DOPE Project Quick & Dirty Narcan Training Checklist

Simple Overdose and Naloxone Training Checklist This document is adapted from the checklist prepared by the DOPE Project in San Francisco. Distributed with permission 2008.

1) Sign-in Sheet: full name, mother’s name, date of birth (or whatever information you need to collect for your records)

2) Mechanism of opiate overdose: when someone dies it’s because they stop breathing. With an upper overdose, the heart stops, or person has seizures or stroke.

3) Risk Factors: a) Mixing: heroin with alcohol/pills, or cocaine. Prevention : use one drug at a time, don’t mix highest risk ones. b) Tolerance: exiting jail, hospital, detox, esp. methadone detox. Prevention: use less when tolerance is low at these times. c) Quality: unpredictable. Prevention: tester shots, release tourniquet, use reliable dealer. d) Using Alone: behind closed, locked door, where cannot be found. Prevention: fix with a friend. Leave door unlocked. Call someone.

4) Recognition: The line between high vs. overdosing: unresponsive. Other signs to look for: slow, shallow breathing, pale, blue, snoring/gurgling.

5) Response: a) Noise: call name, yell “Police!” b) Pain: shake, slap, sternum rub. c) Airway: head tilt, chin lift.

6) Recovery Position: put person on their side if have to leave them alone to call an ambulance.

7) Calling an Ambulance: a) Say: (location), “someone is unconscious, not breathing.” Not: “overdose.” b) Naloxone only works on opiates, not benzos or alcohol. Need ambulance as backup if possible.

8) Administering Naloxone a) Assembling shot: pop top off vial, draw up entire amount, remove air bubbles if possible. b) Site location: arm (deltoid), thigh, butt. Shoot into muscle, not vein, not abscess. c) Administering shot: clean with alcohol wipe. Insert at 90° angle. Push in plunger.

9) Rescue Breathing a) Head tilt, chin lift b) Look, listen, feel: to see if chest rises/falls; listen/feel for breath. c) Two breaths: normal sized, not quick, not a hurricane! d) Check pulse: with two fingers at artery in neck. People often get this wrong. e) One breath every five seconds (count one-one thousand, two-one thousand…) f) Explain need: brain damage/death after 5 min. without oxygen to brain, ambulance may take longer, have to breath for person until narcan kicks in or paramedics arrive.

10) Aftercare: a) Takes several minutes to kick in; wears off in 30-45 minutes b) Person won’t remember overdosing; explain what happened c) Don’t allow to do more heroin, will be wasting drugs, could overdose again d) Need to watch person for at least an hour e) Could need to administer another shot of naloxone

11) Naloxone care: a) Keep out of sunlight b) Expires in two years

12) Logistics: a) Packet contents: alcohol swabs, intramuscular syringes, naloxone vials, breathing mask, instructions for naloxone administration and rescue breathing b) Short questionnaire, prescription from narcologist c) Follow-up: come back for re-fill if used or lost or harassed by police