Overdose Prevention, Recognition, and Response
MISSIONCentering harm reduction in Arizona through participant-driven advocacy, education, and outreach
● Statewide Overdose Prevention and Naloxone Distribution Program
● Comprehensive Harm Reduction Education and Outreach Program● In-depth Trainings on HIV/HCV, Stimulants, Needlestick Prevention,
Stigma, & more● Local and Legislative Advocacy
HOW WE DO IT
OVERVIEW• Harm Reduction & Stigma• National and State Overdose Trends• The Drugs• Overdose Prevention, Recognition &
Response• Next Steps
HARM REDUCTION
19.3 Milliondid not receive substance use treatment at a specialty facility
18.3 Milliondid not perceive a need for treatment
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WHAT IS HARM REDUCTION?
A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.
Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
https://harmreduction.org/about-us/principles-of-harm-reduction/
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WHAT DOES HARM REDUCTION DO?Centers people who use drugs as more than their drug use and as experts on their own care.
Recognizes that drug use and recovery is complex and exists along a continuum. For some, drugs meet important needs so drug-related harm cannot be assumed and abstinence can be just one of many possible goals.
Aims to meet people “where they’re at” by supporting ANY positive change.
Harm reduction does not aim to minimize real harm related to substance use.
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HARM REDUCTION IN ACTION
DRUG USE
● Needle exchanges
● Wound care● Take-home
Naloxone● Fentanyl testing
strips● MAT● Supervised
consumption sites
SEX WORK
● Screening clients● Peer-education● Safe sex supplies● Condom
negotiating skills● The buddy system● Knowing
boundaries
HIV/HCV
● Access to testing● Not sharing
equipment ● Or only sharing
with others who have the same status
● Reducing alcohol consumption for HCV
● PEP, PrEP, Antiretrovirals
● Bleach kits
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STIGMA
WHAT IS STIGMAStereotype: a negative belief about a group (dangerousness, laziness, moral weakness)
Prejudice: Agreement with belief + negative emotional reaction (fear, anger)
Discrimination: Behavior response to prejudice (avoidance, withhold access to basic needs/help)
Stigma permeates every aspect of a marginalized person’s life – relationships, health care, housing, employment, and education.
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• Stigma from individuals– “Junkies”
• Institutional stigma– HCV tx excluding current users
• Self-stigma (internalized)– “I don’t deserve anything good”
• Stigma by association– Married to a person who uses drugs
WHAT IS STIGMA
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Hepatitis C – 33% of young PWID, 70-90% of older & former PWID (CDC)HIV – Global prevalence among PWID 28x higher• 50-90% of PWUD living with HIV also have HCV
Trauma - In surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposureNutrition - Lower average weight than controlsArrest - 1,488,707 drug arrests in 2015 (84% possession)Incarceration - 2,224,400 in 2014Education – Financial aid denied for students w/ drug convictionshttp://www.drugpolicy.org/press-release/2017/09/new-fbi-report-shows-drug-arrests-increased-2016-drug-war-rages
HEALTH DISPARITIES
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TRENDS
NATIONAL TRENDS
• Overdose > motor vehicle accidents• 70,000+ deaths in 2017
• Rural, veterans
• Death most likely in first 28 days after leaving inpatient
https://www.dea.gov/press-releases/2018/11/02/dea-releases-2018-national-drug-threat-assessment-0https://www.cdc.gov/drugoverdose/data/statedeaths.htmlhttps://www.mdedge.com/emergencymedicine/article/132735/toxicology/who-overdoses-opioids-va-emergency-departmenthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/
STIGMAHARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE
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TRENDSHARM REDUCTION STIGMA DRUGS OVERDOSE NALOXONE
• 2017 – 949 opioid related deaths• Age group – 42% 25-44 y.o.• Over 51,000 opioid-related encounters costing
$431 million• 4 Arizonans a day die of OD• Mohave, Pima, Graham, Gila
https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-opioid-emergency-response-report.pdfhttps://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioids/index.php#dashboard
ARIZONA TRENDS
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DRUGS
• A DSM V recognized mental health disorder
• Can be mild, moderate, or severe
• Does not occur in every person who uses drugs, or even every person who becomes physically dependent
• Often related to social determinants of health, past or current abuse and trauma
• Can be a coping mechanism for some people
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525418/
WHAT IS SUBSTANCE USE DISORDER?
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Types• Heroin• Prescription opioids (licit and illicit use)
– Hydrocodone (Vicodin), Oxycodone (Oxycontin, Percocet), Hydromorphone (Dilaudid), Morphine, Methadone, Fentanyl, Codeine
• Methadone used in opioid replacement therapyEffects• Chronic and acute pain relief; cancer and non-cancer
pain• Cough suppression (often codeine)• Sleep• Euphoric feelings• Relaxation
OPIOIDS
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Facts• Most fentanyl found in street drugs is produced illegally• Fentanyl is usually added to the drug supply before it
enters the US• The CDC reports a 200% increase (between 2000 and
2014) in the rate of overdose deaths involving opioids, including an 80% increase in fatal overdoses involving fentanyl and other synthetic opioids in only one year
• It is often impossible to tell if a drug is laced with fentanyl unless you test it
FENTANYL
http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf
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Myths• You can overdose and die from touching
fentanyl• People who know there is fentanyl in their
drugs do not care and will not change their behavior
• Naloxone can’t save you from a fentanyl overdose
• Fentanyl overdoses are different from other opioid overdoses
FENTANYL
http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf
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FENTANYL
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Types• Benzodiazepines – Klonopin, Xanax, Valium, Ativan• Sleep Aids – Ambien, Lunesta• Muscle Relaxers – Somas, Flexeril
Effects• Sedative, sleep-inducing, anti-anxiety, anticonvulsant,
muscle relaxing properties. • Useful in treating anxiety, insomnia, agitation, seizures,
muscle spasms, alcohol & opioid withdrawal• Enhance the effects of heroin, alcohol, and marijuana
NON-OPIOID DEPRESSANTS
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Types• Cocaine – powdered and crack• Meth/Speed• Prescription stimulants – Ritalin, Adderall
Effects• Historically used to treat asthma & other respiratory
problems, obesity, neurological disorders• Prescribed for the treatment of narcolepsy, ADHD, and
depression that has not responded to other treatments• Increased alertness, attention, & energy, elevate blood
pressure, increase heart rate and respiration, constrict blood vessels, increase blood glucose
STIMULANTS
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OVERDOSE
• Also known as “overamping” • Not as cut and dry as an opioid overdose,
more unpredictable & harder to define• Can be physical, psychological, or both• Likelihood of stimulant OD often tied to a
person’s physical health – pre-existing high blood pressure or heart disease, lack of sleep, nutrition, hydration
https://harmreduction.org/issues/overdose-prevention/overview/stimulant-overamping-basics/
WHAT IS A STIMULANT OVERDOSE?
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• First, figure out what is needed, medical assistance, or support and rest?
• There is no “antidote” to a stimulant OD, like Naloxone.
• A stimulant OD can result in serious medical emergencies like seizure, stroke, overheating or heart attack.
HOW TO RESPOND TO A STIMULANT OVERDOSE
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WHAT IS AN OPIOID OVERDOSE?
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LOCATION OF SUSPECTED OVERDOSE
http://azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioid-report.pdf
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High Overdosed
Muscles become relaxed Pale or gray, clammy skin
Speech is slowed or slurred Breathing is infrequent or has stopped
Sleepy looking Deep snoring, gurgling, or rattling
Responsive to shouting, sternal rub, or earlobe pinch
Unresponsive to any stimuli
Normal heart rate and/or pulse Slow or no heart rate and/or pulse
Normal skin tone Blue or gray lips and/or fingertips
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RISK FACTORS FOR OVERDOSE
• Mixing drugs
• Variation in purity
• Tolerance changes
• Using alone
• Physical health
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NALOXONE/NARCAN
RESPONDING: NARCAN/NALOXONE
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ARIZONA NALOXONE LAWS• HB 2489 (2015), HB 2355 (2016), HB 2493 (2017)
A.R.S. 36-2266 & 36-2267• Protects prescribers from certain liabilities• Allows for standing order• Allows for 3rd party prescription• Protects person who administers medication
A.R.S. 32-1979• OTC pharmacy sale• Pharmacy board must create rule
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NALOXONE MYTHS
• “Naloxone encourages drug use.”
• “It sends the wrong message!”
• “It could hurt somebody not overdosing.”
• “Reversal requires medical professional.”
• “But in Pulp Fiction…”
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htmhttps://prescribetoprevent.org/wp2015/wp-content/uploads/PHLRKnowledgeAsset_Naloxone_FINALfull_8June15.pdf
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RESPONDING TO AN OPIOID OVERDOSE
• 1. Sternum rub• 2. Call 911• 3. Administer naloxone, if on
hand• 4. Rescue breathe
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RESPONDING: NARCAN• Administer one dose • Return to rescue breathing• Should work within 2 minutes; if it doesn’t,
give 2nd dose• Narcan can wear off within 45-90 minutes –
overdose could reoccur• Transfer care to EMS, otherwise stay with
person and observe 3 hours• 911 should always be called first!!
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RESPONDING: RESCUE BREATHING• One hand tilting forehead back and plugging nose• Other hand on chin opening mouth• Create a seal with your mouth around their mouth
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RECOVERY POSITION
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INTRAMUSCULAR NARCAN INTRANASAL NARCAN
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WHO SHOULD HAVE NALOXONE?• CDC: 83% of people who administered
naloxone were people who use drugs (2015)
• Friends and family• Law enforcement• Jails, prisons, probation• Treatment centers, sober living• Homeless shelters & services
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm
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AFTER THE OVERDOSE• “Ungrateful that I saved their life”• ONE person communicating, explain what
happened• Prevention messages – what happened
this time and how can we keep it from happening again?
• Get OD survivor and their family Naloxone• Could be a good time to talk treatment and
support options
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WHERE?WHERE TO INCORPORATE?• Street-based outreach• Peer distribution• Co-prescribing• Treatment centers, jails distribute upon
release• Probation/Parole Officers distribute to clients• EMS and hospital distribution/prescription• Pharmacist-initiated distribution
SPW NUMBERS
Sep 2016-May 2019
233,192 Doses of Naloxone
7,251 Overdose Reversals
STIGMAHARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE
RESOURCES● Harm Reduction Coalition -
http://harmreduction.org/issues/overdose-prevention/
● Drug Policy Alliance - http://www.drugpolicy.org/drug-overdose
● Overdose Prevention Alliance - http://overdoseprevention.blogspot.com/
● Prescribe to Prevent - http://prescribetoprevent.org/
Thank youSTAFF NAME
Overdose Prevention Coordinator
STAFF CONTACT INFO
www.spwaz.org
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