What is an overdose?An overdose occurs when a person has taken more of a drug or combination ofdrugs than their body can handle. The difference between a dose that gets youhigh and a dose that can be dangerous or lethal can sometimes be quite small.Heroin and other opiates like, Fentanyl, Methadone, and Oxycontin, slow yoursystem down. A person overdosing on opiates will usually experience extremelyheavy nodding that can lead to coma, slowed or stopped breathing andeventually heart failure. Basically, your whole system “shuts down” and “goes tosleep.”Stimulant overdose from drugs like cocaine, crack and meth can cause heartattack, seizures and stroke and tend to “look” quite different from opiate OD.This training is designed to work on opiate driven overdoses.If someone you are with overdoses on stimulants CALL 911Overdose risk is, unfortunately, a fact of drug use. There are certain things thatcan raise your risk of an overdose and knowing what they are can help you makesafe choices around your drug using behaviors.
Things you can do to prevent overdosing:The tools offered in this training can help keep someone alive in the event of an overdose. Here are someeffective ways to lower your risk of an overdose. Avoid mixing drugs. Try to be aware of what drugs you’ve taken and are taking at the same time. Alcohol and benzoscan be the most hazardous in combination with dope. Booze and pills as well as crack, coke and speed can all affect yourjudgment and may lead to mistakes in dosing.Test the dope. Let your tie off after registering and push the shot in slowly so that you can “taste” or feel the dope as youinject. OR push only ½ of the shot and wait one minute before slowly pushing the rest. This may seem weird at first andmay be difficult to do if you are sick, injecting in a public place or otherwise rushed, BUT if you can do it, you will havegreater control of your high.Do test shots. Push a shot that is smaller than usual, such as 10 units, to feel it out. This can be especially useful if youbought your dope from a new source, you think it may be cut with Fentanyl, or are coming back from a break in your use.Remember: You can always do more. Prepare your own drugs so you know how strong it is.Learn to hit yourself so you can control your high. If someone else hits for you let him or her know to let the tie off after registering and to inject slowly while you tell themwhen to stop. Be careful when using in a new city because dope differs from place to place. Try to cop with someone who knows theconnection.Be careful when switching from tar to powder heroin because strengths vary between the two forms. When mixing with crack, coke or speed try to stay cool and drink plenty of water—your body temperature can rise andthis can be dangerous. Be careful when sick or recovering from an illness because your tolerance will be lowered and if you’ve lost weightyou should adjust your dose accordingly. Avoid using alone or use in a place where people can get to you in case of OD. If no-one is around then no-one canhelp. Have an OD Plan so that your crew or injecting partners know if/when you want 911 called, if you take medications orhave health conditions, if you want your ID removed from your wallet, if you have warrants or legal issues, if you want togo to the hospital and which one and who you want contacted.
Mixing Drugs:Mixing opioids like Methadone, Percocet, Vicodin, and Oxycontin withother drugs, especially depressants such as benzodiazepines (like Xanax,or Clonopin) or alcohol can lead to an overdose. These combined drugsare “synergistic”, which means that the effect of taking mixed drugs isgreater than the effect one would expect if taking the drugs separately.Special note: Cocaine is a stimulant but in high doses it can alsodepress the urge to breath, so it too can be particularly risky whencombined with opiates. Your best option if you just can’t help but to usedifferent drugs in one night would be for you to allow the effects of onedrug to wear off before taking another. Remember that mixing drugs isone of the top reasons that people O.D.
Decreased Tolerance:Regular use of opioids leads to greater tolerance, i.e. more isneeded to achieve the same effect (same high). Overdosesoccur when people start using again following a period of notusing (abstinence) such as incarceration, detox or “drug free”drug treatment. When someone has not used dope in awhile,for whatever reason, it will take less down to get him or heroff but most users don’t take this into consideration. Theywant to do the same old, same old but the problem is thatwhat once got them high may now just get them dead.THINK POSITIVE: If it takes less dope to give you the sameresult it will save you cash, product, and your life if you let it.
BEWARE OF YOUR DRUG’S QUALITY:Strength varies from batch to batch, from dealer to dealer, from cityto city. The plain truth is that when copping on the street you neverreally know what you’re going to get.Street drugs may vary in strength and effect based on thepurity of the heroin (or other opioid) and the amount of otheringredients used to cut the drug. Users should use smallamounts of new batches or inject slowly enough to get a feelof the quality/strength of the drug(s).
USE CAUTION WHEN YOU’RE SICK:When your body is already weak it has a decreased abilityto cope with intoxication.If users have a serious illness including HIV/AIDS, liverdisease, Diabetes, heart disease or just have bad cold or feverthey are at greater risk for an overdose. Care should be takenwhen using to check the strength of the drug, avoid mixingdrugs or using alone.
AVOID USING ALONE:Using Alone increases your risk for an overdose to be fatalbecause there is no one present to initiate rescue measures.Using with people you know and trust assures you thatsomeone will be there to help and/ or call 911 if you do OD.
RECOGNIZING AN OVERDOSE:1) UNCONSIOUSNESS- Lacking awareness and the capacity for sensoryperception; not conscious.2) BLUE SKIN, especially their lips- this is due to a lack of bloodcirculation caused by a lack of oxygen to the body3) Not breathing or shallow or irregular breathing- this is caused byopiates effects on the respiratory system4) Slow, quiet or no pulse at all- once again this is caused by a lack of oxygen tothe body5) Choking, snoring, or gurgling sounds6) Lying in their own vomit
LETS TALK ABOUT PREVENTION MYTHS:There are many myths associated with overdose preventionand recovery. It is important that some of these myths arediscussed because most, if not all, of them can waste timeand/or make problems worse. It is far too much of a risk toloss precious time and ability when helping an overdosevictim. In fact many of these myth’s inaccuracy may shockyou due to how commonly they are heard on the street.
SOME COMMON PREVENTION MYTHS:Myth 1- Walking people around will help- This only wastes time and you riskhaving the person fall and/or hurting themselvesMyth 2- Putting people in cold baths or ice water wakes them up- Acold shower or bath will only lower the victims body temperature or cause him/her to drown.Myth 3 - Hurting, hitting or burning can bring them out of anoverdose- Slapping, kicking or burning the victim will not wake him/her. It will only cause him/hermore physical harm. Stimulating a person is fine beating and burning them is not.Myth 4 – Injecting cocaine will wake them right up. – Remember that mixingdrugs is one of the leading causes of overdose situations. This could put their body into shock.Myth 5- Injecting people with salt water is an antidote- this myth most likely arosefrom people witnessing hospitals injecting a saline solution into overdose patients. The only thing thatsaline solutions do is open veins up so I.V. medications can be received threw the blood steam morequickly.WHAT SHOULD REALLY BE DONE…FIRST: CALL 911
Calling 911 is the most important thing that you can do along with rescue breathing,which we will discuss in a minute. It is understandable why many illegal drug users would notwant to call 911 but you must understand that paramedics are there to help not to makearrests. When emergency personnel are called having police arrive is a risk but they usuallyonly come to protect other emergency personnel. If this is still a worry for you there are thingsyou can do to both limit the risk of police showing up and being caught up in an arrest. Firststay calm on the phone with 911 dispatch. Don’t give them a reason to believe that anythingthreatening is going on. Stay calm and let them know that your friend is unconscious and notbreathing. You are not required to say anything more. If you absolutely must leave it is of theutmost importance that you tell dispatch exactly were the victim is and place them in therecovery position (show illustration). Always know where you are before getting high andmake sure that you leave as many lights on as possible to increase visibility and tell dispatchthat it is an opiate overdose. If you do stay and this is best, when the paramedics arrive youcan tell them then that it is an opiate driven overdose. This will prompt them to injectNaloxone, a life saving medication that takes people out of an overdose. After you call 911 you should take some time to clear out any drugs or needles from sight.This will both help protect you and emergency personnel but don’t take a lot of time doing itjust move the substances and syringes from plain sight. Clearing the area helps paramedics toget to work faster.
TRY TO STIMULATE THE VICTIM BY: SHOUTING THEIR NAME PINCHING THEIR EARLOBES AND/OR RUBBING YOUR KNUCKLES IN THE CENTER OF THEIR CHEST AGGRESIVELYThis is called a sternum rub and it is a very good technique to awaken someonefrom a heavy nod. To do a sternum rub, make a fist and then rub the sternum(also known as the breastbone) with your knuckles in center of the person’schest, and apply pressure while rubbing. If the person does not respond after 15-30 seconds of doing a sternum rub, it is likely that the person is overdosing andrequires immediate attention. So if you have not called emergency services(911) yet now is the time to do so.
PERFORMING RESCUE BREATHINGOTHER THAN CALLING 911 THIS IS THE MOST IMPORTANTACTION THAT YOU CAN TAKE IN SAVING THE LIFE OF ANOVER DOSE VICTIM.
Before performing rescue breathing...1) Open his/her mouth to clear their airway2) Sweep a finger inside their mouth to remove anythingyou see from gum to vomit (wearing a glove is ideal).3) Once the mouth is cleared place your head next to theirnose and mouth.4) LISTEN for breathing, snoring, gurgling or wheezing.5) LOOK at the chest to see if it is rising or falling.6) FEEL for the victim’s breath on your face
If they are breathing slowly or not at all BEGIN RESCUE BREATHINGUse the head-tilt chin lift method to openthe airway as illustrated
FOLLOW THESE STEPS TO RESCUEBREATHING:1) Put one hand under the neck and lift up2) Place fingers of the other hand on forehead and tilt thehead back3) Tilt the head back without closing the mouth4) Place the barrier over the mouth5) Pinch the nose6) Take a deep breath7) Cover the mouth with yours
8) Establish a tight seal (mouth to mouth)STEPS TO RESCUE BREATHING CONTINUED…9) Give two slow breaths10) Blow enough air in the mouth to make sure that thechest rises. If the chest does not rise, gently tilt the headfurther back and try again11) Count to 4 between breaths (one-one thousand, two-one thousand, three- one thousand, four-one thousand)12) Breath again
CONTINUE RESCUE BREATHING UNTIL:• THE PERSON STARTS BREATHING ON THEIR OWN• AN AMBULANCE ARIVES• SOMEONE CAN TAKE OVER