND LACK OF SYRINGES.

(THINKING ABOUT HOW AND WHY WE USE CAN LEAD TO SAFER USE)

PREVENTING OVERDOSES“HOW ODs HAPPEN AND WAYS TO PREVENT THEM”

MIXING DRUGS: (LIKE HEROIN, PILLS AND ALCOHOL) IS THE MOST COMMON CAUSE OF DEATH BY OVERDOSE. DRUGS TAKEN TOGETHER CAN INTERACT IN WAYS THAT INCREASE THEIR OVERALL EFFECT. WITH DEPRESSANTS (DRUGS THAT SLOW YOU DOWN) THE RISK OF PASSING OUT OR STOPPING BRATHING INCREASES. WITH STIMULANTS (DRUGS THAT SPEED YOU UP) THE RISK OF SEIZURES OR HEART ATTACKS INCREASES.

AVOID MIXING DRUGS THAT HAVE THE SAME EFFECTS, SUCH AS HEROIN WITH OTHER DEPRESSANTS LIKE (ALCOHOL, XANAX) OR COCAINE WITH OTHER STIMULANTS LIKE (SPEED AND ECSTACY)

OVERDOSE“PREVENTING OVERDOSES”

• HEROIN AND ALCOHOL AND/OR DOWNS ARE PARTICULARLY DEADLY COMBINATIONS. THE MORE ALCOHOL AND/OR DOWNS YOU HAVE IN YOUR SYSTEM, THE LESS HEROIN YOU NEED TO OVERDOSE. ALCOHOL ALSO AFFECTS YOUR JUDGMENT, WHICH CAN LEAD TO MISTAKES IN DOSING.

OVERDOSE“PREVENTING OVERDOSE”

REMEMBER THE MORE YOU PLAN OUT IN ADVANCE, THE LESS ROOM THERE IS FOR ERROR AND PANIC IN THE EVENT OF AN OD

TOLERANCE: HAS A LOT TO DO WITH OVERDOSING. IF YOU ARE USING A DRUG FOR THE FIRST TIME YOUR BODY WILL NOT BE USED TO IT. IF YOU HAVEN’T USED FOR AWHILE---LIKE TIME IN JAIL OR DETOX--- YOUR TOLERENCE DECREASES AND YOUR BODY CAN’T TAKE AS MUCH AS IT COULD BEFORE.

MANY PEOPLE WHO OVERDOSE HAVE JUST COME OUT OF JAIL OR DETOX. BE ESPECIALLY CAREFUL IF YOU HAVE BEEN AWAY FOR AWHILE.

OVERDOSE“PREVENTING OVERDOSE”

• DO A LITTLE LESS IF YOU HAVEN’T USED LATELY ( EVEN IF IT’S ONLY BEEN A FEW DAYS)

• TAKE THE DRUG IN A WAY THAT GETS YOU HIGH SLOWER ( SNORTING HEROIN OR COCAINE INSTEAD OF INJECTING)

• TRY AND USE WITH SOMEONE WHO KNOWS WHAT TO DO IF YOU GO OUT

• TRY TO FIND OUT AS MUCH AS YOU CAN ABOUT THE STUFF YOU PLAN TO USE.

• BE CAREFUL IF YOU’RE TRYING A NEW DRUG. USE WITH SOMEONE WHO HAS EXPERIENCE WITH THAT PARTICULAR DRUG.

• LET YOUR DRUGS WORK BEFORE YOU DO MORE. GIVE YOUR BODY TIME.

OVERDOSE“PREVENTING OVERDOSE”

• KEEP TRACK OF HOW MUCH YOU HAVE USED. EACH TIME YOU USE YOU ARE INCREASING THE AMOUNT OF DRUGS IN YOUR SYSTEM

• TAKE CONTROL OF YOUR PREPERATION AND INTAKE. YOU ARE THE ONLY ONE WHO REALLY KNOWS HOW MUCH YOU CAN HANDLE.

• CHECK OUT ANYTHING THAT IS NEW: DOES IT TASTE, SMELL AND LOOK OK?

• IF YOU HAVE DOUBTS ABOUT WHAT YOU HAVE JUST BOUGHT AND NORMALLY SHOOT UP, SNORT A BIT FIRST INSTEAD OR DO A TESTER SHOT FIRST TO SEE HOW STRONG IT IS.

• TRY AND BUY FROM A REGULAR SOURCE THAT YOU TRUST. ESTABLISH A RELATIONSHIP WITH THE DEALER AND ASK HIM ABOUT HIS PRODUCT

OVERDOSE“PREVENTING OVERDOSE”

CHANGES IN YOUR HEALTH AND BODY CAN PUT YOU AT RISK FOR OD. IF YOU LOSE WEIGHT OR ARE SICK, YOUR TOLERANCE DECREASES

• USE LESS WHEN YOU ARE SICK OR WHILE YOU ARE RECOVERING FROM AN ILLNESS.

• IF YOU HAVE LOST WEIGHT, DO A TESTER SHOT.

• WOMEN USUALLY WEIGH LESS THAN MEN. IF YOU ARE A WOMAN GETTING HIGH WITH A MAN, MAKE SURE YOUR NEEDS ARE TAKEN INTO ACCOUNT WHEN YOUR DOSE IS MEASURED

• PUT TOGETHER A SUPPORT SYSTEM OF PEOPLE WHO KNOW YOU USE. LET THEM KNOW WHEN YOU PLAN ON USING ALONE AND ASK THEM TO CHECK IN ON YOU.

• IF YOU DO USE ALONE, UNLOCK THE DOOR SO THE PARAMEDICS OR YOUR FRIENDS CAN GET IN.

• THINK THROUGH EACH STEP OF YOUR DRUG-TAKING. THIS WILL LESSEN THE LIKELIHOOD OF MAKING A MISTAKE.

OVERDOSE“SYMPTOMS OF AN OVERDOSE”

• DEPRESSANTS

• AWAKE BUT UNABLE TO TALK

• BODY IS VERY LIMP

• FACE IS VERY PALE

• PULSE (HEARTBEAT) IS SLOW, OR ERRATIC OR NOT THERE AT ALL.

• BREATHING IS VERY SLOW AND SHALLOW, ERRATIC OR HAS STOPPED

• PASSING OUT

• CHOKING SOUNDS OR A GURGLING NOISE

• THROWING UP

• STIMULANTS

• FOAMING AT THE MOUTH

• PRESSURE, TIGHTNESS OR PAIN IN CHEST

• SHAKING OR SEIZURES.

• PASSING OUT

• CHOKING SOUNDS, OR GURGLING NOISE

• THROWING UP

OVERDOSE“WHEN YOU CALL 911”

• WHEN YOU CALL 911, SAY “MY FRIEND IS UNCONSCIOUS AND NOT BREATHING”. IF YOU DON’T TELL THE OPERATOR THAT THE PERSON HAS OVERDOSED, THEY MIGHT NOT SEND THE POLICE.

OVERDOSE“WHAT NOT TO DO IF SOMEONE OVERDOSES”

• PUT A PERSON IN A COLD WATER BATH-- THEY MAY DROWN. IF THEY ARE STILL BREATHING, YOU CAN PUT THEM UNDER A COOL SHOWER TO WAKE THEM UP, BUT STAY THERE WITH THEM AND KEEP THE WATER AWAY FROM THEIR NOSE AND MOUTH

• LEAVE SOMEONE WHO HAS JUST OVERDOSED ALONE, EVEN AFTER YOU’VE CALLED AN AMBULANCE. IF YOU MUST GO, LEAVE THEM IN THE RECOVERY POSITION