Introduction to overdose prevention wgdsc harm reduction forum 2013 (2)

PRESENTATION TO WGDSC HARM REDUCTION FORUM MARCH 2013

INTRODUCTION TO OPIOID OVERDOSE PREVENTION

Presentation property of Preventing Overdose Waterloo Wellington

WHAT WE WILL COVER

• What is an opioid overdose?• Who is at risk for an opioid overdose?• How to recognize an opioid overdose• Myths and Facts about overdose• How to respond to an opioid overdose

WHAT IS AN OPIOID OVERDOSE?

• The Central Nervous System and the effects of psychoactive drugs

• Depressants

• Overdose Defined

• Types of Overdose

Consciousness, Memory, and

Emotion. Three main effects:

1.depressant,

2.stimulant

3.hallucinogenHearingSight,Smell,

Taste, and Touch

Breath,

Movement, and

Balance.

The Central Nervous System

DepressantsDepressants cause the central nervous system to

slow down - breathing and heartbeat are affected.

Desired depressant effectsRelaxation, a sense of calm and drowsinessPain reliefLowering of inhibition

Examples of depressantsOpioid drugs (heroin, morphine, pethidine, codeine,

methadone, dilaudid, fentanyl, hydromorphone)AlcoholBenzodiazepines or ‘benzos’ (diazepam/valium)Cannabis (grass, weed, dope)Inhalants (aerosols, cleaning agents, solvents and gases)

Uppers (Stimulants)Stimulants cause breathing and heartbeat to speed up.

Desired upper effects:Increased energy and alertnessIncreased confidenceAbility to stay awake over long periods of time

Examples of uppers• Amphetamine (speed) and methamphetamine (ice), • Cocaine, • Ecstasy (MDMA), • Nicotine ( tobacco) • Caffeine (tea, coffee, cola drinks)

Hallucinogens (psychedelics)These drugs distort what people hear, think and

see.

Desired hallucinogenic effectsAn altered sense of the world, time, the body,

other people, thoughts, and emotions

Examples of hallucinogens‘Magic’ mushroomsLSD (‘acid’, ‘trips’)Ketamine (‘Special K’)Cannabis (grass, weed, dope)

Overdose is the use of a drug (or drugs) in an amount or way that causes

acute harmful mental or physical effects.

Overdose may produce short-lived or lasting effects,and can sometimes be fatal.

Overdose Defined

TYPES OF OVERDOSE

Depressant overdose: slows the central nervous system down to the point where several systems may stop working.

Stimulant overdose: speeds the central nervous system

up to the point of overworking certain functions leading to failure.

Toxic overdose: organ damage or failure (heart, lungs, kidneys etc.) from taking an excessive amount of a drug.

For today, we will be focusing on opioid overdoses, which fall into the depressant category

After an overdose a person can be left with serious, sometimes permanent, health problems as a result of

the overdose itself

brain damage due to lack of oxygen as a result of seizure, stroke or heart attack

lung damage or pneumonia resulting from vomit/ fluid entering the lungs during a period of unconsciousness

muscle damage due to a long period of unconsciousness especially if a limb is trapped under the body reducing its blood supply.

Serious complications can include paralysis, limb amputation or kidney failure, broken bones due to falls, burns from exposure to heaters or cigarettes, or physical assaults.

After-effects of Non-Fatal Overdoses:

WHO IS AT RISK FOR AN OPIOID OVERDOSE?

Overdose doesn’t discriminate, but there are some key factors and patterns of use that have an increased risk;

• Demographics• Prescription Patterns• Mixing Drugs• Patterns of Use

OD RISK: DEMOGRAPHICS

A B.C. Review of Coronor Data from 2006-2011 allowed them to pull together a profile of risk factors for overdose related death.

Most overdose deaths:

•Are accidental versus suicide (86%), •occur in persons under the age of 60 (87%), •have a documented source of chronic pain (82%), •almost half have a documented co-morbid mental health diagnosis (45%).•are the result of taking at least one other non-opioid class of medications(93%), •Are not the result of “multi-doctoring” - almost all are taking medications prescribed by a single doctor or clinic.•Happen everywhere – no geographical or population density correlation

OD RISK: PRESCRIBING PATTERNS

• a 2009 Ontario study in the Canadian Medical Association Journal linked the 850% rise in oxycodone prescribing with a quintupling in oxycodone-related fatalities.

• Among the highlights:

• 66.4% had visited a physician in the month before death;

• 56.1% had filled a prescription for an opioid in the month before death.

• Approximately 50,000 Ontarians are addicted to opioids and many more are dependent

• Canada has the highest per capita rates of opioid consumption in the world.

• A 2009 CAMH study indicated that more youth in Waterloo-Wellington had consumed opioids for non-medicinal purposes than tobacco (20%), the highest rate in Ontario. Most of them got it from home.

OD RISK: PATTERNS OF USE

Overdose doesn’t discriminate, but there are some key factors and patterns of use that have an increased risk;

• Mixing Drugs• The Way a Drug is Taken• Low or Reduced Tolerance • Using Alone• Long-term use

Different drugs take different amounts of time to leave the body.

New drugs can combine with drugs that may have been used hours earlier.

Drugs may still be in the body long after a person can’t feel their effects.

The majority of overdoses involve the use of a combination of drugs.

OD Major Risk Factors: Mixing Drugs

The way a drug is taken:

How you take a drug can effect how fast and how strong the effect is. The quicker the drug enters the bloodstream, the higher the risk of overdose.

Injection into a vein: Very fast absorption

Injection into a muscle or under the skin: Fast absorption

Smoking: Very fast absorption

Snorting, shafting: Fast absorption

Hooping: Slower absorption

Swallowing: Slowest absorption

Tolerance can take some time to develop - weeks or months - but will reduce far more quickly.

As little as three or four days without certain drugs can be long enough to lower tolerance to the point where there is a higher risk of overdose.• The risk of overdose is high when individuals do

not take into account that their tolerance may be lower than usual.

• Changes in how strong/pure a drug is could lead to a person using more of a drug than they can tolerate by accident.

Major Risk Factors: Reduced tolerance

Times when tolerance will be low or reduced• After drug detox or a rehabilitation program;• After being in custody or jail; • After a period when the drug of choice was not

available;• Being a new or casual user;• Following a period when use of a drug has

reduced or ceased for any reason

Just because a person’s tolerance for one drug is high doesn’t mean that it will be high for a

different drug!

Major Risk Factors: Reduced Tolerance

For a person using alone an overdose could be fatal, as the situation might not be noticed. Using with others does not guarantee that an overdose will be handled well though.

Major Risk Factors: Using alone

It is not just new users who overdose - in fact experienced

or older users are at greater risk.

Long-term users are more likely to mix drugs;

Cycles of abstinence and return to drug use result in more frequent periods of reduced tolerance;

The law of averages - the more a person uses the greater the likelihood of overdose;

A belief that ‘It won’t happen to me’. If a person has used drugs over several years and not suffered an overdose, they could become over confident and take more risks.

Major Risk Factors: Being an experienced, long-term user

If someone is extremely high, and they are using depressants, they may:

have contracted/small pupils; have slack and droopy muscles; be “nodding out”; scratch a lot due to itchy skin; have slurred speech and/or be “out of it”

However, they will respond to outside stimulus

How to Recognize an Overdose : Is it an Overdose, or are they just really high?

How To Recognize an Opioid Overdose: Signs and Symptoms

Person may be awake, but unable to talkBody is very limpFace is very pale or clammyFingernails and lips turn blue or purpleBreathing is very slow and shallow, irregular, or has stopped heartbeat is slow, strange, or not there at allChoking sounds, or a gurgling noise (“death rattle”); Loud, uneven snoringVomiting/throwing upLoss of consciousness/passing outPerson does not respond to noise or pain

OVERDOSE MYTHS AND FACTS

MythPeople collapse (‘drop’) immediately after

injecting.

FactSome do. However, overdose can take place

over one to three hours.

Overdose: The Myths and Facts

Myth: Purity and/or taking too much of the drug are

the main causes of overdose.

Fact: They are factors but definitely not the main

reasons. The main reasons are mixing with other drugs and using when tolerance is low or absent.


Myth: • It is young, inexperienced users who mostly

overdose.

Fact: • It is more likely to be an older user, someone in

his or her early 30s who has been using for a long while.


Myth: Being on methadone means it’s impossible to

overdose.

Fact: Being on a methadone program will reduce the

risk of overdose in the longer term, however, in the first few days the risk is higher (the body is still developing a tolerance to the methadone). Even after being on a methadone program for a long time it is still possible to overdose.


Myth: If the person doesn’t die, they’ll be alright.

Fact: Even when an overdose is not fatal, there can be

serious health effects.


Myth:Injecting Cocaine or Crack will stop an OD

Fact:

•Injecting crack will make the OD happen faster•Crack speeds up your heart rate so the body needs more oxygen•Heroin slows down breathing


Myth:Most overdoses happen when someone is alone

Fact:

A UK report showed that over 50 out of 100 overdoses happen with another person in the room

OVERDOSE: THE MYTHS AND FACTS

MythIf someone ODs you should walk them around

Fact:•This is a waste of time•There is a chance that the person will fall over, bang their head and cause a head injury•Then they’ll be suffering from an overdose and a head injury

Overdose: The Myths And Facts


MythInjecting salt water will stop an OD

Fact:•NO it won’t!•NOR will injecting milk, water, orange juice•All will only add to the problem


Myth:

If someone is snoring they’re ok

Fact:

If someone has been using depressants and they are snoring – it is a sign that they are struggling to breathe


MythIf a friend ODs, you should put them in the bathFact•You can change the body temperature really fast and put them into shock•They could drown•It can be a slippery and wet nightmare trying to get an unconscious person out of a bath tub


MythMaking someone vomit will slow down an OD from ‘Down’Fact•This will just increase the chances of them choking to death•Depressants stop the gag reflex which makes it more likely that you’ll choke

HOW TO RESPOND TO AN OPIOID OVERDOSE

• Call 911• Ensure safety and

infection control• CPR• Naloxone

If the person is conscious:

try to keep them awake and talking as much as possible while you call 911. Moving them around could risk a fall.

If the person is unconscious:

Put them in the recovery position and call 911 for an ambulance.

The Recovery Position:

Places the person securely on their sideto ensure that they cannot choke on Vomit or other fluids

Responding to an Opioid Overdose:Calling an Ambulance

Once in the Recovery Position:

• Call 911 if you haven’t already done so• Ensure Safety: check the scene• Use stimulation to check if they respond• Check for breathing• Begin CPR if the person is not breathing

Responding to an Opioid Overdose: The Recovery Position

CALLING 911

If there is someone else in the room have them call 911. Ask the person who calls 911to come back and tell you they have called the ambulance. That way you are sure that ambulance has been called. If no one else is there, make the call yourself.

In most communities, police will be dispatched at the same time. Police will attend with an ambulance. For many this is the reason they will not call 911, however saving lives always has to be the first priority.

When you call the ambulance they will ask a series of questions. This is to brief paramedics on the situation before arrival. Stay on the phone if you can.

You can’t help someone if you need help yourself

In the event of any emergency, including an overdose, make sure safety comes first.

Check the scene for anything that could be of danger to you, other people or the person experiencing the overdose.

Respond to any other emergencies and ensure the safety of the environment.

When ANY bodily fluid is present, such as blood, vomit, or saliva, always put a barrier between the fluid/victim and yourself such as gloves, or a face mask. Always avoid contact with the fluid(s) and wash hands thoroughly immediately after giving first aid.

Ensuring Safety: First Steps

CPR : COMPRESSIONS, AIRWAY, BREATHING

Remember: Opioids slow the central nervous system down.

The person needs to be breathing to bring in oxygen, and the heart needs to be pumping to circulate the oxygen to the

brain.

In many communities,

6-8 minutes is an average response time once 911 is

called.

CPR: COMPRESSIONS, AIRWAY, BREATHING

Chest Compressions: CPR involves chest compressions at least 5 cm deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart.

Rescue Breathing: The rescuer may also provide breaths by either exhaling into the subject's mouth or nose or using a device that pushes air into the subject's lungs. This will only be effective if the airway is clear.

• Current recommendations place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.

• Chest compressions alone can at least circulate existing oxygen in the blood. A full first aid response to an opioid overdose includes chest compressions and rescue breathing.

Responding To An Overdose: Opioid Overdose Reversal

IF you are trained in the administration of Naloxone (Narcan) and have it available to you, administer the recommended dosage by injection or intra-nasally and continue CPR.

If the person is still not breathing on their own after 5 minutes, re-administer the dose and continue CPR.

If the second administration does not stimulate breathing independently, it is not likely an opiate overdose. Continue CPR.

Continue CPR and wait for paramedics to arrive.

Always dispose of needles in the closest biohazard box.

Naloxone does not replace medical

intervention, but it does

buy life-saving

time!

Questions? Comments?

Preventing Overdose Waterloo Wellingtonhttp://www.preventingoverdose.ca/

[email protected]

Find us on Facebook and Twitter

Introduction to overdose prevention wgdsc harm reduction forum 2013 (2)

Documents

Transcript of Introduction to overdose prevention wgdsc harm reduction forum 2013 (2)