Download What is naloxone? - Greater Manchester West

O v erd o s e Inf o r m at io n
and use of Naloxone
T
his information could help you avoid overdose and know
what to do in the event of someone else overdosing.
It includes information on how you could use the drug naloxone
to reverse overdoses. Greater Manchester West Mental Health NHS
Foundation Trust (GMW) has pioneered distribution of naloxone to
opiate users. This has saved a number of lives already.
GMW - Empowering users and
carers to save lives.
Overdose
Overdose is now the largest single cause of death amongst injecting
drug users. Understanding the risks of different drugs and their
combinations can reduce the likelihood of overdose and if it does
occur, knowing how to respond can prevent it leading to death.
Remember: In case of an overdose phone 999
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Greater Manchester West Mental Health NHS Foundation Trust
Mixing substances that depresses the functioning of the central
nervous system increases risk to life. These include:
Opiates or their substitutes
Heroin – the strength or purity of
heroin is highly variable. This has
been a major factor alone in overdose
deaths in recent years as batches of
higher purity heroin reach British
streets.
Methadone – Long acting opiate substitute that is involved in
many overdoses on its own. In combination with other depressants
and or alcohol, presents a very high risk of overdose. It lasts
longer in the system than other opiates and can lead to overdose
even after naloxone has been administered. The naloxone can
temporarily reverse the effects of the opiate, but if it is still in the
system when the naloxone wears off, the risk of overdose continues.
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Codeine preparations – i.e. Dihydrocodeine, co-codamol. Shorter
acting opiate, still presents high risk if used with other depressants.
Some preparations include paracetamol and this is toxic to the liver
if taken in high doses.
Other opiates; MXL, oramorph, oxycodone/OxyContin, MST.
Alcohol - Alcohol depresses the central
nervous system and also disinhibits
behaviour which can increase the
likelihood of taking risks with other
drugs. Associated confusion can make it
difficult to keep track of dosages. These
risks increase if used in conjunction with
other drugs, including stimulants.
Benzodiazepines – Diazepam (Valium), Temazepam, Nitrazepam.
All benzodiazepines used with other drugs and or alcohol have a
high mortality rate and significantly increase the risk of overdose.
Some benzodiazepines obtained from overseas suppliers are of
dubious quality and are often not benzodiazepines at all. There
have been deaths as a result of bogus benzodiazepines used on
their own. Please beware!
Some anti-depressants – such as amitriptyline/dothiepin, are the
older type of anti-depressants and are not commonly prescribed,
but present as high
risk in overdose
situations as they
have additional
sedative effects
that increase the
risk of overdose.
This is one of the
main reasons
they are hardly
prescribed any
more!
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Greater Manchester West Mental Health NHS Foundation Trust
One Plus One = three
A simple formula may help illustrate the point of using a combination
of substances: (1 + 1 = 3) That is to say that one depressant plus
another depressant used at the same time will not merely give
twice the sedative effect, but up to three times as much.
• Respiratory depression
and sedation are the most
dangerous factors in causing
death from an overdose of
opiates
• Injecting is higher risk than
smoking/chasing
• Changes in purity of heroin
increases risk of overdose
• Drugs taken orally will have
a delayed and unpredictable
onset. E.g. take oral methadone, 15 minutes later inject heroin,
30–60 mins later when methadone absorbed = Overdose
• Anything that may cause drowsiness or sleep, increases the
danger of aspirating (breathing in) vomit because you don’t
wake up when you’re sick
• Some drugs may increase the effects of opiates by interfering
with the body’s mechanism for excreting opiates e.g. cimetidine
• Following a period of abstinence, tolerance is reduced. This is
a high-risk time. To use the same amount the individual may
have used pre detox could result in overdose. This risk is also true
for people who are new to intravenous opiate use who have
previously smoked the drug
• Using alone or using with people they don’t usually use with
increases risk of overdose
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What not to Do When Someone
Overdoses: Some Common Myths
“Treat an opiate overdose by giving a stimulant e.g.
amphetamine”
This is unlikely to have any benefit and may make matters worse by
increasing the speed of absorbtion. An overdose needs immediate
medical attention and treatment- do not delay by administering
black coffee, amphetamines etc.
“Walking people around helps”
This may also make matters worse, again it wastes time and there
is the additional risk they may fall, or get dropped. It is also possible
that the drugs are absorbed into the bloodstream more quickly as
the heartbeat increases.
“Putting people in a cold bath helps”
If the client has heard of people who have come round after being
put in a cold bath it was because they hadn’t taken a lethal dose.
This practice is dangerous for a number of reasons mainly it takes
time to run a bath and they could easily drown or die from the cold.
“Hurting, hitting or burning someone brings them round”
It is important to establish if someone is sleeping or unconscious.
You can use a far less dangerous method – rub your knuckles on the
middle of their chest. If this doesn’t rouse them, chances are they’re
unconscious and you need to call an ambulance.
“Inject them with saltwater”
This is a dangerous practice. It wastes time, time that could be
used putting someone in the recovery position and calling an
ambulance. It could be possible in the panic, to infect the individual
with hepatitis or HIV. (This myth may have come from the practice
of seeing friends in hospital on a saline (salt) drip. The fact is that
this practice is used to keep a vein open so medication can be
administered. Salt does not affect an overdose at all.
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Greater Manchester West Mental Health NHS Foundation Trust
“Don’t call 999 because the police will turn up
and arrest you”
There used to be a common practice of police attending with
paramedics/ambulance crews when an overdose was reported.
This was in part due to the fact that suicide was illegal. This is no
longer the case, so the police do not attend as a matter of course.
The Greater Manchester area operates on an agreed policy of no
automatic police involvement in the event of an overdose being
reported to the ambulance service.
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Naloxone
What is Naloxone?
• Also marketed under the trade name - Narcan
• A pure opiate antagonist – antidote to heroin
• Can be used to counter the effects of overdosing on heroin or
methadone
• Temporarily reverses the effects of an opiate overdose
• Will have no effect on overdoses from other drugs
• How well it works depends on what used, how much taken and
what else used (alcohol, other drugs)
• Short acting – wears off quickly.
• Overdose can last for 8 hrs or more – naloxone can begin to wear
off in 20 minutes
Phone 999
prior to using
• Naloxone brings on a withdrawal – recipient may want to use
straight away and can become aggressive
Effects of naloxone
• Short acting
• Blocks and reverses the effects of opiates
• No opiate – no effect
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Greater Manchester West Mental Health NHS Foundation Trust
Naloxone as part of managing an
opiate overdose
How to recognise opiate overdose
• Person unconscious and cannot be woken
• Cyanosis – blue lips or tongue
• Not breathing at all or breathing slowly/snoring – none or
laboured breathing
• Pin point pupils
What to do if you discover someone who has
overdosed
1. Check environment is safe and that there are no hazards around
(e.g broken glass)
2. Try to rouse – by talking (loudly) ‘Can you hear me?’, ‘Open your
eyes’ and gently shaking their shoulders. If you get no response
apply gentle pressure to the sternum (upper middle of the front
of the chest).
3. If person wakes, make sure airways are clear then phone 999
4. Stay until the ambulance arrives
5. If you are unable to wake them phone 999
6. Check Airways (no tongue/no vomit)
7. Check Breathing (look/listen feel for breath)
8. If not breathing – basic life support – If breathing – recovery
position – wait for ambulance
9. Administer Naloxone
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RECOVERY
POSITION
POSITION
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st the upper leg so that both the hip
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ains open.
The Recovery Position
st the hand under the cheek,
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Lift my leg
are bent at right angles.
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Roll me over
Greater Manchester West Mental Health NHS Foundation Trust
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Naloxone administration
A drug worker can demonstrate the preparation of naloxone
for injection using water ampoules . You may be experienced
in injecting, but it is a different process drawing up an injection
from an ampoule... Especially in a stressful Life threatening
situation.
Please note naloxone is in ampoule form and no longer in mini-jet
preparation
• Naloxone can be given intravenously however intramuscular
injection is recommended. You MUST first phone 999
• Inject into a muscle - upper outer buttock, outer thigh area or
upper arm
• Hold needle 90 degrees above the skin
• Insert needle into muscle
• Slowly and steadily push plunger all the way down
A single injection of naloxone buys time for the ambulance to arrive
- its effects may wear off in as little as 20 minutes. Naloxone has a
short duration of action; therefore:
Continued medical treatment is essential. It is Important to
stress that naloxone alone is not enough
If bleeding appears after administration, apply pressure.
Naloxone has a limited shelf life please check use by date!
If an ambulance isn’t called the person may overdose again, shortly
after the effects of the naloxone wears off.
Any used needles should be disposed of in a sharps bin (paramedics
will have one).
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Greater Manchester West Mental Health NHS Foundation Trust
Where should naloxone be stored?
• Carry on their person, or a specific place at home or the place
they use - Let others know where it is
• Keep away from strong light
• Keep out of reach of children
You will be given the opportunity to familiarise yourself with the
naloxone pre filled syringe and you can practice fitting the needle
to the barrel.
You may be familiar with injecting paraphernalia, but using it in a
different more relaxed setting and very rarely using intramuscular.
The situation of someone you know overdosing will be very stressful
and this may make the administration process very difficult to
remember or carry out.
Practice!
Offer this information to partners/family members/friends you live
or use with - It may save your life.
Please feel free to ask for information leaflets/DVD re
overdose and naloxone
We will check before issuing naloxone to you that you have an
understanding of the information here, this is for your safety.
Please ensure that you have signed your consent form prior to
arranging take home naloxone.
This is not an exhaustive list and you should ask the case manager
about one to one or group training.
If you have any questions about the material in this leaflet or have
any questions after reading it please speak to a member of staff.
Stay safe
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Greater Manchester West Mental Health NHS Foundation Trust
Informed consent to treatment/receipt of
advice to accompany naloxone prescription
I (insert
your name)
.....................................................................................................................................................................................
have had the opportunity to discuss with a member of staff the take
home naloxone scheme and I feel I have a clear understanding of
the circumstances where naloxone should and should not be used.
I have been offered literature /and discussed:
• Signs and symptoms of overdose and how to recognise them.
• Potential drug & alcohol interaction that may lead to overdose.
• What not to do in event of overdose.
• What the correct procedure to follow in the event of overdose.
• How to use naloxone correctly in the event of overdose.
• The literature I have received includes:
• Naloxone and going over DVD
• Overdose detox and you leaflet
• Recovery position card
• Take home methadone overdose prevention card
• Appointment to attend overdose prevention for myself and/or
family member/s
I feel confident in using the take home naloxone where appropriate and
will attend the group programme on:
/
/
(DD/MM/YY)
Signed: ...................................................................................................................................................................
(client)
Signed: ...................................................................................................................................................................
(worker)
Date:
/
/
(DD/MM/YY)
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