1. Heroin Overdose Prevention STAY ALIVE ’TIL HELP ARRIVES Ronald RJ Johnson Health Educator Drug Use & HIV/AIDS Prevention HIV/AIDS Program Public Health – Seattle & King County Thanks to: SF Needle Exchange CHAI Project, New Brunswick, NY April 2002

2. HISTORY

3. 86 people interviewed (needle exchange & on the street) All injected heroin alone or in combo Sex: 58%M 42%F Race: 54% White 7% Nat Am / Alaska Nat 27% Black 4% Multiple race / other 9% Latino Age range: 22-61 (mean: 35.8) Age started injecting: 11-40 (mean: 20.6); >½ started <20 # injections/day: 3 (n=25, 29%), 3-5 ( n=54, 64%), mean: 4.2

4. Understanding the Heroin culture EXPERIENCE OD in last 6 mos. 3 (3%) witnessed OD in last 6 mos. 30 (35%) knew someone who died from OD 61 (71%)

5. Understanding the Heroin culture RISK BEHAVIORS 36% usually or always shoot alone 7% shoot alone ½ time 30% usually use same amount after a break

6. Understanding the Heroin culture RISK KNOWLEDGE < ½ identified  tolerance as risk 62% identified EtOH as risk 44% identified benzos as risk

7. Understanding the Heroin culture RESPONSE KNOWLEDGE 62% thought calling 911 is a life-saving response [only 9 out of 30 actually called 911] 60% identified most obvious sign of OD [cyanosis – turning blue] 38% identified response strategies of ? or negative efficacy 17% rescue breathing 4% clear airway 1% recovery position

8. Understanding the Heroin culture ACTION > ½ had never talked to a friend about OD plan 6 (7%) had plan in place

9. How and Why overdose happens Overdose happens when you take too much of a drug OR a combination of drugs Anyone who uses drugs can overdose [From first time users to the veteran] Some combinations can be DEADLY [Heroin & Alcohol; Heroin & Downers]

10. OVERDOSE RISK Not knowing quality of drugs Not knowing body tolerance Mixing drugs (poly-drug use) Using alone (no one to rescue you may  death)

11. Recognizing Overdose Respiratory depression very slow and ultimately no breathing Cyanosis turning blue on the lips and fingertips first Extreme somnolence hard to awaken: sleepiness Hypotension

12. OVERDOSE The cure for a Heroin Overdose is OXYGEN Breathing support Airway control OD DOES NOT NEED TO BE FATAL

13. How to talk with Clients about overdose prevention Basic overdose protocol: Stay calm, A B C Airway control Breathing & Pulse  Rescue breathing Call 911 know what to say  Recovery position Overdose DON’T s DON’T put a person in a cold water bath DON’T leave someone who has just overdosed

14. Three main factors in a drug overdose are. Quality Tolerance Mixing drugs Q.T.M.D.

15. TIPS FOR PREVENTING OVERDOSE Have an OD plan with the people you get high with. Do test shots, smaller dose than usual, "you can always do more, but you can't do less". Be careful if you switch dealers. Ask around, drug strength will vary. Prepare your own drugs–so you know how strong you've made it and exactly what's in it. Avoid mixing heroin with other drugs. Avoid shooting alone.

16. Tips for gettin' high alone Call up someone you trust and get high while on the phone. Don't lock your door while getting high so roommates or paramedics can get to you, quickly if need be. If you're getting high in a public place (ie. a restaurant/bar bathroom, space toilet, park bathroom), let a friend know where you are.

17. Creating an overdose plan When should someone take action? What’s preferred regarding 911? What should be done after the person resumes breathing? Is it ok to remove friend’s identification if he or she has outstanding warrants ? The more you plan out in advance, the less room there is for error and panic in the event of an overdose.

18. Summary What to do IF an overdose happens Stay CALM A B C Airway Breathing & Pulse  Call 911 Not breathing? Do Rescue Breathing: 2 quick breaths every 5 seconds Recovery Position: Protect from choking on vomit & blocking the airway

19. Summary What NOT to do  DON’T put the person in a bath or shower – they could drown!  DON’T inject them with salt water, milk, or other drugs (like cocaine or speed).  Ice won’t help. Neither will tea, coffee, or alcohol.

20. Make a Plan ahead of time ! If someone goes down CALL 911 Tell them if the person is conscious or not breathing. Save a Life!