National Addiction Centre What do we want to

National Addiction Centre What do we want to achieve with this training session? By the end of this training session we would like you to be able to: n Understand why people overdose n Recognise an overdose n Know what to do if someone overdose n Know about naloxone and how to use it n Clarify any myths/misconceptions n Fell confident in dealing with an overdose 1

National Addiction Centre How this training session works? Teaching session n Film n Practical session n Post questionnaires n Naloxone prescription n Voucher and certificate n 2

National Addiction Centre Heroin Overdose & Naloxone Training

National Addiction Centre Why are we doing this? n Overdose is the major cause of death among injecting drug use n People who inject heroin are 14 X more likely to die than their non-users friend s n Most heroin users will experience an overdose during their life-time n Death from an heroin overdose is preventable 4

National Addiction Centre Why do People Overdose? Reduced tolerance/recent abstinence ¨ Polysubstance use ¨ Injecting heroin use ¨ ¨ Other Reasons • Taking larger than usual doses of heroin • Increase in heroin purity • Using heroin when no one else is present • A long history of heroin use 5

National Addiction Centre What is an Overdose? Too much heroin stops you breathing and can kill you. Any of the following symptoms occurring in combination with heroin use (or other opioid, such as: methadone, morphine or codeine): ¨ Difficulty breathing ¨ Turning blue ¨ Lost consciousness ¨ Unable to be roused 6

National Addiction Centre How do I recognise an overdose? 1. Unrousable 2. Stopped/slow/shallow breathing 3. Turning pale/blue lips 4. Cold to touch 5. Very small pupils 7

National Addiction Centre Be Prepared! If you spend time with people who use you could witness an overdose. “My son died of a heroin overdose, but I couldn’t get to him quick enough, the paramedics couldn’t revive him. My daughter is still on drugs” The majority of overdose deaths are preventable because they usually happened at home, in the presence of other people and most deaths occur within 3 hours after injection. 8

National Addiction Centre What to do if I see an Overdose? 9

National Addiction Centre How to manage an Heroin Overdose? Step 1: Approach with Care Step 2: Check for Response Step 3: If no response – GET HELP – Dial 999 Step 4: Check Airway and Breathing Step 5: Recovery Position Step 6: Give Naloxone

National Addiction Centre Ambulance Breathing and Airways re. Covery Position + NALOXONE 11

National Addiction Centre Step 1: Approach with Care! n Beware of hazards? n Check for danger n Careful with needles 12

National Addiction Centre Step 2: Check for Response n Check if person conscious by: ¨ call their name ¨ pinch ears ¨ pinch finger nail bed 13

National Addiction Centre Is it a heroin overdose? Yes No 14

National Addiction Centre Step 3: GET HELP n Dial 999 - AMBULANCE n Give exact address, postcode if possible n Say what taken & they are unresponsive n Don’t be afraid of calling the ambulance

National Addiction Centre STEP 4: Airway and Breathing Check Airway - Mouth – Clear blockages Open Airway - Head Tilt and Chin Lift Check if Breathing

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National Addiction Centre Step 5: Recovery Position n Put person in the RECOVERY POSITION n So if they vomit, they will not choke

Step 6: Inject Naloxone National Addiction Centre

National Addiction Centre Naloxone 20

National Addiction Centre The Heroin Antidote n User can now be prescribed an “heroin antidote” called Naloxone or Narcan® n Naloxone can temporarily reverse an overdose by kicking the heroin off the person’s system n A legislative change happened in 2005 permitting anyone to administer emergency naloxone for the purpose of saving a life 21

National Addiction Centre Can naloxone be dangerous? n No effect on overdoses resulting from the use of other drugs n No potential for abuse n Naloxone precipitates WITHDRAWAL (going cold Turkey) – the individual may want to use again straight away or become aggressive. 22

National Addiction Centre How long the effect of Naloxone lasts for? Overdose can last for 8 hours or more - especially with methadone It is short acting wears off quickly It can begin to wear off in 20 minutes 23

Step 6: Inject Naloxone n Get naloxone n Attach needle n Needle 90º to skin n Insert needle into muscle n Slowly push plunger n Discard into sharps box National Addiction Centre

National Addiction Centre Where do you inject?

National Addiction Centre Evaluate: Is the person still not breathing? n If not, consider given a second dose, but be careful not to puncture yourself with the needle and ensure you do not use dirty needles 26

National Addiction Centre Evaluate: Is the person still not breathing? If they are still unresponsive Give Basic Life Support (if you know how to do this) 30 Chest compressions + 2 Breaths Repeat until ambulance arrives 27

National Addiction Centre Would you like to learn more about resuscitation techniques? These are some places that offer Basic Life Support Training: n London Ambulance Service (free): 020 7463 3120 n British Red Cross: 0844 871 8000 n St Johns Ambulance: 08700 10 49 50 n Heartstart UK: 0300 3311 28

National Addiction Centre SUMMARY Ambulance Breathing and Airways re. Covery Position + NALOXONE 29

National Addiction Centre And When the Person Comes Around? ¨ The person will be confused ¨ Explain to them what happened ¨ Advise them to not use any further drugs ¨ Remind the person that naloxone will wear off in a little while (about an hour) and the “high” will gradually return ¨ Advise the person not to walk away until they have been seen by the paramedics ¨ If they choose not to go to the hospital, explain to them that they could overdose again and therefore should be monitored for the next 2 -3 hours 30

National Addiction Centre What do I say to the paramedics? ¨ Tell the paramedics what you have found, seen and done to help ¨ If naloxone has been used, dispose used needles safely in a sharp container (paramedics or yours). 31

National Addiction Centre Where should I keep my Naloxone supply? n Carry n In with you, OR a specific place at home n Let other people know where it’s kept n Keep away from strong light n Keep out of reach of children n In case you use it, contact us for a replacement 32