Overdose Prevention, Recognition, and Response MISSION Centering - - PowerPoint PPT Presentation

Overdose Prevention, Recognition, and Response

MISSION

Centering harm reduction in Arizona through participant-driven advocacy, education, and outreach

• 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

HOW WE DO IT

OVERVIEW

• Harm Reduction & Stigma
• National and State Overdose Trends
• The Drugs
• Overdose Prevention, Recognition &

Response

• Next Steps

HARM REDUCTION

19.3 Million

did not receive substance use treatment at a specialty facility

18.3 Million

did not perceive a need for treatment STIGMA HARM REDUCTION 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

• n a belief in, and respect for, the rights of people who use

drugs.

https://harmreduction.org/about-us/principles-of-harm-reduction/

STIGMA HARM REDUCTION 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.

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

HARM REDUCTION IN ACTION

DRUG USE

• Needle

exchanges

• Wound care
• Take-home

Naloxone

• Fentanyl testing

strips

• MAT
• Supervised

consumption sites SEX WORK

• Screening clients
• Peer-education
• Safe sex supplies
• Condom

negotiating skills

• The buddy system
• Knowing

boundaries HIV/HCV

• Access to testing
• Not sharing

equipment

• Or only sharing

with others who have the same status

• Reducing alcohol

consumption for HCV

• PEP, PrEP,

Antiretrovirals

• Bleach kits

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

STIGMA

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.

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

• 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

WHAT IS STIGMA

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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

HEALTH DISPARITIES

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

TRENDS

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/

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

TRENDS HARM REDUCTION STIGMA DRUGS OVERDOSE NALOXONE

• 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

ARIZONA TRENDS

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

DRUGS

• 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/

WHAT IS SUBSTANCE USE DISORDER?

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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

OPIOIDS

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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

FENTANYL

http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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
• verdose
• Fentanyl overdoses are different from other
• pioid overdoses

FENTANYL

http://www.drugpolicy.org/sites/default/files/Synthetic-Opioids-Fact-Sheet.pdf

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

FENTANYL

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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

NON-OPIOID DEPRESSANTS

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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

STIMULANTS

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

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/

WHAT IS A STIMULANT OVERDOSE?

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

• 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

• r heart attack.

HOW TO RESPOND TO A STIMULANT OVERDOSE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

WHAT IS AN OPIOID OVERDOSE?

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

LOCATION OF SUSPECTED OVERDOSE

http://azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioid-re port.pdf

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

High Overdosed

Muscles become relaxed Pale or gray, clammy skin Speech is slowed or slurred Breathing is infrequent or has stopped Sleepy looking Deep snoring, gurgling, or rattling Responsive to shouting, sternal rub, or earlobe pinch Unresponsive to any stimuli Normal heart rate and/or pulse Slow or no heart rate and/or pulse Normal skin tone Blue or gray lips and/or fingertips

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RISK FACTORS FOR OVERDOSE

• Mixing drugs
• Variation in purity
• Tolerance changes
• Using alone
• Physical health

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

NALOXONE/ NARCAN

RESPONDING: NARCAN/NALOXONE

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

ARIZONA NALOXONE LAWS

• HB 2489 (2015), HB 2355 (2016), HB 2493 (2017)

A.R.S. 36-2266 & 36-2267

• Protects prescribers from certain liabilities
• Allows for standing order
• Allows for 3rd party prescription
• Protects person who administers medication

A.R.S. 32-1979

• OTC pharmacy sale
• Pharmacy board must create rule

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

NALOXONE MYTHS

• “Naloxone encourages drug use.”
• “It sends the wrong message!”
• “It could hurt somebody not overdosing.”
• “Reversal requires medical professional.”
• “But in Pulp Fiction…”

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm https://prescribetoprevent.org/wp2015/wp-content/uploads/PHLRKnowledgeAsset_Naloxone_FINALfull_8J une15.pdf

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RESPONDING TO AN OPIOID OVERDOSE

• 1. Sternum rub
• 2. Call 911
• 3. Administer naloxone, if on

hand

• 4. Rescue breathe

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RESPONDING: NARCAN

• Administer one dose
• Return to rescue breathing
• Should work within 2 minutes; if it doesn’t,

give 2nd dose

• Narcan can wear off within 45-90 minutes –
• verdose could reoccur
• Transfer care to EMS, otherwise stay with

person and observe 3 hours

• 911 should always be called first!!

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RESPONDING: RESCUE BREATHING

• One hand tilting

forehead back and plugging nose

• Other hand on chin
• pening mouth
• Create a seal with

your mouth around their mouth

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RECOVERY POSITION

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

INTRAMUSCULAR NARCAN INTRANASAL NARCAN

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

WHO SHOULD HAVE NALOXONE?

• CDC: 83% of people who administered

naloxone were people who use drugs (2015)

• Friends and family
• Law enforcement
• Jails, prisons, probation
• Treatment centers, sober living
• Homeless shelters & services

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

AFTER THE OVERDOSE

• “Ungrateful that I saved their life”
• ONE person communicating, explain what

happened

• Prevention messages – what happened

this time and how can we keep it from happening again?

• Get OD survivor and their family Naloxone
• Could be a good time to talk treatment and

support options

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

WHERE?

WHERE TO INCORPORATE?

• Street-based outreach
• Peer distribution
• Co-prescribing
• Treatment centers, jails distribute upon

release

• Probation/Parole Officers distribute to clients
• EMS and hospital distribution/prescription
• Pharmacist-initiated distribution

SPW NUMBERS Sep 2016-May 2019 233,192 Doses of Naloxone 7,251 Overdose Reversals

STIGMA HARM REDUCTION TRENDS DRUGS OVERDOSE NALOXONE

RESOURCES

• Harm Reduction Coalition -

http://harmreduction.org/issues/overdose-pre vention/

• Drug Policy Alliance -

http://www.drugpolicy.org/drug-overdose

• Overdose Prevention Alliance -

http://overdoseprevention.blogspot.com/

• Prescribe to Prevent -

http://prescribetoprevent.org/

Thank you

STAFF NAME Overdose Prevention Coordinator STAFF CONTACT INFO www.spwaz.org