Slide 1 Maryland Overdose Response Program Educational Training Program CORE CURRICULUM
Maryland Department of Health & Mental Hygiene Behavioral Health Administration dhmh.naloxone@maryland.gov January 2016 Reverse of Great Seal of Maryland]
Slide 2 Program Overview • What is an Opioid? • Prevention of Opioid Overdose • Treatment and Other Resources • Recognizing an Opioid Overdose • Responding to an Opioid Overdose • Important Information for Certificate Holders
Slide 3 What is an opioid? • Any drugs that contain opium or its derivative • Natural or synthetic • Prescription medications or illegal drugs • Pill, capsule, powder or liquid • Swallowed/drunk, smoked, snorted or injected
Slide 4 Opioids • Manage pain, suppress coughs and treat Opioid-use disorders (addictions) • Cause feelings of euphoria, contentment and/or detachment • Effects last from 3 to 24 hours • In excessive amounts, opioids can suppress a person’s urge to breathe
Slide 5 Common Prescription Opioids • Oxycodone (OC, Oxy, 80s, Killers, Roxis) o OxyContin o Percocet o Roxicodone • Hydrocodone (Vikes, Hydro, Fluff, Scratch) o Vicodin o Lorcet o Lortab Slide 6 Common Prescription Opioids • Hydromorphone (D, Hospital Heroin, Smack o Dilaudid • Oxymorphone (Mrs. O, O Bomb, Stop Signs) o Opana • Morphine (M, Miss Emma, Monkey, Dreamer) • Meperidine o Demerol Slide 7 Common Prescription Opioids • Codeine (Captain Cody, Schoolboy, Purple Drink) o Tylenol 3 and 4 • •Methadone (Jungle Juice, Chocolate Chip Cookies) • •Buprenorphine (Box(es), Subs/Subbies) o Suboxone o Subutex Slide 8 Prescription Fentanyl Graphic: Pill bottles, packets, needles and swab stick
Slide 9 Illegal Opioids: Non-pharmaceutical Fentanyl • Illicitly produced, synthetic drug • Pill form packaged to look like oxycodone • Powder form looks like heroin • Fentanyl + heroin = deadly combination Fentanyl can be hundreds of times more potent than heroin
Slide 10 Illegal Opioids: Carfentanyl • Illicitly produced, synthetic drug • 10,000 times more potent than morphine • 100 times more potent than fentanyl • Sometimes used to cut heroin • Even a very small amount of Carfentanyl can be deadly
Slide 11 Illegal Opioids: Heroin, Fentanyl, and Carfentanyl Graphic: Comparing the size of lethal doses of heroin, fentanyl, and carfentanil. The vials here contain an artificial sweetener for illustration (New Hampshire Forensic Laboratory)
Slide 12 Illegal Opioids: Heroin Slang terms: • H, Dope, (Hell) dust, • Hammer, Smack, Junk, Skag, • Horse, Henry, Elephant, • Rock, Brown Sugar, Slow, • Hero, Black Tar, Poison, • Homebake, Thunder, (China) • White, Chinese, H, Train, • White Dynamite, Dragon
Slide 13 Preventing Opioid Overdose
Slide 14 Opioid Overdose Prevention Tips • Keep all medicine in a safe place, such as a locked cabinet. • Take only medicine prescribed for you and only as directed. • Never share your prescription drugs with anyone else. • Properly dispose of expired or unwanted medications at a Drug Drop Box or medications can be mixed with coffee grounds or kitty litter and disposed in the trash.
Slide 15 Opioid Overdose Prevention Tips Don’t Let Your Loved One Be A Victim! Safely dispose of unused and expired medications in a drug drop box at a Baltimore County Police Precinct For details, call 410-887-3828 Baltimore County Drug Drop Box Locations • Precinct 1 Wilkens: 901 Walker Avenue, 21228 • Precinct 2 Woodlawn: 6424 Windsor Mill Road, 21207 • Precinct 3 Franklin: 606 Nicodemus Road, 21136 • Precinct 4 Pikesville: 215 Milford Mill Road, 21208 • Precinct 6 Towson: 115 W. Susquehanna Avenue, 21204 • Precinct 7 Cockeysville: 111 Wight Avenue, 21030 • Precinct 8 Parkville: 8532 Old Harford Road, 21234 • Precinct 9 White Marsh: 8220 Perry Hall Boulevard, 21236 • Precinct 11 Essex: 216 North Marlyn Avenue, 21221 • Precinct 12 Dundalk: 428 Westham Way, 21224 You can dispose of unused or expired medications 24 hours a day, seven days a week, year-round.
Slide 16 Opioid Overdose Prevention Tips • If you have breathing problems (e.g., asthma, sleep apnea), check with your doctor before taking opioids. • Never mix pain medication with alcohol, benzos, sleeping pills, muscle relaxants, anti-nausea drugs, other opioids or illegal drugs.
Slide 17 Prevention Tips for the Opioid User • If you must use illegal opioids, do not use alone. • Make an overdose prevention plan and share it with someone you trust to give you naloxone if needed. • If you have not used opioids in a while, your tolerance will be lower and risk for overdose greater, so use much less than you normally would.
Slide 18 Prevention Tips for the Opioid User • You are also at greater risk for overdose if you have overdosed before. • Always keep naloxone on hand. • Get treatment for drug dependence or addiction. • Seek professional help if you are depressed.
Slide 19 What can you do to prevent an opioid overdose? A. Keep all medicines locked in a safe place B. Dispose of expired and unwanted medications C. Never share your prescription drugs with anyone else D. All the above
Slide 20 Treatment and Other Resources
Slide 21 Bureau of Behavioral Health at Eastern Family Resource Center • Located at 9150 Franklin Square Drive, Suite 201 & (3525 Resource Dr. Randallstown) • Information, screenings and referrals for Baltimore County residents – call 410-887-6465. • Walk-in assessments on Monday, Tuesday and Thursday. If client arrives anytime from 8:30 am to 1 pm, very attempt will be made to see client that day.
Slide 22 Treatment and Other Resources State insured/uninsured residents • Call 410-887-6465 to speak with a counselor about possible treatment options, or to schedule an appointment for a free screening and referral • Uninsured individuals may apply for treatment at any provider that accepts Medical Assistance - outpatient, intensive outpatient, methadone maintenance, and residential treatment
Slide 23 Treatment and Other Resources For private health insurance • Call the number provided on the insurance card to find out what providers and services are covered • If your insurance does not cover the kind of treatment that is needed, Baltimore County may be able to assist.
Slide 24 Treatment and Other Resources Community Reinforcement and Family Training (CRAFT) • A free program for individuals or families who have a loved one with substance use disorder • Helps the individual or family change their behaviors to encourage their loved one to get treatment • Located at Eastern Family Resource Center • Call (410) 887-6465 for more information or to make an appointment
Slide 25 Treatment and Other Resources Peer Recovery Specialists • Individuals in stable, long term recovery who act as a guide and mentor • Provide help with accessing resources to support recovery • Not a sponsor, counselor, doctor or clergy person • For more information or to speak with a Peer Recovery Specialist call 410-88-REACH (410-887-3224 (8:30am to midnight, Monday-Saturday)
Slide 26 Treatment and Other Resources • Baltimore County Crisis Response 410-931-2214 (a 24-hour hotline for mental health crisis, suicidal thoughts, information and referral line) • Narcotics Anonymous 410-468-0060 www.baltoareana.org • Nar-Anon Family Groups | 800-477-6291 www.nar-anon.org
Slide 27 Recognizing an Opioid Overdose
Slide 28 What is an Opioid Overdose? • Opioid overdose happens when a toxic amount of an opioid o alone or mixed with other opioid(s), drugs and/or substances o overwhelms the body’s ability to handle it. • Many opioid-related overdoses result from mixing prescription painkillers or heroin with benzodiazepines (benzos), cocaine and/or alcohol.
Slide 29 Signs & Symptoms of an Opioid Overdose • Loud snoring or gurgling noises (death rattle) • Body very limp • Unresponsive • Skin pale/gray, clammy • Lips/fingertips turn blue(ish) • Pulse slow or erratic • Breathing very slow, shallow, or not at all • Unconscious
Slide 30 What leads to overdose death? • Respiratory failure–lack of sufficient oxygen in the blood • Vital organs like the heart and brain start to fail • Leads to unconsciousness, coma, death Surviving an opioid overdose = BREATHING and OXYGEN
Slide 31 What is Naloxone? (NARCAN®) • Reverses opioid overdose by restoring breathing • No potential for abuse or getting high • No effect on someone who hasn’t taken opioids • Side effects are minimal and rare • Safe for children and pregnant women • Intramuscular, intranasal or intravenous • Wears off in 30-90 minutes Naloxone is only effective in reversing opioid overdoses
Slide 32 What is an overdose? (Graphic photo of round ball with line pointing to Opioid; two round balls; Opioids fit exactly on receptors-two lines pointing to each ball; One line to pointing to Opioid receptor on brain) Source: http//harmreduction.org/issues/overdose-prevention-basic/understanding-naloxone Graphics by Maya Doe-Simkins
Slide 33 Naloxone Reversing an Overdose (Graphic Photo showing Naloxone reversing an overdose) Naloxone; Naloxone; Opioid Receptor on brain Source: http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding- naloxone Graphics by Maya Doe-Simkins
Slide 34 Naloxone Storage & Disposal • Storage o Store naloxone in original package at room temperature; avoid exposure to light o Keep in a safe place away from children and pets • Expiration o Naloxone loses its effectiveness over time o Check date on label; if expired, get a new prescription • Disposal o Use one of the 10 Drug Drop Boxes located in the County Slide 35 Which of the following is a sign that a person has overdosed? A. Slowed or shallow breathing B. Bluish fingertips and lips C. Tossing and turning D. All of the above E. A and B only
Slide 36 Responding to an Opioid Overdose
Slide 37 How Not to Respond to an Opioid Overdose • Anecdotal Remedy: Use ice to cool down body. Possible Consequences: Slowed heart rate, arrhythmia. • Anecdotal Remedy: Put person in bath/shower. Possible Consequences: Drowning. • Anecdotal Remedy: Hit/slap or burn fingers/feet. Possible Consequences: Bruising, broken bones, infection, amputation. • Anecdotal Remedy: Give drink/induce vomiting. Possible Consequences: Choking to death. • Anecdotal Remedy: Inject person with cocaine, salt water, milk, epinephrine. Possible Consequences: High blood pressure, infection.
Slide 38 Responding to an Opioid Overdose 1. Rouse and stimulate 2. Call 9-1-1 3. Give naloxone 4. Further resuscitation 5. Care for the person until help arrives
Slide 39 Step 1: Rouse & Stimulate • Noise o Shake person’s shoulders and yell, “[Name!] Are you all right? Wake up!” • Pain o If no answer, do a sternal rub: Make a fist, rub your knuckles firmly up and down the breast bone.
Slide 40 Sternal (Sternum) Rub (Photo of a woman doing a sternal rub to a woman sitting in a chair)
Slide 41 Recovery Position • If you have to leave the person — even briefly — put him/her into the recovery position. • This keeps the airway clear and prevents choking if vomiting occurs.
Slide 42 Recovery Position Face & Body Turned to side Bent Knee supports body (Graphic photo of a man lying on his side with knee bent supporting his body) (A.B.C.D.-Graphic photo a man using the steps of Recovery Position)
Slide 43 Step 2: Call 9-1-1 Get emergency medical help for someone experiencing an overdose! • May have complications or other health problems. • Naloxone is only temporary. • May need to give additional doses of naloxone. • May be a non-opioid overdose situation. Slide 44 Call 9-1-1: What to Say Tell 9-1-1 operator: • Where you are • What you observe about the person in distress: o e.g., gurgling noises, turning blue, won’t wake up Tell emergency responder on site: • Drugs/substances the person used • Naloxone administered–how much/when
Slide 45 Alternate Step 3: Administer NARCAN® (Photo of Narcan Nasal Spray)
Slide 46 Step 3: Administer NARCAN® • Lay the person on their back • Tilt the person’s head back supporting the neck • Gently insert the tip of the nozzle into one nostril, press the plunger firmly to give the dose of NARCAN Nasal Spray. • If no response after 1 to 3 minutes, give a second dose of NARCAN.
Slide 47 Let’s watch a video!
Slide 48 NARCAN® Administration Video (Photo of hand peeling label off an Narcan Nasal Spray bottle)
Slide 49 Step 4: Rescue Breathing • Assess breathing: if the person is not breathing, or if breath is shallow or short: o Give rescue breaths, or o If you are trained in cardiopulmonary resuscitation (CPR), administer traditional CPR, chest compressions with rescue breaths, or o Follow the 9-1-1 dispatcher’s instructions • Continue until the person wakes up or medical help arrives.
Slide 50 Step 4: Rescue Breathing • Rescue breathing is the quickest way to get oxygen into the body and one of the most important things you can do to prevent someone from dying from an opioid overdose.
Slide 51 Rescue Breathing Steps • Step 1 o Lay the person on his/her back on a flat surface. • Step 2 o Tilt the chin to open the airway. • Step 3 o Remove anything blocking the airway. Slide 52 Rescue Breathing Steps • Step 4 o Pinch the person’s nose closed completely. • Step 5 o Cover his/her mouth with your mouth and blow 2 regular breaths about 1 second each. • Step 6 o Breathe again. Give 1 breath every 5 seconds. Slide 53 Step 5: Care After Administering Naloxone • Stay with the person until medical help arrives. • If s/he is unable to sit up, put person in recovery position. • Keep person calm and encourage him/her not to take more opioids. • If overdose reoccurs, give another dose of naloxone.
Slide 54 Step 5: Care After Administering Naloxone After receiving naloxone, a person may: • Feel physically ill/vomit. • Experience withdrawal symptoms, which can be unpleasant, but not life-threatening. • Become agitated and upset due to withdrawal symptoms or coming off high. • Have a seizure, though this is rare.
Slide 55 Which of the following is the first thing you do if you suspect some has overdosed? A. Give naloxone B. Give two quick breaths C. Yell their name and rub your knuckles up and down their breastbone D. Call 9-1-1
Slide 56 Why is it important to call 911? A. Naloxone won’t work if the person has not used opioids B. Overdose may reoccur after the naloxone wears off C. The person may need other medical attention D. All of the above
Slide 57 If the first dose of Naloxone does not wake up the person, how long should you wait before giving the second dose? A. 1 to 3 minutes B. 5 minutes C. 8 minutes D. 10 minutes
Slide 58 If You Administer Naloxone to Reverse an Opioid Overdose Call the Poison Center 1-800-222-1222 You can also contact the Bureau of Behavioral Health at 410-887-3828 The information collected will be used for statistical purposes to inform critical public health programs to prevent opioid overdoses.
Slide 59 Important Information for Certificate Holders
Slide 60 Good Samaritan Laws CODE OF MARYLAND, CRIMINAL PROCEDURE ARTICLE, §1–210 A person who seeks, provides or assists with medical assistance for another person experiencing an alcohol-or drug-related medical emergency cannot be arrested, charged, or prosecuted for: • Possession of a controlled dangerous substance • Possession or use of drug paraphernalia • Providing alcohol to minors Calling 911 WILL NOT affect your PAROLE or PROBATION status.
Code of Maryland, Health General § 13–3110 An individual who administers naloxone to an individual believed to be experiencing and overdose shall have immunity from liability under §§ 6-603 and 5-629 of the Courts and Judicial Proceedings Article. You cannot be held liable for a good faith attempt to help someone.
Slide 61 Obtaining a Prescription & Naloxone • Those who complete today’s training and the Trainee Application will receive a completion certificate. • The Baltimore County Department of Health will provide two doses of naloxone for those who wish to receive it. • You can now obtain Naloxone at your local pharmacy under the statewide standing order; call your local pharmacy to make sure they stock the medication. • Please be advised that all insurances may not cover the cost. Check with your insurance carrier or pharmacy for the cost.
Slide 62 General Responsibilities • Certificates are valid for two years. Apply for renewal no later than 90 days before your certificate expires. • Administer naloxone in accordance with training procedures. • Make a good faith effort to get emergency medical help for the person experiencing an opioid overdose. • Please remember to contact the Poison Center or training entity after administering naloxone.
Slide 63 Questions & Comments For more information or if you have questions that have not been answered today, please contact: Amy Park, LCSW-C Baltimore County Department of Health Bureau of Behavioral Health [email protected] 410-887-3828