Grays Harbor EMS & Trauma Care Council October 2016 EMT Naloxone Program Grays Harbor EMS & Trauma Care Council October 2016

Naloxone Introduction Purpose: Early intervention can help reduce fatalities The Emergency Medical Technician Narcan Program is designed to educate EMTs’ in recognizing signs and symptoms of opiate overdose and proper administration of life-saving Narcan

OBJECTIVES At the conclusion of this training participants will be able to: Identify Opioids/narcotics Recognize signs and symptoms of opiate overdose Initiate appropriate treatments and interventions Assemble equipment needed to administer Narcan Successfully administer appropriate dosing of Narcan

Background Annually in Washington State approximately 600 individuals die each year from an opiate overdose according to the January 2016 Washington State Interagency Opioid Working Plan. According to a recent statewide survey of syringe exchange clients, 57% of those who inject heroin said they were “hooked on” prescription opiates before they begun using heroin. Timely administration of Narcan has proven to reduce the number of opiate related deaths

Definitions Opioid – an opiumlike compound that binds to one or more of the three opioid receptors of the body Opiate – a subset of the opioid family, and refers to natural, non-synthetic opioids Narcotic – a drug that causes sleep or altered mental consciousness Agonist – a chemical that binds to a receptor and activates the receptor to produce a biological response Antagonist – a substance that interferes with or inhibits the physiological action of another

Naloxone

Naloxone Hydrochloride Generic Name : Naloxone Hydrochloride

Brand Name : Narcan®

Naloxone is.. An opiate antagonist which reverses opiate overdoses Some commonly abused opiates are: Heroin Oxycontin Percocet Vicodin Methadone Morphine Hydrocodone

Narcan®/Naloxone has been used in emergency rooms and EMS for more than forty years as an antidote for opiate overdoses.

Pharmacology Opiates produce their effects as an agonist on the mu receptors in the central nervous system Mu¹ receptors are responsible for a large portion of analgesic (pain management) effects Mu² receptors are responsible for respiratory distress

Mu receptors Also known as Morphine receptors Located in the Brain Stem and Medial Thalamus Responsible for supraspinal analgesia, respiratory depression, euphoria, sedation, decreased gastrointestinal motility, and physical dependence

Naloxone is a opiate antagonist Naloxone kicks opiates out of the brain by blocking certain receptor sites. Naloxone occupies the receptor sites and prevents opiates from binding to the brain. Naloxone in conjunction with rescue breathing has life saving potential.

Opioids/Opiates are; CNS depressants Type of narcotic medications used to relieve pain

An opiate overdose is.. When opiates settle in the part of the brain that regulates breathing. The immediate concern during an opiate overdose is respiratory depression.

BE PREPARED FOR THE PATIENT TO RELAPSE The effects of Naloxone wears off between 30- 60 minutes after administration Heroin lasts 6-8 hours Methadone lasts 24 hours Opiates outlast Naloxone BE PREPARED FOR THE PATIENT TO RELAPSE

When am I supposed to give Narcan©?

Signs and symptoms of Opiate Overdose

Signs and Symptoms Weak/Thready pulse Slow or Absent Respirations In addition to a known history of opiate abuse, responders should look for: Weak/Thready pulse Slow or Absent Respirations Constricted Pupils Weakness/Unresponsiveness

Indications Known narcotic or opioid overdose Respiratory depression of unknown origin Coma or Altered LOC of unknown origin

Routes IN – Intra-nasal (preferred route) IM – Inra-muscular (secondary route) SQ – Sub-cutaneous (this is not a route that the EMT will be using except in the case of an obese pt where the subcutaneous layer is larger than the needle is long Note; Prior to administaring Narcan the EMT MUST first check the pts blood sugar level

Administration (preferred route) The preferred administration route of Narcan will be Intra-nasally A preloaded/prefilled syringe will be affixed with a mucosal atomization device (MAD)

Dosage Adult: 1mg – repeat 1mg after 4 minutes if the pt did not respond to the initial dose Peds: 0.5mg – repeat 0.5mg after 4 minutes if the pt did not respond to the initial dose Note: A ped becomes an adult at the time of puberty May repeat dosing after 15 minutes and only if the pt is responding to the initial two doses

Factors that affect absorption IN Vasoconstrictors Epistaxis Nasal congestion

Contraindications to the preferred route Excessive Epistaxis Nasal trauma Septal abnormalities Nasal congestion with mucous discharge Destruction of nasal mucosa from surgery or past cocaine abuse

Advantages to the preferred route Absorption almost as fast as IV Very near to 100% amount of drug absorbed Decreased potential for needle stick injuries

Administration (secondary route) The secondary administration route will be Intra-muscular (IM). May be sub-cutaneous (SQ) due to the pts build I;E, obese pts A needle (21g 1 1/2 “ minimum) will be attached to a preloaded/prefilled syringe

Administration (routes) IM injection sites Deltoid – upper arm Dorsal Glutereal – butt muscle Vastus Laterolis – anterior surface of upper leg Rectus Femoris – lateral surface of upper leg

Contraindications secondary route Hypersensitivity to Naloxone

Adverse/side affects Tachycardia Diaphoresis Hypertension N/V Dysrhythmias Withdrawls

Schedule Naloxone is not in the DEA schedule of drug classes, yet requires a prescription Naloxone has no potential for abuse

Naloxone has no other purpose besides reversing an opiate related overdose. Naloxone has no mind altering effects

Naloxone is the only treatment in medicine that literally cannot hurt anyone. The only possible effect is the individual may become dope sick (withdrawal). Naloxone is specific, safe, and effective

Epidemiology People coming out of jail or treatment have highest risk of overdose. Most deaths are among opiate users who are in their late twenties to early thirties and have been actively using for the past five to ten years. Only 17 % of opiate related deaths are among new users.

Nobody needs to die from an opiate overdose Bottom Line Nobody needs to die from an opiate overdose

Questions??? Opioid life-threatening response Algorithm Test time – must score an 80% to pass Practical assessment – student will be given a scenario and must pass with an 80% and have no critical criteria failures