agenda - missouri laboragenda • understanding opioids • opioid overdose: physiology and risk...
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Agenda
• Understanding Opioids • Opioid Overdose: Physiology and Risk Factors
• Opioid Overdose: Signs and Symptoms
• Responding to an Overdose • Getting Naloxone at a Pharmacy
Opiates:
Semi-Synthe0c Synthe0cOpium
Morphine
Codeine
Heroin
Hydrocodone
Hydromorphone
Oxycodone
Oxymorphone
Buprenorphine
Fentanyl
Methadone
Tramadol
Opioids
OpioidsDiffer
Drug Duration Potency
Methadone 24-32 hours ****
Heroin 6-8 hours *****
Oxycontin 3-6 hours *****
Codeine 3-4 hours *
Demerol 2-4 hours **
Morphine 3-6 hours ***
Fentanyl 2-4 hours *********
Chart from OOD Prevention & Reversal Trainers Manual-BPHC
HowOpioidsAreUsed
• Ingested–pillsthatareswallowed• Snorted–heroinorcrushedpills
• Smoked–opiumorheroin
• Injected–heroinorcrushedpills
SignsofOpioidUse
• SedaFon,sleepiness• Slurredspeech• Euphoria• Respiratorydepression• Smallpupils• Nausea,vomiFng• Itching,flushing• ConsFpaFon
ConsequencesofOpioidUse
• Increasedtolerance-needforincreasedamountofopioidsforthesameeffect
• Dependence-theexperienceofwithdrawalsymptomswhenopioidsarestopped
• Progression,asaresultofincreasedtoleranceanddependence,tomorepotentopioidsandmethodsofadministraFon
OpioidWithdrawalSymptoms
• Muscleandjointpain• Runnynoseandeyes• Nausea,vomiFng,abdominalcramps,
diarrhea• Goosebumps,chills,sweaFng• Anxiety,depression,intensecraving• LossofappeFte• Confusion,irritability
OpioidReceptorsintheBrain
From MA BSAS OOD Prevention & Reversal Trainers Manual - BPHC
Opiatesfitperfectlyinopioidreceptorsthroughoutthebrain.
DisFnguishingIntoxicaFonfromOverdose
Intoxication OVERDOSE
Muscles become relaxed Deep snoring or gurgling (death rattle)
Speech is slowed/slurred Very infrequent or no breathing
Sleepy looking Pale, clammy skin
Nodding Heavy nod, not responsive to stimulation
Will respond to stimulation like yelling, sternal rub, pinching, etc.
Slow heart beat/pulse
WhenOverdosesTypicallyHappen
• Dependingontheopioid,anoverdosemayhappen
withinminutesorhours
• Ormayhappenquicklywhenfentanylisinvolved
• AUerperiodsofabsFnence(Forexample,aUer
treatmentstay,hospitalizaFonorincarceraFon)
• Newdealer• NewrouteofadministraFon
TopOverdoseRiskFactors
• Misjudgingbodytolerance(relapseaUerperiodofabsFnence)
• Usinganopioidwithotherdepressantssuchasalcoholorbenzodiazepinesincreasestherisk
• VariaFonofsubstance• Usingdrugswhenalone• Mixingdrugsandalcohol• Poorphysicalhealth• Cocaine/methamphetaminearesFmulantsbutcan
contributetooverdoseriskwhenusedincombinaFonwithopioids
WhatareBenzodiazepines?
• ClassofprescripFondrugsthatdepresscentralnervoussystemandcommonlyusedtotreatanxietyandinsomniaandalcoholdetox
• BenzosareoUenusedincombinaFonwithopioids
• CommonlyusedbenzodiazepinesareXanax,Klonopin,AFvan,Valium,Libriumthataredivertedorsoldillegally
SignsofanOverdose
• BluishorgrayishFnttotheskinandlips• Cold,clammyskin• Shallowbreath,infrequentbreathorno
breath• Deepsnoringorgurgling• Notresponsivetoloudsoundorother
sFmuli,suchasasternalrub• Slowheartbeatorpulse
Overdose:MostCriFcalSigns
• Unresponsiveandunconscious
• Breathingissloworhasstopped
RespondingtoanOverdose
• Call911• Rescuebreathing• Administernaloxone• Staywithperson• RecoveryposiFon
Calling911
• Call911• Say,“Myfriendisunconsciousornot
breathing”• GiveexactlocaFon• Emergencyresponsemaydifferby
community• StaywiththepersonunFlhelparrives
RescueBreathing
Makesurethereisnothinginthemouth
Tiltheadback,liUchin,pinchnose
Giveabreathevery5seconds.
RescueBreathing
• EssenFalforgecngoxygenintothelungs• Theairweexhalehasonly4-5%less
oxygenthantheairweinhale• Wemaybeabletohelpapersonget
enoughoxygenunFlthenaloxonereversestheoverdose
• Ithelpkeepsomeonealiveandavoidbraindamage
RecoveryPosiFon
Ifyoumustleavethepersonwhoisoverdosing,putthemintotherecoveryposiFonsotheywon’tchokeontheirownvomit.
RecoveryPosiFon
WhenanOverdoseHappens
1 2 3 Call 911
Rescue breathing
Administer naloxone
Naloxone
• Naloxone(Narcan)willreversetheeffectsofopioids,reversinganoverdose.• Simplenasalsprayorinjectable• Noeffectotherthanblockingtheopioids• NoadversereacFons• NopotenFalforabuse• NopotenFalforoverdose
NaloxoneFormulaFons
Nasalwithseparateatomizer“MulF-step”
AmphastarPharmaceuFcals
Auto-injector
KaleoInc.
NarcanNasalSpray
“Single-Step”
AdaptPharma
IntramuscularInjecFon
VariousCompanies
Naloxone
• AprescripFonmedicinethatreversesanopioidoverdose,butmaycausewithdrawal
• InjectableandintranasalapplicaFons• Wakesapersonwhoisoverdosingin3-5minutesandlasts30-90minutes
• DoesnothavepsychoacFveeffects–doesnotmakeaperson“high”
Naloxone
• Cannotcauseharm,evenifthepersonisnotoverdosing
• UsedrouFnelybyEMS&EmergencyRooms
• Availableinmostpharmacies
OpioidReceptorsintheBrain:
Opiatesfitperfectlyinopioidreceptorsthroughoutthebrain,especiallyintheareasthatregulatebreathingandsoapersonstopsbreathingandlackofoxygenleadstodeath.
Opioids
naloxone
Heroin
opioidreceptorNaloxonehasastrongeraffinitytotheopioidreceptorsthantheheroin,soitknockstheheroinoffthereceptorsforashortFmeandletsthepersonbreatheagain.
NaloxoneFacts
• Naloxoneisashort-acFngemergencyresponsemedicaFon
• Itseffectscanlastfrom30-90minutes• AUer90minutes,effectsofopioidmayreturndepending
ontheopioidandifthereisenoughdrugsFllinthebloodstream
• Reassurepersonexperiencingtheoverdosethattheymayexperiencewithdrawalsymptoms
• Adviseagainstusingmoreopioidsinceaddingmoreopioidwouldbeextremelydangerousincreasetheriskforre-overdose
HowPeopleRespondtoNaloxone
• MostawakenslowlyaUer2doses,somerequiremore,especiallyifthereisfentanylonboard
• MostoUenpeoplefeelveryconfused,embarrassed-tellthemthattheyhavehadanoverdose;theyweregivennaloxoneandtheambulanceiscoming
• SomeFmespeoplemayexperiencemildtomoderatewithdrawalsymptoms
• Rarelypeoplewillfeelseverewithdrawalsymtoms• Reassurethemthatwithdrawalsymptomswilldiminishasthenaloxonewearsoff
CommunityBystanderNaloxoneRescueReports:Post-NaloxoneWithdrawalSymptoms,1/13–9/16
0%
5%
10%
15%
20%
25%
30%
35%
40%
None "Dopesick" VomiFng IrritableorAngry
PhysicallyCombaFve
MulF-Step1/13-9/16,n=8612
*Morethanonepost-naloxonewithdrawalsymptomcanbereportedperoverdose
TimingIsEverything:TheDuraFonofNaloxoneandtheOpioid
Drug Duration Naloxone wears off in…
Methadone 24-32 hours 30-90 mins Heroin 6-8 hours 30-90 mins Oxycontin 3-6 hours 30-90 mins Codeine 3-4 hours 30-90 mins Demerol 2-4 hours 30-90 mins Morphine 3-6 hours 30-90 mins Fentanyl 2-4 hours 30-90 mins
GecngNaloxoneatthePharmacy
• Manypharmacieshaveastandingorderfor
naloxone
• Manyhavethesingle-stepormulF-stepnasal
naloxone
• Notallpharmaciesareequallypreparedtofill
theprescripFon
GoodSamaritanLaw
TheMissouriGoodSamaritanLawprotectsvicFmsandthosewhocall9-1-1forhelpfromcharge,prosecuFonandconvicFonforpossessionoruseofcontrolledsubstances.
CriFcalInformaFon
MissouriSubstanceAbuseHelpline
1-800-575-7480
hrps://dmh.mo.gov/ada/prescripFon-drug-misuse.html
www.labor.mo.gov/opioids
www.labor.mo.gov/opioids
573-751-3403
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