Overdose Prevention, Recognition, and Response
MISSION Centering harm reduction in Arizona through participant-driven advocacy, education, and outreach HOW WE DO IT ● Statewide Overdose Prevention and Naloxone Distribution Program ● Comprehensive Harm Reduction Education and Outreach Program ● In-depth Trainings on HIV/HCV, Stimulants, Needlestick Prevention, Stigma, & more Local and Legislative Advocacy ●
OVERVIEW • Harm Reduction & Stigma • National and State Overdose Trends • The Drugs • Overdose Prevention, Recognition & Response • Next Steps
HARM REDUCTION
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE 19.3 Million did not receive substance use treatment at a specialty facility 18.3 Million did not perceive a need for treatment
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS HARM REDUCTION? A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. https://harmreduction.org/about-us/principles-of-harm-reduction/
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT DOES HARM REDUCTION DO? Centers people who use drugs as more than their drug use and as experts on their own care. Recognizes that drug use and recovery is complex and exists along a continuum. For some, drugs meet important needs so drug-related harm cannot be assumed and abstinence can be just one of many possible goals. Aims to meet people “where they’re at” by supporting ANY positive change. Harm reduction does not aim to minimize real harm related to substance use.
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE HARM REDUCTION IN ACTION DRUG USE SEX WORK HIV/HCV ● Needle ● Screening clients ● Access to testing ● Not sharing exchanges ● Peer-education equipment ● Wound care ● Safe sex supplies ● Or only sharing ● Take-home ● Condom with others who Naloxone negotiating skills have the same ● Fentanyl testing ● The buddy system status strips ● Knowing ● Reducing alcohol ● MAT boundaries consumption for ● Supervised HCV consumption sites ● PEP, PrEP, Antiretrovirals ● Bleach kits
STIGMA
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS STIGMA Stereotype: a negative belief about a group (dangerousness, laziness, moral weakness) Prejudice: Agreement with belief + negative emotional reaction (fear, anger) Discrimination: Behavior response to prejudice (avoidance, withhold access to basic needs/help) Stigma permeates every aspect of a marginalized person’s life – relationships, health care, housing, employment, and education.
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS STIGMA • Stigma from individuals – “Junkies” • Institutional stigma – HCV tx excluding current users • Self-stigma (internalized) – “I don’t deserve anything good” • Stigma by association – Married to a person who uses drugs
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE HEALTH DISPARITIES Hepatitis C – 33% of young PWID, 70-90% of older & former PWID (CDC) HIV – Global prevalence among PWID 28x higher • 50-90% of PWUD living with HIV also have HCV Trauma - In surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposure Nutrition - Lower average weight than controls Arrest - 1,488,707 drug arrests in 2015 (84% possession) Incarceration - 2,224,400 in 2014 Education – Financial aid denied for students w/ drug convictions http://www.drugpolicy.org/press-release/2017/09/new-fci-report- shows-drug-arrests-increased-2016-drug-war-rages
TRENDS
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE NATIONAL TRENDS • Overdose > motor vehicle accidents • 70,000+ deaths in 2017 • Rural, veterans • Death most likely in first 28 days after leaving inpatient https://www.dea.gov/press-releases/2018/11/02/dea-releases-2018-national-drug-threat-assessment-0 https://www.cdc.gov/drugoverdose/data/statedeaths.html https://www.mdedge.com/emergencymedicine/article/132735/toxicology/who-overdoses-opioids-va-emergency-departm ent https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE
OVERDOSE NALOXONE HARM REDUCTION STIGMA TRENDS DRUGS
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE ARIZONA TRENDS • 2017 – 949 opioid related deaths • Age group – 42% 25-44 y.o. • Over 51,000 opioid-related encounters costing $431 million • 4 Arizonans a day die of OD • Mohave, Pima, Graham, Gila https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-o pioid-emergency-response-report.pdf https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioids/index.php# dashboard
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE
DRUGS
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS SUBSTANCE USE DISORDER? • A DSM V recognized mental health disorder • Can be mild, moderate, or severe • Does not occur in every person who uses drugs, or even every person who becomes physically dependent • Often related to social determinants of health, past or current abuse and trauma • Can be a coping mechanism for some people https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525418/
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE OPIOIDS Types • Heroin • Prescription opioids (licit and illicit use) – Hydrocodone (Vicodin), Oxycodone (Oxycontin, Percocet), Hydromorphone (Dilaudid), Morphine, Methadone, Fentanyl, Codeine • Methadone used in opioid replacement therapy Effects • Chronic and acute pain relief; cancer and non-cancer pain • Cough suppression (often codeine) • Sleep • Euphoric feelings • Relaxation
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE FENTANYL Facts • Most fentanyl found in street drugs is produced illegally • Fentanyl is usually added to the drug supply before it enters the US • The CDC reports a 200% increase (between 2000 and 2014) in the rate of overdose deaths involving opioids, including an 80% increase in fatal overdoses involving fentanyl and other synthetic opioids in only one year • It is often impossible to tell if a drug is laced with fentanyl unless you test it http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE FENTANYL Myths • You can overdose and die from touching fentanyl • People who know there is fentanyl in their drugs do not care and will not change their behavior • Naloxone can’t save you from a fentanyl overdose • Fentanyl overdoses are different from other opioid overdoses http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE FENTANYL
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE NON-OPIOID DEPRESSANTS Types • Benzodiazepines – Klonopin, Xanax, Valium, Ativan • Sleep Aids – Ambien, Lunesta • Muscle Relaxers – Somas, Flexeril Effects • Sedative, sleep-inducing, anti-anxiety, anticonvulsant, muscle relaxing properties. • Useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol & opioid withdrawal • Enhance the effects of heroin, alcohol, and marijuana
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE STIMULANTS Types • Cocaine – powdered and crack • Meth/Speed • Prescription stimulants – Ritalin, Adderall Effects • Historically used to treat asthma & other respiratory problems, obesity, neurological disorders • Prescribed for the treatment of narcolepsy, ADHD, and depression that has not responded to other treatments • Increased alertness, attention, & energy, elevate blood pressure, increase heart rate and respiration, constrict blood vessels, increase blood glucose
OVERDOSE
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS A STIMULANT OVERDOSE? • Also known as “overamping” • Not as cut and dry as an opioid overdose, more unpredictable & harder to define • Can be physical, psychological, or both • Likelihood of stimulant OD often tied to a person’s physical health – pre-existing high blood pressure or heart disease, lack of sleep, nutrition, hydration https://harmreduction.org/issues/overdose-prevention/overview/stimulant-overamping-basics/
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE HOW TO RESPOND TO A STIMULANT OVERDOSE • First, figure out what is needed, medical assistance , or support and rest ? • There is no “antidote” to a stimulant OD, like Naloxone. • A stimulant OD can result in serious medical emergencies like seizure, stroke, overheating or heart attack.
HARM REDUCTION STIGMA TRENDS DRUGS OVERDOSE NALOXONE WHAT IS AN OPIOID OVERDOSE?
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