Incorporating Overdose Prevention, Recognition, and Response Education into Our Work with IDUs

Incorporating Overdose Prevention, Recognition, and Response Education into Our Work with IDUs Emalie Huriaux, MPH Harm Reduction Coalition dope@harmreduction.org 510.444.6969 x 16

Who We Are • The Drug Overdose Prevention & Education (DOPE) Project • Founded December 2001 • Team of overdose educators • Mission to reduce the number of fatal ODs to zero

What We Do • Trainings for service providers & law enforcement • Trainings in SROs • Trainings at syringe exchange sites • Collaboration with SFDPH • Rotate through 7 sites per month • DOPE trainers pull folks from the line & train them • SFDPH providers give 2 free pre-filled units of naloxone

naloxone (Narcan®) • An opiate antagonist that temporarily reverses the effects of an opiate (heroin) overdose • Traditionally administered by paramedics • Legal, nonscheduled, prescription medication

naloxone prescriptions • Since November 2003, over 700 people have received training and take-home naloxone. • To date, over 180 of these participants have reversed an overdose using naloxone.

OD leading cause of death among IDUs Addressing OD is part of addressing IDU’s overall health & wellness Research shows the risk of OD closely associated with HIV risk HIV risk indicators may prove useful in determining OD risk, illuminating the need to include OD prevention alongside HIV risk reduction efforts. (Ochoa, et al, 2000) Share our model of OD prevention, recognition, and response education Possible venues for education include: HIV test counseling Case management with HIV- and HIV+ clients Needle exchange Why We Are Here

What is an Overdose? • Toxic amount of drug or combination that causes the body to shut down • Heroin & Other Downers (e.g., alcohol, benzos) • Breathing slows and stops, then heart stops • Stimulants (e.g., cocaine, speed) • Heart speeds up, body temp rises, resulting in seizure, heart attack, stroke

Mixing Use one drug at a time If mixing, reduce amounts of everything Don’t mix alcohol with heroin/pills If drinking with heroin, do shot first RISKS & PREVENTION

Tolerance Use less after leaving detox, jail, or when sick HCV+ and HIV+ individuals may be at a higher risk for experiencing OD Do tester shot RISKS & PREVENTION

Quality Try to use the same dealer Do tester shot RISKS & PREVENTION

Using Alone Fix with a friend Leave door unlocked Call someone trusted RISKS & PREVENTION

Assessing Downer Overdose How do you tell if someone is really high vs. having an overdose? HIGH “the line”=UNRESPONSIVE OVERDOSING

Signs of Overdose • Unresponsive (shouting, pain won’t awaken) • Unconscious • Breathing slow or shallow (<12/minute) • Pale, clammy, loss of color • Blue or gray (esp. lips or nails) • Loud, uneven snoring/gurgling • Not breathing • Faint or no pulse

Stimulation • NOISE • PAIN (sternum rub) • Are they responsive?

Call 911 • Quiet down the scene • Be calm, speak clearly • Don’t argue • Tell ‘em • Exact address • Victim unconscious • Victim not breathing or blue

Call 911 (con’t.) • You DO NOT have to tell 911 • Your name (give an AKA if you’re worried) • That it’s an overdose • That drugs are involved • Do tell the paramedics, once they arrive, everything you know

Airway • Head Tilt / Chin Lift • Look for chest rise/fall with your eyes • Listen for breath with your ear • Feel for air with your cheek

Rescue Breathing • Head Tilt / Chin Lift • Pinch nose • 2 slow breaths and check chest • Keep at it • 1 breath every 5 seconds

If You Leave for Any Reason Put the person in the recovery position Put the left arm across the chest, so that the back of the hand rests against the cheek Put the right hand by the head (as if they were waving) Hold the hand in place and lift up the left knee Turn the person on their side by pushing down on the knee

If You Have Naloxone EVALUATE • Has the person resumed breathing? • Can you get to the naloxone?

Naloxone – IM Injection • Assemble 1 dose • Muscle shot, either • Shoulder (deltoid) • Butt (gluteus) • Thigh (quads) KEEP BREATHING FOR THEM

Evaluate & Support • Is a 2nd shot needed? • Inform them what happened • Stay with them (2-3 hours)

How to Incorporate OD Information In Your Work • Discussion

THANK YOU • Our amazing participants • Rachel McLean, MPH, Founder, The DOPE Project • Kristin Ochoa, MD, Los Angeles Overdose Taskforce • Josh Bamberger, MD, S.F. Department of Public Health • Peter Davidson, PhD (c), U.C. San Francisco • Mary Howe, Homeless Youth Alliance/S.F. Needle Exchange • Naloxone Advisory Group • All the DOPE Project trainers and service providers we’ve worked with over the years!

Incorporating Overdose Prevention, Recognition, and Response Education into Our Work with IDUs