elearning Module Script Slide 1-3 Review the outline and the plan for the presentation. Slide 4 We do accept the cynicism of this poster. Slide 5 Read from the slide the definition of Harm Reduction Slide 6 Take home naloxone is a safe and effective harm reduction strategy that aims to reduce morbidity and mortality related to opioid overdose by providing education, resources and tools to those at risk. Slide 7 Harm reduction includes: policies, programs and practices that aim to keep people safe and healthy and recognizes that the high risk behavior may continue despite the potential negative consequences. It s about meeting individuals where they re at acknowledging the stages of change and recognizing that everyone moves through change in their own way It s about engagement - providing a safe space for individuals to make decisions, access resources, and make behavior changes when they re ready Harm Reduction refers to policies, programmes, and practices that aim primarily to reduce the adverse health, social, and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs. Harm reduction benefits people who use drugs, their families and the community. It is a targeted approach, and is based on a strong commitment to public health and human rights. Some examples of Harm Reduction Programs include: Needle exchange programs which distribute sterile needles and other harm reduction supplies, recover used needles and other supplies, and provide information and containers for their safe disposal Take home naloxone programs that provide overdose response training and kits to reverse opioid overdoses and prevent death from overdose
Supervised consumption sites that help prevent overdose deaths and other harms by providing a safer, supervised environment for people using substances Substitution therapies such as Methadone or Suboxone which provide a safer controlled alternative to illicit opioids such as heroin And Outreach and Education services that make contact with people who use substances to encourage safer behavior Slide 8 Harm reduction has many benefits for people who use substances, their families, and communities. Research shows harm reduction activities can: Reduce hepatitis C and HIV transmission Decrease the amount of emergency visits and lower healthcare costs and wait times Reduce crime and increase employment among people who use substances Reduce injection substance use in public places, and reduce the number of used needles left in public spaces. Increase referrals to treatment programs and health and social services Reduce overdose deaths and other early deaths among people who use substances And creates opportunities for people to lead healthier lives and achieve quality of life Slide 9 Opioids or downers refers to a family of drugs related to opium, a substance derived from the poppy plant. Opioid drugs are typically used as an analgesic and act by attaching to specific receptors in the brain resulting in decreased perception of pain. Side effects of opioids include: drowsiness, respiratory depression and feelings of euphoria. Opioids are central nervous system depressants. The central nervous system controls our ability to breathe and keep the heart beating. The biggest concern with opioid use is respiratory depression breathing slows and can eventually stop which of course can lead to death Examples include: READ FROM SLIDE Slide 10, 11 Fentanyl is of special concern because of the increased number of deaths in Alberta. Historically fentanyl was used for pain relief in acute care settings after surgery (IV administration) and in the community in the form of transdermal patches used to help with chronic pain. Now it s being reported that illicit fentanyl is being manufactured in unregulated labs, mixed with a variety of unknown fillers and pressed into pills.
Fentanyl can be purchased on the internet and sent through the mail in small undetectable packages. Once these arrive in Canada, are pressed into pills and sold - initially as fake Oxy (green beans, greenies, shady 80s) for about $20/pill. And here lies the danger - there is no way to control or know the amount of fentanyl that is in each pill. The concern is that people don t know that they re consuming fentanyl and placing them at risk of an overdose. Fentanyl is up to 100 times stronger than other opioids like morphine, heroin or oxycodone. Slide 12 Carfentanil: Read from slide Slide 13 Risk factors for Opioid Overdose See slide all info there The terms, tolerance, physical dependence and addiction are often confused. To clarify: Tolerance: The effects of the drug decrease with repeated exposure over time. People can develop tolerance to both illicit drugs and prescription medications. Tolerance is the physical effect of repeated use of that drug, not a sign of addiction. Over time, the individual may need more of the drug to either feel normal to participate in activities of daily living or receive the benefits they are seeking from that drug. Physical Dependence the body has adapted to the presence of the drug. If they suddenly stop taking the drug, they will experience withdrawal symptoms Addiction is a primary, chronic, brain disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the 4 C s impaired control over drug use compulsive use continued use despite harm craving Development of tolerance and physical dependence is not addiction
Slide 14 General overdose prevention Don t use alone won t increase risk of overdose but no one will be available to help if needed Use safer routes swallow or snort rather than inject Do a test hit first see how the body reacts to drug Know signs and symptoms of an overdose this is reviewed in detail on next slide Do not mix drugs increases risk of overdose, especially other central nervous system depressants (alcohol, benzos), speedball (stimulant + depressant = increases stress on heart) Carry naloxone Call 911 emphasize this!! Know where to find local resources to support you Slide 15 Recognizing an Opioid Overdose See slide all info there Slide 16 What is Not Helpful? Let them sleep it off - person may be experiencing respiratory depression. Always check to see if they are breathing Give amphetamines increases stress on heart. Put them in a cold bath or shower decreases core body temperature which can lead to shock and the risk of drowning if unconscious and breathes in the water. Slap, punch, hit - Does nothing to displace opioids from receptors. Only physically harms the person. Try to get them to vomit increases risk of choking Slide 17 SAVEME: is a simple way to remember these important steps Slide 18 S Stimulate try to wake the person up. Do they respond to verbal or painful stimulus? If not call 911. Calling 911 tell dispatcher person is unconscious and not breathing. When EMS arrives tell them everything you know and you did including administering naloxone. Slide 19 A Airway and V - Ventilate
Check to see if the person is breathing. Is there anything blocking the airway? If so, remove it if safe to do so. Place rescue breathing mask over mouth of person, plug their nose head tiltchin lift to open airway and initiate rescue breathing: 1 breath every 5 seconds for 2 minutes. Should see the chest rise. (Info on slide). If the belly rises reposition the head to open the airway. Slide 20 Heart and Stroke Guidelines: read from slide Slide 21 E- Evaluate the situation Slide 22 is a drug and should be dispensed or distributed in conjunction with overdose prevention training. Safe and effective antidote to opioid overdose - reverses the effects of opioids by blocking the opioid receptor sites in the central nervous system Only contraindication is hypersensitivity to naloxone No pharmacologic effects when used in the absence of opioids or with other drugs can t get a person high, stoned, or intoxicated May produce withdrawal symptoms (confusion, thrashing behaviors) although uncomfortable, not life-threatening Not effective when taken orally to be given IM, IV Onset of action is 2-5 minutes with a half-life of 30-60 minutes Should be stored between 15-30 C and protected from light Slide 23 Kit Contents of THN Kit listed on slide Slide 24 Injectable and Intranasal: Read from Slide Slide 25 Administer IM- muscular injection of naloxone All info on slide
Slide 26 Visual of the injection site Anatomy and Physiology Slide 27 Injection site: all info on the slide and read from slide Slide 28 Adult and Infant landmarks for the injection sites. Slide 29 NARCAN Nasal Spray: visual This product has recently come to the Canadian market. It is available for purchase cost is currently $150/2 doses Slide 30 Administer Nasal Spray: read from slide; all info on slide Organizations that wish to purchase can do so. The injectable formulation is the standard for the THN kit program. Slide 31 E-evaluate again All info on slide Slide 32 Recovery position emphasize this point. Recovery position decreases the risk of aspiration if person vomits. Wait for EMS to arrive!! Slide 33 After the event: all information is on the slide: read the slide Slide 34 De-scheduling of : It is important to understand what it means now that is unscheduled. Slide 35
Distribution of THN kits: all information is on the slide: read the slide Slide 36 Role of Nurses Outside the Hospital Setting: all information is on the slide: read the slide Slide 37: CONCLUSION: What s your role? Engage As health care providers we are particularly well positioned to apply our knowledge, skills and judgment to engage with clients, assess risks, provide person-centred education, and empower clients to make decisions that will keep them safer and healthier. Acknowledge that you may be the only point of engagement to the health care system that this individual uses. Collaborate with clients and create therapeutic relationships. Listen and develop a plan of care. Assess We find out what s going on in their lives. Are they using? What are they using? Are they at risk of overdose? What do we need to discuss in order to keep that client safe and healthy? Educate Providing effective, person-centred education is integral to our practice and has a significant impact on client health and safety. This is true of any practice setting. Providing clients with information and knowledge so they can make choices that are right for them at that particular time that is the basis of what we do. Discuss addiction and mental health services and supports with clients and their loved ones. Refer to the appropriate resources and programs available in your community. Recommended Steps: 1. Use the client hand out and the knowledge checklist to review the key concepts related to opioid overdose prevention, recognition and response. Ensure each knowledge objective is covered and be confident the client understands the education provided. 2. Review the contents of the kit with the client, making sure all items are in the kit and the client knows what each item is for and how to use them. 3. If a kit is used, direct the client to call Health Link at 811 for information about:
Where and how to get a replacement kit Where to access support and resources including debriefing after the incident How to complete a THN Kit User Questionnaire 4. The Site reporting survey should be completed monthly by one member of the team Distribution of a Kit Based on your assessment you diagnose and possibly distribute a THN kit. It only takes 10 minutes to complete THN training and it could save a life! Encourage family and friends to participate in training on opioid overdose and how to use the kit. They can now receive kits as well. Empower Access to education, resources and supports decreases stigma related to opioid use and provides opportunity to make more informed choices. Knowledge empowers clients and their families to be safe and healthy. The THN Program provides opportunity to actively address this public health crisis. As health care professionals we have a duty to clients to protect them from future overdose, and to provide professional, nonjudgmental care, which can be difficult to come by for many people suffering with an addiction. I encourage you to identify ways in your practice setting to empower clients, to save lives and make a difference. Slide 38/39 Resources: see links Slide 40: QUESTIONS