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

Overview• Take home naloxone programs

– Overdose prevention education – Naloxone distribution

• Research project • Training components

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

Prevention• Preventing overdose deaths

– OMT/OST (LAR)– Switch campaign– Education programs– Drug consumption rooms– Take home naloxone

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

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)

Take home naloxoneThese programs have prevented numerous deaths

and underlie the importance of prevention strategies, overdose recognition, and provision of

naloxone

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

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

Naloxone• Lasts 30-90 minutes• No effect if opioids not used• No potential for abuse• Withdrawal symptoms possible• Various administration formulations

– Injectable, nasal, nebulized

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

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)

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

Research Study • Implemented in Oslo and Bergen at

various low threshold facilities • June 2014- December 2016

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

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

Training Technique• Not ‘lecture’ format• Ask and engage the clients • Fill in the gaps

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

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

Recognition of an Opioid Overdose

• High vs. OD– RESPONSIVENESS*

• Opioid OD Triad– Unconsciousness– Slowed or stopped

breathing– Small pupils

Responding to an Overdose 1. Assess for signs of an overdose 2. Stimulate3. Ring 113!4. Rescue breathing5. Recovery position6. Naloxone7. Aftercare

Assess• If the victim is:

– Not breathing or shallow (not deep) breathing

– Turning blue– Nonresponsive

Stimulate • Sternal rub

– Safe stimulating option – Other methods may be

effective, but this is fast, easy, and most effective

– (really hurts!)

Ring 113• First ring 113!• The need to call

the ambulance still exists, even if naloxone has been peer administered

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

Rescue Breathing

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

Administration of Naloxone• If the victim is:

– Not breathing, nonresponsive to stimuli

– Given a few rescue breaths

– Ambulance called – Administer

naloxone

Assembling Naloxone

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

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

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

Overview of OD response 1. Assess for signs of an overdose2. Stimulate3. Ring 113!4. Recovery position5. Rescue breathing6. Administer naloxone7. Aftercare

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

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

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

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

Contact:Desireem@medisin.uio.no