Saves Lives A R D T F Oklahoma

Saves Lives A R D T F Oklahoma

Saves Lives A R D T F Oklahoma First Responder Naloxone Initiative Collaborators City of Tulsa

Tulsa Police Department Tulsa County Sheriff's Office Tulsa Fire Department Oklahoma Department of Mental Health & Substance Abuse Services

Oklahoma State Department of Health Oklahoma Department of Public Safety EMSA Oklahoma First Responder Naloxone Initiative Learning Objectives

Obtain baseline understanding of the opiate overdose problem Understand how opioids work Identify an opioid overdose Learn how to respond to an opioid overdose

Learn how to administer naloxone, an opiate antidote Become familiar with OK statute 63-1-2506 Background Drug overdose is now the leading cause of injury death in the United States.1 Opioid analgesics, such as prescription painkillers, account for about 80 percent of

those deaths.1 Overdose rates have increased five-fold since 1990.1 Oklahoma Oklahoma ranks 8th highest in drug overdose deaths nationally. 2 Oklahoma

Four out of five of unintentional poisoning deaths involved at least one prescription drug. Of those deaths, nearly 90% were related to prescription painkillers. 3 In 2014, Oklahoma ranked in the top five for per capita distribution of many common opioids, such as: hydrocodone (Lortab, Vicodin), morphine, fentanyl, and meperidine (Demerol).4 More overdose deaths involved hydrocodone or oxycodone than all illegal drugs and alcohol combined. 3

Adults aged 35-54 had the highest death rate of any age group for both prescription and non-prescription-related overdoses.3 Unintentional Poisoning Death Rates by County of Residence1, 2007-2013 1 County of residence was unknown for 39 persons. Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports) The Solution A multi-faceted approach

to overdose prevention is required. PPRREEVVEENNTTIIO ONN & & EEDDUUCCAT ATIIO ONN M MO ONNIITTO ORRIINNGG & & DDIIVVEERRSSIIO ONN CCO ONNTTRRO OLL

A comprehensive array of efforts are underway in Oklahoma, including: IINNTTEERRVVEENNTTIIO ONN & & TTRREEAT ATM MEENNTT The Solution Effective November 2013, Oklahoma Statute 63-1-2506.1 Administration of opiate antagonists allows: First responders shall have the authority to administer, without prescription, opiate antagonists when encountering an individual exhibiting signs of an opiate overdose.

The Solution For users who attempt to achieve abstinence from drugs, the average time from first treatment to last use is 9 years with multiple episodes of care (3 to 4).5 Naloxone is a drug used to reverse the effects of opioids. Naloxone is safe and effective.

Naloxone has no effect on non-opioid overdoses. The Solution Widespread support for Naloxone programs: The White House, Office of National Drug Control Centers for Disease Control and Prevention Federal Drug Administration Substance Abuse and Mental Health Services

Administration Recommendation D: Equip Health Care Providers and First Responders to Recognize and Manage Overdoses CBS News: Nose spray Narcan reverses overdoses in Mass. town at high rate In the United States6: Over 640 naloxone programs Over 150,000 people trained Over 25,000 overdose reversals (lives saved) Opioids are used primarily in medicine for pain relief, treatment of opioid use disorders, and cough relief.

T F Opiates A R D Opioids Natural Semi-synthetic Fully synthetic

opium morphine codeine heroin hydrocodone oxycodone fentanyl methadone Demerol All categories have overdose risk How do opioids affect breathing? OVERDOSE Opioid Receptors, brain

Opioid Naloxone A R D Naloxone knocks the opioid off the opiate receptor Only blocks opioid receptors; no opioids = no effect

Not harmful if no opioids in system T F Temporarily takes away the high, giving the person the chance to breathe Naloxone works in 1 to 3 minutes and lasts 30 to 90 minutes Naloxone can neither be abused nor cause overdose

Only known contraindication is sensitivity, which is very rare Too much naloxone can cause withdrawal symptoms such nausea/vomiting muscle discomfort as: diarrhea disorientation chills combativeness

How does Narcan affect overdose? Restores breathing Narcan = naloxone Little street value because they cause withdrawal symptoms Street value because they can relieve withdrawal symptoms Reverses opioid overdose Short and fast-acting opioid blocker Vivitrol = naltrexone Treatment for opioid and alcohol addiction

Long-acting opioid blocker Suboxone = buprenorphine + naloxone Treatment for opioid addiction The naloxone is added to discourage injecting or sniffing Subutex = buprenorphine only Treatment for opioid addiction in pregnant women REALLY HIGH Identify an Opioid Overdose OVERDOSE Pupils pinned

Pupils pinned Nodding, but arousable (responds to sternal rub) Not arousable (no response to sternal rub) Speech is slurred Very infrequent or no breathing Sleepy, intoxicated, but breathing 8 or more times per minute

Breathing slow or stopped Less than 8 times per minute May hear choking sounds or gurgling/snoring noises Blue lips, blue fingertips Stimulate and observe Rescue breathe + give naloxone 1. Recognize overdose symptoms + Environmental Clues

A R D T F 2. Recognize drug paraphernalia + 3. Recognize the drug = Recognize need for naloxone Look for symptoms, but if uncertain - land on the side of naloxone Remember Scene Safety

Oncoming traffic Unstable surfaces Leaking gasoline Downed electrical lines Potential for violence Fire or smoke

Hazardous materials Other dangers at crash or rescue scenes Crime scenes Needles Assume all body fluids present a possible risk for infection>> wear gloves Respond to Opioid Overdose A R D T F

1. Stimulate 2. Alert EMS 3. Administer naloxone 4. CPR Rescue breathing/ventilations 5. Repeat 3 & 4, if necessary 6. Recovery position, if breathing Respond: Stimulate & Alert EMS A R D 1. Stimulate victim with a sternal rub T

F 2. If no response, delirious, or altered consciousness, call for EMS support Respond: Administer Naloxone A R D 3. If no response from stimulation, give naloxone T F

Kit contents: Two (2) individual pre-filled syringes of Naloxone One (1) mucosal atomizer (nose pieces/spray device) Prefilled ampule of naloxone Mucosal Atomization Device (MAD) A

R D T F Luer-lock syringe 1. Remove yellow caps from delivery device How to Give Nasal Spray 2. Remove purple cap from medication vial 3. Thread atomizer on to the top of the delivery device

How to Give Nasal Spray 4. Gently screw the medication vial into the delivery device until you feel it catch. 5. Spray half (1 ml) up one nostril and half up the other nostril. How to Give Nasal Spray Respond: Rescue Breathing A R

D 4. Give rescue breaths7, if you have proper safety equipment and training T F Place 1 hand on the chin and tilt head back to open airway Make sure the airway is clear and remove anything in their mouth

Pinch the nose closed Give 2 slow rescue breaths into the mouth Use a rescue breathing mask if available Use a bag valve mask if you are trained Respond: Rescue Breathing

A R D 4. Give rescue breaths7, if you have proper safety equipment and training T F Make sure the chest (not the stomach) is rising with the breaths Give 1 breath every 5 seconds until the person

can breath on their own If no pulse, start CPR Respond: Repeat 3 & 4 if Necessary A R D T F 5. After 3-5 minutes, if the victim is still

unresponsive with slow or no breathing, administer another dose of naloxone and continue rescue breathing. Respond: Recovery Position 6. Recovery position, when breathing is restored Review: Respond to Opioid Overdose A

R D T F 1. Stimulate 2. Alert EMS 3. Administer naloxone 4. CPR Rescue breathing/ventilations 5. Repeat 3 & 4, if necessary 6. Recovery position, if breathing Respond to Opioid Overdose: Naloxone Administration

Intranasal delivery route has advantages: Uncomplicated and convenient Nose is an easy access point for medication delivery It is painless No shots needed It eliminates any risk of a needle stick Naloxone Deployment & Supply: Initial supply = 2 units per kit Inventory & re-supply actions should be outlined in protocol Use it/Lose it = request re-supply Personnel turnover = manage equipment accordingly

Store naloxone per manufacturer guidelines Used naloxone dispensing devices can be utilized for training purposes Simply follow these steps: Respond to Opioid Overdose: Naloxone Administration 1. Screw atomizer on to the top of the delivery device. 2. Screw medication vial into delivery device. 3. Push the medication vial all the way into the delivery device. 4. Insert the tip of the atomizer into a cup of water and draw up 2 mls of liquid into the device (until

the bottom of the gray stopper is at the 0 ml mark). 5. Gently pull back on the medication vial until the bottom of the gray stopper inside the vial is at the 0 ml mark. 6. Replace purple stopper on medication vial. 7. Remove atomizer and replace both yellow caps. 8. The device is now ready to be used for training purposes. Legal Considerations: Oklahoma Naloxone Law Okla. Stat. tit. 63, 1-2506.1 Administration of opiate antagonists effective November 1, 2013. A. First responders shall have the authority to administer, without prescription, opiate antagonists when encountering an individual

exhibiting signs of an opiate overdose. For the purposes of this provision, a first responder shall include: 1. Law enforcement officials; 2. Emergency medical technicians; 3. Firefighters; and 4. Medical personnel at secondary schools and institutions of higher education. B. Any first responder administering an opiate antagonist in a manner consistent with addressing opiate overdose shall be covered under the Good Samaritan Act. Legal Considerations: Oklahoma Naloxone Law Okla. Stat. tit. 63, 1-2506.2 Prescription of opiate antagonists to family members A. Upon request, a provider may prescribe an opiate antagonist to

an individual for use by that individual when encountering a family member exhibiting signs of an opiate overdose. B. When an opiate antagonist is prescribed in accordance with subsection A of this section, the provider shall provide: 1. Information on how to spot symptoms of an overdose; 2. Instruction in basic resuscitation techniques; 3. Instruction on proper naloxone administration; and 4. The importance of calling 911 for help. C. Any family member administering an opiate antagonist in a manner consistent with addressing opiate overdose shall be covered under the Good Samaritan Act. Documentation: Used every time you train others

Naloxone Training Form Sign-in sheet Pre/post training evaluation used to report knowledge and perception of project Accessible through TakeAsPrescribed.org website or equipment officer Documentation: Naloxone Administration Reporting Form

Used to report overdose events Check boxes used to describe overdose events No identifying information on victim is reported Needs to be completed right away Accessible through TakeAsPrescribed.org website or equipment officer

Review Learning Objectives: Obtain baseline understanding of the opiate overdose problem Understand how opioids work Identify an opioid overdose

Learn how to respond to an opioid overdose Learn how to administer naloxone, an opiate antidote Become familiar with OK statute 63-1-2506 For Campaign Information: Oklahoma Department of Mental Health and Substance Abuse Services Odmhsas.org 405.522.3908

Visit TakeasPrescribed.org Acknowledgements Austin Box 12 Foundation City of Tulsa Dr. Clayton Morris, MD, Project Medical Director Dr. Timothy Hill, MD Dr. William Yarborough, MD Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma Department of Public Safety Oklahoma Poison Control Center Oklahoma State Department of Health DuPage County Department of Public Health Tulsa Health Department, Regional Prevention

Coordinator EMSA Tulsa County Sheriffs Office Massachusetts Department of Public Health Tulsa Fire Department Maya Doe-Simkins, MPH Tulsa Police Department Oklahoma Board of Pharmacy References 1. Centers for Disease Control and Prevention. Wide-ranging OnLine Data for Epidemiologic Research (WONDER) [online]. (2012) Available from

URL: http://wonder.cdc.gov/mortsql.html. Massachusetts Department of Public Health 2. Centers for Disease Control and Prevention, National Center for Health Statistics. Mortality File 1999-2013 on CDC WONDER Online Database, released October 2014. Data are from the Compressed Mortality File, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/cmf-icd10.html (accessed November 2015). 3. Oklahoma State Department of Health, Injury Prevention Service. Unintentional Poisoning Fatality Surveillance System (abstracted from medical examiner reports). 4. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, Automation of Reports and Consolidated Orders System (ARCOS) Reports, Retail Drug Summary Reports by State, Cumulative Distribution Reports (Report 4). 5. Dennis, M., Scott, C., Funk, R., & Foss, M. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, 51-62. 6. Centers for Disease Control and Prevention. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons United States, 2014, Morbidity and Mortality Weekly Report. June 19, 2015 / 64(23);631-635 7. Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heath Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S414-S435. The Oklahoma Department of Mental Health and Substance Abuse Services wishes to acknowledge the DuPage County Department of Public Health and the Massachusetts Department of Public Health for permitting use of training content.

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