The document outlines a bystander opioid overdose reversal program implemented in Wilkes-Barre, PA. It found that 75% of overdose cases, the antagonist was administered by a friend. However, only 23% of bystanders called 911 due to fear of legal repercussions. The program aims to train friends and families to recognize overdoses and administer naloxone, an opioid antagonist that is safe and effective at reversing overdoses. It also educates about "Good Samaritan" laws providing immunity for those who call 911 to report an overdose. The program seeks to prevent opioid overdose deaths by empowering bystanders to intervene.

1. Bystander Opioid Overdose Reversal Medicine
Program for Friends and Families of at Risk
Residents in Wilkes-Barre, PA
Developed in collaboration by
Director: Ted Kross
Public Health Nurse: Delphine Torbik
Master’s of Public Health Intern: Melissa DeFina
Sept 2015 1

2.  Fatal overdoses have increased dramatically in recent
years (Lisman, 2015).
 Increase in deaths are primarily from non-medical use
of prescription pain relievers (opioids).
 Heroin overdoses have also increased in many
communities (Pennsylvania State Coroners Association,
2014).
 Overdose affects all sectors of society regardless of
income, ethnicity, gender, age or geography (Lisman,
2015).
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3.  During an 8-week period, the MPH candidate
will plan, design and implement a bystander
Opioid overdose reversal medicine program
for friends and families of at risk residents in
Wilkes-Barre, PA to decrease the occurrences
of death resulting from heroin and
prescription opioid overdose and lead the at
risk population toward the substance abuse
treatment they need.
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4. (Pennsylvania State Coroners Association, 2014)
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5.  Deaths caused by opioids are especially tragic
because they are PREVENTABLE (Bell & Doe-
Simkins, 2014).
 A safe and effective way to administer an
antidote exists – naloxone hydrochloride;
also known as Narcan(Bell & Doe-Simkins,
2014).
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6.  In March of 2015 Wilkes-Barre City had
adopted the Narcan program to decrease the
number of Opioid overdoses (Kross, 2015).
 Narcan is available to first responders to save
lives(Kross, 2015).
 As of May 13th 2015 Wilkes-Barre has utilized
Narcan 10 times (Kross, 2015).
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7.  90% of respondents (18 of 20) interviewed at REACH
and on the streets of WilkesBarre reported a drug
addiction problem (MHDSLW, 2013).
 The average age of drug addiction onset for those
interviewed was 12 years of age (MHDSLW, 2013).
 The cost of Narcan injectable has dramatically
increased now to approximately $425/dose (Kross,
2015).
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8.  The project will follow the program planning,
implementation and evaluation capstone project
path.
 It will connect the current public health
intervention program of Opioid-associated
overdose and Naloxone training for the city and
health professionals developed in March of 2015
and enhanced in June (Kross, 2015).
 This program will expanded the availability of
Naloxone and training to the public.
 This capstone project is based off the Healthy
People topic of Substance Abuse.
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9.  Overdoses can occur with almost any drug
(HRC, 2015).
 Most overdoses in the US are due to opioid
toxicity (poisoning) from drugs like
◦ Heroin
◦ Prescription pain relieves
 Overdoses can occur with this drugs both on
there own or in combination with other
substances (HRC, 2015).
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10.  What are common opioids?
 What opioid toxicity depend on.
 Naloxone
 Symptoms of Opioid-associated overdoses
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11. Street Drugs Prescription
 Heroin (slang: junk,
dope, smack, shot,
shit, h, & manteca)
 Opium (slang: O.P.,
hop, midnight oil, tar,
dope, Big O)
(HRC, 2015).
 Codeine (Tylenol 3®)
 Fentanyl (Duragesic®)
 Hydrocodone (Vicodin®, Norco®,
Lortab®, Lorcet®)
 Hydromorphone (Dilaudid®)
 Meperidine (Demerol®)
 Morphine (Astramorph®, Avinza®,
Kadian®, MS Contin®)
 Oxycodone (OxyContin®,
Percocet®, Percodan®)
 Oxymorphone (Opana®)
 Levorphanol (Levo-Dromoran®)
 Methadone Dolophine®)
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12.  How much was used (HRC, 2015).
 The timing of use (HRC, 2015).
 The user’s tolerance for the drug (HRC, 2015).
 The user’s overall health (HRC, 2015).
Opioid-associated overdoses tend to occur after a
period of abstinence; such as (HRC, 2015):
 Hospitalization.
 Drug treatment.
 Incarceration
 Any period of time without use of the drug.
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13.  Naloxone only works with opioids (HRC, 2015).
 If overdose is caused by an opioid combined with
other drugs, it may take longer for Naloxone
work (HRC, 2015).
 If overdose is caused by other drugs like cocaine,
alcohol or acetaminophen; Naloxone will not
help, but it won’t hurt either (HRC, 2015).
IF IN DOUBT, USE NALOXONE
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14.  Naloxone is a highly effective opioid
antagonist (CDC, 2012).
 It blocks effects of opioids on the brain’s
respiratory control center (CDC, 2012).
 Quickly reverses effects of opioid (CDC,
2012).
 It restores respiration rates depressed by the
overdose (CDC, 2012).
NALOXONE IS THE ANTIDOTE FOR AN
OPIOID-ASSOCIATED OVERDOSE
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15.  Breathing is suppressed (slow or no breathing)
 Unconsciousness
 Cyanosis (lips and nail beds are ashen, blue or
purple)
 Pale or clammy skin
 Gurgling or snoring (a.k.a. “dealth rattle”)
(HRC, 2015).
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16. A person who is really
high
A person who is
overdoing
 WILL RESPOND to
stimulation (calling out
there name or sternum
rub)
 Has small, pinpoint
pupils
 Slowed or slurred
speech
 Looks sleepy
 WILL NOT RESPOND to
stimulation.
And often
 Has bluish lips or nail
beds
 Infrequent or no
breathing (less then 8
breaths per minute)
 Snoring or gurgling
 Slow, erratic or no
pulse.
(HRC, 2015)
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17.  Follow Wilkes-Barre standard resuscitation
protocol.
 Opioid overdose is an exception to the chest
compression protocol ONLY- IMMEDIATE
ventilation is VITAL.
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18. 1. Place the victim on their back
2. Tilt chin up to open airway
3. Look to see there is nothing in the mouth
blocking airway.
4. Place bag valve mask over face and pinch
nose
5. Give two even, regular-sized breaths to
make chest rise. (if no chest rise re-tilt head
and make sure nose is pinched).
6. Give one breath every five seconds.
(HRC, 2014)
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19. One responder Two responders
 Give rescue breathing
 Call 911
 Give rescue breathing
 administers Narcan
 Divide the duties
 1st person calls 911.
 2nd gives rescue
breathing, conts
 1st person administers
Narcan.
(HRC, 2014)
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20. (HRC, 2014) 20

21. 1. Do rescue breathing if the person is not breathing.
2. Affix the nasal applicator to the needleless syringe
and then assemble the naloxone cartridge.
3. Tilt the head back and spray half of the naloxone
up one side of the nose (1cc) and half up the other
side of the nose (1cc).
4. If there is no breathing or breathing continues to be
shallow, continue to perform rescue breathing for
them while waiting for the naloxone to take effect.
5. If there is no change in 3-5 minutes, administer
another dose of naloxone and continue to breathe
for them.
(HRC, 2014)
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22.  The bystander Opioid overdose reversal medicine
program for friends and families of at risk
residents in Wilkes-Barre, PA the results show
that out of all 425 reported overdose cases, 75%
of the cases the opioid antagonist was
administered by a friend (Kross, 2015).
 The bystander Opioid overdose reversal medicine
program for friends and families of at risk
residents in Wilkes-Barre, PA has also shown that
only 23% bystander called 911. This low rate is
attributed to concern on the part of many
bystanders that if they called the authorities, they
risked arrest for drug possession (Kross, 2015).
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23.  Are intended to maximize the willingness to
call 911 - IN PA THE LAW IS:
 35 PA. Cons. Stat. § 780-
113.7 Drug overdose response
immunity Drug Overdose Response Immunity
 Signed into law on September 30.
 This new law encourages a person to act the
‘Good Samaritan,’ and call the authorities
immediately, when they encounters a
possible life-threatening drug overdose.
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24. “A person may not be charged and shall be
immune from prosecution for any offense listed
in subsection b) and for a violation of probation
or parole if the person can establish the
following”:
a) law enforcement officers only became
aware of the person's commission of an offense
listed in subsection
b) because the person transported a person
experiencing a drug overdose event to a law
enforcement agency, a campus security office or
a health care facility; or
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25. ii. all of the following apply:
 1. the person reported, in good faith, a drug overdose event to a law
enforcement officer, the 911 system, a campus security officer or
emergency services personnel and the report was made on the
reasonable belief that another person was in need of immediate medical
attention and was necessary to prevent death or serious bodily injury
due to a drug overdose;
 2. the person provided his own name and location and cooperated
with the law enforcement officer, 911 system, campus security officer or
emergency services personnel; and
 3. the person remained with the person needing immediate medical
attention until a law enforcement officer, a campus security officer or
emergency services personnel arrived.
 b) The prohibition on charging or prosecuting a person as described in
subsection a) bars charging or prosecuting a person for probation and
parole violations and for violations of section 13(a)(5), (16), (19), (31),
(32), (33) and (37).
 c) Persons experiencing drug overdose events may not be charged
and shall be immune from prosecution as provided in subsection b) if a
person who transported or reported and remained with them may not be
charged and is entitled to immunity under this section.
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26.  Bystander Opioid overdose reversal medicine program for
friends and families of at risk residents in Wilkes-Barre, PA
will help to prevent death due to Opioid related overdoses.
It will use training and educational tools to help family
members save the others of loved ones. In this program I
have been able to take on many responsibilities and
perform many actives that have been vital to the Bystander
Opioid overdose reversal medicine program for friends
and families of at risk residents in Wilkes-Barre, PA. The
use of Naloxone is an eminently safe and nonabusable
substance that has only one pharmacological function and
that is to reverse the effects of opioids on the brain and
respiratory system in order to prevent the ultimate adverse
event of death (CDC, 2012).
26

27. Bell, A., & Doe-Simkins, M. (2014). Opioid overdose prevention and
related trauma: incorporating overdose prevention, response,
and experience into substance use disorder treatment. Retrieved
from http://prescribetoprevent.org/wp2015/wp-
content/uploads/Incorporating-OD-into-SUD-Tx-12.141.pdf
CDC. (2012). Community-Based Opioid Overdose Prevention
Programs Providing Naloxone — United States, 2010. Retrieved
from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm
HRC. (2014). Administer Naloxone. Retrieved from
http://harmreduction.org/issues/overdose-
prevention/overview/overdose-basics/responding-to-opioid-
overdose/administer-naloxone/
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28. HRC. (2015). Recognizing Opioid Overdose. Retrieved from
http://harmreduction.org/issues/overdose-
prevention/overview/overdose-basics/recognizing-opioid-
overdose/
Kross, T. (2015). Wilkes-Barre health department. (M. DeFina,
Interviewer)
Lisman, W. (2015). Coroner William Lisman calls pinpointing drugs
that cause overdose deaths difficult. Retrieved from
http://www.timesleader.com/news/local-news/152834330/
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29. MHDSLW. (2013). Luzerne-wyoming counties mh/mr program,
Annual mental health plan update, Fiscal year 2013-2017 .
Retrieved from
http://www.mhdslw.org/uploads/documents/Electronic%20Versi
on%20%20%20MH%20Plan%2012-13.pdf
Pennsylvania State Coroners Association. (2014). Heroin Overdose
Death Report2009 – 2013. Retrieved from
http://www.co.westmoreland.pa.us/Archive/ViewFile/Item/495
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