Naloxone formulation update October 2014

3) If no change after 3 – 5 min repeat naloxone Overdose Suspected No Pulse Check Pulse 1) Administer Naloxone 2) Rescue breathing 3) If no change after 3 – 5 min repeat naloxone 4) Rescue breathing until help arrives 1) 2 min of CPR, 5 Cycles 2) Administer Naloxone 3) Apply Defibrillator 4) Follow Defib. prompts 5) Continue CPR Pulse If you suspect an overdose (not breathing or slow breathing, blue lips or finger tips ect.), check the pulse If no pulse and with 2 or more responders, administer naloxone during first 5 cycles of CPR Also, if you have another person with you, one person can be putting together the narcan and/or doing crowd control and keeping area safe, while another is doing the rescue breathing

Remember “Four Rights” for medication administration Massachusetts Office of Emergency Medical Services Minimum Standards for First Responder Training in First Aid, Epinephrine Auto-Injector and Naloxone Use AR-2-100 Right Patient (opioid overdose) Right Medication (Naloxone-check for clarity) Right Date (check expiration) Right Dose (spray half (1ml) in each nostril)

Naloxone formulations Intranasal Auto-injector

Intranasal Naloxone Intranasal naloxone needs to be dispensed with the mucosal atomization device If there is nasal trauma or bleeding, do not administer naloxone Benefits of Intranasal Naloxone Nose is an easy access point Painless Eliminates risk of contaminated needle sticks and needle dispensing Key Point: Benefits of intranasal naloxone

Give Naloxone: Intranasal Remove both yellow caps from the ends of the syringe Twist the nasal atomizer onto the tip of the syringe Remove the purple cap from the naloxone Twist the naloxone on the other side of the syringe Review how to put together naloxone kit. Interactive: have participants put together demo naloxone kits

Give Naloxone: Intranasal Push 1ml (1mg) of naloxone into each nostril Administer the entire contents of the 2ml syringe with approximately one half (1ml) administered in each nostril Administering one half in each nostril maximizes absorption

Auto-injector Naloxone Each auto-injector contains only 1 dose Inject into muscle or skin of the outer thigh Can be injected through clothing if needed Device injects intramuscularly or subcutaneously, delivers the naloxone, and retracts the needle fully into its housing Needle not visible before, during, or after Key Point: Benefits of intranasal naloxone

Auto-injector Naloxone Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency The Trainer does not contain a needle or medicine It can be reused to practice your injection The red safety guard can be removed and replaced on the Trainer Key Point: Benefits of intranasal naloxone

Give Naloxone: Auto-injector Review how to put together naloxone kit. Interactive: have participants put together demo naloxone kits

Give Naloxone: Auto-injector Review how to put together naloxone kit. Interactive: have participants put together demo naloxone kits

Give Naloxone: Auto-injector Review how to put together naloxone kit. Interactive: have participants put together demo naloxone kits

Give Naloxone: Auto-injector Review how to put together naloxone kit. Interactive: have participants put together demo naloxone kits

How does a person respond to Naloxone? Scenarios: Gradually improves breathing and becomes responsive within 3 – 5 minutes Immediately improves breathing, responsive, and is in withdrawal Starts breathing within 3 – 5 minutes but remains unresponsive Does not respond to first dose and naloxone must be repeated in 3 – 5 minutes (keep rescue breathing) Very often those who become responsive won’t immediately realize they just overdosed

After Administering Naloxone Continue rescue breathing with 1 breath every 5 seconds until emergency responders arrive After 3-5 minutes, if the patient is still unresponsive with slow or no breathing, administer another dose of naloxone Key Point: Continue rescue breathing, if still unresponsive and EMS has not arrived administer second dose of naloxone after 3-5 minutes

If victim is breathing, but unresponsive place in recovery position If for any reason the victim needs to be left along place in recovery position

Naloxone Storage Intranasal: Storage between 59 degrees to 86 degrees. Avoid extremes in temperatures for long periods of time Replace every 6-12 months, before expiration date Auto-injector: 59°F to 77°F (15°C to 25°C) Temperature excursions are permitted between 39°F and 104°F Keep in outer case until needed If solution through viewing window is discolored, cloudy, then replace Replace before expiration date Keeping inventory is important. Narcan has 12-18 month shelf life Storage in recommended temperatures is important