Morrow County Project DAWN June 2016 Morrow County

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* Morrow County Project DAWN June 2016

* Morrow County Project DAWN June 2016

* Morrow County Health Department Kay Benick, RN, BSN

* Morrow County Health Department Kay Benick, RN, BSN

*Drug overdose in Ohio * Unintentional drug overdose is the leading cause of injury-related

*Drug overdose in Ohio * Unintentional drug overdose is the leading cause of injury-related death in Ohio (and the US); ahead of motor vehicle traffic crashes – a trend that began in 2007 * Unintentional drug overdose caused 2, 744 deaths in Ohio in 2014, a nearly 20% increase from 2013 * Ohio had the 5 th highest overdose death rate in the country in 2014 – behind West Virginia, New Mexico, New Hampshire, and Kentucky

* Opioids are sedative narcotics They are used in medicine mainly to relieve pain

* Opioids are sedative narcotics They are used in medicine mainly to relieve pain Opioids repress the urge to breath – When someone is having an opioid overdose they stop breathing and could die

An overdose occurs when an opioid fits in too many opioid receptors in the

An overdose occurs when an opioid fits in too many opioid receptors in the brain resulting in the slowing and then stopping of a person’s breathing. Opioid fits exactly on receptor Opioid receptor on brain *

Naloxone has a stronger affinity to the opioid receptors than opioids like heroin or

Naloxone has a stronger affinity to the opioid receptors than opioids like heroin or Percocet, so it knocks the opioids off the receptors for a brief time. This allows the person to breathe again and effectively reverses the overdose. Naloxone Opioid receptor on brain *

 • Reverses Opioid Drug Overdose • Safely Used for 40 years • Given

• Reverses Opioid Drug Overdose • Safely Used for 40 years • Given by intranasal, IV or IM injection • Works rapidly (2‐ 8 minutes) • Wears off in 30 to 90 minutes #1 Function is to reverse the effects of opioids on the brain and respiratory systems to prevent death *

* • Changes in tolerance • Mixing drugs • Physical health • Previous experience

* • Changes in tolerance • Mixing drugs • Physical health • Previous experience of non‐fatal overdose • Variation in strength and content of “street drugs”

* Overdose affects some individuals directly others indirectly and the society at large Overdose

* Overdose affects some individuals directly others indirectly and the society at large Overdose deaths can be prevented by laypeople and lives can be saved Conversations about overdose prevention and reversal can provide another way for providers and clients to connect and have a rapport

*No Pharmaceutical Effect *No effect if opioids are not present *Few serious negative side

*No Pharmaceutical Effect *No effect if opioids are not present *Few serious negative side effects reported with administration * Prevents complications that result in costly drug overdose‐related hospital stays *

* It is a waste of time to give opioid users naloxone, since they

* It is a waste of time to give opioid users naloxone, since they are not capable of recognizing and managing an overdose. Yes and no. Knowledge Saves Lives The person who receives naloxone will react violently when the medication is administered and his/her overdose is reversed. Not always. Reaction (withdrawal) depends on the level of addiction The fact that drug users can have access to naloxone will postpone their entry into drug treatment, and will also encourage riskier drug use. Not true. Can Provide Access to Treatment.

* There is very little you can do when a person is having an

* There is very little you can do when a person is having an opioid overdose since he/she could die instantaneously Not true. It can take 1‐ 3 hours for someone to die It is really hard to prevent someone from dying from a drug overdose since people usually use drugs in private Not true. Most overdoses are actually witnessed Preventing death due to an overdose is not easy and you have to complete a lengthy, difficult training Not true. Overdose Education and Naloxone Distribution Programs Save Lives

Average, age-adjusted unintentional drug overdose death rate per 100, 000, by county, Ohio residents,

Average, age-adjusted unintentional drug overdose death rate per 100, 000, by county, Ohio residents, 2007 -20121, 2 Ohio Rate: 13. 9 Community-based Project DAWN site Treatment or Hospitalbased PD site 14 Potential/ Developing

* § Education components include: 1. Overdose prevention techniques 2. Recognizing signs and symptoms

* § Education components include: 1. Overdose prevention techniques 2. Recognizing signs and symptoms of overdose 3. Calling 911 4. Airway and breathing assessment/Rescue breathing/Recovery position 5. Naloxone storage, carrying, and administration in an emergency 6. 7. situation Reporting of overdose and refill procedures Post‐overdose follow‐up care § Program emphasizes the importance of talking with family members. Ohio law permits teaching overdose response techniques including the administration of Naloxone to Naloxone recipients and others who might be in a position to administer it.

* *Kit with 2 doses of 1 mg/1 m. L naloxone hydrochloride in pre‐filled

* *Kit with 2 doses of 1 mg/1 m. L naloxone hydrochloride in pre‐filled needleless syringes, nasal adaptors, breathing masks, instructions, referrals to local substance abuse/dependence treatment/label *Must use 300 MAD adaptor for intranasal use *Total cost=approx. $72. 00

* § Total Cost of Project DAWN Kit = $72. 00 § Medical Cost

* § Total Cost of Project DAWN Kit = $72. 00 § Medical Cost of a Fatal Drug Overdose: $ 2, 980 § Naloxone can prevent complications that result in costly drug overdose‐related hospital stays. In 2008, the average in‐patient treatment charge for a drug overdose was $10, 488.

Atomizer

Atomizer

* Individual at risk * Family Members * Friends * Group (Follow HIPAA Guidelines)

* Individual at risk * Family Members * Friends * Group (Follow HIPAA Guidelines) *

*Naloxone can now be prescribed to a friend, family member or other individual who

*Naloxone can now be prescribed to a friend, family member or other individual who is in a position to provide assistance to an individual who there is reason to believe is at risk of experiencing an opioidrelated overdose. *

Individuals The Bill grants immunity from criminal prosecution for the unauthorized practice of medicine

Individuals The Bill grants immunity from criminal prosecution for the unauthorized practice of medicine and certain drug offenses to a family member, friend, or other individual who is in a position to assist an individual who is apparently experiencing or at risk of experiencing an opioid‐related overdose if all of the following apply: 1. The individual acts in good faith 2. Obtains naloxone or prescription for naloxone from a licensed health professional 3. The individual summons emergency services either immediately before or after administering the naloxone to the individual who is apparently experiencing an opioid‐related overdose *

* If you are not a Law Enforcement Agency, you must have a current

* If you are not a Law Enforcement Agency, you must have a current Unlimited Category II or III Terminal Distributer of Dangerous Drugs issued by the Ohio Board of Pharmacy to purchase Naloxone and keep it onsite at your facility.

*Storage and Temperature Control for Naloxone Store at room temperature (between 68 and 77

*Storage and Temperature Control for Naloxone Store at room temperature (between 68 and 77 degrees Fahrenheit Keep out of bright light Do not leave in car for long periods of time Do not expose to extreme heat or cold

*Shelf Life for Naloxone All doses should be checked periodically to ensure that the

*Shelf Life for Naloxone All doses should be checked periodically to ensure that the naloxone is not adulterated. A dose of naloxone is considered adulterated when: a) It is beyond the manufacturer’s or distributor’s expiration date; and/or b) There are signs of discoloration or particulate matter in the naloxone solution !Do not use the dose if it adulterated!

* In order to keep track of expiration dates, clinics and law enforcement agencies

* In order to keep track of expiration dates, clinics and law enforcement agencies should keep careful records of when and to whom the medication was dispensed.

*How can you identify an opioid overdose? The person who is overdosing exhibits the

*How can you identify an opioid overdose? The person who is overdosing exhibits the following symptoms: • Blue skin tinge (usually lips and fingertips show first) • Body very limp • Face very pale • Pulse (heartbeat) is slow, erratic, or not there at all • Throwing up • Passing out • Choking sounds or gurgling/snoring sounds • Breathing is very slow, irregular, or has stopped • Awake, but not able to respond

*OD Response Step 1: Assess • Step 1: Assess the signs to confirm person

*OD Response Step 1: Assess • Step 1: Assess the signs to confirm person is experiencing an overdose • • Unresponsive No signs of breathing or breathing is shallow Snoring or gurgling noises Fingernails and/or lips blue or ashen depending on skin color

*OD Response Step 2: Stimulate *Step 2: Stimulate the person * Call out to

*OD Response Step 2: Stimulate *Step 2: Stimulate the person * Call out to the victim * Do a sternal rub * Rub knuckles hard up and down the breast bone

*OD Response Step 3: Activate EMS * Simply say, “I have someone who is

*OD Response Step 3: Activate EMS * Simply say, “I have someone who is not breathing and is unresponsive” * If you feel comfortable, inform of overdose

*OD Response Step 4: Rescue breathing * Place person on their back * Lift

*OD Response Step 4: Rescue breathing * Place person on their back * Lift the chin to open their airway * Remove any objects from mouth that could block the airway * Pinch the nose and give two strong breaths, enough to see the chest rise

*OD Response Step 5: Administer Naloxone • Step 5: Administer naloxone • Pop off

*OD Response Step 5: Administer Naloxone • Step 5: Administer naloxone • Pop off PURPLE cap attached to naloxone vial and two YELLOW caps attached to the delivery device • Screw on nasal atomizer • Gently screw naloxone vial into delivery device • Administer entire vial by spraying half of the medication into one nostril and half into the other nostril

*OD Response Step 6: Monitor and support • If the victim has not become

*OD Response Step 6: Monitor and support • If the victim has not become responsive and begun breathing on their own: • Continue to provide rescue breathing • After two minutes with no response, administer second dose of naloxone • If still unresponsive, continue to provide rescue breathing until EMS arrives

*OD Response Step 6: Recovery Position The recovery position: • If the person must

*OD Response Step 6: Recovery Position The recovery position: • If the person must be left alone-even for a few minutes-put him/her into the recovery position to avoid choking • Place person on their side • Top leg bent at the knee, bottom leg straight out • Bottom arm extended straight above head, top arm bent at the elbow with hand under face as if it were a pillow

*Recovery Position

*Recovery Position

*OD Response Step 6: Monitor and support Naloxone only lasts between 30 -90 minutes,

*OD Response Step 6: Monitor and support Naloxone only lasts between 30 -90 minutes, but opioids may last much longer • Important that victim is monitored by medical professionals as an individual can fall back into an overdose as the naloxone wears off • Similarly, important that victim does not use again after awakening from overdose • Withdrawal symptoms from naloxone will subside after 30 -90 min

*Response Steps • Assess • Stimulate • Activate EMS • Rescue breathing • Administer

*Response Steps • Assess • Stimulate • Activate EMS • Rescue breathing • Administer naloxone • Monitor and support • May include additional dose of naloxone • May include continued rescue breathing • Recovery position

*Use the program registration or refill form provided *Have each training participant print their

*Use the program registration or refill form provided *Have each training participant print their name on the registration/refill form *Assign a Client ID # and fill in the site number *Make sure participant completes the entire form *Provide assistance with the form as needed *Complete the prescription label for the kit *Each kit MUST have a prescription label *Individuals MUST complete the training in order to receive a kit *

*Keep registration and refill forms on file according to agency HIPAA protocol *Enter data

*Keep registration and refill forms on file according to agency HIPAA protocol *Enter data into electronic version of form and submit to ODH by the 5 th of each month *Submit tracking data to Morrow County Health Department by the 5 th of each month *

*The Medical Director will determine how many refills will be available to each participant

*The Medical Director will determine how many refills will be available to each participant through Project DAWN *Individuals are encouraged to request a refill and report when they have used a kit *Use the same Client ID # for registration and refills *

* *Paper Forms *Electronic Forms

* *Paper Forms *Electronic Forms

*Find all program materials at the Morrow County Health Department website: www. morrowcountyhealth. org

*Find all program materials at the Morrow County Health Department website: www. morrowcountyhealth. org *

* Kay Benick, RN, BSN Project Manager Morrow County Health Department (419) 947‐ 1545,

* Kay Benick, RN, BSN Project Manager Morrow County Health Department (419) 947‐ 1545, ext. 318 kay. benick@morrowcountyhealth. org

* www. healthy. ohio. gov/vipp/drug/Project. DAWN

* www. healthy. ohio. gov/vipp/drug/Project. DAWN