sarz maxwell md fasam sarzmaxmd @yahoo.com. www. anypositivechange.org
TRANSCRIPT
![Page 1: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/1.jpg)
Sarz Maxwell MD FASAMSarz Maxwell MD FASAMsarzmaxmd @yahoo.com. sarzmaxmd @yahoo.com.
www. AnyPositiveChange.orgwww. AnyPositiveChange.org
![Page 2: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/2.jpg)
“… he was nodding and then I looked over and he was … well,
there’s a smell, you know? I knew he was dead.
And I didn’t know what to do, I just parked the car and got on the bus.
He was dead. What could I do?”
![Page 3: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/3.jpg)
0
50
100
150
200
250
300
350
400
450
500
19961997199819992000
1996 1997 1998 1999 2000
![Page 4: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/4.jpg)
The diagnosis and management of anaphylaxis.
SOURCE(S): J Allergy Clin Immunol 1998 Jun;101(6 Pt 2):S465-S528 [337 references] MAJOR RECOMMENDATIONS: Patient education may be the most important preventive strategy. Patients should be carefully instructed about hidden allergens, cross-reactions to various allergens, unforeseen risks during medical procedures and when and how to use self-administered epinephrine.
Standards of medical care for patients with diabetes mellitus.
SOURCE(S): Diabetes Care 2001 Jan;24(Suppl 1):S33-S43 [32 references] MAJOR RECOMMENDATIONS:Family members and close associates of the patient who uses insulin should be taught to use glucagon.
![Page 5: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/5.jpg)
Pure opiate antagonist >40 years experience by emergency
personnel for OD reversal Only effect is blockade of opiate
receptor Not addictive; no potential for
abuse No side effects except precipitation
of withdrawal Dose- and delivery-sensitive
![Page 6: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/6.jpg)
Options Advantages Disadvantages
Single-dose pre-loaded syringe
Pre-measuredNo add’l equipment
Cost (~$15 USD /dose)Fragile apparatusSingle dose
Intranasal atomizer
No needlesPremeasured
Cost (~10 USD /dose)Slightly less efficacySingle dose
Multi-dose multi-use 10cc vial
Cost (~$0.27 /dose)Multiple dosesVery portable / durable
Need add’l needles?contamination?
![Page 7: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/7.jpg)
Average heroin user has witnessed 4 OD’s, at least 1 of them fatal
Deaths of peers & personal experience with OD do not ‘teach’ actively-using heroin addicts to stop using heroin
Heroin addicts are interested in helping other addicts in trouble
![Page 8: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/8.jpg)
Participants definitely motivated to intervene in OD situations
Participant focus groups informed program developmentLow thresholdMulti-dose vial formulation
![Page 9: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/9.jpg)
89% approve the idea 92% express willingness to attend
training session Concerns:
Police harrassment & legality of naloxone possession
Fear of dopesickness Dose- and delivery-sensitive Wright et al 2006 UK
Kerr et all 2008 Australia
![Page 10: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/10.jpg)
“I was just freakin’ out, thinking: ‘I wish I knew
how to do CPR’… and I was like,
‘Oh, why don’t I know this?’”
![Page 11: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/11.jpg)
Death of CRA co-founder in 1997 Begin distributing naloxone in 1997 2000 actively expanding program Train all CRA operatives to educate and
distribute
![Page 12: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/12.jpg)
US law allows a prescription to be written when a doctor-patient relationship exists Chart Documentation of education RE prescription
Medical director trained CRA operatives to educate & distribute
Intake form developed with brief history, checklist for education, and standing order
OEND occurred at all 22 weekly SEP sites plus cell phone on-call
Participants quickly became distributors
![Page 13: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/13.jpg)
OD Prevention Early Recognition
› Unresponsive› Before cyanosis
Rescue Breathing Naloxone administration
› 1 cc (0.4 mg) IM› > 1” needle› Multi-use vial
Aftercare › Do not use more opiate!
High will return in 30-40 min› Return of OD› Transport for medical f/u
![Page 14: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/14.jpg)
Age > 34 Using in combination with other drugs
AlcoholCocaine
![Page 15: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/15.jpg)
PONSRespiratory CentreOpiates depress respiratory drive
MEDULLACardiac Centre
Cocaine stimulates heartbeat, blood
pressure
![Page 16: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/16.jpg)
Mixing drugs Using alone Recent period of abstinence – as
brief as 3 days will decrease toleranceDetox programIncarceration
![Page 17: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/17.jpg)
… I put myself in detox and I got out, shot up a bag … and he was with me, thank god, because I went out.”
“He got out of the joint… came back, thought he had the same tolerance… but he didn’t…
![Page 18: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/18.jpg)
Drug Duration potency
Methadone 24 hr ++++
Heroin 6 – 8 hr +++++
Oxycodone 3 – 6 hr +++++
Codeine 3 – 4 hr +
Demerol 2 – 4 hr ++
Morphine 3 – 6 hr +++
Fentanyl 2 - 4 hr ++++++++++++++++++++++++
![Page 19: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/19.jpg)
0
50
100
150
200
250
300
350
400
450
500 1996199719981999200020012002200320042005200620071996 2000 2004 2007
![Page 20: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/20.jpg)
![Page 21: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/21.jpg)
HopeHopeFuture-orientationFuture-orientation
NALOXONENALOXONE
EmpowermentEmpowerment++
New Message:New Message:““it matters if you it matters if you
live or die”live or die”
community, community, altruismaltruism
![Page 22: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/22.jpg)
“I did something that made a difference. The whole world can’t see it
but I know it made a difference. And that’s important… to me.”
![Page 23: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/23.jpg)
Statewide program supported by state DPH Operating in 13 communities SEPs, drop-in centers, treatment programs ( detox,
OTP, residential tx, inpt), ER, home visits, street outreach
>9000 enrolled, ~1000 reversals (11%)
![Page 24: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/24.jpg)
Top 3 most common sites for OTP patient naloxone refills: Needle Exchange Program (40%) Drop-in Center (30%) Methadone Clinic (9%)
Slide courtesy Maya Doe-Simkins
![Page 25: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/25.jpg)
70 patients with opioid dependence syndrome in abstinence-based program trained & given naloxone
6 mos later, participants had retained knowledge, still had the naloxone, but none had used it Transportability Stigma Fear of police
Harm Reduct J, 2009 Sep 24; 6:26
![Page 26: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/26.jpg)
Low threshold – on demand, easily accessible, minimal paperwork
Education – duration; by whom Venue – user-friendly Formulation – simple, durable Doses and Refills – multiple doses
OD relapse Multiple simultanerous victims Abundance >> Confidence
![Page 27: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/27.jpg)
““It used to be, overdose, you always It used to be, overdose, you always
talked about it in past tense: ‘I HAD talked about it in past tense: ‘I HAD
a friend who OD’d.’ Now, overdose a friend who OD’d.’ Now, overdose
is in the present tense: ‘I HAVE a is in the present tense: ‘I HAVE a
friend who OD’d last week’.friend who OD’d last week’.
Naloxone did that.”Naloxone did that.”
![Page 28: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/28.jpg)
Dan Bigg Karen Stanczykiewiz Greg Scott Suzanne Carlberg –
Racich John Gutenson
Susie Gualtieri Sharon Sereda Esther, Cheryl, Cliff, Andrew …
All of our courageous participants, who make this
program work
![Page 29: Sarz Maxwell MD FASAM sarzmaxmd @yahoo.com. www. AnyPositiveChange.org](https://reader035.vdocuments.us/reader035/viewer/2022062718/56649ebe5503460f94bc8787/html5/thumbnails/29.jpg)
the end(s)
www. AnyPositiveChange .orgsarzmaxmd @ yahoo.com