recognizing and preventing overdose and administering naloxone substance use disorder treatment...
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Recognizing and Preventing Overdose
andAdministering Naloxone
www.OverdoseFreePA.pitt.eduSubstance Use Disorder Treatment Professional Curricula
Core Component 2© 2014, Overdose Prevention Coalition
The OverdoseFreePA website is brought to you by the Overdose Prevention Coalition, a
collaborative between:
The Pennsylvania Department of Drug and Alcohol Programs (DDAP)
The Single County Authorities (SCAs) of:
Allegheny CountyBlair County
Bucks CountyButler County
Dauphin CountyDelaware County
Westmoreland County
The Allegheny County Medical Examiner’s Office
The Program Evaluation Research Unit, University of Pittsburgh School of Pharmacy
The project is supported by a generous grant from the Pennsylvania Commission on Crime and Delinquency.
Background Photo for Slide Set by Jason Pratt from Pittsburgh, PA (Trees and light) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
SAMHSA National Survey Past Month Nonmedical Use of Types of
Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2012
Substance Abuse and Mental Health Services Administration (SAMHSA), 2013
SAMHSA National Survey Source Where Pain Relievers Were Obtained for Most Recent
Nonmedical Use among Past Year Users Aged 12 or Older: 2011-2012
SAMHSA, 2013
Past-Year Initiates for Specific Illicit Drugs Among Persons Age 12 or Older, 2008
Overview of Substance and Drug Use
SAMHSA, 2009
Overdose• An overdose means having too
much of a drug or alcohol, or a mix of drugs and/or alcohol for your body to safely handle.
• Overdose can result in permanent brain damage, permanent organ damage or death.
• Overdose symptoms can look different depending what kinds of drugs were used.
DDAP, 2014; Centers for Disease Control and Prevention (CDC), 2012
Overdose (cont’d)
• Drug overdose was the leading cause of injury death in the U.S. in 2010.
• Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes in 2010.
CDC, 2012
Overdose Deaths in Pennsylvania
Based on Pennsylvania Department of Health data, overdose deaths have been on the rise over the last two decades, with an increase in the rate of death from 2.7 to 15.4 per thousand Pennsylvanians.
DRUG OVERDOSE DEATHS IN PENNSYLVANIA
YearNumber of
DeathsPA
PopulationRate per
1,000
2011 1,909 12,742,886 15.4
2010 1,550 12,702,379 12.5
2008 1,522 12,448,279 12.6
2006 1,344 12,440,621 11.2
2004 1,278 12,406,292 10.6
2002 895 12,335,091 7.5
2000 896 12,281,054 7.4
1998 628 12,001,451 5.4
1996 630 12,056,112 5.4
1994 596 12,052,410 5.1
1992 449 11,995,405 3.8
1990 333 11,881,643 2.7
DDAP, 2014
Different drugs have different overdose
symptoms.
International Overdose Awareness Day (IOAD), 2014
It’s Good to Know …
Symptoms of Overdose
• Depending on the drug(s) involved, an overdose victim can exhibit different symptoms.
• It’s important to be able to recognize the symptoms of overdose. – Time is a factor.– Prescription pills are involved in about
60% of overdose deaths.
IOAD, 2014; Jones, 2013
Signs of Alcohol Overdose:
• Confusion• Difficulty remaining conscious
• Slow breathing or gaps in breathing • Clammy skin• Vomiting• Seizures
• Slow heart rate• Dulled responses
• Extremely low body temperature
DDAP, 2014
Signs of Amphetamine/Other Stimulant (“Speed”)
Overdose:• Amphetamine-induced psychosis
– (paranoia, hallucinations and/or delusions)
• Overheating• Dehydration
• High blood pressure• Seizures
DDAP, 2014
Signs of Opioid (Heroin, Narcotic Pain Medication,
Etc.) or Depressant (Xanax, Valium, Etc.) Overdose:
• Slow and shallow breathing • Very sleepy and unable to talk
• Unconscious • Blue lips or fingertips
• Snoring or gurgling sounds
DDAP, 2014
Overdose Prevention
• Recognize the symptoms of an overdose.
• Call 911 immediately!
• Act quickly to administer rescue breathing.
• Administer Naloxone (Narcan®) if it’s available.
DDAP, 2014
By Lviatour (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
• Prescription Monitoring Programs: • Reduce Diversion, not demonstrated to
reduce overdose. • Concern about increase in heroin use.
• Methadone and Suboxone treatment: Very effective
• Abstinence-based drug treatment: • Risk of overdose increases when relapse
occurs.
Strategies for Reducing Overdose Deaths
Bell, 2012
– Community Based Education: Risk Factors, Identification of Symptoms, Effective Response, including Rescue Breathing, Calling 911 and Naloxone Administration
– Naloxone Prescription Programs
– Physician Prescribing when prescribing opioids for pain
Strategies for Reducing Overdose Deaths (cont’d)
Bell, 2012
About Naloxone• Naloxone reverses opioid-related sedation
and respiratory depression = pure opioid antagonist– Not psychoactive, no abuse potential– May cause withdrawal symptoms
• May be administered IM, IV, SC, IN• Acts within 2 to 8 minutes• Lasts 30 to 90 minutes, overdose may
return • May be repeated• Narcan® = naloxone• naloxone ≠ Suboxone ≠ naltrexone
Walley, 2013
Prefilled naloxone ampule
Intranasal Administration
Pro• 1st line for some local EMS• RCTs: slower onset of
action but milder withdrawal
• Acceptable to non-users• No needle stick risk• No disposal concerns
Con• Not FDA approved• No large RCT• Assembly required, subject to
breakage • High cost:
– $40-50+ per kit
Mucosal Atomization
Device (MAD) Luer-lock syringe
Walley, 2013
http://www.healthycommunitiesme.org/rx-prevention.html
Intranasal Administration (cont’d)
Walley, 2013
When is Naloxone Prescribed?
1. Patient release after emergency medical care involving opioid OD/intoxication2. Suspected history of illicit or nonmedical opioid use3. High-dose opioid prescription (> 50 mg of morphine equivalence/day)4. Any methadone prescription to opioid naïve patientAny opioid prescription and …a. smoking/COPD/emphysema/asthma or other
respiratory illnessb. renal dysfunction, hepatic disease c. known or suspected concurrent alcohol used. concurrent benzodiazepine prescriptione. concurrent SSRI or TCA anti-depressant prescription
Powers, 2012
When is Naloxone Prescribed? (cont’d)
5. Prisoner released from custody6. Release from opioid detoxification or mandatory
abstinence program7. Voluntary request from patient8. Patients in methadone or buprenorphine
detox/maintenance (for addiction or pain)9. Patient may have difficulty accessing emergency medical
services (distance, remoteness)10. Other reasons?
Powers, 2012
The Prescription Opioid Epidemic
• Deaths due to prescription opioid use have more than tripled in the past ten years across the U.S.
• Prescription opioids have been linked to a significant increase in overdose deaths in Pennsylvania.
CDC, 2014; Sapatkin, 2014
Overdose is Preventable
The best strategy for preventing
overdose is to address SUD or
pain management
issues appropriately
before they lead to overdose.
NIDA, 2014
By Charlesjsharp (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons