Healthy Streets Outreach Programa program of Northeast Behavioral Health

280 Union StreetLynn, ma

781-592-0243

First things first…slang Jammed, jambox, jam sandwich: really high

Falling out: overdosing

Fell out: overdosed

Dope: heroin

Narcon or Narcain: Narcan pronounced incorrectly

Beaned out: on a lot of benzos

Opioid OD Stats:Two people die from opioid overdoses every day in

Massachusetts.

More people are killed by opioid overdoses in Massachusetts

than by car accidents.

In 2007, there were over 6 times more deaths due to opioid-

related overdoses than in 1990.

For every death due to an opioid overdose in 2007, there

were 47 people who were treated for an overdose and lived. *Sources:  “Opioids: Trends and Current Status in Massachusetts,” Massachusetts Department of Public HealthBureau of

Health Information, Statistics, Research, and Evaluation and the Bureau of Substance Abuse Services, 2009 DAWN data “Massachusetts Oxycontin Commission: Final Report” 2009

MDPH Pilot Details: Standing order authorizes Approved Opioid Overdose Trainers to

possess nasal naloxone and to distribute it to Approved Opioid

Overdose Responders.

Trainers and Responders are authorized to administer naloxone

to person experiencing a drug overdose.

Approved by MDPH Drug Control Program and the Commissioner

of DPH, overseen by medical director Dr. Alexander Walley.

DPH General Counsel’s Office determined the legality of the pilot

programs. Once efficacy of the pilots has been established, Public

Health Council will be asked to pass regulation to make the

program permanent.

Expanded AccessCurrently providing OD

prevention in additional venues:

DetoxMethadone clinicsSuboxone programsHomeless sheltersOther HIV P&E

programs Parent support groupsCorrections

Opportunity for Family InterventionMajority of ODs occur in the presence of others

ODs can be reversed by rescue breathing and/or Narcan

(Naloxone) administration

Many younger drug users are still living at home or are still

allowed to visit the home.

Treatment options can be discussed at the hospital with

family present in the case of an overdose.

Realistic and useful education for families.

Narcan Training Components20-minute session (or longer)

Enrollment form (used for data collection, risk

assessment, risk reduction)

Review of overdose risks, prevention, response,

calling 911, rescue breathing, refill procedure

Participant repeats information back,

demonstrates ability to assemble Narcan

What is an Opioid Overdose?

The brain has many, many receptors for opioids. Too much opioid fitting in too many receptors slow and stop the breathing.

Opioid fits exactly in receptor

Opioid receptor on brain

Narcan reversing an OD

Narcan has a stronger affinity to the opioid receptors than the heroin, so it knocks the heroin off the receptors for a short time and lets the person breathe again.

Opioid receptor

Narcan

Heroin

Opioid ODs, continued

ODs are rarely instantaneous!

ODs happen as a process- someone slowly stops

breathing

They usually happen 1-3 hours after the drug was used

Someone “found dead with a needle in their arm” is a rare

event that is sensationalized

What are the Signs/Symptoms of an OD?

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 a gurgling/snoring

noise

Breathing is very slow, irregular, or has

stopped

Awake, but unable to respond

REALLY HIGH OVERDOSE

Muscles become relaxed

Deep snoring or gurgling (death rattle)

Speech is slowed/slurred

Very infrequent or no breathing

Sleepy looking Pale, clammy skin

Nodding Heavy nod, not responsive to stimulation

Will respond to stimulation like yelling, sternal rub, pinching, etc.

Slow heart beat/pulse

Slow heart beat/pulse

What puts people at risk for ODs?

Mixing Drugs

Variation in strength and content of ‘street’ drugs (purity)

Tolerance changes (coming out of jail/TX)

Using alone

Physical Health (liver functioning, weight loss, etc.)

Transient living – new dealers/new product

Thinking you “know everything”

Switching from sniffing/eating to injection.

How can you avoid an opioid overdose?Know your tolerance

Know your supply

Control Your Own High

Be Aware of the Risks of Mixing Drugs

Try not to use alone

Make a plan

Talk with other users

Stop Using

Prevention Messages for FamiliesI want to remind you that (BECAUSE OF) your

tolerance is very low, you are at high risk for an

overdose.

Do you have an overdose plan? Do you and your

friends know about Narcan?

I love you but not what you do and I do not want

anything to happen to you.

If you relapse please do not do it alone.

A few words about benzos: They are long acting (at least a day, usually)

They impair your short-term memory. So you can actually forget how

many benzos or how much heroin you have used in the last 24 hours-

this could put someone in danger for an OD!!

Very common and easy to find on the street

Cheaper than heroin

They are frequently necessary for mental health reasons- there is a

high comorbidity between substance abuse disorders and mental

illness like anxiety, depression, and post-traumatic stress disorder

Make people who are in withdrawal feel better

People use benzos to get jammed- enhances the effects of heroin (or

methadone, etc)

Drugs could be cut or enhanced with benzos without the user knowing

Responding to an Overdose“Are you alright? You ok?”

No response try a STERNUM RUB

Call 9-1-1

Give the person AIR using rescue breathing

Give 2 or 3 breaths and set-up the Narcan

Spray the Narcan

Continue rescue breathing

Spray second dose if necessary

Continue rescue breathing

If an OD happens…Recovery Position

Overdose Prevention Using Nasal Narcan

Simple device, medication and nasal spray

Narcan is a pure opiate antagonist

No physiological effect other than blocking opiates

No adverse reactions

No potential for abuse or potential for OD

Narcan Kit components

What are barriers to calling 911 from the perspective of a substance user?

Fear of legal risk (outstanding warrants, DSS

involvement, loss of public housing)

Fear of judgment from family/ community

Personal embarrassment/shame

Other punitive measures (students loose federal

financial aid)

Manslaughter charges if someone dies on the scene

What about families?Are there fears about calling 9-1-1 among

families?

How will YOU handle this discussion if it

comes up without judging the person in front

of you?

Street Methods now have safer alternatives Don’t leave the person alone--they could stop breathing

Don’t put them in a bath--they could drown

Don’t induce vomiting--they could choke

Don’t give them something to drink--they could throw up

Don’t put ice down their pants- it’ll make their pants wet! Cooling down the core

body temperature of someone who is ODing is dangerous because it will slow down

their body function even more than just the OD.

Don’t try to stimulate them in a way that could cause harm- slapping too hard,

kicking in the testicles, burning the bottom of the feet, etc. can cause long-term

damage

Don’t inject them with anything (saltwater, cocaine, milk)--it won’t work any more

than physical stimulation and can waste time or make things worse depending on

what you inject; a salt injection, for instance, could cause someone to go into

cardiac arrest if they already have high sodium levels in their system. Also, every

injection brings a risk of bacterial infection, abscesses, endocarditis, cellulitis, etc.

Does Speedballing balance you out?“Speedballing” refers to any combination of a stimulant

(upper) and a depressant (downer) taken together, esp.

a mixture of heroin and cocaine or heroin and

methamphetamine injected into the bloodstream.

No- speedballing does not cancel out OD risk

The more different drugs someone’s body has to

process, the harder it is on their body

People who speedball usually use much more frequently

that people who use only heroin- this increases OD risk

Will using Narcan help someone give a clean urine?No

Narcan knocks opiates off the opiate

receptors, but the drug is still floating around

in the body (AND urine!)

Can you use Suboxone to reverse an OD?Not a good idea, probably not enough Naloxone in a Suboxone

to reverse and overdose, will not act fast enough

Suboxone is a drug that contains both Buprenorphine (a partial

agonist) and Naloxone (antagonists, same thing as Narcan)

Suboxone is supposed to be taken sublingually, and if taken

this way, the Naloxone has no effect

If crushed and snorted, or injected, the Naloxone is “activated”

and acts as an antagonist

EnrollmentsBLUE or BLACK Pen

Non-users do not get asked any questions below the lot number.

Must fill in all information

If you do not have an answer use X’s or a zero

Use leading zeroes

If someone is not sure they are enrolled please fill out another

enrollment

DO NOT FORGET THE BSAS CODE

All codes are on the back of the enrollment

RefillsNever give a kit without doing the refill form.

Only answer all the questions if they are

reporting an overdose.

ALWAYS write comments, especially if it is a

reversal.

I used the Narcan.Trauma associated with witnessing an OD

may not manifest immediately.

Be open to hearing the details but never ask

for the details.

Positively reinforce all actions performed by

the responder.

Refill Narcan

Mary WheelerProgram Director – Healthy Streets Outreach

Program a program of Northeast Behavioral Health

781-592-0243mwheeler@nebhealth.org