5/24/20131Mathew Wong, RN BScNStreetworks, Edmonton, ABAlberta Harm Reduction Conference 2013StatsOur ProgramOverdose PreventionAround theWorld911 Good SamaritanActsNaloxone Kit Distribution andODTrainingIncreasingAvailability of NaloxoneOverview
5/24/20132• Globally, in 2012, there were between 99,000 and 253,000 deathsattributed to illicit drugs (UNODC, 2012)• At its highest, that is 693 lives lost each day in the world• Drug overdose is the second leading cause of accidental death aftermotor vehicle collisions in the United States, with over 38,000 in 2010• That is over 100 people dying each from accidental drug overdose (CDC, 2010)• Fragmented reporting systems in Alberta report at least one drugoverdose death each day back in 2004 (Office of Chief Medical ExaminerAlberta Justice, 2009)• Canada just recently surpassed the US to be number one in per capitalconsumption of opioids (International Narcotics Control Board, 2012)• To put some perspective on that, number 3, Norway, has a 40 percent lower usagerate than usStatsThis is a tragedy.Began in 2005 (Dong et al, 2005)First of its kind in all ofCanadaModeled after the first NaloxoneDistributionprogram in the US (ChicagoRecoveryAllianceOne physician prescribing exclusively to opiateusersTraining is completed by a Registered Nursewho cosigns the prescriptionOur Program
5/24/20133To date:• 206Trainees• 22Overdose reversals• an approximately 10% reversal rateInvolves and empowers communitymembersto become active participants in the healthcare of themselves and their communityTwo Parts to OverdoseTraining• Overdose PreventionTips• Life Saving MeasuresOur Program (Continued)Overdose happens when a person takes more of a drugor combination of drugs than the body can handle. Asa consequence, the central nervous system (CNS) isnot able to control basic life functions.Overdose
5/24/20134Preventing Overdose:Never use alone!If someone is there, that someone canhelp call 911 and give Naloxone.Preventing Overdose:Know your source!Know your dealer and buy from the samesource, that way you know how safe and howpure the stuff you are getting.
5/24/20135Preventing Overdose:Don’t mix!It’s much, much easier to overdose ifyou’re mixing drugs, especially alcohol.Preventing Overdose:Do a tester (Use Slowly)!The strength of the drug can differ.Start small so you don’t use too much.
5/24/20136Preventing Overdose:Use less after a break!After a short break from using (like being injail, hospital or detox), your tolerance can goway down. Even as little as three days.Preventing Overdose:Eat/Snort/Smoke!Injecting is the most dangerous as itgoes straight into your system andcan’t be taken out.
5/24/20137Preventing Overdose:Stay Healthy!Not sleeping, not eating well, nottaking care of yourself – all of it makesit easier to OD.Preventing Overdose:Get trained!Know your stuff!Prevent overdoses, spread theknowledge, and save lives.
5/24/20138LSD(acid)MescalinePCPCannabisEcstasySalviaKetamineCan lead to high bloodpressure, seizures, highheart rate, high bodytemperature.Psychosis, kidneydamageRealistically thegreatest harm would berisk of self harm oraccidentsOverdose – HallucinogensCocaineCrackSpeedMethEcstasyAnxiety, Psychosis,Vomiting, Sweating,Foaming at mouth,Chest pain, Elevatedbody tempOverheatingStrokeHeart attackSeizuresOverdose – Ups (Stimulants)
5/24/20139• Call 911• Reduce stimuli:turn of sounds andlights, crowd control• Talk calmly and stay with the personuntil help arrives• If the person is overheating, use fans,ice packs, cool sips of water,If the personis conscious• Call 911• StartCPR if certified• If not place person in recovery positionIf the personisunconsciousWhat to do in Stimulant/HallucinogenOD?Cops show up(Possession,paraphernalia,warrants)Distrust of theHealthcare SystemPreviousexperience ofperson waking upConfidence inmythical streetantidotesFear of associationin ODWhy not call 911?
5/24/201310HeroinMethadoneMorphineOxycodoneFentanylDilaudidPercocetTylenol 3, 4Feelings of Euphoria andanalgesia, Gradualdecrease in the urge tobreathe andresponsiveness toincreasing levels of carbondioxideOxygen Starvationeventually stops the vitalorgans – the heart thenbrainOverdose – Down (Depressants)
5/24/2013110.4 mg/ml single use vialsCan be given by intramuscular injection orintranasal sprayDoes not replace emergency medicalassistanceOnly works for OpioidOverdoseLast 30-90 minutesIn Canada, approx. $13/vialNaloxone (Narcan®)
5/24/201312What to do in Opiate OD?S – timulation Can you wake them up? If not, call9-1-1!A – irway Make sure there’s nothing in theirmouth that stops them frombreathingV – entilate Breathe for them! (one breatheevery 5 seconds)E – valuate Are they any better? Are youtrained to give naloxone?M – uscularinjectionInject 1cc ofnaloxone into a muscle.E – valuateandsupportIs the person breathing on theirown? If they’re not awake in 5min,another 1cc dose is needed.Tell the person not to use any moredrugs right now – wait at least acouple of hours.911 GoodSamaritanActsProvidelimitedimmunityfrom criminalcode whencalling tosavesomeone’slifeNaloxoneKits andODTrainingTake HomeNaloxoneProgramsOverdosePreventionEducationIncreasingAvailabilityofNaloxoneOver thecounterNaloxoneBystanderscarryingNaloxoneIntranasalSprayIncreasingAwarenessInternationalOverdoseAwarenessDay – August31Around theWorld
5/24/201313911 Good Samaritan Acts“No one should go to jail for calling 911 tosave someone’s life”Law in place to provide limited immunityfrom the criminal code when calling 911to save someone fromODNew Mexico was first state in 200711 other states (WA, NY, CT, IL, CO, RI,FL, MA, CA, NC and NJ) plus 2 (AK, MD)as of May 2013911 Good Samaritan ActsNovember 2012 – Gov.Christieof New JerseyVetoesGoodSamaritan Law• Said he was afraid they would let drugdealers off the hook, “How about ifthey’re not a Good Samaritan?”May 2013 – Gov.Christie signsthe OD prevention bill into law• Said he was moved by the letters ofgrieving parents who had lost childrento OD, including Jon Bon Jovi whosedaughter survived a heroinOD
5/24/201314Naloxone Kits and ODTrainingCanada – BC, Ontario (Toronto), andEdmonton• Toronto’s program which began in 2011 has 580trained and 68 reversals as of Feb 2013• BC’s pilot project has distributed 350 kits and hashad 8 reversals as of Dec 2012USA – 188 community based take homeNaloxone Programs• 50,000Trained• 10,000 Overdose ReversalsGermany, UK,Australia, Russia, Estonia,Afghanistan,Cambodia and numerousother countriesNaloxone Kits and ODTrainingEffective in Saving Lives(Walley et al, 2013)• 2912 trained and 327 in Massachusetts• Significantly reduced rate ofoverdoses• Significantly reduced rate of overdosedeathsCost Effective(Phillip, Coffin & Sean, 2013)• Saves costs to health care• Study did not account for reduceddrug use and healthier habits broughton from the training
5/24/201315IncreasingAvailability of NaloxoneIncreasingAvailability of NaloxoneOver the CounterNaloxone – ItalySpecialized ODAmbulances – MoscowDoctors co-prescribingNaloxoneTrain Professionals – lawenforcement (NM, NY –51 lives saved), EMTsTrain BystandersMassachusetts – has 2900TrainedIntranasal Spray
5/24/201316IncreasingAwarenessThe Purple ribbon is anInternational symbol of OverdoseAwareness• The silver badge is the symbol forOverdoseAwareness day onAugust 31Streetworks Overdose PreventionNewsletter• Add your email to the mailing list!Spread the word!“Out beyond ideas of wrongdoing and rightdoing,there is a field. I’ll meet you there.”--Rumi
5/24/201317• Anex. (2010). Lifesavers: a position paper on access to naloxone hydrochloride for potential opiate overdose witnesses. Apex: MelbourneAustralia.• Anex (2011). http://www.anex.org.au/what-we-do/current-interests/access-to-naloxone/• CDC. (2010). Death and Mortaility. Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/nchs/fastats/deaths.htm• Dong K., Taylor M., Wild CT., Rose M., Salvalaggio G., Rowe BH. (2012). Community based Naloxone: a Canadian pilot program. CanadianJournal of Addiction Medicine, 3(2):4-9.• Hardeman S. (2011). How to save a life: overdose prevention and Naloxone training. Streetworks Alberta Harm Reduction Conference.Edmonton, AB.• LawAtlas. (2013). Public Health Law Research. Retrieved on May 6, 2013 from: http://lawatlas.org/• Marteau, D., Wishart, S., Strang, J., Bird, S., and Parmar, M. (21 February 2011). Prison-based Naloxone-on-release pilot randomised controlledprevention trial.• Office of the Chief Medical Examiner Alberta Justice. (2009). Unclassified Manner of Death. Retrieved from:http://justice.alberta.ca/programs_services/fatality/ocme/Publications_OCME/AnnualReviewOCME2009.aspx/DispForm.aspx?ID=38• Phillip O., Coffin MD., Sean DS. (2013). Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversals. Annals of InternalMedicine1, 58(1):1-9. doi:10.7326.• The Network for Public Health. (2013). Legal interventions to reduce overdose mortality: Naloxone access and overdose good Sa maritan laws.Retrieved from: http://www.networkforphl.org/_asset/qz5pvn/naloxone-_FINAL.pdf• Towards the Heart. (2012). http://towardtheheart.com/• UNODC. (2012). International Narcotics Control Board. The United Nations Office on Drugs and Crime. Retrieved from http://www.incb.org/• Walley AY., Xuan X., Hackman HH., Quinn E., Doe-Simkins M., Sorensen-Alawad A., Ruiz S., Ozonoff A. (2013). Opioid overdose rates andimplementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. British MedicalJournal, 346. doi: 10.1136.References