Slide 1 Maryland Overdose Response Program Educational Training Program CORE CURRICULUM Maryland Department of Health & Mental Hygiene Behavioral Health Administration [email protected] 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