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1 Copyright Notice This presentation is copyrighted by the Psychopharmacology Institute. Subscribers can download it and use it for professional use. The contents of the presentation may be modified, but the Psychopharmacology Institute logo must remain visible in all slides.

2 Naloxone for Overdose Prevention
Joji Suzuki, MD Director, Division of Addiction Psychiatry Department of Psychiatry, Brigham and Women’s Hospital Assistant Professor of Psychiatry, Harvard Medical School

3 Overview General strategies for minimizing overdoses
How to identify high-risk patients How to use naltrexone General strategies for minimizing overdoses

4 Strategies for reducing overdoses
Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

5 Strategies for reducing overdoses
Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

6 Strategies for reducing overdoses
Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

7 Strategies for reducing overdoses
Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

8 Strategies for reducing overdoses
Increase access to medication treatment Naloxone rescue kits In some countries: drug consumption facilities Prescriber training

9 Naloxone rescue kit Delivered by laypeople Very effective in reversing overdoses rapidly If individual is not experiencing an overdose: Harmless No side effects

10 Naloxone rescue kit Delivered by laypeople Very effective in reversing overdoses rapidly If individual is not experiencing an overdose: Harmless No side effects

11 Naloxone kits Requires assembly Each vial: 2 mg

12 Naloxone kits Requires assembly Each vial: 2 mg No assembly required
Recommended: effective for fentanyl OD

13 Naloxone kits Requires assembly Each vial: 2 mg No assembly required
Recommended: effective for fentanyl OD

14 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

15 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

16 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

17 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

18 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Multidrug OD events: patient may not have this Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

19 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

20 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

21 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

22 Rescue breathing if needed
Identify overdose Stupor (unresponsive to verbal or external stimulation) Constricted pupils Respiratory depression Call 911 Rescue breathing if needed Administer Narcan Spray into nostril Repeat if no response in 3 -5 minutes Recover position Stay with victim Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

25 High-risk patients Criteria Naloxone Rx Naloxone training
Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

26 High-risk patients Criteria Naloxone Rx Naloxone training
Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

27 High-risk patients Criteria Naloxone Rx Naloxone training
Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

28 High-risk patients Criteria Naloxone Rx Naloxone training
Opioid use disorder Overdose history Opioids for chronic pain at doses greater than 50mg morphine equivalent On both opioids and benzodiazepines Identify family or friends to be trained Some pharmacies have “standing orders” Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY: Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016

29 Key points Naloxone Very effective Can be delivered by a layperson
Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

30 Key points Naloxone Very effective Can be delivered by a layperson
Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

31 Key points Naloxone Very effective Can be delivered by a layperson
Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines

32 Key points Naloxone Very effective Can be delivered by a layperson
Harmless New version: 4mg: higher dose Recommended version (fentanyl OD) Opioid overdose Stupor Constricted pupils Respiratory depression High risk patients OUD History of overdose Opioids for pain: doses greater than morphine 50 mg equivalent Opioids+ benzodiazepines