1. Sexual Health and Infectious Disease
COPE – BRANT
Community Overdose
Prevention
and
Education
Shawna Wilson
Public Health Nurse
Sexual Health and Infectious Disease
History of Naloxone Program
Prevention and response techniques for a non-professional population are important.
Research has shown that people who use drugs or those around them are willing to learn the appropriate first responder treatment when witnessing and overdose.
Currently, there are hundreds of Naloxone Distribution Programs around the world.
Internationally
1995 – England & Germany became the first countries to distribute Naloxone to opioid users
1999 – The United States began Naloxone distribution program and now have over 180 programs throughout the U.S.
Canada
2005 – Edmonton initiated the first Canadian program via Street Outreach program
2011 – Ontario – Toronto Public Health was the first Health Unit in Canada to operate a Naloxone program
2012 – Ottawa Public Health began Naloxone Overdose Prevention Program

2. “In less than 3 minutes he came back to life”
After entering the brain, the drug binds to the body’s opioid receptors with an attraction so strong that it can remain locked in place for hours. Some of these receptors switch on the brain’s reward circuits – they generate feelings of pleasure, some are involved in pain transmission – heroin causes the receptors to dampen down pain signals entering the brain from the spinal cord. There are also opioid receptors on neurons that control breathing. Take too much heroin, and these neurons will dangerously slow down respiration. Starved of oxygen, the lips and fingers turn blue, the person falls unconscious and stops breathing. Death can occur within minutes. Naloxone reverses the process, by shoving the opiate out of the way and binding to the receptor itself. This sends the user into immediate withdrawal.

3. What is Naloxone (Narcan)?
Naloxone is a safe antidote to opioid overdose
Naloxone takes 1-5 minutes to work
Naloxone displaces or “kicks out” the opioids from the receptors, then blocks those receptors and the effects of the opiate for approximately minutes
Why is it used?
Opioid overdose is the leading cause of accidental death
Opioids are a family of pain management drugs with a high potential for addiction and subsequent misuse

5. Naloxone Kits Contents of Naloxone Kit:
2 – ampules of 1cc (.4mg) Naloxone Hydrochloride
2 -1cc 25g 1 inch,1-3cc 25g safety engineered syringes
Alcohol swabs
Naloxone identifier card
Non-latex gloves
Naloxone Step by Step instructions
Mouth barrier

6. Drug Categories
Depressant Drugs: slow down the brain and nervous system activity Stimulant Drugs: will speed up the communication between the brain and the nervous system Hallucinogens: Interferes with the brain and results in hallucinations

7. Drug Categories …continued
Depressants
Stimulants
Hallucinogens
Opioids:
Buprenorphine, Codeine, Demerol, Fentanyl, Heroin, Hydrocodone (Vicodin), Hydromorphone (Dilaudid), Oxycodone (Oxycontin, OxyNEO, Percodan, Percocet) Pentazocine
*Benzodiazepines:
Ativan, Halcion, Restoril, Rohypnol, Serax, Valium, Xanax
*Barbituates:
Amytal, Nembutal, Seconal
*Zopiclone
*Alcohol
*GHB
Cocaine
Crack Cocaine
Amphetamine (speed, crystal meth)
Methylphenidate (Ritalin)
Khat
LSD
Magic Mushrooms
PCP
MDMA
DMT
GHB

8. Drug Categories…continued
*Naloxone only reverses the effects of opioids such as heroin, methadone, morphine, opium, codeine, or hydrocodone.
It does not counter the effect of other types of drugs, such as benzodiazepines (as above), antihistamines, alcohol, or other sedatives (drugs such as phenobarbital) or stimulants such as cocaine and amphetamines.
But if the person is not breathing it will not hurt to administer naloxone. If there is an opioid involved they will likely start breathing again–though they will still be sedated from the other drugs.
Many overdoses happen due to mixing opioids with other drugs, which is common practice.   
In the worst case scenario, naloxone will simply do nothing,
but in the best case scenario it will save a life.

9. What is an overdose?
An Overdose can occur when a person has used too much of one drug or multiple drugs and the body is not able to withstand the substance and/or the amount used.
Overdose causes a depression of the respiratory system that can lead to death.
Over dose can occur suddenly or over several hours
Overdose can happen to anyone, there is no exact formula to determine the amount or combination of drugs that could lead to an overdose.

10. Who is at risk? Those who may be at risk for an overdose include;
Individuals with a reduced tolerance to the drug: for example those just released from jail, treatment facilities or hospital
Those who may be using a supply of drugs that has changed from the norm; for example buying from a new dealer
Individuals who rely on someone else to inject them with a drug
Those who use drugs alone
It’s a no-brainer - get these kits in to the people most likely to be on the scene, which is other users.

11. How would I recognize an overdose?
Seizures
Sweating
Difficulty breathing/chest tightness
Foaming at mouth, Vomiting
Sudden collapse, unconsciousness
Racing pulse
Headache, dizziness, ringing in ear
STIMULANTS
STIMULANTS
HALLUCINOGENS
Psychosis
Seizures
Nausea, Vomiting
Catatonic Syndrome (Trance-Like)
OPIODS
Breathing is slow/absent
Deep snoring or gurgling
Finger nails look blue or purple
Unresponsive to stimuli
Vomiting
Loss of consciousness

12. Responding to an opioid overdose
STIMULATION
CALL 911
GIVE NALOXONE
CHEST COMPRESSIONS
CHECK
REASSESS

13. 1. Stimulation Try to wake the person Shout their name,
shake their shoulders

14. 2. Call 911 When speaking with the 911 dispatcher:
Remain quiet, speak calmly and quietly.
Tell them the victim is unresponsive
Tell them the address, if you can, have someone wait outside
Never leave the victim alone
When help arrives, tell them as much as you know about the situation
Tell them that NALOXONE was given

15. Give Naloxone How to administer Naloxone:
Look at the Naloxone vial, if there is liquid in the top of the vial gently tap with your finger until the liquid drops below the neck of the vial
Break open the Naloxone vial (you may use an alcohol swab to protect your fingers)
Insert a new syringe into the ampule and slowly draw up ALL of the Naloxone into the syringe
Inject ALL of the Naloxone into the upper arm muscle or thigh muscle at a 90 degree angle
If you cannot remove the clothing, the needle is long enough to go through light clothing.

16. 4. Start Chest Compressions
Make sure to lay the person on a hard
flat surface
Find the middle of the person’s chest
Hands one on top of the other, elbows locked, push down hard and fast with heels of hands
Push at least 2 inches with each compression
Continue until EMS arrives
If you are able to switch with another person, change every few minutes in order to rest between

17. 5. Check… is it working? Wake up suddenly Wake up slowly Be confused
Naloxone should work in 3-5 minutes
When Naloxone starts working the person may:
Wake up suddenly
Wake up slowly
Be confused
Be angry and agitated and combative
Want to use more drugs
WARNING!
Naloxone may cause MILD to SEVERE withdrawal symptoms that could include; nausea, vomiting, sweating, muscle aches, anxiety and agitation.

18. 6. Reassess If the person has not started breathing on their own in
3-5 minutes, give a SECOND dose of NALOXONE
Continue chest compressions until EMS arrives
If the person wakes, explain to them that they have overdosed and should NOT use more drugs as this will increase their chance of having another overdose when the Naloxone wears off.
WATCH for signs of the OVERDOSE returning
Place the person in the recovery position which allows the mouth and nose to drain, keeps tongue from blocking the airway.

19. What not to do! Do not leave the person alone
Do not leave the person alone
 They could stop breathing
Do not put them in a bath or shower
 They could drown
Do not inject them with anything besides NALOXONE
 It could seriously harm them and it will not help them
Do not slap, kick, punch or burn the person or use ice.
 It will not wake them up and it could harm them
Do not try to give them a drink
 They could vomit and choke
Do not try to induce vomiting
 They could choke

20. FOLLOW UP! After an overdose…
It can be a traumatic event for everyone involved in an overdose.
Talk with the people around you who support you, like family or a friend, a health professional that you may have connected with, share your experience.
Ensure that everyone in your life knows that you carry a Naloxone kit
Seek support
Please contact us at the Brant County Health Unit and we will provide you with new supplies and a refill of Naloxone

21. Naloxone Kit Care Store Naloxone in a cool dark place
Check the expiry date on the ampoules of Naloxone, if it has expired or is near to the expiry; take it back for a refill.
Check your kit supplies regularly

22. Adapted with permission from materials produced by City of Hamilton Health Services Department September 2015

23. Naloxone nasal spray – Jan 2017