Facilitator s Manual. Preventing and Responding to an Opioid Overdose THREE-SESSION TRAINING

Transcription

1 Facilitator s Manual Preventing and Responding to an Opioid Overdose THREE-SESSION TRAINING

2 PRAXIS IS A PROGRAM OF THE 200 Reservoir Street Needham Heights, MA Telephone: Fax: Praxis@center4si.com Website: PRAXIS STAFF Cheryl Gagne, project director cgagne@center4si.com Marc Dones, trainer Ann Young, project coordinator ACKNOWLEDGEMENTS Praxis would like to acknowledge Jim Hogan and Mindy Domb who developed the curriculum while working for SPHERE, a program of Health Imperatives. FEEDBACK Praxis would like to know about your experience using this curriculum. We would like to hear from you with any suggestions for improving it. or call with your feedback. NEED HELP? Praxis is available to help BSAS-funded programs and providers to use this training curriculum. Technical assistance is available by contacting Praxis@center4si.com or call x

3 TABLE OF CONTENTS Introduction to the training...page 4 5 Session One Overview...page 6 Session One Outline...page 7 9 Session Two Overview...page 10 Session Two Outline... page Session Three Overview...page 15 Session Three Outline... page Opioid Overdose Prevention Handout... page Pre Group Evaluation...page 24 Post Group Evaluation...page 25 Post Group Evaluation Answer Key...page 26 Optional Additional 4th Session:Naloxone Responder Training...page 27 How to Access Naloxone through Pharmacy with a Standing Order...page 28 List of Resources...page 29 3

4 INTRODUCTION TO THE THREE-SESSION OPIOID OVERDOSE TRAINING PURPOSE OF THE TRAINING CURRICULUM This training curriculum delivers three 60-minute sessions and focuses on preventing and responding to opioid overdoses. The increasing problem of opioid overdoses underscores the need to educate participants in drug and alcohol treatment programs about the opioid overdose prevention and responding to an opioid overdose. This training curriculum is designed for use in treatment programs, correctional facilities, homeless shelters, HIV service organizations and other health and human service settings. BENEFITS OF THE TRAINING Support people at risk for opioid overdose. Program participants are potentially at an increased risk for an opioid overdose if they relapse and use opioids after a period of abstinence. Support witnesses/bystanders: Program participants may, if they witness an overdose have the opportunity to intervene and prevent an overdose death. They may also have an opportunity to educate others about the risks of opioid overdoses. LEARNING OBJECTIVES As a result of this training, group participants will be able to: Name three risk factors for an opioid overdose Name two risk reduction strategies Recognize the signs of an opioid overdose Describe or show three actions that respond to an opioid overdose WHO SHOULD USE IT? This training curriculum should be used by providers who facilitate educational groups with people WHERE SHOULD IT BE USED? This three-session curriculum can take place anywhere educational groups are held. Some settings that have used this curriculum include: Community corrections programs Jails or prisons Methadone treatment programs Outpatient programs Residential treatment programs/recovery homes Relapse prevention programs TSS or CSS programs Peer education groups 4

5 ORGANIZATION OF THE CURRICULUM The session is organized into a table describing the activity with curriculum notes with the estimated time frame for that activity. The table s Activity/Curriculum Notes column provides guidance on conducting the session. Activities used include: Presentation Card game Group brainstorm Small group discussion Key questions MATERIALS NEEDED Facilitators will need to prepare materials for the training session. Materials include: Opioid overdose prevention card game Flipchart Opioid overdose prevention handout Referral cards PREPARING FOR THE THREE SESSIONS participants. Facilitators need to have: Experience conducting educational groups with program participants Training with Praxis on how to facilitate this group An opportunity to review the curriculum before the training Experience with the Opioid Overdose Prevention Card Game Familiarity with local resources for opioid overdose prevention and health BEFORE THE SESSIONS BEGIN Print Opioid Overdose Prevention Handout (pages 22 &23) Print post group evaluation (page 26) Review the Opioid Overdose Prevention Card Game Facilitator s Guide Review resource list at end of curriculum (page 29) Prepare referral cards for group members Bring pens! POST GROUP EVALUATION There is a post-group evaluation included on page 26. This is to test participants acquisition of facts presented in the training. 5

6 SESSION ONE: DEATHS FROM OPIOID OVERDOSES OVERVIEW ACTIVITY OVERVIEW TIME 1 Welcome, overview 5 minutes 2 Presentation: Opioid overdoses: Why is it important? 5 minutes 3 Opioid Overdose Card Game 25 minutes 4 Presentation: What are opioids? 5 minutes 5 (A B) Discussion: Reason to Talk or Not Talk about Overdose 15 minutes 6 Wrap up and summary 5 minutes BEFORE THE SESSION: Print Opioid Overdose Prevention Handout (pages 22 23) Print group evaluation, pages (24 25) Review resource list at end of curriculum (page 29) Prepare referral cards for group members Consider scheduling a Naloxone Responder Training (page 27) Bring pens! 6

7 ACTIVITY/CURRICULUM NOTES STEP 1 (5 minutes) WELCOME AND OVERVIEW Tell the participants: Three 60 minute sessions, today we will: Discuss the public health problem of opioid overdoses Consider the pros and cons of talking about opioid overdoses Learn more about opioids Ask: What are your experiences with opioid overdose? People may have witnessed or responded to an overdose. The purpose is not to go into all the details of the experience but to acknowledge that people are brining personal experiences to the training. STEP 2 (5 minutes) PRESENTATION: THE PROBLEM OF OPIOID OVERDOSES Facts about opioid overdoses: Deaths from unintentional opioid overdoses continue to increase The drug overdose death rate has more than doubled from 1999 through 2013 Drug overdose was the leading cause of injury death in Among people 25 to 64 years old, drug overdose caused more deaths than Most drug overdoses are caused by opioids, either prescription or illegal STEP 3 (25 minutes) CARD GAME: To test what we know about opioid and overdoses. Here are the directions: 1. Divide into groups (small group sizes depends on size of whole group) 2. Each group gets deck of cards-each card has a statement about opioids or opioid overdose minutes to review cards and decide as a group if statement is true, false or not sure or no consensus 4. Put cards into 3 piles-one is true, the next is false and the third is we re not sure or we can t agree. Begin the game. Ask participants to read statements from the pile of cards that they were unsure of or couldn t reach consensus. Consult the Opioid Overdose Card Game Facilitator s Guide to review facts with participants. After the card game, summarized key points. Key Points: All opioids suppress the part of the brain that controls breathing Opioids cause a fatal overdoses by stopping a person s breathing People die from lack of oxygen-no breath-no oxygen-no life 7

8 ACTIVITY/CURRICULUM NOTES STEP 4 (5 minutes) WHAT ARE OPIOIDS? Ask participants to call out names of opioid drugs Opioids are pain relievers both prescription and illegal Name some prescription opioid drugs-vicodin, Percocet, OxyContin, Opana, morphine, codeine, methadone Name some illegal drugs: heroin, opium. STEP 5 (15 minutes) A) GROUP DISCUSSION: CHALLENGES OF TALKING ABOUT OPIOID OVERDOSE Some people are concerned that talking about overdose prevention to people in drug and alcohol treatment is not supportive, helpful or appropriate. They are reluctant to talk about overdose prevention to people in treatment. Ask: What are the reasons to talk about opioid overdose prevention or reason not to talk about it in treatment? B) FACILITATOR DIRECTIONS Flip Chart # 1: Reasons to Talk/Not Talk about Overdose Ask participants to share their ideas Try to engage everyone in the group Review the list Suggested comments: Reasons not to talk about overdose: It could be perceived as encouraging drug use and relapse It could be seen as a lack of faith in a client s recovery It could make people remember sad experiences about witnessing an overdose Reasons to talk about overdose Learn that any abstinence leads to loss of tolerance to an opioid. Recognizing that this increases the risk of death from an opioid overdose Overdose prevention might reinforce relapse prevention Program participants may witness an overdose or be a bystander. The can use this information to save a life. Most overdoses are witnessed Program participants can share this information with people they know who may still be using. at risk for dying from an opioid overdose by training people in the community in opioid overdose prevention 8

9 ACTIVITY/CURRICULUM NOTES STEP 6 (5 minutes) SUMMARY AND ADJOURN The number of opioid overdose deaths in Massachusetts is increasing Opioids are prescription and illegal painkiller drugs that can also suppress breathing leading to death over time opioid overdose prevention in drug and alcohol treatment programs 9

10 SESSION TWO: OPIOID OVERDOSE RISKS AND RISK REDUCTION OVERVIEW ACTIVITY OVERVIEW TIME 1 Welcome, review 5 minutes 2 Group Brainstorm: Who Overdoses? 10 minutes 3 (A B) Group Brainstorm: Naming and Understanding Opioid Overdose Risk Factors? 10 minutes 4 10 minutes 5 (A B) Small Group Discussion: Reducing the Risk for an Opioid Overdose 15 minutes 6 Wrap up and summary 10 minutes 7 Post-group evaluation 5 minutes BEFORE THE SESSION: Flip chart # 2 Who Overdoses? Flip chart #3 T chart: Overdose Risks Flip chart #4 T chart: Risks and Risk Reduction Review facilitator s guide for the session Review resource list at end of curriculum (page 29) Prepare referral cards for group members Bring pens! 10

11 ACTIVITY/CURRICULUM NOTES STEP 1 (5 minutes) WELCOME EVERYONE Review Previous Session Many factors contribute to opioid overdoses: strong product, lower tolerance, using alone Today we will talk about what puts a person at risk for an opioid overdose sonal experiences to the training. STEP 2 (10 minutes) GROUP BRAINSTORM: WHO OVERDOSES? Show: Flipchart # 2: Who Overdoses? 1. Ask participants: Who do you think overdoses? Use words like young person, older person, new user 2. Anyone who uses opioid could overdose but there is research that suggests that the following groups are at higher risk for an opioid overdose: Experienced user (on average people who overdose have been using for over 5 years) People recently discharged or released from treatment, prison, hospital (loss of tolerance) People who relapse after a period of abstinence (loss of tolerance) People who mix drugs People who have overdosed before and survived (Smoking and hepatitis) Ask participants: Why do you think more experienced users are at a higher risk? Answers might be: Experienced users have a high tolerance and believe that their bodies can handle higher doses. They may have chronic health problems that increase the risk of an opioid overdose. STEP 3 (10 minutes) A) GROUP BRAINSTORM: NAMING AND UNDERSTANDING OPIOID OVERDOSE RISK FACTORS Ask: What are things people do or believe that can put them at risk for an opioid overdose? 11

12 ACTIVITY/CURRICULUM NOTES B) FACILITATOR NOTES: 2. Use list to reveal the factual overdose risks 3. Circle the factual overdose risks 4. The list should include: Using alone or being left alone Using too much Mixing opioids with other substances (alcohol, benzodiazepines, cocaine) Not knowing the product Having a lower tolerance (due to abstinence, illness, hospitalization, treatment, incarceration, aging) Having overdosed before and survived (due to feelings of invincibility and the large amount of the drug used) Using in an unfamiliar setting STEP 4 (10 minutes) DISCUSSION QUESTION: EXPLORING IDENTIFIED RISKS Ask the following discussion questions: RISK FACTOR Using alone/being left alone Not knowing where the opioid comes from/what s in it or buying drugs from an unknown source DISCUSSION QUESTION Why would someone use alone? What makes it hard to stay with a person who s using opioids? (fear of police, shame) Why would this create a risk? (Substances could be stronger than expected, not knowing the drug s strength or composition) Having a lower tolerance-due to abstinence, aging, incarceration What causes periods of abstinence? (treatment stay, recovery, hospital stay, incarceration Having overdosed before and survived Using in an unfamiliar setting Mixing opioids with other substances Why do you think it might be true (amount of drug person Why would this be true? (don t know product, use too quickly, no time for a tester, use in a hidden place) Why does mixing increase risk? breathing) 12

13 ACTIVITY/CURRICULUM NOTES STEP 5 (10 minutes) A) SMALL GROUP DISCUSSION: REDUCING THE RISK FOR AN OPIOID OVERDOSE 1. Form small groups (3-4 people) 2. Small groups will identify strategies for each risk factor 3. Small groups could choose a person to write down the strategy 4. Small group could choose someone to recite the list to the whole group Reconvene to the larger group Ask each group to share its strategies for each risk factor. (You ll start to hear duplicate strategies. Collect all the novel suggestions.) B) ACTIVITY 2. Review each risk and ask group to name risk reduction strategies for that risk. 3. Write the strategy in the right column 4. Review RISK FACTOR DISCUSSION QUESTION Using alone Not knowing where the opioid comes from Talk with someone in advance to stay with the person who is using, make a contract for a phone call, Kitestring Determine the strength of the substance before using by doing a tester shot, buy the drug from the same source, Having lower tolerance Use a smaller dose, take a tester shot Having overdosed before Using an unfamiliar setting Mixing opioids with other substances Encourage person to follow all harm reduction strategies, use less, take care of health Determine strength of substance before using, better to use in a familiar place where a person is not going to be rushed Consider not mixing drugs, especially not mixing opioids, alcohol, and benzodiazepines 13

14 ACTIVITY/CURRICULUM NOTES STEP 6 (10 minutes) WRAP UP Ask: What is something that you ll take from today s session? Key messages: The main risk factors for dying from an opioid overdose are: using too much of the drug, mixing drugs, using alone, changes in tolerance There are ways to reduce the risks of an opioid overdose Knowing the risk behaviors help us choose risk reduction strategies People can prevent unintentional opioid overdoses. Ask: Any questions? Next session s topic: Recognizing and Responding to an Opioid Overdose STEP 7 (5 minutes) POST-GROUP EVALUATION Handout evaluation and pens. Collect from everyone. Can read it aloud if some mem- 14

15 SESSION THREE: REVERSING AN OPIOID OVERDOSE OVERVIEW ACTIVITY OVERVIEW TIME 1 Welcome, Review 5 minutes 2 Discussion: What does an opioid overdose look like? 5 minutes 3 Presentation: Signs and symptoms of an opioid overdose 10 minutes 4 (A G) Group Brainstorm: Responding to an opioid overdose: Actions and challenges 5 (A B) Presentation: Reversing an opioid overdose: Naloxone (Narcan) (If you have scheduled the optional 4th session with naloxone responder training, then make this section very brief) 25 minutes 10 minutes 6 Wrap up, Key Messages, Additional Questions, and Evaluation 5 minutes BEFORE THE SESSION: Flip chart # 5: Signs and Symptoms of an Opioid Overdose Flip chart # 6: T-chart: Responding to an Opioid Overdose: Dos and Don ts Flip chart # 7 T-chart: Response challenges and strategies to address them Review facilitator s guide for the session Review resource list at end of curriculum, page 29 Prepare referral cards for group members Post-group evaluation Bring pens! 15

16 ACTIVITY/CURRICULUM NOTES STEP 1 (5 minutes) WELCOME Review previous session Review risk factors and risk reduction Remind participants that for today s discussion, it s important to remember Answer: Opioids suppress respiration or breathing. Too high a dose will lead to death by suppressing breathing STEP 2 (5 minutes) PRESENTATION: SIGNS AND SYMPTOMS OF AN OPIOID OVERDOSE What does and overdose look like? Ask participants: Let s imagine that we are witnessing an opioid overdose, how would we know it s happening STEP 3 (10 minutes) MAKE FLIPCHART # 5: SIGNS AND SYMPTOMS OF OPIOID OVERDOSES Signs and Symptoms of an Overdose Unresponsive-person cannot be woken up when you shout the person s name or when you give a sternal rub (Demonstrate sternal rub) Shallow, irregular or no breathing Clammy pale skin Slow, weak pulse Deep snoring, gurgling sound, death rattle Tell: An overdose happens over time-1-3 hours after using. Instantaneous overdoses (needle in the arm) are rare. There is usually time to intervene. 16

17 ACTIVITY/CURRICULUM NOTES STEP 4 (25 minutes) GROUP BRAINSTORM: RESPONDING TO AN OPIOID OVERDOSE: ACTIONS AND CHALLENGES A) BACKGROUND This discussion addresses participants in their possible future roles as overdose bystanders. As such, the discussion focuses on what they can do to intervene and respond to an overdose, and possibly, reverse an opioid overdose and save a life Ask participants: What can someone do if they recognize these signs and decide they are witnessing an actual overdose? How can someone overcome some of the challenges they might face when responding to an opioid overdose? B) FACILITATOR NOTES: Directions 1. Write and review all responses 2. Place the responses that are recommended in the RIGHT column and those that are not recommended in the LEFT column 3. Stress that the RIGHT column includes recommended steps C) PRESENTATION: OVERDOSE RESPONSE Shout the person s name Do a sternum rub (demonstrate and have participants try it on themselves) Call 911 Perform rescue breathing Give naloxone (if available) Stay with the person If you have to leave the person, put person into the recovery position (See page 2 of handout on page 23.) 17

18 ACTIVITY/CURRICULUM NOTES D) REVIEW FLIP CHART # 6, (which should have the recommended responses circled) Reinforce the group All of these measures are safe for the person and will cause no injury Remind the group gain that too many opioids can cause a person to stop breathing and that reversing the overdose means that we have to help the person to start breathing In order to reverse an opioid overdose, the person need oxygen. When considering an action to reverse an overdose, consider if it will restore oxygen. Stress: Steps you can take to take to reverse an overdose should Not harm or injure the person Not waste time Help the person breath and restore oxygen E) GROUP BRAINSTORM Ask participants: What would be hard about responding to an opioid overdose? es? (for example, consider why a person might not call 911?) Reinforce participants: We will now explore strategies to make it more possible for people to respond to overdose. 18

19 ACTIVITY/CURRICULUM NOTES F) FACILITATOR NOTES: 2. For each response, ask the group what they could do to address that challenge 3. Write those strategies in the appropriate column OVERDOSE RESPONSES Call 911 Give naloxone, if available Perform rescue breathing Put person in recovery position Stay with the person POSSIBLE CHALLENGES Don t want to call the police Don t want to invite trouble Don t have naloxone available Don t know how to use naloxone Not trained as a naloxone responder Uncomfortable doing mouth-tomouth breathing Afraid to hurt the person Don t know how to do it No space to maneuver Afraid to hurt the person Don t know how to do it Don t want to run into the police STRATEGY You can say, My friend is not breathing Give address There are programs where people can be trained as a naloxone responder Consult handout and practice steps for rescue breathing Get trained as a naloxone responder Consult handout and practice the steps Leave the door to the room unlocked so that medical personnel can get to the person Leave person in recovery position if you have to leave Stay as long as you can. 19

20 ACTIVITY/CURRICULUM NOTES G) ACTIVITIES AND DIRECTIONS To address the actions that were listed but not recommended share this rule of thumb: When responding to an opioid overdose, avoid anything that wastes time or could cause injury to the person. The person needs oxygen Do Not put the person in a shower Do Not put ice on the genitals Do Not punch, pinch or slap the person Rescue breathing can help keep the person alive until emergency medical personnel arrive and use naloxone (Narcan) to stop and reverse an opioid overdose. Review these key points: 1. Opioid overdose can happen over a 1-3 hour time period 2. Over that time, the person who is overdosing will appear to have slowed breathing and s/he may appear pale or bluish 3. They need oxygen 4. The most important action to do when witnessing an overdose is call In Massachusetts you don t have to wait for 911 to arrive in order to try and reviews the overdose because you can be trained as a naloxone responder STEP 5 (10 minutes A) PRESENTATION: REVERSE AN OPIOID OVERDOSE WITH NALOXONE (NARCAN) Ask participants: Has anyone ever heard of or know about naloxone (Narcan)? Facts There is a medicine called naloxone or Narcan that can be used to reverse an opioid overdose and is available through a special program across Massachusetts Naloxone stops the overdose, allowing the person to breathe again. receptors for minutes, allowing the person to breathe again. In Massachusetts, people can become trained to become naloxone responders When you re trained as a naloxone responder, you get naloxone that is administered through the nose. This can be used to reverse an opioid overdose In other states, naloxone responders may use injectable naloxone. In other states naloxone is not available to the public and only used by medical personnel. Remember: In the Massachusetts naloxone program, the nasal form of Narcan is those receptors and the person can breathe again because the brainstem is working, less impaired by opioids. If you schedule a naloxone responder training, as an optional fourth session, you can skip the following section as this information will be covered in the naloxone responder training 20

21 ACTIVITY/CURRICULUM NOTES B) COMMON QUESTIONS ABOUT NALOXONE 1 Can naloxone hurt a person? No. No matter what substance a person used, naloxone will not cause harm. It may cause withdrawal symptoms in people who are dependent on opioid 2 Can a person get high from naloxone? No. No matter how much naloxone is used, a person cannot get high from naloxone. 3 How long does naloxone last? Naloxone lasts from minutes. A person can go back into an overdose after doses of naloxone. 4 Where can a person get trained as a naloxone responder? There are naloxone training and distribution programs across Massachusetts. These programs provide naloxone responder training. A web link to a listing of these programs is included on page 29 of this Guide. STEP 6 (5 minutes WRAP UP Ask: What are the most important pieces of information about opioid overdose that you learned in this session? Key Messages: 1. There is adequate time to respond to an overdose 2. If you witness an overdose: call 911, stay with the person, perform rescue breathing, 3. Naloxone will reverse an opioid overdose 4. Even if a person has naloxone, he/she should call 911. The person needs medical attention 5. Don t waste time taking actions that do not restore breathing or ones that may injure the person 6. If you have to leave the person, even for a moment, place them in the recovery position so they don t choke on vomit or saliva. Evaluation: 1. Distribute group evaluation forms for participants 2. Collect evaluation forms If applicable: Preview the Naloxone Responder Training OR: Refer to Naloxone Responder Training in the community 21

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24 PRE-GROUP EVALUATION Please circle the correct answer. 1. After being in a drug treatment program or being incarcerated in a jail, a person can be at increased risk for an opioid overdose, if they pick up and use again. TRUE FALSE NOT SURE 2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose. TRUE FALSE NOT SURE Please respond to the prompts below: 3. Name two signs of an opioid overdose. 4. Describe what you would do if you saw someone in an overdose. 5. What was the most important thing you learned in this training? 24

25 POST-GROUP EVALUATION Please circle the correct answer. 1. After being in a drug treatment program or being incarcerated in a jail, a person can be at increased risk for an opioid overdose, if they pick up and use again. TRUE FALSE NOT SURE 2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose. TRUE FALSE NOT SURE Please respond to the prompts below: 3. Name two signs of an opioid overdose. 4. Describe what you would do if you saw someone in an overdose. 5. What was the most important thing you learned in this training? 25

26 POST-GROUP EVALUATION ANSWER KEY Please circle the correct answer. 1. After being in a drug treatment program or being incarcerated in a jail, a person can be at increased risk for an opioid overdose, if they pick up and use again. TRUE FALSE NOT SURE 2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose. TRUE FALSE NOT SURE Please respond to the prompts below: 3. Name two signs of an opioid overdose. Not responsive to noise or pain Slow or no breathing Bluish skin and nail beds Drooling Snoring 4. Describe what you would do if you saw someone in an overdose. Call 911 Begin rescue breathing Make sure person isn t choking Stay with person until medical personnel come Administer Narcan 5. What was the most important thing you learned in this training? 26

27 OPTIONAL ADDITIONAL 4TH SESSION: NALOXONE RESPONDER TRAINING Praxis recommends that programs schedule naloxone (Narcan) responder training with participants from the one-session training. To schedule training, contact the training program near you. PARTICIPANTS OF THE NALOXONE RESPONDER TRAINING WILL: Learn how to administer naloxone and use the nasal naloxone applicator Receive two doses of naloxone Complete appropriate paperwork with trainer BENEFITS FOR PROGRAMS TO SET UP NALOXONE RESPONDER TRAINING Programs will have a higher number of naloxone responders If unable to schedule a training in your program, refer people leaving the program to Naloxone (Narcan) Responder Training Programs! 27

28 HOW TO ACCESS NALOXONE FROM A PHARMACY WITH A STANDING ORDER THERE ARE TWO WAYS TO ACCESS A NALOXONE RESCUE KIT FROM A PHARMACY: 1. Obtain a prescription from your prescriber and take it to a pharmacy that stocks naloxone. 2. Go directly to a pharmacy with a naloxone standing order and request a naloxone kit. For pharmacies with naloxone standing orders, a prescription is not needed. PHARMACIES WITH PHYSICIAN STANDING ORDERS FOR NARCAN Many pharmacies across the whole state have orders to distribute Narcan kits to customers. Many insurance companies, including Mass Health will cover the cost of the Narcan kits but some require a small co-pay. For a list of pharmacies with standing orders for naloxone visit: ACCESS CHECKLIST Have your insurance card ready if you have one Bring an ID if you have one If yes, Indicate to the pharmacist if you prefer nasal or injectable The pharmacy tech will input your information and the pharmacist will check the order If the pharmacy declines the request please ask politely if they are familiar with the standing order another pharmacy on the list. 28

29 LIST OF RESOURCES NARCAN TRAINING PROGRAMS Bureau of Substance Abuse Services information on Naloxone Responder Training with List of Training Programs List of Pharmacies with Standing Orders for Naloxone by Town VIDEOS ON OPIOID OVERDOSE PREVENTION Staying Alive on the Outside (18:58) The Center for Prisoner Health and Human Rights Bunny and the Wolf: An Animated Guide to Opioid Overdose (4:22) Hungarian Civil Liberties Union (HCLU)(in English) Take Home Naloxone (9:22) and Spanish subtitles. Includes personal stories. 29