The Central Nervous System (CNS) The CNS sends and receives messages from the brain through the spinal cord to perform a range of functions. The CNS Maintains consciousness, memory and emotion Sends messages from the body to the brain so that we can hear, see, smell, taste and touch Sends messages from the brain to the body so that we can breath, move and maintain balance. Drugs can affect the messages of the CNS in three main ways, causing one or more of the following effects: depressant effect, stimulant effect and/or hallucinogen effect.
depressants (Depressants) depressants cause breathing and heartbeat to slow down. Desired depressant effects Relaxation, a sense of calm and drowsiness Pain relief Lowering of inhibition Examples of depressants Opioid drugs (heroin, morphine, pethidine, codeine) Alcohol Benzodiazepines or ‘benzos’ (diazepam/valium) Cannabis (grass, weed, dope) Inhalants (aerosols, cleaning agents, solvents and gases) depressants can make simple tasks take longer than usual to do. Reflexes become slower and energy levels may decrease. You can feel cold and un-coordinated.
Depressant overdos e : might lead to unconsciousness or trouble breathing. An unconscious person might breathe in vomit or other fluids, leading to blocked breathing or lung damage. Stimulant overdose : The drug places great stress on the heart and blood vessels, leading to heart attack, seizures or stroke. stimulants can lead to increased physical energy and activity, putting a person at risk of overheating and dehydration. Toxic overdose : organ damage or failure (heart, lungs, kidneys etc) from taking an excessive amount of a drug.
After-effects of Non-Fatal Overdoses: After an overdose a person can be left with serious, sometimes permanent, health problems. Overdose can--- Cause brain damage due to lack of oxygen as a result of seizure, stroke or heart attack; Lead to lung damage or pneumonia resulting from vomit/ fluid entering the lungs during a period of unconsciousness; Result in muscle damage due to a long period of unconsciousness. This happens if a limb is trapped under the body, reducing its blood supply. Serious complications include paralysis, limb amputation or kidney failure; Lead to serious injuries such as: broken bones due to falls, burns from exposure to heaters or cigarettes, or physical assaults.
Locally and across Ontario, 2007 data points to accidental overdoses as the 3rd leading cause of unintentional death, after motor vehicle collisions(2) and falls(3). The death toll includes victims who were taking medications as prescribed, and those who were using illicitly, exceeding deaths from H1N1 and HIV combined. Similarly, a 2009 Ontario study in the Canadian Medical Association Journal linked the 850% rise in oxycodone prescribing with a quintupling in oxycodone-related fatalities. Among the highlights: • 66.4% had visited a physician in the month before death; • 56.1% had filled a prescription for an opioid in the month before death.
Mixing Drugs: The majority of overdoses involve the use of a combination of drugs. People may combine drugs without realizing it, different drugs take different amounts of time to leave the body. New drugs can combine with drugs that may have been used hours earlier. Drugs may still be in the body long after a person can’t feel their effects. Some examples of Problems with Mixing Drugs : Some drugs, like benzo’s, can make you forgetful. You might forget that you have taken them or forget how much you took. Sleeping actually slows the drug down as it leaves the body. Just because a person can’t feel the effects anymore doesn’t mean the drug is not still working. Alcohol and stimulants both cause dehydration. If an stimulant wears off before the alcohol does, the person may suddenly become very drunk. When a person first starts methadone maintenance treatment the risk of overdose is very high if other depressants are used as well. This is because the person is still developing a tolerance to the methadone. Once stabilized on methadone the risk of overdose decreases. Alcohol can cause nausea and vomiting. The effects of a depressant can affect the ‘gag and cough’ reflexes - the reflexes that stop fluid, vomit, saliva and other things from entering the airway and lungs.
Prescription drugs are designed to work in certain fashion. The route of the drug is important. On oral medication takes into consideration stomach acid and gut absorption rates. Special coatings to protect from stomach acid and slow release formulation so there is a gradual release and absorption of drug. Oral medication are not designed for injection and vice versa. Dangers in crushing and injecting/snorting or using rectal or vaginal and rectal (hooping) routes can cause irritation and bleeding and increases risk of HIV transmission. Rapid absorption of a drug that should be absorbed slowly. Introduction of material that could lead to tissue and cell and vien damage and could act like a foreign body/clot and lead to stroke or heart attack.
Reduced Tolerance: Tolerance to a drug can go up or down many times in a person’s drug using history. Tolerance can take some time to develop - weeks or months - but will reduce far more quickly. As little as three or four days without certain drugs can be long enough to lower tolerance to the point where there is a higher risk of overdose. The risk of overdose is greatly increased when individuals do not take into account that their tolerance may be lower than usual. Changes in how strong or pure a drug is could lead to a person to use more of a substance than they can tolerate by accident. Changes in availability of a drug and/or disruptions to the drug market could lead to a person to use more of a substance than they can tolerate by accident
Using alone Others might not be able or willing to call an ambulance (afraid of the police showing up) to help, or might simply not know what to do.
Being an experienced, long-term user It is not just new users who overdose - in fact experienced or older users are at greater risk. Long-term users are more likely to mix drugs; Cycles of abstinence and return to drug use result in more frequent periods of reduced tolerance; The law of averages - the more a person uses the greater the likelihood of overdose; A belief that ‘It won’t happen to me’. If a person has used drugs over several years and not suffered an overdose, they could become over confident and take more risks.
If someone is extremely high, and they are using depressants, they may: have contracted/small pupils; have slack and droopy muscles; be “nodding out”; scratch a lot due to itchy skin; have slurred speech and/or be “out of it” (but they will respond to outside stimulus like loud noise or a push). However, if a person is experiencing an overdose , the following is a list of symptoms to watch for:
There are distinct differences between an overdose and when someone is just really high. It is important to be able to recognize the signs and symptoms of overdose for various drugs so that you will be able to help. The following is a general overview of some of the symptoms apparent in an overdose. Changes in drug composition can alter the symptoms of an overdose.
Danger of fire from candles, cigarettes etc. Electrical hazards
Show short video Narcan about 8 minutes ??
Introduction to overdose prevention wgdsc harm reduction forum 2013 (2)
INTRODUCTION TO OPIOID OVERDOSE PREVENTIONPRESENTATION TO WGDSC HARM REDUCTION FORUM MARCH 2013 Presentation property of Preventing Overdose Waterloo Wellington
WHAT WE WILL COVER• What is an opioid overdose?• Who is at risk for an opioid overdose?• How to recognize an opioid overdose• Myths and Facts about overdose• How to respond to an opioid overdose
WHAT IS AN OPIOID OVERDOSE?• The Central Nervous System and the effects of psychoactive drugs• Depressants• Overdose Defined• Types of Overdose
The Central Nervous SystemConsciousness,Memory, and Emotion. Three main effects: Breath,Movement, and 1.depressant, Balance. 2.stimulant Hearing Sight, 3.hallucinogen Smell, Taste, and Touch
DepressantsDepressants cause the central nervous system to slow down - breathing and heartbeat are affected.Desired depressant effects Relaxation, a sense of calm and drowsiness Pain relief Lowering of inhibitionExamples of depressants Opioid drugs (heroin, morphine, pethidine, codeine, methadone, dilaudid, fentanyl, hydromorphone) Alcohol Benzodiazepines or ‘benzos’ (diazepam/valium) Cannabis (grass, weed, dope) Inhalants (aerosols, cleaning agents, solvents and gases)
Uppers (Stimulants) Stimulants cause breathing and heartbeat to speed up.Desired upper effects: Increased energy and alertness Increased confidence Ability to stay awake over long periods of timeExamples of uppers• Amphetamine (speed) and methamphetamine (ice),• Cocaine,• Ecstasy (MDMA),• Nicotine ( tobacco)• Caffeine (tea, coffee, cola drinks)
Hallucinogens (psychedelics) These drugs distort what people hear, think and see.Desired hallucinogenic effectsAn altered sense of the world, time, the body, other people, thoughts, and emotionsExamples of hallucinogens‘Magic’ mushroomsLSD (‘acid’, ‘trips’)Ketamine (‘Special K’)Cannabis (grass, weed, dope)
Overdose DefinedOverdose is the use of a drug (or drugs) in an amount or way that causes acute harmful mental or physical effects. Overdose may produce short-lived or lasting effects, and can sometimes be fatal.
TYPES OF OVERDOSE Depressant overdose: slows the central nervous system down to the point where several systems may stop working. Stimulant overdose: speeds the central nervous system up to the point of overworking certain functions leading to failure. Toxic overdose: organ damage or failure (heart, lungs, kidneys etc.) from taking an excessive amount of a drug.For today, we will be focusing on opioid overdoses, which fall into the depressant category
After-effects of Non-Fatal Overdoses: After an overdose a person can be left with serious, sometimes permanent, health problems as a result of the overdose itself brain damage due to lack of oxygen as a result of seizure, stroke or heart attack lung damage or pneumonia resulting from vomit/ fluid entering the lungs during a period of unconsciousness muscle damage due to a long period of unconsciousness especially if a limb is trapped under the body reducing its blood supply. Serious complications can include paralysis, limb amputation or kidney failure, broken bones due to falls, burns from exposure to heaters or cigarettes, or physical assaults.
WHO IS AT RISK FOR AN OPIOID OVERDOSE?Overdose doesn’t discriminate, but there are somekey factors and patterns of use that have anincreased risk; • Demographics • Prescription Patterns • Mixing Drugs • Patterns of Use
OD RISK: DEMOGRAPHICSA B.C. Review of Coronor Data from 2006-2011 allowed them to pulltogether a profile of risk factors for overdose related death.Most overdose deaths:•Are accidental versus suicide (86%),•occur in persons under the age of 60 (87%),•have a documented source of chronic pain (82%),•almost half have a documented co-morbid mental health diagnosis(45%).•are the result of taking at least one other non-opioid class ofmedications(93%),•Are not the result of “multi-doctoring” - almost all are taking medicationsprescribed by a single doctor or clinic.•Happen everywhere – no geographical or population density correlation
OD RISK: PRESCRIBING PATTERNS• a 2009 Ontario study in the Canadian Medical Association Journal linked the 850% rise in oxycodone prescribing with a quintupling in oxycodone-related fatalities.• Among the highlights: • 66.4% had visited a physician in the month before death; • 56.1% had filled a prescription for an opioid in the month before death.• Approximately 50,000 Ontarians are addicted to opioids and many more are dependent• Canada has the highest per capita rates of opioid consumption in the world.• A 2009 CAMH study indicated that more youth in Waterloo- Wellington had consumed opioids for non-medicinal purposes than tobacco (20%), the highest rate in Ontario. Most of them got it from home.
OD RISK: PATTERNS OF USEOverdose doesn’t discriminate, but there are somekey factors and patterns of use that have anincreased risk; • Mixing Drugs • The Way a Drug is Taken • Low or Reduced Tolerance • Using Alone • Long-term use
OD Major Risk Factors: Mixing DrugsDifferent drugs take different amounts of time to leave the body.New drugs can combine with drugs that may have been used hours earlier.Drugs may still be in the body long after a person can’t feel their effects.The majority of overdoses involve the use of a combination of drugs.
The way a drug is taken:How you take a drug can effect how fast and how strong the effect is. The quicker the drug enters the bloodstream, the higher the risk of overdose.Injection into a vein: Very fast absorptionInjection into a muscle or under the skin: Fast absorptionSmoking: Very fast absorptionSnorting, shafting: Fast absorptionHooping: Slower absorptionSwallowing: Slowest absorption
Major Risk Factors: Reduced toleranceTolerance can take some time to develop - weeks or months - but will reduce far more quickly.As little as three or four days without certain drugs can be long enough to lower tolerance to the point where there is a higher risk of overdose.• The risk of overdose is high when individuals do not take into account that their tolerance may be lower than usual.• Changes in how strong/pure a drug is could lead to a person using more of a drug than they can tolerate by accident.
Major Risk Factors: Reduced ToleranceTimes when tolerance will be low or reduced• After drug detox or a rehabilitation program;• After being in custody or jail;• After a period when the drug of choice was not available;• Being a new or casual user;• Following a period when use of a drug has reduced or ceased for any reason Just because a person’s tolerance for one drug is high doesn’t mean that it will be high for a different drug!
Major Risk Factors: Using aloneFor a person using alone an overdose could be fatal, as the situation might not be noticed. Using with others does not guarantee that an overdose will be handled well though.
Major Risk Factors: Being an experienced, long-term user It is not just new users who overdose - in fact experienced or older users are at greater risk. Long-term users are more likely to mix drugs; Cycles of abstinence and return to drug use result in more frequent periods of reduced tolerance; The law of averages - the more a person uses the greater the likelihood of overdose; A belief that ‘It won’t happen to me’. If a person has used drugs over several years and not suffered an overdose, they could become over confident and take more risks.
How to Recognize an Overdose : Is it an Overdose, or are they just really high?If someone is extremely high, and they are using depressants, they may: have contracted/small pupils; have slack and droopy muscles; be “nodding out”; scratch a lot due to itchy skin; have slurred speech and/or be “out of it” However, they will respond to outside stimulus
How To Recognize an Opioid Overdose: Signs and SymptomsPerson may be awake, but unable to talkBody is very limpFace is very pale or clammyFingernails and lips turn blue or purpleBreathing is very slow and shallow, irregular, or hasstoppedheartbeat is slow, strange, or not there at allChoking sounds, or a gurgling noise (“death rattle”);Loud, uneven snoringVomiting/throwing upLoss of consciousness/passing outPerson does not respond to noise or pain
Overdose: The Myths and FactsMythPeople collapse (‘drop’) immediately after injecting.FactSome do. However, overdose can take place over one to three hours.
Overdose: The Myths and FactsMyth:Purity and/or taking too much of the drug are the main causes of overdose.Fact:They are factors but definitely not the main reasons. The main reasons are mixing with other drugs and using when tolerance is low or absent.
Overdose: The Myths and FactsMyth:• It is young, inexperienced users who mostly overdose.Fact:• It is more likely to be an older user, someone in his or her early 30s who has been using for a long while.
Overdose: The Myths and FactsMyth:Being on methadone means it’s impossible to overdose.Fact:Being on a methadone program will reduce the risk of overdose in the longer term, however, in the first few days the risk is higher (the body is still developing a tolerance to the methadone). Even after being on a methadone program for a long time it is still possible to overdose.
Overdose: The Myths and FactsMyth:If the person doesn’t die, they’ll be alright.Fact:Even when an overdose is not fatal, there can be serious health effects.
Overdose: The Myths and FactsMyth:Injecting Cocaine or Crack will stop an ODFact:•Injecting crack will make the OD happen faster•Crack speeds up your heart rate so the bodyneeds more oxygen•Heroin slows down breathing
OVERDOSE: THE MYTHS AND FACTSMyth:Most overdoses happen when someone is aloneFact:A UK report showed that over 50 out of 100overdoses happen with another person in theroom
Overdose: The Myths And FactsMythIf someone ODs you should walk them aroundFact:•This is a waste of time•There is a chance that the person will fall over,bang their head and cause a head injury•Then they’ll be suffering from an overdose anda head injury
Overdose: The Myths And FactsMythInjecting salt water will stop an ODFact:•NO it won’t!•NOR will injecting milk, water, orangejuice•All will only add to the problem
Overdose: The Myths And FactsMyth:If someone is snoring they’re okFact:If someone has been using depressantsand they are snoring – it is a sign thatthey are struggling to breathe
Overdose: The Myths And FactsMythIf a friend ODs, you should put them in thebathFact•You can change the body temperature reallyfast and put them into shock•They could drown•It can be a slippery and wet nightmare tryingto get an unconscious person out of a bathtub
Overdose: The Myths And FactsMythMaking someone vomit will slow down an ODfrom ‘Down’Fact•This will just increase the chances of themchoking to death•Depressants stop the gag reflex which makesit more likely that you’ll choke
HOW TO RESPOND TO AN OPIOID OVERDOSE• Call 911• Ensure safety and infection control• CPR• Naloxone
Responding to an Opioid Overdose: Calling an AmbulanceIf the person is conscious:try to keep them awake and talking as much as possible while you call 911. Moving them around could risk a fall.If the person is unconscious:Put them in the recovery position and call 911 for an ambulance.The Recovery Position:Places the person securely on their sideto ensure that they cannot choke onVomit or other fluids
Responding to an Opioid Overdose: The Recovery PositionOnce in the Recovery Position:• Call 911 if you haven’t already done so• Ensure Safety: check the scene• Use stimulation to check if they respond• Check for breathing• Begin CPR if the person is not breathing
CALLING 911 If there is someone else in the room have them call 911. Ask the person who calls 911to come back and tell you they have called the ambulance. That way you are sure that ambulance has been called. If no one else is there, make the call yourself. In most communities, police will be dispatched at the same time. Police will attend with an ambulance. For many this is the reason they will not call 911, however saving lives always has to be the first priority. When you call the ambulance they will ask a series of questions. This is to brief paramedics on the situation before arrival. Stay on the phone if you can.
Ensuring Safety: First Steps You can’t help someone if you need help yourselfIn the event of any emergency, including an overdose, make suresafety comes first. Check the scene for anything that could be of danger to you, other people or the person experiencing the overdose. Respond to any other emergencies and ensure the safety of the environment. When ANY bodily fluid is present, such as blood, vomit, or saliva, always put a barrier between the fluid/victim and yourself such as gloves, or a face mask. Always avoid contact with the fluid(s) and wash hands thoroughly immediately after giving first aid.
CPR : COMPRESSIONS, AIRWAY, BREATHING Remember: Opioids slow the central nervous system down. The person needs to be breathing to bring in oxygen, and theheart needs to be pumping to circulate the oxygen to the brain. In many communities, 6-8 minutes is an average response time once 911 is called.
CPR: COMPRESSIONS, AIRWAY, BREATHINGChest Compressions:CPR involves chest compressions at least 5 cm deep and at a rate of atleast 100 per minute in an effort to create artificial circulation bymanually pumping blood through the heart.Rescue Breathing:The rescuer may also provide breaths by either exhaling into the subjectsmouth or nose or using a device that pushes air into the subjects lungs.This will only be effective if the airway is clear. • Current recommendations place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers. • Chest compressions alone can at least circulate existing oxygen in the blood. A full first aid response to an opioid overdose includes chest compressions and rescue breathing.
Responding To An Overdose: Opioid Overdose Reversal IF you are trained in the administration of Naloxone (Narcan) and have it available to you, administer the recommended dosage by injection or intra-nasally and continue CPR. If the person is still not breathing on their own after 5 minutes, re-administer the dose and continue CPR. If the second administration does not stimulate breathing independently, it is not likely an opiate overdose. Continue CPR. Naloxone does not Continue CPR and wait for paramedics to replace medical arrive. intervention, but Always dispose of needles in the closest it does buy biohazard box. life-saving time!
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