Recognizing and Preventing Overdose

andAdministering Naloxone

www.OverdoseFreePA.pitt.eduSubstance Use Disorder Treatment Professional Curricula

Core Component 2© 2014, Overdose Prevention Coalition

The OverdoseFreePA website is brought to you by the Overdose Prevention Coalition, a

collaborative between:

The Pennsylvania Department of Drug and Alcohol Programs (DDAP)

The Single County Authorities (SCAs) of:

Allegheny CountyBlair County

Bucks CountyButler County

Dauphin CountyDelaware County

Westmoreland County

The Allegheny County Medical Examiner’s Office

The Program Evaluation Research Unit, University of Pittsburgh School of Pharmacy

The project is supported by a generous grant from the Pennsylvania Commission on Crime and Delinquency.

Background Photo for Slide Set by Jason Pratt from Pittsburgh, PA (Trees and light) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

SAMHSA National Survey Past Month Nonmedical Use of Types of

Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2012

Substance Abuse and Mental Health Services Administration (SAMHSA), 2013

SAMHSA National Survey Source Where Pain Relievers Were Obtained for Most Recent

Nonmedical Use among Past Year Users Aged 12 or Older: 2011-2012

SAMHSA, 2013

Past-Year Initiates for Specific Illicit Drugs Among Persons Age 12 or Older, 2008

Overview of Substance and Drug Use

SAMHSA, 2009

Overdose• An overdose means having too

much of a drug or alcohol, or a mix of drugs and/or alcohol for your body to safely handle.

• Overdose can result in permanent brain damage, permanent organ damage or death.

• Overdose symptoms can look different depending what kinds of drugs were used.

DDAP, 2014; Centers for Disease Control and Prevention (CDC), 2012

Overdose (cont’d)

• Drug overdose was the leading cause of injury death in the U.S. in 2010.

• Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes in 2010.

CDC, 2012

Overdose Deaths in Pennsylvania

Based on Pennsylvania Department of Health data, overdose deaths have been on the rise over the last two decades, with an increase in the rate of death from 2.7 to 15.4 per thousand Pennsylvanians.

DRUG OVERDOSE DEATHS IN PENNSYLVANIA

YearNumber of

DeathsPA

PopulationRate per

1,000

2011 1,909 12,742,886 15.4

2010 1,550 12,702,379 12.5

2008 1,522 12,448,279 12.6

2006 1,344 12,440,621 11.2

2004 1,278 12,406,292 10.6

2002 895 12,335,091 7.5

2000 896 12,281,054 7.4

1998 628 12,001,451 5.4

1996 630 12,056,112 5.4

1994 596 12,052,410 5.1

1992 449 11,995,405 3.8

1990 333 11,881,643 2.7

DDAP, 2014

Different drugs have different overdose

symptoms.

International Overdose Awareness Day (IOAD), 2014

It’s Good to Know …

Symptoms of Overdose

• Depending on the drug(s) involved, an overdose victim can exhibit different symptoms.

• It’s important to be able to recognize the symptoms of overdose. – Time is a factor.– Prescription pills are involved in about

60% of overdose deaths.

IOAD, 2014; Jones, 2013

Signs of Alcohol Overdose:

• Confusion• Difficulty remaining conscious

• Slow breathing or gaps in breathing • Clammy skin• Vomiting• Seizures

• Slow heart rate• Dulled responses

• Extremely low body temperature

DDAP, 2014

Signs of Amphetamine/Other Stimulant (“Speed”)

Overdose:• Amphetamine-induced psychosis

– (paranoia, hallucinations and/or delusions)

• Overheating• Dehydration

• High blood pressure• Seizures

DDAP, 2014

Signs of Opioid (Heroin, Narcotic Pain Medication,

Etc.) or Depressant (Xanax, Valium, Etc.) Overdose:

• Slow and shallow breathing • Very sleepy and unable to talk

• Unconscious • Blue lips or fingertips

• Snoring or gurgling sounds

DDAP, 2014

Overdose Prevention

• Recognize the symptoms of an overdose.

• Call 911 immediately!

• Act quickly to administer rescue breathing.

• Administer Naloxone (Narcan®) if it’s available.

DDAP, 2014

By Lviatour (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

• Prescription Monitoring Programs: • Reduce Diversion, not demonstrated to

reduce overdose. • Concern about increase in heroin use.

• Methadone and Suboxone treatment: Very effective

• Abstinence-based drug treatment: • Risk of overdose increases when relapse

occurs.

Strategies for Reducing Overdose Deaths

Bell, 2012

– Community Based Education: Risk Factors, Identification of Symptoms, Effective Response, including Rescue Breathing, Calling 911 and Naloxone Administration

– Naloxone Prescription Programs

– Physician Prescribing when prescribing opioids for pain

Strategies for Reducing Overdose Deaths (cont’d)

Bell, 2012

About Naloxone• Naloxone reverses opioid-related sedation

and respiratory depression = pure opioid antagonist– Not psychoactive, no abuse potential– May cause withdrawal symptoms

• May be administered IM, IV, SC, IN• Acts within 2 to 8 minutes• Lasts 30 to 90 minutes, overdose may

return • May be repeated• Narcan® = naloxone• naloxone ≠ Suboxone ≠ naltrexone

Walley, 2013

Prefilled naloxone ampule

Intranasal Administration

Pro• 1st line for some local EMS• RCTs: slower onset of

action but milder withdrawal

• Acceptable to non-users• No needle stick risk• No disposal concerns

Con• Not FDA approved• No large RCT• Assembly required, subject to

breakage • High cost:

– $40-50+ per kit

Mucosal Atomization

Device (MAD) Luer-lock syringe

Walley, 2013

http://www.healthycommunitiesme.org/rx-prevention.html

Intranasal Administration (cont’d)

Walley, 2013

When is Naloxone Prescribed?

1. Patient release after emergency medical care involving opioid OD/intoxication2. Suspected history of illicit or nonmedical opioid use3. High-dose opioid prescription (> 50 mg of morphine equivalence/day)4. Any methadone prescription to opioid naïve patientAny opioid prescription and …a. smoking/COPD/emphysema/asthma or other

respiratory illnessb. renal dysfunction, hepatic disease c. known or suspected concurrent alcohol used. concurrent benzodiazepine prescriptione. concurrent SSRI or TCA anti-depressant prescription

Powers, 2012

When is Naloxone Prescribed? (cont’d)

5. Prisoner released from custody6. Release from opioid detoxification or mandatory

abstinence program7. Voluntary request from patient8. Patients in methadone or buprenorphine

detox/maintenance (for addiction or pain)9. Patient may have difficulty accessing emergency medical

services (distance, remoteness)10. Other reasons?

Powers, 2012

The Prescription Opioid Epidemic

• Deaths due to prescription opioid use have more than tripled in the past ten years across the U.S.

• Prescription opioids have been linked to a significant increase in overdose deaths in Pennsylvania.

CDC, 2014; Sapatkin, 2014

Overdose is Preventable

The best strategy for preventing

overdose is to address SUD or

pain management

issues appropriately

before they lead to overdose.

NIDA, 2014

By Charlesjsharp (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons