The Fight-or-Flight Response Fact Sheet What is the fight-or-flight response? The fight-or-flight response is one of the tools your body uses to prote

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16 The Fight-or-Flight Response Fact Sheet What is the fight-or-flight response? The fight-or-flight response is one of the tools your body uses to protect you from danger. When you feel threatened, the fight-or-flight response is automatically triggered, and several physiological changes prepare you to either confront or flee from the threat. What are the symptoms of fight-or-flight? Increased heart rate Dizziness or lightheadedness Shaking Racing thoughts Nausea / butterflies in stomach Sweating Difficulty concentrating Rapid, shallow breathing Tensed muscles How is the fight-or-flight response triggered? Even threats to emotional well-being, such as the fear of embarrassment before giving a presentation, can trigger the fight-or-flight response. In these cases, the symptoms often do more harm than good. An increased heart rate and sweating might help you escape from a bear, but they won t do much to help you look cool and collected during a presentation. Is the fight-or-flight response bad? Everyone will experience the fight-or-flight response at times, to varying degrees. Usually, it s natural, healthy, and not a problem. However, when the fight-or-flight response leads to excessive anger, anxiety, prolonged stress, or other problems, it might be time to intervene. How can I manage the fight-or-flight response? In addition to the fight-or-flight response, your body can also initiate an opposing relaxation response. Many symptoms of the relaxation response counteract fight-or-flight, such as slower and deeper breathing, relaxed muscles, and a slower heart rate. The relaxation response can be triggered by using relaxation skills, such as deep breathing or progressive muscle relaxation Therapist Aid LLC Provided by TherapistAid.com

17 What is Trauma? Trauma: A powerful emotional response to a distressing event, such as war, an accident, the unexpected loss of a loved one, or abuse. Trauma can continue to cause both emotional and physical symptoms for many years after the event has concluded. Trauma Risk Factors The traumatic experience was unexpected. The victim has experienced past traumas. The experience happened repeatedly, or over a prolonged period of time. The trauma occurred during childhood. Feeling of helplessness during the experience. The victim is dealing with other major stressors, unrelated to the trauma. Symptoms of Trauma Everyone s experience with trauma is unique. Some people will develop every symptom, while others develop very few. The following list of symptoms is not comprehensive, and should not be used to form a diagnosis. avoidance of trauma reminders, including memories flashbacks to the traumatic event exaggerated startle response distressing dreams and other sleep problems irritability, anger, and other negative emotions self-blame regarding the traumatic event Treating Trauma Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is a common and well-supported treatment for trauma disorders. CBT works by identifying and challenging unhealthy thinking patterns that contribute to the symptoms of trauma. The benefits of CBT can be long-lasting. Exposure Therapy During exposure therapy, the patient is exposed to reminders of their trauma in a gradual and safe way. With enough exposure, the trauma begins to lose its emotional power, and the symptoms diminish. Exposure therapies have extensive research support. Medication Medication may be used to manage the symptoms of trauma, such as anxiety, depression, and insomnia. Medication can be especially valuable when a person s symptoms are so intense that they are unable to participate in psychotherapy. Other Treatments Many other treatments, such as Narrative Exposure Therapy, Eye Movement Desensitization and Reprocessing (EMDR), and group therapy have all been found to be helpful for survivors of trauma. It s always ok to ask your therapist what treatments they use Therapist Aid LLC Provided by TherapistAid.com

18 7/25/2018 Opioid Overdose Education/ Prevention Training A LIFE SAVED APP FOR RESCUE IN TEXAS TONI 1

19 7/25/2018 MISSION To decrease the adverse impact of opioids on Texas residents, with an immediate emphasis on reducing overdose mortality through best practices and providing greater access to opioid overdose medication such as Naloxone/Narcan. WORKSHOP GOAL To provide an introduction to the basics of overdose prevention and education to the peer recovery community so that we may better engage with individuals that we may be working with that are experiencing difficulty with opioids. How to Recognize- Respond-Evaluate an opioid overdose. 2

20 7/25/2018 TRAINING OBJECTIVES By the end of this workshop, you will be able to: 1. Identify what are opioids are and how to explain differences and similarities. 2. Explore how opioids work in the brain 3. Define three major risk factors for opioid overdose TRAINING OBJECTIVES 4. What are the signs of an opioid overdose 5. How to respond to an opioid overdose 6. The role of Naloxone/Narcan in negative opioid events 7. The law in Texas OVERDOSES HAVE BECOME THE LEADING CAUSE OF UNINTENTIONAL DEATHS IN THE UNITED STATES. SAMHSA, CDC, NIDA, AMA,ONDCP, HHS, DEA AND MANY OTHERS HAVE CALLED THIS THE EPIDEMIC OF OUR GENERATION TONI Charles Thibodeaux Mark Kinzly 3

21 7/25/2018 TEXAS CDC DEATH DATA Texas Year Deaths Crude Rate Age Adjusted Rate TRAVIS COUNTY NARCAN ADMINISTRATION DEMOGRAPHICS

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23 7/25/2018 Question: What caused the epidemic in deaths related to opioid overdoses? Answer: There were several causes, but the predominant cause was the decrease in opioid prescriptions to individuals who were already addicted, causing them to switch to injection drug use and to street drugs like heroin, and ultimately to overdose and die. The National Picture Prior to 2011, overdoses from any type of opioid had risen only slowly. In 2011, the first time opioid prescriptions decreased from the year before, overdose deaths suddenly spiked by more than 7% a singleyear increase not seen since the mid-2000 s. In 2012, the decrease from the prior year was reversed, and national prescribing of opioids increased slightly. That same year, the overdose death rate was essentially flat. In 2013, the decrease in opioid prescriptions resumed and overdose deaths again spiked again by more than 7%. From 2014 and forward, the opioid prescription rate decreased every year and the overdose death rate grew by more than 13% every year. 6

24 7/25/2018 Solution: Do not impose policy changes that will cause opioidaddicted patients to abruptly be cut off without a safety net of medication assisted treatment and other recovery services. Additionally, allow primary care physicians to slowly wean addicted patients off of opioid painkillers rather than requiring doctors to cut patients off abruptly if the patient is suspected of having an addiction problem. ***In short, one (1) fewer person is dying from prescription opioids, but nearly four (4) additional people are dying from Heroin + Fentanyl ***In the absence of universally available Medication Assisted Treatment (MAT), which all states severely lack, rather than saving lives, our policies are now killing four times as many people as they are saving 7

25 7/25/2018 WHAT ARE OPIOIDS Opioids include: heroin, morphine, codeine, methadone, oxycodone (Oxycontin, Percodan, Percocet), hydrocodone (Vicodin) fentanyl (Duragesic), and hydromorphone (Dilaudid) illicitly-made fentanyl (IMF) Naloxone does not work for- Non-opioid sedatives: Valium, Xanax, Clonopin, Clonidine, Elavil, alcohol Stimulants: cocaine, amphetamines TONI Charles Thibodeaux Mark Kinzly ARE ALL OPIATES CREATED EQUAL? IN SOME WAYS ALL OPIATES ARE THE SAME AND IN OTHER WAYS THEY ARE DIFFERENT: ALL OPIATES ARE THE SAME IN THAT THEY COME FROM THE OPIUM POPPY OR ARE CHEMICALLY CREATED TO BE LIKE A DRUG WHICH COME FROM THE POPPY; HAVE THEIR EFFECT ON THE SAME PART OF THE BRAIN CAUSE OVERDOSE IN THE SAME WAY IF TOO MUCH IS USED--THIS OVERDOSE COMES IN THE FORM OF STOPPED BREATHING TONI Charles Thibodeaux Mark Kinzly ARE ALL OPIATES CREATED EQUAL? IN SOME WAYS ALL OPIATES ARE THE SAME AND IN OTHER WAYS THEY ARE DIFFERENT: OPIATES ARE DIFFERENT IN THAT THEY: HAVE DIFFERENT CONCENTRATIONS OR STRENGTHS HAVE VARYING DURATIONS OF ACTION SUCH AS.. TONI Charles Thibodeaux Mark Kinzly 8

26 7/25/2018 DURATION OF EFFECTS Methadone: hours Heroin: 6 8 hours Oxycodone: 3 5 hours, except extended release formulations Codeine: 3 4 hours Demerol: 2 4 hours Morphine: 3 6 hours (IMF)Fentanyl: 2 hours, however, also available as a patch, which lasts 3 days not (IMF) TONI Charles Thibodeaux Mark Kinzly MOST COMMONLY USED OPIOIDS 26 Hydrocodone Oxycodone Heroin Levorphanol Codeine Vicodin Demerol OxyContin Morphine Tylenol 3 Darvocet Tylox Fentanyl Percocet Dilaudid Percodan Methadone Opium PAIN RELIEF AND EUPHORIA 9

27 7/25/2018 TOTAL HEALTHCARE COSTS ASSOCIATED WITH OPIOID MISUSE TONI Charles Thibodeaux Mark Kinzly TONI Charles Thibodeaux Mark Kinzly 170 Americans die each day from drug overdose More than half are from prescription drugs alone 10

28 7/25/2018 Loss of Life from Overdose = Plane Crash Every 4 Days TONI Charles Thibodeaux Mark Kinzly 11

29 7/25/2018 WHY WE CAN DO THIS IN TEXAS SB 1462 Third party prescription Standing orders and individual prescriptions Prescriptions written for medical purposes Protection from criminal and civil liability as well as professional disciplinary action, so long as they act in good faith TONI Charles Thibodeaux Mark Kinzly The following is a response vetted by HHSC: Subchapter E of Chapter 483, Texas Health and Safety Code, permits any person or organization acting under a standing order issued by a prescriber authorized by law to prescribe an opioid antagonist to store and distribute naloxone to a person at risk of experiencing an opioid-related drug overdose or to a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid-related drug overdose, as long as the person or organization acting under a standing order does not seek or receive compensation for those actions. This provision acts to permit groups such as nonprofits, drug treatment centers, and other organizations to distribute naloxone to those who might be able to use it to save lives. The law also permits any person to possess naloxone, even if the person does not have a prescription for it. Finally, the law permits any person who acts in good faith and with reasonable care to administer naloxone to anotherperson who the person believes is suffering an opioid-related overdose. Anyone who does so is immune from criminal prosecution, civil liability, and sanction under professional licensing statutes. TONI Charles Thibodeaux Mark Kinzly OPIOIDS ON BRAIN 12

30 7/25/2018 Heroin Sources and Supply Routes 13

31 7/25/2018 Mexican Black Tar Heroin Mexican Brown Heroin & SW Asian South American Heroin, SE Asian, & new Mexican White Heroin TONI Charles Thibodeaux Mark Kinzly Fentanyl related deaths are up 540% nationwide in the last 3 years. 14

32 7/25/2018 HIGH RISK FACTORS: People experiencing homelessness: #1 cause of death People experiencing incarceration: #1 cause of death People entering and exiting treatment for opioid use disorder (OUD) Persons with COPD and other respiratory morbidity People living with HIV/AIDS: 74% higher if HIV+ TONI Charles Thibodeaux Mark Kinzly MORE RISK FACTORS Loss of Tolerance: Regular use of opioids leads to tolerance- more is needed to achieve the same effect (same high). Overdoses occur when people start to use again, following a period of abstinence such as incarceration, detox or drug free drug treatment. Mixing Drugs: Mixing opioids with other drugs, especially depressants such as benzodiazepines (Xanax, Clonopin) or alcohol. They are synergistic - the effect of taking mixed drugs is greater than the effect one would expect if taking the drugs separately or together. Cocaine is a stimulant but in high doses it can also depress the urge to breath. Using alone: When using drugs alone there is no one present to see signs of overdose. As noted above, users are at greater risk of overdosing if recently abstinent or mixing drugs and should try to avoid doing that when alone. Variation in strength of street drugs Street drugs may vary in strength and effect based on the purity of the heroin (or other opioid) and the amount of other ingredients used to cut the drug. Users can use small amounts of new batches or inject slowly enough to get a feel of the quality. TONI Charles Thibodeaux Mark Kinzly WHAT IS AN OVERDOSE/PHYSIOLOGY Generally happens over course of 1-3 hours- the stereotype needle in the arm death is only about 15% Opioids repress the urge to breath decrease response to carbon dioxide -leading to respiratory depression and death Slow breathing>breathing stops>heart stops>circulation of blood to the brain stops 15

33 7/25/2018 CONTINUUM OF AN OVERDOSE Overdose is rarely immediate can happen over 1-3 hours Heavy/ Uncontrollable Nodding Still arousable Snoring or loud breathing Overdose Not responsive Very shallow breathing, gurgling Skin changes, blue lips and nails Fatal Overdose CONTEXT OF OPIOID OVERDOSE The majority of heroin overdoses are witnessed (gives an opportunity for intervention) Fear of police may prevent calling 911 Witnesses may try ineffectual things Myths and lack of proper training=milk/salt Shot/Ice in Genitals Abandonment is the worst response USERS EXPERIENCE About 2% of heroin users die each year- many from heroin overdose 1/2 to 2/3 of heroin users experience at least one nonfatal overdose (once you have overdosed more susceptible to another) 80% have observed an overdose 16

34 7/25/2018 STEP 1: CHECK RESPONSIVENESS 1. FIRST TAP THE PERSON S SHOULDER. IF THAT DOESN T WORK TRY PINCHING AN EARLOBE OR FINGERTIP. TONI Charles Thibodeaux Mark Kinzly 2. ASK ARE YOU OK? SHOUT THE PERSON S NAME; SHOUT WAKE UP! IF NO RESPONSE, CONTINUE. ROLL PERSON ONTO BACK 1. DO THIS AS GENTLY AS POSSIBLE TO AVOID INJURY. TONI Charles Thibodeaux Mark Kinzly OVERDOSE THE CURE FOR A OPIOID/HEROIN OVERDOSE IS OXYGEN, BREATHING SUPPORT AND AIRWAY CONTROL. TONI Charles Thibodeaux Mark Kinzly 17

35 7/25/2018 IF YOU HAVE TO LEAVE SCENE GIVE FIRST AID PUT THEM IN THE RECOVERY POSITION. TONI Charles Thibodeaux Mark Kinzly THE ANTIDOTE Naloxone (Narcan), an injectable or intranasal opioid antagonist will reverse the effects of opioids preventing a fatal overdose. NALOXONE/NARCAN Opioid antagonist which reverses opioid overdose: injectable or intranasal Pushes most other opioids off the receptors, then sits on the receptor preventing it from being activated for minutes Analogy- getting the wrong key stuck in a lock 18

36 7/25/2018 NALOXONE/NARCAN IN ACTION Reverses opiate effects of sedation and respiratory depression Causes sudden withdrawal in the opioid dependent person an unpleasant experience No psychoactive effects low potential for diversion, is not addictive Routinely used by EMS (but often in larger doses) Has no effect if an opiate is not present TONI Charles Thibodeaux Mark Kinzly OVERDOSE: TREAT Narcan/naloxone high affinity! 19

37 7/25/2018 NALOXONE NASAL TONI Charles Thibodeaux Mark Kinzly NALOXONE INTRANASAL SPRAY NALOXONE INTERMUSCULAR - AUTO INJECTOR TONI Charles Thibodeaux Mark Kinzly TONI Charles Thibodeaux Mark Kinzly 20

38 7/25/2018 NALOXONE INTERMUSCULAR - SYRINGE TONI Charles Thibodeaux Mark Kinzly MORE MEDICATION MORE LIVES SAVED X12 = NALOXONE CAN CAUSE WITHDRAWAL IN A PERSON USING OPIOIDS. WITHDRAWAL CAN HARM SOMEONE. TONI Charles Thibodeaux Mark Kinzly MORE THAN ONE SHOT MAY BE NEEDED TO STOP OD AND IF OD RETURNS WHEN NALOXONE WEARS OFF. 21

39 7/25/2018 TONI Charles Thibodeaux Mark Kinzly FENTANYL TESTING STRIP TONI Charles Thibodeaux Mark Kinzly 22

40 7/25/2018 TONI Charles Thibodeaux Mark Kinzly CONTACT INFORMATION Texas Overdose Naloxone Initiative Mark Kinzly ; Charles Thibodeaux ; Naloxonesaved.us 23

41 7/25/2018 RESOURCES getnaloxonenow.org prescribetoprevent.org operationnaloxone.org TONI Charles Thibodeaux Mark Kinzly naloxonesaved.us Texas Overdose Naloxone Initiative Donation Information ative.com/ 24

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