1. What is an overdose?
An overdose occurs when a person has taken more of a drug or combination of
drugs than their body can handle. The difference between a dose that gets you
high and a dose that can be dangerous or lethal can sometimes be quite small.
Heroin and other opiates like, Fentanyl, Methadone, and Oxycontin, slow your
system down. A person overdosing on opiates will usually experience extremely
heavy nodding that can lead to coma, slowed or stopped breathing and
eventually heart failure. Basically, your whole system “shuts down” and “goes to
sleep.”
Stimulant overdose from drugs like cocaine, crack and meth can cause heart
attack, 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 911
Overdose risk is, unfortunately, a fact of drug use. There are certain things that
can raise your risk of an overdose and knowing what they are can help you make
safe choices around your drug using behaviors.

2. 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 some
effective 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 benzos
can be the most hazardous in combination with dope. Booze and pills as well as crack, coke and speed can all affect your
judgment 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 you
inject. OR push only ½ of the shot and wait one minute before slowly pushing the rest. This may seem weird at first and
may be difficult to do if you are sick, injecting in a public place or otherwise rushed, BUT if you can do it, you will have
greater 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 you
bought 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 them
when to stop.
Be careful when using in a new city because dope differs from place to place. Try to cop with someone who knows the
connection.
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 and
this can be dangerous.
Be careful when sick or recovering from an illness because your tolerance will be lowered and if you’ve lost weight
you 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 can
help.
Have an OD Plan so that your crew or injecting partners know if/when you want 911 called, if you take medications or
have health conditions, if you want your ID removed from your wallet, if you have warrants or legal issues, if you want to
go to the hospital and which one and who you want contacted.

3. Mixing Drugs:
Mixing opioids like Methadone, Percocet, Vicodin, and Oxycontin with
other drugs, especially depressants such as benzodiazepines (like Xanax,
or Clonopin) or alcohol can lead to an overdose. These combined drugs
are “synergistic”, which means that the effect of taking mixed drugs is
greater than the effect one would expect if taking the drugs separately.
Special note: Cocaine is a stimulant but in high doses it can also
depress the urge to breath, so it too can be particularly risky when
combined with opiates. Your best option if you just can’t help but to use
different drugs in one night would be for you to allow the effects of one
drug to wear off before taking another. Remember that mixing drugs is
one of the top reasons that people O.D.

4. Decreased Tolerance:
Regular use of opioids leads to greater tolerance, i.e. more is
needed to achieve the same effect (same high). Overdoses
occur when people start using again following a period of not
using (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 her
off but most users don’t take this into consideration. They
want to do the same old, same old but the problem is that
what once got them high may now just get them dead.
THINK POSITIVE: If it takes less dope to give you the same
result it will save you cash, product, and your life if you let it.

5. BEWARE OF YOUR DRUG’S QUALITY:
Strength varies from batch to batch, from dealer to dealer, from city
to city. The plain truth is that when copping on the street you never
really know what you’re going to get.
Street drugs may vary in strength and effect based on the
purity of the heroin (or other opioid) and the amount of other
ingredients used to cut the drug. Users should use small
amounts of new batches or inject slowly enough to get a feel
of the quality/strength of the drug(s).

6. USE CAUTION WHEN YOU’RE SICK:
When your body is already weak it has a decreased ability
to cope with intoxication.
If users have a serious illness including HIV/AIDS, liver
disease, Diabetes, heart disease or just have bad cold or fever
they are at greater risk for an overdose. Care should be taken
when using to check the strength of the drug, avoid mixing
drugs or using alone.

7. AVOID USING ALONE:
Using Alone increases your risk for an overdose to be fatal
because there is no one present to initiate rescue measures.
Using with people you know and trust assures you that
someone will be there to help and/ or call 911 if you do OD.

8. RECOGNIZING AN OVERDOSE:
1) UNCONSIOUSNESS- Lacking awareness and the capacity for sensory
perception; not conscious.
2) BLUE SKIN, especially their lips- this is due to a lack of blood
circulation caused by a lack of oxygen to the body
3) Not breathing or shallow or irregular breathing- this is caused by
opiates effects on the respiratory system
4) Slow, quiet or no pulse at all- once again this is caused by a lack of oxygen to
the body
5) Choking, snoring, or gurgling sounds
6) Lying in their own vomit

9. LETS TALK ABOUT PREVENTION MYTHS:
There are many myths associated with overdose prevention
and recovery. It is important that some of these myths are
discussed because most, if not all, of them can waste time
and/or make problems worse. It is far too much of a risk to
loss precious time and ability when helping an overdose
victim. In fact many of these myth’s inaccuracy may shock
you due to how commonly they are heard on the street.

10. SOME COMMON PREVENTION MYTHS:
Myth 1- Walking people around will help- This only wastes time and you risk
having the person fall and/or hurting themselves
Myth 2- Putting people in cold baths or ice water wakes them up- A
cold shower or bath will only lower the victim's body temperature or cause him/her to drown.
Myth 3 - Hurting, hitting or burning can bring them out of an
overdose- Slapping, kicking or burning the victim will not wake him/her. It will only cause him/her
more physical harm. Stimulating a person is fine beating and burning them is not.
Myth 4 – Injecting cocaine will wake them right up. – Remember that mixing
drugs 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 arose
from people witnessing hospitals injecting a saline solution into overdose patients. The only thing that
saline solutions do is open veins up so I.V. medications can be received threw the blood steam more
quickly.
WHAT SHOULD REALLY BE DONE…FIRST: CALL 911

11. 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 not
want to call 911 but you must understand that paramedics are there to help not to make
arrests. When emergency personnel are called having police arrive is a risk but they usually
only come to protect other emergency personnel. If this is still a worry for you there are things
you can do to both limit the risk of police showing up and being caught up in an arrest. First
stay calm on the phone with 911 dispatch. Don’t give them a reason to believe that anything
threatening is going on. Stay calm and let them know that your friend is unconscious and not
breathing. You are not required to say anything more. If you absolutely must leave it is of the
utmost importance that you tell dispatch exactly were the victim is and place them in the
recovery position (show illustration). Always know where you are before getting high and
make sure that you leave as many lights on as possible to increase visibility and tell dispatch
that it is an opiate overdose. If you do stay and this is best, when the paramedics arrive you
can tell them then that it is an opiate driven overdose. This will prompt them to inject
Naloxone, 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 it
just move the substances and syringes from plain sight. Clearing the area helps paramedics to
get to work faster.

12. TRY TO STIMULATE THE VICTIM BY:
SHOUTING THEIR NAME
PINCHING THEIR EARLOBES
AND/OR
RUBBING YOUR KNUCKLES IN THE CENTER OF THEIR CHEST
AGGRESIVELY
This is called a sternum rub and it is a very good technique to awaken someone
from 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’s
chest, 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 and
requires immediate attention. So if you have not called emergency services
(911) yet now is the time to do so.

13. PERFORMING
RESCUE
BREATHING
OTHER THAN CALLING 911 THIS IS THE MOST IMPORTANT
ACTION THAT YOU CAN TAKE IN SAVING THE LIFE OF AN
OVER DOSE VICTIM.

14. Before performing rescue breathing...
1) Open his/her mouth to clear their airway
2) Sweep a finger inside their mouth to remove anything
you see from gum to vomit (wearing a glove is ideal).
3) Once the mouth is cleared place your head next to their
nose 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

15. If they are breathing slowly or not at all
BEGIN RESCUE BREATHING
Use the head-tilt chin lift method to open
the airway as illustrated

16. FOLLOW THESE STEPS TO RESCUE
BREATHING:
1) Put one hand under the neck and lift up
2) Place fingers of the other hand on forehead and tilt the
head back
3) Tilt the head back without closing the mouth
4) Place the barrier over the mouth
5) Pinch the nose
6) Take a deep breath
7) Cover the mouth with yours

17. 8) Establish a tight seal (mouth to mouth)
STEPS TO RESCUE BREATHING CONTINUED…
9) Give two slow breaths
10) Blow enough air in the mouth to make sure that the
chest rises. If the chest does not rise, gently tilt the head
further back and try again
11) Count to 4 between breaths (one-one thousand, two-
one thousand, three- one thousand, four-one thousand)
12) Breath again

18. CONTINUE RESCUE
BREATHING UNTIL:
• THE PERSON STARTS BREATHING ON THEIR
OWN
• AN AMBULANCE ARIVES
• SOMEONE CAN TAKE OVER

19. IF ALL GOES WELL
YOU JUST SAVED

20. SOMEONES LIFE
A GOOD WAY TO REMEMBER ALL OF THIS IS TO
REMEMBER THE WORD S.C.A.R.
S- STIMULATE VICTIM
C-CALL 911
A- AIRWAY CHECK

21. R-RESCUE BREATHING

23. AT THIS TIME
PLEASE ADMINISTER C.O.P.E. QUIZ
PLEASE DISPENCE OF PREVENTION KITS TO EACH CLIENT WHO SCORES
80% OR HIGHER.