Naloxone in Schools. Training for School Staff

Transcription

1 Naloxone in Schools Training for School Staff

2 Objectives Learn the signs and symptoms of opioid drug overdose Have the skills to administer naloxone Review the use of naloxone protocol in responding to a opioid drug overdose

3 WHAT IS THE RISK?

4 The Opioid Epidemic Young adults (age 18 to 25) are the biggest abusers of prescription opioid pain relievers, ADHD stimulants, and anti-anxiety drugs (National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2016)

5 The scariest thing I ever hear a parent say about drug abuse is Not My Kid. Dr. Drew Pinsky

6 Commonly Abused Prescription Drugs Opioids (for pain) Stimulants (ADHD medicines) Benzodiazepines/ CNS Depressants (for anxiety and sleep disorders)

7 You May Know Them As Benzodiazepines Xanax Valium Nembutal Opioids Hydrocodone Vicodin Percocet Oxycontin Demerol Fentanyl Stimulants Ritalin Concerta Adderall Dexadrine

8 Most teens get their hands on prescription drugs from the homes of friends and relatives (Driscoll-Malliarakis, 2009)

9 Misuse and abuse of prescription medicine continues to be the third most prevalent drug abuse behavior measured among teens, following use of marijuana and alcohol (Partnership for Drug-Free Kids, 2013)

10 Why Kids Abuse Prescription Medicines? Easy access Perceive them to be safer To get high To help them study To relieve stress and anxiety To experiment To fit in (Partnership for Drug-Free Kids, 2013)

11 Important to understand the body doesn t know the difference Opioid Opioid From a prescription From heroin

12 The Opioid Epidemic In 2014, 467,000 adolescents were current nonmedical users of pain reliever, with 168,000 having an addiction to prescription pain relievers (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2015) Graphic source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 2016

13 The Opioid Epidemic A trend exists for adolescents who are using prescription opioid agents is to substitute heroin because it is significantly cheaper than pills (approximately half of the cost) and is often more readily available (Fogger & McGuinness, 2015)

14 There has been a significant rise in the number of people aged 12 and older who received treatment for a heroin problem from 277,000 in 2002 to 526,000 in 2013 (Substance Abuse and Mental Health Services Administration, 2015)

15 Opioid Overdose Opioid drug attaches to brain receptors that affect breathing Person slows breathing and eventually stops breathing Oxygen starvation eventually stops other vital organs like the heart, then the brain (National Institute on Drug Abuse, 2014)

16 Overdose vs. High Opioid High Relaxed muscles Speech slowed, slurred, breathing Appears sleepy, nodding off Responds to stimuli Normal heart beat/pulse Normal skin color Opioid Overdose Pale, clammy skin Speech infrequent, not breathing, very shallow breathing Deep snorting or gurgling Unresponsive to stimuli (calling name, shaking, sternal rub) Slowed heart beat/pulse Cyanotic skin coloration (blue lips, fingertips) Pinpoint pupils (Adapted from Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution)

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18 Missouri RSMo RSMo Allows for the administration of opiod antagonists or naloxone (Narcan) to another person to prevent an opioid/heroin dose from becoming fatal. Includes Good Samaritan provision shielding people from prosecution when seeking to help someone who overdoses from heroin/opioids.

19 Narcan Administration Protocol 4 Rs Recognize Respond Reverse Refer

20 RECOGNIZE

21 Recognize Observe individual for signs and symptoms of opioid overdose Suspected or confirmed opioid overdose consists of: Respiratory depression evidenced by slow respirations or no breathing (apnea) Unresponsiveness to stimuli (such as calling name, shaking, sternal rub)

22 Suspicion of Overdose Suspicion of opioid overdose can be based on: Presenting symptoms History Report from bystanders School nurse or staff prior knowledge of person Nearby medications, illicit drugs or drug paraphernalia

23 RESPOND

24 Respond Immediately call for help Call for help Dial 911 Request Advanced Life Support

25 Rescue Breathing Perform rescue breathing if needed 1. Place the person on their back 2. Tilt their chin up to open the airway 3. Check to see if there is anything in their mouth blocking their airway, such as gum, toothpick, undissolved pills, syringe cap, cheeked Fentanyl patch If present, remove it

26 Rescue Breathing 4. If using mask, place and hold mask over mouth and nose 5. Give 2 even, regular-sized breaths 6. Blow enough air into their lungs to make their chest rise 7. If you are using a mask and don t see their chest rise, out of the corner of your eye, tilt the head back more and make sure the seal around the mouth and nose is secure 8. Breathe again 9. Give one breath every 5 seconds

27 Rescue Breathing If not using mask, pinch their nose with one hand and place your mouth over their mouth Give 2 even, regular-sized breaths Blow enough air into their lungs to make their chest rise If you are not using a mask and don t see their chest rise, out of the corner of your eye make sure you re pinching their nose

28 REVERSE

29 Naloxone Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine, and oxycodone Naloxone is the first line treatment for an opioid overdose Naloxone is the generic name of the medication

30 Graphic credit: Maya Doe-Simkins

31 Graphic credit: Maya Doe-Simkins

32 Administer Narcan (naloxone) PEEL back the package to remove the device PLACE the tip of the nozzle in either nostril until your fingers touch the bottom of the patient s nose PRESS the plunger firmly to release the dose into the patient s nose

33 Administer Narcan Tilt head back and given spray (4 mg) into one nostril If additional doses are needed, give in the other nostril Photo source: Adapt Pharma, 2016

34 How to Administer Narcan Graphic source: ADAPT Pharma, 2015

35 Narcan Packaging Photo source: Adapt Pharma, 2016

36 Photo source: Adapt Pharma, 2016 Do not prime plunger, you may lose ½ the dose of Narcan

37 Remain with the Person Place person in recovery position (lying on their side) Stay with the person until help arrives Seize all illegal and/or nonprescribed opioid narcotics found on victim and process in accordance with school district protocols

38 Recovery Position Photo source: Adapt Pharma, 2016

39 Safety of Using Naloxone Naloxone is the first line treatment for opioid overdose Should be administered IMMEDIATELY Parents & school administrators should not be concerned about adverse health effects of naloxone If the person has not overdosed on an opioid, there is no effect on the body! (Green, Heimer, & Grau, 2008)

40 A delay in administering naloxone could result in death

41 Opioid Withdrawal Using naloxone in patients who are opioid dependent may result in severe opioid withdrawal symptoms such as: Restlessness or irritability Body aches Diarrhea Increased heart rate Fever Runny nose Sneezing Goose bumps Sweating Yawning Nausea or vomiting Nervousness Shivering or trembling Abdominal cramps Weakness Increased blood pressure

42 Risk of adverse reaction should not be a deterrent to administration of naloxone

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44 REFER

45 Refer Have the individual transported to nearest medical facility, even if symptoms seem to get better Contact parent/guardians per school protocol Complete Naloxone Administration Report form Follow up with treatment referral recommendations

46 Be Prepared Everyone should know WHERE the medication is and HOW TO RESPOND

47 Document and Debrief Discuss with the school nurse how to record that you administered naloxone and the symptoms you witnessed Have a debriefing meeting with the nurse and school administration after giving naloxone Talk about how response went Talk about feelings Talk about ways to improve in the future

48 You Can Do It! You know what to do when someone has suffered an opioid overdose You know how to give naloxone!

49 References Fogger, S. & McGuinness, T.M. (2015). Adolescents at Risk Pain Pills to Heroin: Part II. Journal of Psychosocial Nursing, 53(2), Green, T.C., Heimer, R., Grau. L.E. (2008). Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction, 103(6): Harm Reduction Coalition. (n.d.) What is an overdose. Available at: Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution. (n.d.) Opioid Overdose Education and Naloxone Distribution MDPH Naloxone pilot project Core Competencies. Available at: National Institute on Drug Abuse. (2014). Prescription Drug Abuse. How do opioids affect the brain and body? Available at: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2016). Abuse of Prescription (Rx) Drugs Affects Young Adults Most. Available at: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available at