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Naloxone for Overdose Prevention Joji Suzuki, MD Director, Division of Addiction Psychiatry Department of Psychiatry, Brigham and Women’s Hospital Assistant Professor of Psychiatry, Harvard Medical School

Overview General strategies for minimizing overdoses How to identify high-risk patients How to use naltrexone General strategies for minimizing overdoses

Strategies for reducing overdoses Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

Strategies for reducing overdoses Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

Strategies for reducing overdoses Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

Strategies for reducing overdoses Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

Strategies for reducing overdoses Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

Naloxone rescue kit Delivered by laypeople Very effective in reversing overdoses rapidly If individual is not experiencing an overdose: Harmless No side effects

Naloxone rescue kit Delivered by laypeople Very effective in reversing overdoses rapidly If individual is not experiencing an overdose: Harmless No side effects

Naloxone kits Requires assembly Each vial: 2 mg

Naloxone kits Requires assembly Each vial: 2 mg No assembly required Recommended: effective for fentanyl OD

Naloxone kits Requires assembly Each vial: 2 mg No assembly required Recommended: effective for fentanyl OD

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Multidrug OD events: patient may not have this Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Rescue breathing if needed Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

© Copyright AAAP 2016 - www.ncsl.org

© Copyright AAAP 2016 - www.ncsl.org

High-risk patients Criteria Naloxone Rx Naloxone training Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

High-risk patients Criteria Naloxone Rx Naloxone training Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

High-risk patients Criteria Naloxone Rx Naloxone training Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

High-risk patients Criteria Naloxone Rx Naloxone training Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

Key points Naloxone Very effective Can be delivered by a layperson Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

Key points Naloxone Very effective Can be delivered by a layperson Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

Key points Naloxone Very effective Can be delivered by a layperson Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

Key points Naloxone Very effective Can be delivered by a layperson Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines