overdose prevention education and naloxone distribution administer naloxone • spray 1 dose in one...
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Overdose Prevention Education and Naloxone
Distribution
Desiree Madah-AmiriPhilipp LobmaierThomas Clausen
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Overview• Take home naloxone programs
– Overdose prevention education – Naloxone distribution
• Research project • Training components
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Prevention • 250 overdose deaths annually in Norway
– More than car accidents • Preventing car accident deaths
– Multi-prong approach• Seatbelts• Safe driving laws – no phones• Driving school • Safe car regulations
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Prevention• Preventing overdose deaths
– OMT/OST (LAR)– Switch campaign– Education programs– Drug consumption rooms– Take home naloxone
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Take home naloxone• Naloxone is a drug that can reverse the
effects of an opioid overdose• Programs entail:
– Overdose prevention education– Distribution of naloxone for peer
administration• Nonmedical responders
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Take home naloxone• >200 communities worldwide have
demonstrated the efficacy and feasibility with little to no adverse events
• >50 programs in the US with over 10,000 reported reversals collectively
• Drug users as capable to recognize and respond to overdose as medical professionals
(Walley, 2013; Wermeling, 2013; Doe-Simkins, 2009; Ashton, 2006)
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Take home naloxoneThese programs have prevented numerous deaths
and underlie the importance of prevention strategies, overdose recognition, and provision of
naloxone
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Opioid Overdose• Toxic amount of drug(s) overwhelms the body• Focus on opioids:
– Heroin, methadone, oxycodone, fentanyl • Depresses central nervous system
– Loses signal to breath– Oxygen levels decrease blue skin, BT and heart
rate decrease without O2, eventual organ failure, coma, and death
OD survival relies on oxygen being restored
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Naloxone• “Heroin antidote”• Short acting opioid antagonist
– Developed in the 1960’s– Reverses the effect of the OD – Stronger affinity for opioid receptor sites and
can knock off for a period of time– Once site is free, breathing can return
• Works only on opioids
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Naloxone• Lasts 30-90 minutes• No effect if opioids not used• No potential for abuse• Withdrawal symptoms possible• Various administration formulations
– Injectable, nasal, nebulized
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Naloxone nasal spray• Clinical response comparable to injectable
(Robertson, 2009; Kelly 2005; Kerr, 2009: Merlin, 2010)
• Reduced risk for needle-stick injury • Less stigma• Easier delivery
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Opioid Overdoses• 85% of nonintentional opioid overdoses
occur in the presence of others• Window of one to three hours where
naloxone, if available, could be successfully administered
• Opportunity
(Coffin, 2013)
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Project• SERAF research study
– Senter for rus-og avhengighetsforskning• Part of the government’s 5-year overdose
prevention strategy • Purpose is to reduce fatal and non-fatal
overdose deaths in Norway
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Research Study • Implemented in Oslo and Bergen at
various low threshold facilities • June 2014- December 2016
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Project •To evaluate the impact of distribution of naloxone nasal spray to those trained to identify and respond to an overdose •Target group:
–Heroin users •Low-threshold facilities, drug consumption rooms, dormitories, prisons etc.
–Friends, acquaintances, family–Anyone interested
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Training• Training trainers at various low threshold
facilities • Performed by existing staff at these
facilities • Training sessions are to be flexible and
tailored to the individual user’s specific needs and risk factors
• Last about 15-20 minutes
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Training Technique• Not ‘lecture’ format• Ask and engage the clients • Fill in the gaps
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Components of a Training1. What is an overdose?2. Why Naloxone during an overdose?3. Prevention messages4. Recognition5. Response6. Aftercare7. Follow-up and refills8. Data collection
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Risk Factors and Prevention • Preventing an overdose requires an
understanding of what puts people at risk of overdosing
– Mode of administration– Mixing– Using alone– Tolerance– Quality
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Recognition of an Opioid Overdose
• High vs. OD– RESPONSIVENESS*
• Opioid OD Triad– Unconsciousness– Slowed or stopped
breathing– Small pupils
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Responding to an Overdose 1. Assess for signs of an overdose 2. Stimulate3. Ring 113!4. Rescue breathing5. Recovery position6. Naloxone7. Aftercare
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Assess• If the victim is:
– Not breathing or shallow (not deep) breathing
– Turning blue– Nonresponsive
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Stimulate • Sternal rub
– Safe stimulating option – Other methods may be
effective, but this is fast, easy, and most effective
– (really hurts!)
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Ring 113• First ring 113!• The need to call
the ambulance still exists, even if naloxone has been peer administered
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Rescue Breathing For someone who is overdosing, rescue breathing is one of the most important
parts of preventing death
• Shallow, decreased (1 breath/ 10 seconds), or stopped breathing with unresponsiveness requires rescue breathing as soon as possible
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Rescue Breathing
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Recovery Position • If the overdosing person
must be left alone for any period of time, place them in recovery position
• This will keep the airway clear and prevent them from choking if they begin to vomit
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Administration of Naloxone• If the victim is:
– Not breathing, nonresponsive to stimuli
– Given a few rescue breaths
– Ambulance called – Administer
naloxone
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Assembling Naloxone
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Administer Naloxone• Spray 1 dose in one nostril and
1 dose in the other nostril• Wait 2-3 minutes for effect
– Desired response is the return of breathing
• If no response, deliver another dose of naloxone
• While waiting for effect and ambulance, continue rescue breathing
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Aftercare • Naloxone lasts between 30-90 minutes,
while the effects of opioids can be much longer
– Another overdose can reoccur after the naloxone wears off
• Victim must be monitored
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Aftercare• Withdrawal symptoms
– Nausea, headache, sweating, feeling sick may occur
• Important that they do not use again• Reassure that these symptoms will
subside– Tell them they have been given naloxone
• Stay with victim until ambulance arrives • CPR
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Overview of OD response 1. Assess for signs of an overdose2. Stimulate3. Ring 113!4. Recovery position5. Rescue breathing6. Administer naloxone7. Aftercare
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Refill• Return for refill after used, lost, or stolen• Briefly review overdose prevention
education and dispense another naloxone kit
• Important to document aspects of their OD experience
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Debriefing • Offer counseling sessions or debriefing
after naloxone use – This may be a traumatic experience for a
friend or family member, and the option to talk about it should be available
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Respect• Honor the user and respect their past
experiences• Many (if not most) will have had some
experience, either personally, or with a friend with overdosing
• Whatever they have attempted in the past during an overdose has been in the interest of saving someone’s life, and therefore is not wrong
• The overdose prevention training and naloxone distribution is now offering information and a new alternative for handling an overdose
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Summary• Opioid overdoses
– Can be traumatic, fatal require swift intervention
• Education on the recognition and response to an overdose can be helpful
• Peer administration offers an opportunity to save a life
• Offers an additional solution