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Produced by the Alabama Department of Public HealthDistance Learning and Telehealth Division

Produced by the Alabama Department of Public HealthDistance Learning and Telehealth Division

ALABAMA ALABAMA LAW ENFORCEMENT LAW ENFORCEMENT

NALOXONENALOXONE TRAININGTRAINING

Provided by:Provided by:

Ann Slattery, DrPH, RN, RPh, DABAT Managing Director

Justin Arnold, DO, MPHMedical Director

Regional Poison Control Center at Children’s of Alabama

University of Alabama at Birmingham Department of Emergency Medicine

Ann Slattery, DrPH, RN, RPh, DABAT Managing Director

Justin Arnold, DO, MPHMedical Director

Regional Poison Control Center at Children’s of Alabama

University of Alabama at Birmingham Department of Emergency Medicine

No DisclosuresConflict of Interest Statement

No DisclosuresConflict of Interest Statement

• This presentation was prepared by

the Regional Poison Control Center

in cooperation with the Alabama

Department of Public Health

• The authors of this presentation have

no conflicts of interest to disclose

• This presentation was prepared by

the Regional Poison Control Center

in cooperation with the Alabama

Department of Public Health

• The authors of this presentation have

no conflicts of interest to disclose

GoalsGoals• Discuss need for naloxone training

• Review 2015 Alabama House Bill 208

• Define and identify opioids

• Recognize signs of an opioid overdose

• Understand how naloxone works

• Learn how to administer naloxone

• Discuss need for naloxone training

• Review 2015 Alabama House Bill 208

• Define and identify opioids

• Recognize signs of an opioid overdose

• Understand how naloxone works

• Learn how to administer naloxone

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Why Are We Here Today?Why Are We Here Today?

Opioid Prescriptions Per 100 PeopleOpioid Prescriptions Per 100 People

Why Are We Here Today?Why Are We Here Today?Drug Overdose and Motor Vehicle

Accident DeathsDrug Overdose and Motor Vehicle

Accident Deaths

• Law enforcement officers, firefighters,

and EMTs are increasingly being

called to respond to opioid overdoses

– Law enforcement officers are often

the first responders on the scene

• Timing of the administration of

naloxone and rescue breathing is

critical after an opioid overdose

• Law enforcement officers, firefighters,

and EMTs are increasingly being

called to respond to opioid overdoses

– Law enforcement officers are often

the first responders on the scene

• Timing of the administration of

naloxone and rescue breathing is

critical after an opioid overdose

Why Are We Here Today?Why Are We Here Today? 2015 House Bill 2082015 House Bill 208

• Expanded naloxone use by limiting

liability to prescribers, family and

friends, and permitting law-

enforcement use after training

– Permits law enforcement use of

naloxone (intra-nasal)

– Permits patient assessment

– Permits rescue breathing

• Expanded naloxone use by limiting

liability to prescribers, family and

friends, and permitting law-

enforcement use after training

– Permits law enforcement use of

naloxone (intra-nasal)

– Permits patient assessment

– Permits rescue breathing

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What is an Opioid?What is an Opioid?• Opioids are substances that bind to

specific receptors in the brain and decrease

the body’s perception of pain

• Opioids are substances that bind to

specific receptors in the brain and decrease

the body’s perception of pain

• Buprenorphine -Suboxone®

• Codeine - Tylenol #3®

• Fentanyl - Actiq®, Duragesic®, Sublimaze®

• Heroin - 1898-1910

• Hydrocodone - Lorcet®, Norco®, Vicodin®,

Lortab®

• Hydromorphone -Dilaudid®

• Levorphanol - Levo-Dromoran®

• Buprenorphine -Suboxone®

• Codeine - Tylenol #3®

• Fentanyl - Actiq®, Duragesic®, Sublimaze®

• Heroin - 1898-1910

• Hydrocodone - Lorcet®, Norco®, Vicodin®,

Lortab®

• Hydromorphone -Dilaudid®

• Levorphanol - Levo-Dromoran®

• Meperidine - Demerol®

• Methadone - Dolophine®

• Morphine - Roxanol®, Duramorph®

• Opium - Paragoric®

• Oxycodone - Percocet®, Percodan, ® Tylox, ® Oxycontin®

• Oxymorphone - Opana®, Numporphan®, Numorphone®

• Tramadol - Ultram®, Ultracet®

• Meperidine - Demerol®

• Methadone - Dolophine®

• Morphine - Roxanol®, Duramorph®

• Opium - Paragoric®

• Oxycodone - Percocet®, Percodan, ® Tylox, ® Oxycontin®

• Oxymorphone - Opana®, Numporphan®, Numorphone®

• Tramadol - Ultram®, Ultracet®

Generic and Brand NamesGeneric and Brand Names

• Other Pain Medications

• Acetaminophen – Tylenol ®

• Ibuprofen – Motrin ®

• Naproxen - Aleve ®

• Benzodiazepines

• Lorazepam – Ativan ®

• Diazepam – Valium ®

• Alprazolam – Xanax ®

• Muscle Relaxants

• Cyclobenzaprine – Flexaril ®

• Methocarbamol - Robaxin ®

• Other Pain Medications

• Acetaminophen – Tylenol ®

• Ibuprofen – Motrin ®

• Naproxen - Aleve ®

• Benzodiazepines

• Lorazepam – Ativan ®

• Diazepam – Valium ®

• Alprazolam – Xanax ®

• Muscle Relaxants

• Cyclobenzaprine – Flexaril ®

• Methocarbamol - Robaxin ®

• Cocaine

• Methamphetamine

• PCP

• LSD

• Molly / MDMA

• Marijuana

• Cocaine

• Methamphetamine

• PCP

• LSD

• Molly / MDMA

• Marijuana

What is NOT an Opioid?What is NOT an Opioid? Signs of an Opioid OverdoseSigns of an Opioid Overdose“High” versus Overdose“High” versus Overdose

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“High” from Opioids“High” from Opioids

• Person will respond to commands

• Breathing appears normal (not

labored or excessively shallow)

• Slow/slurred speech

• Pinpoint pupils (some exceptions)

• Person will respond to commands

• Breathing appears normal (not

labored or excessively shallow)

• Slow/slurred speech

• Pinpoint pupils (some exceptions)

Signs of an Opioid OverdoseSigns of an Opioid Overdose• Depressed mental status

– Unconscious – does not respond to

voice, sternal rub, limp body

• Depressed or absent breathing

– Suppressed breathing < 8

breaths/minute, shallow

– Cyanosis – blue or gray lips or

fingernails

• Depressed mental status

– Unconscious – does not respond to

voice, sternal rub, limp body

• Depressed or absent breathing

– Suppressed breathing < 8

breaths/minute, shallow

– Cyanosis – blue or gray lips or

fingernails

Signs of an Opioid OverdoseSigns of an Opioid Overdose– Pale, clammy skin

– Slow or irregular pulse

– Snoring, gurgling, or choking sounds

(a.k.a. death rattle)

• Pinpoint pupils

– Pale, clammy skin

– Slow or irregular pulse

– Snoring, gurgling, or choking sounds

(a.k.a. death rattle)

• Pinpoint pupils

What is Naloxone?What is Naloxone?

– Generic name for Narcan®

– Rapid opioid reversal agent

– Blocks the effects on the

respiratory control center and

restores respirations

– Blocks the effects on CNS

depression and can restore

alertness

– Generic name for Narcan®

– Rapid opioid reversal agent

– Blocks the effects on the

respiratory control center and

restores respirations

– Blocks the effects on CNS

depression and can restore

alertness

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What is Naloxone?What is Naloxone? Naloxone is Only Useful for Opioid Overdoses

Naloxone is Only Useful for Opioid Overdoses

– Naloxone will NOT work to

reverse the effect of any drug or

medication that is not an opioid!

– CPR should be used instead of

naloxone if the individual does

not have have a pulse!

– Naloxone will NOT work to

reverse the effect of any drug or

medication that is not an opioid!

– CPR should be used instead of

naloxone if the individual does

not have have a pulse!

Responding to a Suspected Opioid Overdose EmergencyResponding to a Suspected Opioid Overdose Emergency• Use universal precautions (minimal

level is medical gloves)

• Check for responsiveness and

administer initial rescue breaths if

the person is not breathing

• Request assistance (911)

• Administer naloxone

• Use universal precautions (minimal

level is medical gloves)

• Check for responsiveness and

administer initial rescue breaths if

the person is not breathing

• Request assistance (911)

• Administer naloxone

Responding to a Suspected Opioid Overdose EmergencyResponding to a Suspected Opioid Overdose Emergency• Resume rescue breathing if the

person is not breathing on their

own yet

• Reassess for response and

administer a second dose of

naloxone if no response after 3

minutes

• Resume rescue breathing if the

person is not breathing on their

own yet

• Reassess for response and

administer a second dose of

naloxone if no response after 3

minutes

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Intranasal Naloxone Intranasal Naloxone Prepare to Administer Intranasal Naloxone

Prepare to Administer Intranasal Naloxone

NeedlelessNeedlelessSyringeSyringe

MedicationMedicationCapsuleCapsule

MADMAD

Step 1 – Remove Protective Caps

Step 1 – Remove Protective Caps

Step 2 – Attach the Mucosal Atomization Device (MAD)

Step 2 – Attach the Mucosal Atomization Device (MAD)

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Step 3 – Gently Screw the Medication Into the SyringeStep 3 – Gently Screw the

Medication Into the SyringeStep 4 – Administer ½ of the Medication Into Each NostrilStep 4 – Administer ½ of the Medication Into Each Nostril

Step 5 – Provide Rescue Breathing if Needed and

Consider Need to Re-dose

Step 5 – Provide Rescue Breathing if Needed and

Consider Need to Re-dose

Alternative Formulationsof Naloxone

Alternative Formulationsof Naloxone

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Side EffectsSide Effects• Precipitated opioid withdrawal

– Restlessness, irritability, body aches,

dizziness, weakness, diarrhea,

abdominal pain, nausea, vomiting, fever,

sweating, piloerection (goosebumps),

hypertension and tachycardia

• Allergic Reaction to the medication itself

– Hives, trouble breathing, swelling of

face, lips, tongue or throat

• Precipitated opioid withdrawal

– Restlessness, irritability, body aches,

dizziness, weakness, diarrhea,

abdominal pain, nausea, vomiting, fever,

sweating, piloerection (goosebumps),

hypertension and tachycardia

• Allergic Reaction to the medication itself

– Hives, trouble breathing, swelling of

face, lips, tongue or throat

Frequently Asked QuestionsFrequently Asked Questions• What should I expect once naloxone

has reversed the overdose?

– Improved breathing (goal of naloxone

administration) and possible

withdrawal symptoms

• Can you administer it under the

tongue?

– No, the lining of the mouth is

different than the nose

• What should I expect once naloxone

has reversed the overdose?

– Improved breathing (goal of naloxone

administration) and possible

withdrawal symptoms

• Can you administer it under the

tongue?

– No, the lining of the mouth is

different than the nose

Frequently Asked QuestionsFrequently Asked Questions

• Does it work with a fentanyl patch?

What about the newer fentanyl

analogues?

– Yes, but be prepared to give a

second dose

– Fentanyl (especially a patch)

victims may need multiple

naloxone doses

• Does it work with a fentanyl patch?

What about the newer fentanyl

analogues?

– Yes, but be prepared to give a

second dose

– Fentanyl (especially a patch)

victims may need multiple

naloxone doses

Frequently Asked QuestionsFrequently Asked Questions

• How do you store naloxone?

– It should ideally be stored at room

temperature and away from light

– If stored in a vehicle, store in a

cool place, out of direct sunlight

• How do you store naloxone?

– It should ideally be stored at room

temperature and away from light

– If stored in a vehicle, store in a

cool place, out of direct sunlight