1. Morrow County Project DAWN June 2016

2. Morrow County Health Department Kay Benick, RN, BSN

3. * Unintentional drug overdose is the leading cause of injury-related death in Ohio (and the US); ahead of motor vehicle traffic crashes – a trend that began in 2007 * Unintentional drug overdose caused 2,744 deaths in Ohio in 2014, a nearly 20% increase from 2013 * Ohio had the 5 th highest overdose death rate in the country in 2014 – behind West Virginia, New Mexico, New Hampshire, and Kentucky

4. Opioids are sedative narcotics They are used in medicine mainly to relieve pain Opioids repress the urge to breath – When someone is having an opioid overdose they stop breathing and could die

6. An overdose occurs when an opioid fits in too many opioid receptors in the brain resulting in the slowing and then stopping of a person’s breathing. Opioid Opioid fits exactly on receptor Opioid receptor on brain

7. Naloxone has a stronger affinity to the opioid receptors than opioids like heroin or Percocet, so it knocks the opioids off the receptors for a brief time. This allows the person to breathe again and effectively reverses the overdose. Naloxone Opioid receptor on brain

8. Reverses Opioid Drug Overdose Safely Used for 40 years Given by intranasal, IV or IM injection Works rapidly (2-8 minutes) Wears off in 30 to 90 minutes #1 Function is to reverse the effects of opioids on the brain and respiratory systems to prevent death

9. Changes in tolerance Mixing drugs Physical health Previous experience of non-fatal overdose Variation in strength and content of “street drugs”

10. Overdose affects some individuals directly others indirectly and the society at large Overdose deaths can be prevented by laypeople and lives can be saved Conversations about overdose prevention and reversal can provide another way for providers and clients to connect and have a rapport

11. * No Pharmaceutical Effect * No effect if opioids are not present * Few serious negative side effects reported with administration * Prevents complications that result in costly drug overdose-related hospital stays

12. It is a waste of time to give opioid users naloxone, since they are not capable of recognizing and managing an overdose. Yes and no. Knowledge Saves Lives The person who receives naloxone will react violently when the medication is administered and his/her overdose is reversed. Not always. Reaction (withdrawal) depends on the level of addiction The fact that drug users can have access to naloxone will postpone their entry into drug treatment, and will also encourage riskier drug use. Not true. Can Provide Access to Treatment.

13. There is very little you can do when a person is having an opioid overdose since he/she could die instantaneously Not true. It can take 1-3 hours for someone to die It is really hard to prevent someone from dying from a drug overdose since people usually use drugs in private Not true. Most overdoses are actually witnessed Preventing death due to an overdose is not easy and you have to complete a lengthy, difficult training Not true. Overdose Education and Naloxone Distribution Programs Save Lives

14. 14 Ohio Rate: 13.9 Average, age-adjusted unintentional drug overdose death rate per 100,000, by county, Ohio residents, 2007-2012 1,2 Community-based Project DAWN site Treatment or Hospital- based PD site Potential/ Developing

17.  Education components include: 1. Overdose prevention techniques 2. Recognizing signs and symptoms of overdose 3. Calling 911 4. Airway and breathing assessment/Rescue breathing/Recovery position 5. Naloxone storage, carrying, and administration in an emergency situation 6. Reporting of overdose and refill procedures 7. Post-overdose follow-up care  Program emphasizes the importance of talking with family members. Ohio law permits teaching overdose response techniques including the administration of Naloxone to Naloxone recipients and others who might be in a position to administer it.

18. * Kit with 2 doses of 1 mg/1 mL naloxone hydrochloride in pre‐filled needleless syringes, nasal adaptors, breathing masks, instructions, referrals to local substance abuse/dependence treatment/label * Must use 300 MAD adaptor for intranasal use * Total cost=approx. $72.00

19.  Total Cost of Project DAWN Kit = $72.00  Medical Cost of a Fatal Drug Overdose: $ 2,980  Naloxone can prevent complications that result in costly drug overdose-related hospital stays. In 2008, the average in-patient treatment charge for a drug overdose was $10,488.

22. Atomizer

23. * Individual at risk * Family Members * Friends * Group (Follow HIPAA Guidelines)

24. * Naloxone can now be prescribed to a friend, family member or other individual who is in a position to provide assistance to an individual who there is reason to believe is at risk of experiencing an opioid- related overdose.

25. Individuals The Bill grants immunity from criminal prosecution for the unauthorized practice of medicine and certain drug offenses to a family member, friend, or other individual who is in a position to assist an individual who is apparently experiencing or at risk of experiencing an opioid-related overdose if all of the following apply: 1. The individual acts in good faith 2. Obtains naloxone or prescription for naloxone from a licensed health professional 3. The individual summons emergency services either immediately before or after administering the naloxone to the individual who is apparently experiencing an opioid-related overdose

26. If you are not a Law Enforcement Agency, you must have a current Unlimited Category II or III Terminal Distributer of Dangerous Drugs issued by the Ohio Board of Pharmacy to purchase Naloxone and keep it onsite at your facility.

27. Store at room temperature (between 68 and 77 degrees Fahrenheit Keep out of bright light Do not leave in car for long periods of time Do not expose to extreme heat or cold

28. All doses should be checked periodically to ensure that the naloxone is not adulterated. A dose of naloxone is considered adulterated when: a) It is beyond the manufacturer’s or distributor’s expiration date; and/or b) There are signs of discoloration or particulate matter in the naloxone solution !Do not use the dose if it adulterated!

29. In order to keep track of expiration dates, clinics and law enforcement agencies should keep careful records of when and to whom the medication was dispensed.

30. The person who is overdosing exhibits the following symptoms: Blue skin tinge (usually lips and fingertips show first) Body very limp Face very pale Pulse (heartbeat) is slow, erratic, or not there at all Throwing up Passing out Choking sounds or gurgling/snoring sounds Breathing is very slow, irregular, or has stopped Awake, but not able to respond

31. Step 1: Assess the signs to confirm person is experiencing an overdose Unresponsive No signs of breathing or breathing is shallow Snoring or gurgling noises Fingernails and/or lips blue or ashen depending on skin color

32. * Step 2: Stimulate the person * Call out to the victim * Do a sternal rub * Rub knuckles hard up and down the breast bone

33. * Step 3: Activate EMS * Simply say, “I have someone who is not breathing and is unresponsive” * If you feel comfortable, inform of overdose

34. * Place person on their back * Lift the chin to open their airway * Remove any objects from mouth that could block the airway * Pinch the nose and give two strong breaths, enough to see the chest rise

36. Step 6: Monitor and support If the victim has not become responsive and begun breathing on their own: Continue to provide rescue breathing After two minutes with no response, administer second dose of naloxone If still unresponsive, continue to provide rescue breathing until EMS arrives

37. The recovery position: If the person must be left alone-even for a few minutes-put him/her into the recovery position to avoid choking Place person on their side Top leg bent at the knee, bottom leg straight out Bottom arm extended straight above head, top arm bent at the elbow with hand under face as if it were a pillow

39. Naloxone only lasts between 30-90 minutes, but opioids may last much longer Important that victim is monitored by medical professionals as an individual can fall back into an overdose as the naloxone wears off Similarly, important that victim does not use again after awakening from overdose Withdrawal symptoms from naloxone will subside after 30-90 min

40. Assess Stimulate Activate EMS Rescue breathing Administer naloxone Monitor and support May include additional dose of naloxone May include continued rescue breathing Recovery position

42. * Use the program registration or refill form provided * Have each training participant print their name on the registration/refill form * Assign a Client ID # and fill in the site number * Make sure participant completes the entire form * Provide assistance with the form as needed * Complete the prescription label for the kit * Each kit MUST have a prescription label * Individuals MUST complete the training in order to receive a kit

43. * Keep registration and refill forms on file according to agency HIPAA protocol * Enter data into electronic version of form and submit to ODH by the 5 th of each month * Submit tracking data to Morrow County Health Department by the 5 th of each month

44. * The Medical Director will determine how many refills will be available to each participant through Project DAWN * Individuals are encouraged to request a refill and report when they have used a kit * Use the same Client ID # for registration and refills

45. * Paper Forms * Electronic Forms

47. * Find all program materials at the Morrow County Health Department website: www.morrowcountyhealth.org

48. Kay Benick, RN, BSN Project Manager Morrow County Health Department (419) 947-1545, ext. 318 kay.benick@morrowcountyhealth.org

49. www.healthy.ohio.gov/vipp/drug/ProjectDAWN