1. Opiate Overdose Prevention Harm Reduction and Naloxone Administration Training

2. Purpose of Training This training is designed to offer a brief education on opiate addiction and opiate overdose in relation to it’s effects on the brain. This training program will teach you possible actions that you can take to prevent overdose and fatal overdose, such as Naloxone administration. This training will not qualify you as a medical professional, but you will leave with a better understanding of the opiate epidemic and the life-saving actions your capable of performing.

3. Training Overview Pre-test Presentation -Drug use, Addiction, Overdose statistics -Addiction and Overdose and the Brain -Naloxone and the Brain Live Video Naloxone Administration Demonstration Paperwork/Follow up Questions

4. Is this training Necessary? Drug use, Addiction, and Overdose Facts Everyday in the U.S. 100 people die of overdose

5. Is this training necessary? Nationally Drug Overdose has become the leading cause of injury death Opioids, such as heroin, account for about 80% of those deaths. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes Drug overdose death rates have been rising steadily since 1992 with a 102% increase from 1999 to 2010 alone

6. Is this training Necessary? State of Illinois In Illinois, more people die from overdose, then the national leading cause of death, Car Accidents. Heroin is the most commonly cited drug among primary drug treatment admissions in Illinois.

7. Is this training necessary? According to “Heroin Use in Illinois: A Ten-year Multiple Indicator Analysis” by the Illinois Consortium on Drug Policy at Roosevelt University 1998-2008 Regional Level Chicago metropolitan area was ranked among the worst nationally for heroin-related problems It ranked first in the number of individuals admitted to the emergency room for heroin abuse and first in percentage of arrests testing positive for heroin

8. Cook County “Heroin Hub” In 2012, nearly 25,000 people were admitted to Cook County emergency rooms for heroin-related incidents. That same year 533 people died from Opiate Overdose.

9. DuPage County 46 Heroin related deaths in 2013 15 people in 17 days in July 2013 alone Both males and females Ages 15-64

10. McHenry County 122 drug overdose deaths occurred from 2009 to 2012 in McHenry County McHenry County had 16 heroin deaths in 2012, the highest total since 2008 A study found a large increase in deaths from heroin overdoses in the collar counties, including a 150% increase in McHenry County in a 3-year period.

11. Lake County Gender MaleFemale 814 2012 Opioid Overdoses Age Range 21-306 31-401 41-509 51-607 Ages 0-20 and 61+ did not see any overdoses this year (2012)

12. All that said….Yes, this training is necessary! Not all first responders are trained and equipped with Narcan or Naloxone Opiate overdose deaths are on the rise, especially in the suburbs. Its anticipated that this epidemic will get worse before it starts to get better. YOU can save a life! YOU have the ability to save a life

13. Opiates, Addiction, and the Brain

14. Opioids All categories have overdose risk. Opioids NaturalSemi-SyntheticFully Synthetic Opiates Opium Morphine Codeine Heroin Hydrocodone Oxycodone Fentanyl Methadone Demerol

15. Opiate Similarities and Differences SimilaritiesDifferences Come from the opium poppy or are chemically created to be like a drug that comes from the opium poppy Effect the same part of the brain Can cause overdose in the same way (when breathing stops) Have different concentrations or strengths Have varying durations of action “Opiates are like beef, you can have steak or you can have hamburger, but either way you are eating beef. Same with opiates.”

16. Opiate Comparisons DrugDurationPotency Methadone24hr++++ Heroin6-8hrs+++++ Oxycotin3-6hrs+++++ Codeine3-4hrs+ Demerol2-4hrs++ Morphine3-6hrs+++ Fentanyl2-4hrs+++++++++++

17. To be more specific… Street names Heroin: Smack, H, Tar, Junk, Dope Hydrocodone: norcos, vikes, vic, watson Oxycodone: oxy, percs, OC, cets

18. Brain Stem Memory Pleasure Drive Prefrontal Cortex Critical impulse control (The Brake) Gas pedal Steering Wheel Not fully developed in women until 21yrs and 25 yrs for men Vitals (Breathing) We are wired for addiction

19. Our Pleasure line Steak Dinner Heroin Use “dope sick”

20. Let’s Talk Prevention What message do we want our loved ones to hear Overdose Risk Factors  Using alone  Low tolerance (treatment/lock-up)  Mixing drugs is a recipe for overdose  Silence kills  Don’t use! Tips for safe using  Don’t use along  Start low, go slow  Be intentional/ don’t mix  Talk, be honest have a user contract and a plan

21. Let’s talk Preventing Fatal Overdose Recognize and Respond Have an overdose plan Be trained to carry and administer Naloxone, have family and friends trained, people who use with you trained and know about the Good Samaritan

22. Signs to Recognize Overdose Signs of being really high Pupils pinned Nodding (but arousable) Sleepy, intoxicated, but breathing (8 or more time per minute) Slurred speech Stimulate & Observe Signs of Overdose Pupils pinned Not arousable (Sommolence) (does not respond to sternal rub or painful stimuli) Breathing slow or stopped (Respiratory Depression/Apnea) -chocking/gurgling/ snoring sounds Slow Heartbeat (Bradycardia) Cold or Clammy Skin Blue lips or nails Rescue Breathe & Naloxone

23. Can you wake the individual? If they are not responsive Lay them in the recovery position Head turned Mouth down Brain at same level as heart

24. The Good Samaritan Act Calling for help Illinois Public Act 097-0678 You & the overdose victim cannot be charged with possession for small amounts of illegal drugs when calling 911 or taking someone to an emergency room for an overdose. For more information visit: www.stopoverdoseil.org

25. The A & B of Life Airway and Breathing Make sure the air way is clear and nothing is preventing the person from breathing by checking their mouth. Breathe for them. Two quick breathes every five seconds

26. Evaluate Are they any better? Can you get and prepare Naloxone quick enough that they won’t go too long without you breathing for them?

27. How does Naloxone work? What is Naloxone?  The opiate antagonist  Opiate overdose antidote  Opiate Reversal Naloxone Breathing restored! Naloxone has stronger affinity for opioid receptor How do opioids affect breathing? Opioids are depressants that at high levels can repress the urge to breath

28. Naloxone Illinois Public Act 096-0361 allows individuals to administer naloxone in the event of an overdose Also known as Narcan Works in 1-3 minutes Non-scheduled drug Cannot be abused Benign substance that has not shown any adverse side effects in a healthy person Temporarily takes away high, allowing the person the chance to breathe Too much can cause withdrawal symptoms

29. Naloxone Administration 1ml-2ml or cc (equals 100units) Repeat the dose every 2-3 minutes until they’re waking up If they aren’t responding after 3 doses, it’s probably not an opiate overdose (If you haven’t already, call for help and continue CPR until help arrives)

30. Naloxone Administration There are different forms of Naloxone (Nasal spray, one-dose glass ampoules, pre-loaded single-dose syringe, multi-dose 10mg bottle) Intramuscular injection (with 1-1½ inch needle)  Into the muscle  Needle goes all the way in  Goes through clothes May take a few minutes to work

31. DrugDuration Methadone24hrs Heroin6-8hrs Oxycotin3-6hrs Codeine3-4hrs Demerol2-4hrs Morphine3-6hrs Fentanyl2-4hrs Naloxone30-40minutes Does not last in system as long as other drugs. High can return, overdose can occur again. Therefore, it is important to stay with individual for TWO hours to make sure they don’t overdose again or try to get high. Are they breathing on their own? Is another dose needed?

32. Evaluate and Support Coming off Naloxone Emergency Rooms administer 2mg through IV IV/Intravenous injection is fastest route of administration (You are NOT trained for this) This results in SEVERE withdrawals Support is needed! Using again will make the OD worse when the naloxone wears off. If you can support the person as they deal with the discomfort, the naloxone will wear off and the withdrawal will fade. Find out what they took. Opiates that last longer have longer lasting overdoses. (i.e.. Methodone may last 6-8hours)

33. Live! The live demonstration

34. Questions?

35. So Naloxone will save lives! Great! Now I can use. Yes, Naloxone will save your life. However, there is no saying what state the overdose will leave you in.

36. Overdose obstructs oxygen from getting to your brain Physically you may come to, paralyzed Jazzmin’s Journey: Directed by God Overdose can lead to Hypoxic brain injury. These brain injuries can cause coma, seizures and, in worst case scenarios, brain death A brain injury can result in mild to severe impairment of: movement, balance and co-ordination senses such as hearing or vision spoken and written communication thinking, concentration and memory. In severe cases, brain injuries from overdoses can leave people in a vegetative state.

37. It is not naloxone that leaves these unfortunate consequences It is the overdose!

38. Silence Kills “There's not enough being done. There's no state action plan. People are always going to talk about the cost of things. Well it costs about $30,000 every time someone overdoses, but it costs $25 for a Naloxone kit. It costs more to not do something that to do something." It cost 7 times more to imprison an individual for their disease than to treat them for it. To put that in perspective, in Illinois it cost nearly $38,258.00 per inmate in 2010 to house an individual. Illinois is in the top ten states to have the highest population of inmates and highest cost per year per inmate. It cost each tax payer $1,743.20 a year. We spent nearly 1.2 billion in prison expenditures $566.1 million in prison related cost outside the budget “I could pay $10,000 for treatment or I could pay that much for a funeral” Break the Stigma The word “addict”  Confidentiality  People first language  User friendly  Someone’s loved one

39. Break the Stigma Addiction is not a matter of will power.  Addiction is a mental illness  Addiction is a brain disease  Addiction is a chemical rewiring of the brain and the way in which we respond to pleasure  Addiction has little to nothing to do with will power  Those with an addiction cannot just stop. They need professional and medical treatment.

40. What is being done to fight this epidemic Illinois’ Good Samaritan Act Illinois law, 20 ILCS 301/5-23 You & the overdose victim cannot be charged with possession for small amounts of illegal drugs when calling 911 or taking someone to an emergency room for an overdose. For more information visit: www.stopoverdoseil.org Illinois’ Naloxone Expansion Act This act explains the expansion of naloxone to lay people with proper Training through overdose Prevention programs such as this one. Illinois public Act 096-0361

41. GRASP LTM Foundation Take A Stand Don’t Roll the Dice- Ja2Soon Stop Overdose IL High on Life Chicago Recovery Alliance Live4Lali New Directions Addiction Recovery Services The Other Side H.E.R.O. Together we are One Loud Voice Serenity Family Outreach Open Hearts open eyes PATH

42. Refer your friends and family to us Speak up! Carry Naloxone Educate others Talk to your kids, your parents, your peers Write a letter to your school or your child’s school Write a letter to your local police station or a government official/politician Find local take back days -Addiction can stem from prescription drugs -Monitor your drug cabinet

43. Thank you! Credits: Wake the Nation Massachusetts Department of Public Health Dr. Walley MA Harm Reduction Coalition Dr. Celeste Napier Center for Disease Control and Prevention Kathie Kane-Willis and Illinois Consortium on Drug Policy Roosevelt University Dan Bigg and the Chicago Recovery alliance DuPage County Health Department DuPage Coalition Against Heroin McHenry County Public Health Department Wanereye Communication ISTOCK images