BIOLOGY OF TOXINS SPRING 2012MARY MURPHY, SARAH COOK, AND

GILBERT ORNELAS

Responding to an Opiate Overdose

Introduction

More than 70 people die a day in the United States from drug overdoses. New Mexico has the highest overdose death rates* of any state, with Bernalillo and Rio Arriba counties’ overdose death rates exceeding that of both Los Angeles and New York. Many of these deaths resulted from opiate use. It is an epidemic of unnecessary tragic deaths but there is an antidote…

*Death rate is defined as deaths per 100,000 people over a year period.

What is an opiate?

the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant

a drug containing opium or its derivatives, used in  medicine for inducing sleep and relieving pain

any sedative, soporific, or narcotic with morphine like effects

anything that causes dullness or inaction or that  soothes the feelings

What are Opiate Receptors?

They are a group of  G-protein coupled receptors with opioids as ligands. The endogenous opioids include: dynorphins, enkephalins, endorphins and nociceptin. These receptors are found primarily in the brain but also in the spinal chord and the digestive tract.

Examples of Common Opiates

Heroin “chiva”Oxycontin (oxycodone) “oxys”Percocet (oxycodone) “perks”Demerol (mepiridine)Vicodin (hydrocodone) “hydros”morphinecodieneFentanylMethadone

The risks associated with opiate use apply to medications prescribed legally by a physician as well as illicit drugs. Heroin was invented by Bayer as a painkiller and was a treatment for morphine addiction. Many of the legal opiates available now are considered as addictive as Heroin. Legal does not equal safe.

What is an Overdose?

when a person has a greater effect than anticipated from a substance they have taken into their system

getting the jitters from too much coffee or energy drinks

chewing tobacco for the first time and feeling nauseated

in the case of opiates this could mean getting “too high” or even stopping breathing

Common Symptoms of Opiate Overdose

Unconscious/ passed outUnresponsiveShallow or no breathingSkin turning pale or blueMaking choking and gasping soundsSnoringLimp body or lack of muscle toneCold to the touchAwake but unable to speakVomiting

(This is not intended to be a comprehensive list and a person experiencing an opiate overdose may not exhibit every one of these symptoms.)

What Causes an Opiate Overdose?

1.Mixing Drugs

2.Lowered Tolerance

3.Changing Drug Concentration

4.“Solo Drugs”

1. Mixing Drugs

Mixing drugs is the most common cause of death by opiate overdose – the fewer drugs someone takes the less likely they are to die of an overdose. Mixing drugs with alcohol as another way that people can have an overdose. If a person uses drugs and they are unprepared to stop, perhaps they can consider only using one or two drugs.

2.Lowered Tolerance

Lowered tolerance can be caused by: If a person who uses opiates has not been using for

even a day tolerance can decrease. Opiate users exiting rehab, hospitalization and jail are

at much higher risk for overdose if they relapse. Lowered tolerance can also be the result of not taking

in enough food or water, having an illness, or not having enough sleep.

An inexperienced (new) drug user will have a low tolerance.

3.Changing Drug Concentration

Illicit drugs do not always come in standardized strengths. A person can have a opiate overdose as a result of acquiring Heroin from a new dealer or a dealer getting a new batch. A person should use caution if trying a drug for the first time or trying a new batch of drug for the first time. For example: the 'China White' type of Heroin is a great deal more potent than the ‘Black Tar' typically found in New Mexico. When 'China White' appears in New Mexico it is always followed by an increase in opiate overdoses.

4. “Solo Drugs”

Using opiates alone is a cause on unnecessary opiate overdose death. If a person is using opiates when no one is around, there is nobody there to rescue them if they stop breathing.

Even Though Overdoses are Scary:

Do not hit the person who overdosingDo not inject them with drugs or breath

drugs into their lungsDo not abandon the person who is overdosingTry not to panic

Other Potentially Dangerous Responses Are:

Placing ice or bags of frozen green chili on the groin

Putting the person in a shower or in the riverElectrocuting the person

 

Help them walk around if they are consciousAsk the person to breathe more deeply

What Can you do?

If they are unconscious:

1. Do a sternal rub (rub knuckles on bone in chest – will cause pain, not injury)

2. Call 9113. Breathe for the person (opiate overdose

deaths result from oxygen starvation)4. Administer the antidote (naloxone)

1. Sternal Rub

A sternum rub can sometimes help to revive an overdose victim.

Making a fist, you rub your knuckles into the sternum and the center of the person's chest. It is intended to be painful and can cause bruising. However, it is an excellent alternative to hitting the person because it is less harmful and may achieve the purpose of getting the person to respond.

2. Calling 911

Try to stay calmTry to keep the background of the phone call sounding calmTell 911 that someone is unconscious and not breathing (you

don't have to mention drugs)Give 911 good directions to where you areStay with the person and breathe for them as long as you canStay long enough to make sure the ambulance is headed to

the right placeIf you have to leave the person for some reason, leave them

in the rescue position and leave the door open to where you were

If you administer naloxone, and you have to go, leave the vial nearby so the EMTs will see that you already gave some

The Rescue Position

If you have to leave someone who is unresponsive alone to go for help, leave them in The Rescue Position. The Rescue Position decreases the likelihood that they will choke if they vomit.

•Lay the person on their side with one arm supporting the head.

•The other arm should be in front with their elbow and forearm bearing a bit of upper body weight.

•Follow the same pattern with the legs – lower leg straight, upper leg bent to bear some weight.

•This position may prevent choking if the victim vomits.

3. How to administer rescue breathing ONE BREATH EVERY FOUR SECONDS

A person has to breathe one breath every four seconds to keep their brain alive

Count seconds between the overdose victim's breaths If there is more that 4 seconds between the person's breaths they will

need you to breathe for them Check for a pulse, if no pulse, administer CPR If the heart is still beating but they are not breathing enough tilt the

head back a bit, pinch the nose shut and give the person one regular-sized breath every four seconds

Giving someone large breaths may cause air to go into the stomach and may end up in vomiting

Keep giving rescue breathing until the person wakes up, or someone takes over for you, or the emergency personnel arrive

Do not give up! If you cannot call 911, or you do not have naloxone, you may be able to keep the person alive by breathing for them as their body processes the opiates

3. How to administer rescue breathing ONE BREATH EVERY FOUR SECONDS

4. Administer the Antidote (naloxone)What is naloxone (Narcan)?

Naloxone causes a rapid blockade of μ-opioid receptors stopping the opioid overdose and often producing rapid onset of withdrawal symptoms

It is a synthetic drug, similar to morphine, that blocks opiate receptors acting as a opioid antagonist in the nervous system

It was developed by Sankyo (global pharmaceutical company) in the 1960s

Naloxone has an exceptionally high affinity for μ-opioid receptors in the brain and spinal cord making it a μ-opioid receptor competitive antagonist

How to Administer naloxone (Narcan)

1. Naloxone can be administered as a nasal spray. 2. Remove the caps (red and yellow plastic corks) from the vial of naloxone and

the syringe barrel.3.Insert the vial into the barrel & turn the vial 3 times – slowly and gently – until

it stops.4. Screw the nasal atomizer onto the tip of the syringe. The naloxone is now

ready to use.5. Place the assembled naloxone atomizer in one of the overdose victim’s

nostrils.6. Press firmly on the base of the glass vial or plunger, spraying half of the

naloxone deep into the overdose victim’s nasal cavity.7. Spray the remainder into the other nostril. 8. If the person does not regain consciousness in a minute or two, administer a

second dose.

Stanford Public Health Office (near

UNM)1111 Stanford Drive

NEAlbuquerque, NM

87106(505) 841-4100

Casa de Salud/Just Healthcare

1608 Isleta Blvd. NWAlbuquerque, NM

87501(505) 907-8311

Where to Get naloxone (Narcan)

Conclusion

There are few experiences in life that can cause such suffering as drug addiction. Until drug addicted people are ready to attempt sobriety, incarcerating them or allowing them to die lacks compassion and is poor public health policy. New Mexicans finally have tools to help keep our loved ones alive until they are ready to seek help. If you or someone you know use heroin or other opiates, avail yourself of naloxone.

Resources

http://www.odgame.org/ (Click to play the overdose game)

http://www.drugpolicy.org/new-mexico

http://harmreduction.org/

http://www.thegooddrugsguide.com/

http://www.thebody.com/content/art38411.ml

Literature Cited:

Enteen, L., Bauer, J., McLean, R., Wheeler, E., and Huriaux, E.(2010),Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco. Journal of Urban Health, Volume 87, Number 6, Pages 931-941.

Joen-Rong, S., Yen-Mei, L., Ling-Wen, L., Hsiang-Ning, L., & Mao-Hsiung, Y. (1998). INHIBITORY MECHANISMS OF NALOXONE ON HUMAN PLATELETS.Clinical & Experimental Pharmacology & Physiology, 25(7/8), 585.

New Mexico Department of Public Health. Harm Reduction Program. Overdose Prevention Short Curriculum. Santa Fe, NM: New Mexico Harm Reduction Program, 2012. Print.

Strang, J., Darke, S., Hall, W., Farrell, M., and Ali, R. (1996) Heroin overdose: the case for take-home naloxone - home based supplies of naloxone would save lives. British Medical Journal, 312 7044: 1435-1436.

Strang, J., Manning, V., Mayet, S., Best, D., Titherington, E., Santana, L., Offor, E. and Semmler, C. (2008), Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction, 103: 1648–1657.

Weckman, Michelle. Use of a Continuous Subcutaneous Naloxone (Narcan) Infusion to Treat Methadone-Induced Respiratory Depression (414-A). (2009).Journal of Pain & Symptom Management, 37(3), 500.

Wheeler, E., Davidson, P. J., Jones, T., & Irwin, K. S. (2012). Community-Based Opioid Overdose Prevention Programs Providing Naloxone -- United States, 2010. MMWR: Morbidity & Mortality Weekly Report, 61(6), 101-105.

Thank You