1. MBEMSC /PIER Committee
Nasal Naloxone
MBEMSC /PIER Committee

2. Nasal Naloxone/Introduction
Purpose:
Early intervention can help reduce fatalities
The First Responder Narcan Program is designed to educate first responders in recognizing signs and symptoms of opiate overdose

3. OBJECTIVES
At the conclusion of this training participants will be able to:
Recognize signs and symptoms of opiate overdose
Initiate appropriate treatments and interventions
Assemble the nasal narcan delivery device
Successfully administer appropriate dosing of Nasal Narcan

4. Background
Annually XXXX # of patients suffer from opiate overdoses in Massachusetts
XXX # result in death
Timely administration of Narcan has proven to reduce the # of opiate related deaths

5. Since officers started carrying Narcan in October 2010, 163 doses have been administered, resulting in 157 overdose reversals. In the 18 months before October 2010, there were 46 overdose related deaths. In the 18 months after the implementation of the Narcan program there were 22 overdose related deaths. Read more: PAUL KEENAN: The Quincy Narcan model is saving – and changing – lives - Quincy, MA - The Patriot Ledger Under Creative Commons License: Attribution Non-Commercial Follow on Twitter | patriotledger on Facebook

6. Naloxone

7. Naloxone Hydrochloride
Generic Name :
Naloxone Hydrochloride

8. Brand Name : Narcan®

9. Endo Pharmaceuticals brought Narcan® to the market in the 1960's
Narcan® is currently available generically under the name Naloxone

10. Naloxone is.. An opiate antagonist which reverses opiate overdoses
Some commonly abused opiates are:
Heroin
Oxycontin
Percocet
Vicodin
Methadone
Morphine

11. Narcan®/Naloxone has been used in emergency rooms and EMS for more than forty years as an antidote for opiate overdoses.

12. Pharmacology
Opiates produce their effects as an agonist on the mu receptors in the central nervous system
Mu¹ receptors are responsible for a large portion of analgesic (pain management) effects
Mu² receptors are responsible for respiratory distress

13. Naloxone kicks opiates out of the brain by blocking certain receptor sites.
Naloxone occupies the receptor sites and prevents opiates from binding to the brain.
Naloxone in conjunction with rescue breathing has life saving potential.

14. An opiate overdose is..
When opiates settle in the part of the brain that regulates breathing.
The immediate concern during an opiate overdose respiratory depression.

15. BE PREPARED FOR THE PATIENT TO RELAPSE
The effects of Naloxone wears off between minutes after administration
Heroin lasts 6-8 hours
Methadone lasts 24 hours
Opiates outlast Naloxone
BE PREPARED FOR THE PATIENT TO RELAPSE

16. When am I supposed to give Narcan©??????

17. Signs and symptoms of Opiate Overdose

18. Signs and Symptoms Weak/Thready pulse Slow or Absent Respirations
In addition to a known history of opiate abuse, responders should look for:
Weak/Thready pulse
Slow or Absent Respirations
Constricted Pupils
Weakness/Unresponsiveness

19. Administration
First Responder administration of Narcan© will be Intra-Nasally.
A preloaded syringe will be affixed with a mucosal atomization device (MAD)

20. Administration Pre loaded syringes contain 2mg in 2ml.
Per statewide treatment protocols for EMTs and Paramedics the dose for Naloxone in mg and may be repeated if necessary

21. Storage of Narcan©

22. Common Misconceptions
Administering Naloxone does not require extreme force

23. Schedule
Naloxone is not in the DEA schedule of drug classes, yet requires a prescription
Naloxone has no potential for abuse

24. Naloxone has no other purpose besides reversing an opiate related overdose.
Naloxone has no mind altering effects

25. Naloxone is the only treatment in medicine that literally cannot hurt anyone.
The only possible effect is the individual may become dope sick (withdrawal).
Naloxone is specific, safe, and effective

26. Epidemiology
People coming out of jail or treatment have highest risk of overdose.
Most deaths are among opiate users who are in their late twenties to early thirties and have been actively using for the past five to ten years.
Only 17 % of opiate related deaths are among new users.

27. Programs that work with drug users are educating them in the use of Naloxone.
The Chicago Recovery Alliance has been providing Naloxone in Cook County, IL since 2001
From the 2011 Annual report Chicago Recovery Alliance reports 2,972 peer reversals using Naloxone since the programs inception.

29. If interested in knowing more about overdose..
Mass DPH-Bureau of Substance Abuse Services

30. Nobody needs to die from an opiate overdose
Bottom Line
Nobody needs to die from an opiate overdose

31. Questions??????