Recognition, Response and Administration of Naloxone (Narcan) Opioid Overdose 101

What are opioids? Hydrocodone Heroin Oxycodone Codeine Vicodin Demerol OxyContin Tylenol 3 Tylox Levorphanol Percocet Percodan Heroin Codeine Demerol Morphine Darvocet Fentanyl Dilaudid Methadone Opium

Opioids Methadone ++++ 24-32 Hours Heroin +++++ 6-8 Hours Oxycontin +++++ Codeine + Demerol ++ Morphine +++ Fentanyl +++++ + Potency 24-32 Hours 6-8 Hours 3-6 Hours 3-4 Hours 2-4 Hours

Opioids Natural opioids: contained in resin of opium poppy (morphine, codeine) Semi-synthetic opioids: created from natural opioids such as hydromorphone, hydrocodone, oxycodone, heroin etc., Fully Synthetic Opioids: Methadone, Fentanyl

What is an OPIOID Overdose? Rarely instantaneous Can happen 1-3 hours after use Body has ingested more than it can handle Opioids attack receptors that control breathing Oxygen can’t get to the brain Heart stops Unconscious, Coma, Death Long-term Brain/Nerve/Physical Damage

Risk Factors Tolerance Shift Mixing Drugs Physical Health Variation in strength/content Switching from snorting/smoking to injection Using alone

What are the Signs/Symptoms of an OD? REALLY HIGH OVERDOSE Muscles become relaxed Deep snoring or gurgling (death rattle) Speech is slowed/slurred Very infrequent or no breathing Sleepy looking Pale, clammy skin Nodding Heavy nod, not responsive to stimulation Will respond to stimulation like yelling, sternal rub, pinching, etc. Slow heart beat/pulse Blue skin tinge- usually lips and fingertips show first Body very limp Face very pale Pulse (heartbeat) is slow, erratic, or not there at all Throwing up Passing out Choking sounds or a gurgling/snoring noise Breathing is very slow, irregular, or has stopped Awake, but unable to respond

Response Are you alright? Are you ok? Pain Stimulus If no response call 9-1-1 Rescue Breathing Naloxone

Response Myths Salt Water Suboxone Ice On Body Cold Shower Cocaine Milk Burning Skin Punching Slapping

What are barriers to calling 911 from the perspective of a substance user? Fear of legal risk (outstanding warrants, DSS involvement, loss of public housing) Fear of judgment from family/ community Personal embarrassment/shame Other punitive measures (students loose federal financial aid) Urban legends (homicide charge for being at an OD, being deported)

Naloxone Hydrochloride (Narcan) Opioid Antagonist Medication that reverses only OPIOID overdose Can not get high on it Can not abuse it Stays active for 20-90 minutes depending on metabolism, amount of drug used Liver Function If they use before the Narcan wears off Heroin Narcan Narcan has a stronger affinity to the opioid receptors than the heroin, so it knocks the heroin off the receptors for a short time and lets the person breathe again. Opioid receptor

Talking with Patients/Clients Harm Reduction? Know some street slang (does not mean YOU have to use it) Know the street myths about response Referrals to outside programs for Narcan Not just people who inject are at risk for overdose.

Mary Wheeler Street Outreach Coordinator Christian Alba Health Educator CAB Health and Recovery Services Inc., Healthy Streets Outreach Program 280 Union Street Lynn, MA 01901 Phone: (781) 592-0243 Thank You!!