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ILLINOIS DEPARTMENT OF HUMAN SERVICES
DIVISION OF ALCOHOLISM AND SUBSTANCE ABUSE
Drug Overdose Prevention Program
Training Module
Dr. Seth Eisenberg, MD
Rosie Gianforte, LCSW
TOPICS
 Overview of the Heroin/Opiate Problem
 Illinois Public Act 099-0480 (HB0001)
 IDHS/DASA Drug Overdose Prevention Program
(DOPP) and how to enroll
 Identifying Opioid Overdoses
 How to Respond to an Overdose
 Use of Naloxone
 After Naloxone – Outreach Efforts/Treatment
Referrals
OBJECTIVES
 Explain the risk factors for opioid abuse and
overdose and discuss strategies for preventing
overdose
 Gain an understanding of the opiate overdose
problem & how opioids work
 Identify people who meet the criteria for the
provision of naloxone, and explain how to respond to
opioid overdose
 Compare the different types of Naloxone:
 Intra-nasal
 Intra-muscular
OBJECTIVES (CONT.)
 Explain how a person will respond to naloxone rescue therapy
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and discuss managing adverse events following the use of
naloxone rescue therapy
Discuss indications, contraindications, safety, any drug
interactions, and adverse effects of naloxone rescue therapy
Explore Medication Assisted Treatment MAT Options
(PA 99-0553) Effective January 1, 2017, all substance use
treatment programs licensed by IDHS/DASA must provide
educational information to clients identified as having or
seeking treatment for opioid use disorder, including the use of
a medication for the use of opioid use disorder, recognition of
and response to opioid overdose, and the use and
administration of naloxone
Recommend support programs and resources for clients and
care-givers for follow-up care for opioid use disorder.
Why focus on the heroin/opioid
epidemic?
OPIOIDS
 Opioids are a class of drugs in both legal
(prescription medications such as oxycodone,
hydrocodone, morphine, fentanyl) and
illegal(heroin) forms.
 Opioids are natural or synthetic substances that act
on the brains opiate receptors.
 Opioids dull pain and relieve anxiety.
 People may misuse opioids because they are in pain
(physical and emotional) and opioids produce a
feeling of euphoria.
2004
2010
2006
2012
2008
2014
A NATIONAL EPIDEMIC
According to the Centers
for Disease Control:
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Between 2000 – 2013,
Deaths from prescription opioid
overdose death more than
tripled.
In 2014, 52 people died every
day as a result of an overdose
from a prescription painkiller.
In 2014, almost 2 million
Americans abused or were
dependent on prescription opioids
 Every day, over 1,000 people are
treated in emergency departments
for misusing prescription opioids.
 Since 2010, Heroin-related
overdose deaths have more
than quadrupled.
 More than nine in 10 people
who used heroin in also
used at least one other
drug.
 Among new heroin users,
approximately three out of
four report having abused
prescription opioids prior
to using heroin.
FENTANYL
 Fentanyl is a synthetic opioid pain reliever that is much more
powerful than any other opioids.
 It is prescribed for severe pain, such as advanced cancer pain.
It has been illegally made and distributed through illegal drug
markets, and is often mixed with heroin and other drugs,
sometimes without the buyer’s knowledge.
 Fentanyl overdoses are more lethal than heroin or prescription
opioids alone.
 Overdose deaths involving synthetic opioids, which includes
fentanyl, increased by 80% from 2013 to 2014.
OPIOID AND HEROIN DEATH STATISTICS
IN ILLINOIS – THE OPIATE CRISIS 2013 - 2015
 Illinois was one of 14 states with statistically
significant increases in overall drug overdose deaths
between 2013 and 2014.
 Opioid drug overdoses killed 45% more people than
homicides
 The Chicago Metropolitan area ranks first
nationwide in emergency department mentions for
heroin use.
 Cook County ranks first in the nation for percentage
of arrestees testing positive for opiates.
Source: Illinois Department of Public Health
IN ILLINOIS DRUG POISONING DEATHS
2013-2015
 3,614 were due
to opioids
 2,113 were due
to heroin
 1,344 were due
to prescription
opioids
According to Illinois Public
Health data, Illinois has one
of the higher rates of death
from heroine and opioid
use.
Illinois is one of 16 states in
which more people die of
drug overdoses than car
accidents.
Source: CDC/statistics 2014
WHO IS AT RISK OF AN OVERDOSE?

Anyone who may use opioids for chronic cancer pain or non-cancer
pain, as well as people who use heroin, may be at risk for opioid
overdose

Some situations that may increase a person’s risk include:
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Switching between opioids
Mixing opioids with depressants, such as alcohol or
benzodiazepines; such as oxycodone and xanax and alcohol.
People with chronic medical conditions (Substance Use Disorders,
HIV, cardiovascular or respiratory disease, mental illnesses) or
homeless conditions;
Recently released from incarceration and in-patient tx programs.
Recently completing a mandatory opioid detoxification or having
abstained from use for a period of time; the person’s tolerance has
decreased but they have a high risk of relapse
Discharge from emergency medical care after opioid intoxication
HOW TO REDUCE THE RISK OVERDOSE
Talk to people and caregivers about ways to avoid an
accidental overdose, especially at discharge:
 Do not adjust prescribed dosage, skip doses, or
take any extra doses
 Do not mix with other dugs and/or alcohol (i.e.
anti-anxiety drugs like benzodiazepines,
antidepressants, or cocaine)
 Abstain from use of opioids unless prescribed,
and attempt abstinence from heroin.
OVERDOSE
 Overdose is an acute condition that usually occurs
over 1-3 hours
 May be caused by:
 Excess intake of opioids
 Combination of opioid and a Central Nervous
System depressant
 Opioid use in someone with a compromised
respiratory system or metabolic condition
OVERDOSE
Slow Breathing
Breathing Stops
Lack of oxygen may cause
brain damage
Heart Stops
Seizure, stroke, or even death
Mechanisms of overdose
HOW TO RECOGNIZE AN OVERDOSE

The difference between being high and overdosing is if the
patient is responsive or not.
 Other signs to look for include:
 In an opiate overdose, the person’s breathing will be slow
and shallow, their coloring may be pale or blue, and they
may be snoring or gurgling
 In a stimulant overdose, the person may have chest pain,
difficulty breathing, dizziness, vomiting, foaming at the
mouth, lots of sweat or NO sweat, a racing pulse, and/or
seizures
 Checking for a response (downer/opioid overdose)
 Make noise, call the person’s name
 Shake the person, rub their sternum or forehead with
knuckles
 Check that their airway is clear by tilting their head back
and lifting their chin
 Check for syringe caps, undissolved pills, fentanyl patches
in their cheek, toothpicks, gum, etc.
ILLINOIS PUBLIC ACT 099-0480 (HB1)
 Illinois Public Act 099-0480 (HB0001) passed and
became effective September 9, 2015.
 Enables non-medical persons to administer Naloxone to
persons experiencing an opioid overdose
 Requires emergency responders such as EMS,
firefighters, law enforcement, and pharmacists to be
trained in administering Naloxone through its various
forms of administration
 Updates previous laws and Allows Department of Human
Services- DASA to further implement the Drug Overdose
Prevention Program (DOPP) to encourage, establish
and authorize programs to become enrolled to distribute
naloxone statewide.
DRUG OVERDOSE PREVENTION
PROGRAM (DOPP)
 Potential enrollees include:
 DASA Treatment Programs and Recovery Homes
 Licensed prescribing practitioners
 For profit community-based organizations & not-for- profit
community-based organizations
 Hospitals, and Local Health Departments,
 Health care providers, including FQHCs and Health Care for
the Homeless clinics, urgent care facilities, faith-based
organizations.
 Agencies engaged with incarcerated individuals, such as
jails, prisons, probation and parole, problem-solving courts,
and
 Police and Sheriff departments
WHAT IS NALOXONE AND HOW DOES
IT WORK?

Naloxone is an opioid
receptor antagonist that
works by reversing both
the clinical and toxic
effects of the overdose. It
works by blocking the
opioid’s action on the
brain and restoring
breathing.

The only purpose is to
reverse overdose; there is
no abuse potential and
this medication cannot
produce a “high”
ACTION PLAN STEPS
Step 1: Recognizing an overdose
Step 2: Attempt to Arouse – Sternal Rub
Step 3: Calling 9-1-1
Step 4: Administer naloxone, Rescue Breathing
Step 5: Stay Until Help Arrives
ACTION PLAN
1. Stay Calm
2. Give Sternal Rub (Call out persons name and shake shoulders)
3. Call 911 for Emergency Rescue Responder Services
4. Perform Rescue Breathing and Chest Compression Techniques
5. Administer Naloxone either through muscular injection or nasal
spray.
6. Continue rescue breathing for 3-5 mins, if person is still not
responding administer second dose of Naloxone
7. Goal is to restore adequate breathing, but not necessarily
complete arousal
8. Stay with person until Emergency Responders arrive. If person
is still unconscious but breathing on his/her own, put him or her
in recovery position.
TIPS FOR CALLING 9-1-1 & NALOXONE
 Whichever you can do the quickest – DO FIRST!
 Tell the dispatcher the person has stopped
breathing
 The dispatcher may give instructions on rescue
breathing or chest compressions
 Have the address and location ready
 The dispatcher may connect you with the
paramedics who will ask you the same
questions – this is a normal process.
RESCUE BREATHING
 Please review the steps below to perfect your rescue
breathing technique:
1. Be sure the person’s airway is clear (check that
nothing inside the person’s mouth or throat is blocking
the airway
2. Place one hand on the person’s chin, tilt the head
back.
3. Pinch the nose closed.
4. Place your mouth over the person’s mouth to make a
seal and give 2 slow breaths.
5. The person’s chest should rise (but not the stomach).
6. Follow up with one breath every 5 seconds until the
person can breath on their own
WHY NALOXONE?
 Naloxone is an opioid overdose antidote.
 Naloxone counteracts the effects of prescription
opioids like hydrocodone, oxycodone, morphine,
methadone and fentanyl and illegal opioids like
heroin.
 Naloxone is safe. It is as nontoxic as water and has no
potential for addiction. If a person has not taken
opioids, naloxone will not hurt them.
 Naloxone is cost effective.
 In Illinois anyone can be trained to administer
naloxone.
2 WAYS TO ADMINISTER
NALOXONE
Most Common:
 Nasal (intranasal – IN)
 Injectable (intramuscular – IM)
Extremely Expensive:
 Auto-injector(intramuscular – IM)
HOW TO GIVE NASAL SPRAY
NALOXONE
 In the case of a known or
suspected opioid overdose:
 Peel back the tab to remove
NARCAN® Nasal Spray from
its package.
 Place the device into one
nostril.
 Press the device plunger
firmly.
 Get emergency help right
away.
HOW TO GIVE INJECTABLE
NALOXONE
1.
Remove cap from Vial and uncover the needle
2.
Insert needle through rubber plug with vial upside down.
Pull back on plunger and take up 1mL
HOW TO GIVE INJECTABLE
NALOXONE
3.
Inject 1mL of naloxone into upper arm, thigh, buttocks
4.
If no reaction in 3 minutes, give second dose.
WHILE YOU’RE WAITING FOR
NALOXONE TO KICK IN…
 Start rescue breathing again until you see the person
start to breathe on their own.
 Wait 2-3 minutes (longer if administering IN naloxone)
to give the medication a chance to work.
 If no response after 2-3 minutes, give a second dose of
naloxone and begin rescue breathing again.
 If still no response, continue rescue breathing until
paramedics arrive and let them take over.
 Note: naloxone will only work if the individual has taken
an opioid. If they overdosed on a non-opioid, naloxone
will not have an effect on them.
WHAT TO EXPECT AFTER
ADMINISTRATION OF NALOXONE…

Stay with the person for as long as you can or until help
arrives
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If the person is still unresponsive, make sure to lay them in the
recovery position to prevent choking and wait for help.
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If the person is responsive, they will be confused about what is
happening and will probably not remember overdosing.
 Explain what has happened
 Comfort the person; withdrawal symptoms triggered by
naloxone can feel unpleasant.
 Some people may become agitated or combative and will
need help remaining calm.
 Don’t allow the person to take more opioids, as they can
overdose again.
NALOXONE FACTS
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Onset of action is about 2-3 minute
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Duration of action is 30-120 minutes depending on method of
administration
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It will not reverse an overdose caused by other drugs, only
opioids
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May be used in children and pregnant women
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Naloxone should be stored in its original packaging, while
avoiding light, at room temperature.
 It can be left in the car glove box overnight, but not as a
permanent storage option

Pay attention to the expiration date for any naloxone product.
Most have an expiration date of about 12-18 months.
 Expired naloxone can still be administered if there is no
other alternative available. However, it may not be as
effective and a second dose may be required.
REMEMBER S.C.A.R.E.M.E.
SIGNS OF WITHDRAWAL
 Body aches
 Diarrhea
 Tachycardia
 Fever, runny nose, sneezing
 Piloerection, Sweating, Yawning
 Nausea or Vomiting
 Nervousness, Restlessness or Irritability
 Shivering or Trembling, Abdominal Cramps, Weakness
 Increased Blood Pressure
SUMMARY – DO’S AND DON’TS
 DO support the person’s breathing by administering naloxone
or performing rescue breathing
 DO administer naloxone
 DO put the person in the “recovery position” on the side, if the
person is breathing independently
 DO stay with the person and keep him/her warm
 DON’T slap or try to forcefully stimulate the person
 DON’T put the person into a cold bath or shower
 DON’T inject the person with any substance
 DON’T make the person vomit what he/she may have
swallowed
SAMSHA Treatment Locator: Convenient and Easy to use
Behavioral Health and Substance Abuse Treatment locator:
https://findtreatment.samhsa.gov/locator
M.A.T. - MEDICATION ASSISTED TREATMENT
 History: In the post- WWII there was a significant rise in the use of
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opioids. The federal government became concerned with the
effects this was having on communities, so they began to increase
punishment for possession and distribution.
At this time the psychiatric community was finding that people
addicted to opioids were much more likely to relapse despite the
completion of detoxification and treatment programs.
When this did little to quell the problem, the medical community
began to advocate for opioid maintenance programs in which
people dependent on opioids were given small doses under the
care of a medical professional.
The initial interventions didn’t work because they used short halflife medications such as morphine. Patients quickly developed
tolerance and needed increasing amounts of medication. Higher
doses of morphine caused increased sedation and interfered with
patients social functioning.
In response the federal government began funding experimental
programs to use Methadone.
FORMS OF M.A.T.
 Methadone was the first successful medication used in conjunction
with dependency treatment. It is a long acting agonist that is taken
orally and binds with the opiate receptors. It stops withdrawal and
craving while allowing the patient to function, and at appropriate
dosing does not have any of euphoric or sedative effects. It is only
available through approved treatment programs and is usually
dispensed daily.
 Buprenorphine/Naloxone combination medication contains
buprenorphine (a partial agonist) and naloxone (an antagonist)
designed to ward off attempts to get high through injection
because if injected it can trigger withdrawal effects. In 2002 brand
name Suboxone became the first form of MAT to be available by
prescription from an office-based physician.
 Long acting injectable naltrexone (Vivitrol) is the newest form of
MAT. It is an antagonist that prevents the opioids to attaching to
receptors, thus if a person takes an opioid any opioid effect is
blocked. It is given monthly administered through a treatment
program or office based physician.
EFFECTIVENESS
 Support for MAT is on a international scale. A 2014 briefing
from SAHMSA lists the following as supporters of MAT:
 National Association of State Alcohol and Drug Abuse Directors
 World Health Organization
 National Institute of Drug Court Professionals
 National Institute on Drug Abuse
 This study also reviewed current literature to find the
effectiveness of each type of MAT
 Methadone- In 11 clinical trials of involving 1969 people,
methadone improved retention and reduced use compared to nonmedication treatment.
 Suboxone-SAHMSA reviewed clinical trials and saw that Suboxone
was more effective than placebo, but not as effective as methadone.
 Vivitrol- A six month multi state study of people under legal
supervision had “significantly fewer” positive urine tests.
NALOXONE FOR THOSE WHO NEED IT MOST
 NUMBER ONE priority: Put naloxone in the hands of those most
likely to be on the scene and first to respond, individuals who
use opioids, themselves.
 How best to reach this population? By making naloxone
available, in these settings:
 Syringe Exchange Programs
 Jails
 Hospital Emergency Departments
 Free Clinics
 First Responders
 Friends and Family members
 Methadone, Suboxone and Other Treatment Programs
IN TREATMENT – VULNERABLE POPULATION
 People entering & exiting Treatment for Opiate Use Disorder
 Effective January 1, 2017, all substance use treatment programs
licensed by IDHS/DASA must provide educational information
to clients identified as having or seeking treatment for opioid
use disorder, including the use of a medication for the use of
opioid use disorder, recognition of and response to opioid
overdose, and the use and administration of naloxone (PA 990553).
 Ideally, each treatment program would:
 Train each staff person/participant how to administer naloxone
 Encourage each participant to access a dose of naloxone either
through an outreach effort or with an insurance card at a pharmacy
NALOXONE KIT LOCATIONS
Where & Why?
 1 in 5 Overdose Deaths Happen
in Public Bathrooms
 Mount Kits in Highly visible area
 Kits must be easily accessible
 Naloxone kits are seen as
another tool to be kept in the
traditional “Emergency Kit”
EXAMPLES OF MOUNTED KITS
DHS/DASA DRUG OVERDOSE
PREVENTION PROGRAM (DOPP)
Benefits of Enrolling
•
•
•
•
Be part of the effort to reduce opioid deaths in Illinois.
Gain access to innovative training;
Stay informed about the most current legislation;
Inform your community about naloxone and help save
lives!
Click here for Program Guideline Manual
IDHS/DASA DRUG OVERDOSE
PREVENTION PROGRAM (DOPP)
VOLUNTARY REGISTRATION STEPS
 On DHS/DASA Website recover DASA Drug Overdose Drug Program
Implementation Guideline from :
http://intranet.dhs.illinois.gov/oneweb/page.aspx?item=58142
 Fill form IL444-2051 Enrollment form
1.
4.
EMAIL form IL444-2051 and Naloxone Training Slideshow/Training
Module to [email protected] *
Upon review and consideration an acceptance letter and certificate will
be issued out to the Program Director (valid for five (5) years)
Note: All updates or changes to the enrolled agency (i.e. change of Program
Director, Address, Phone Number) must be submitted to
[email protected] within 30 days of the change.
5.
Within 30 days of enrollment expiration, an email will be sent to the
Program Director to renew enrollment with the Illinois Drug Overdose
Prevention Program
PROGRAM ADMINISTRATION
The Program Director Will:
 Identify a physician, physician assistant, or advanced
practice nurse to oversee the clinical aspects of the Drug
Overdose Prevention Program ;
 Establish the content of a training program, which is
consistent with the SAMHSA toolkit and IDHS/DASA
policies and procedures ;
 Maintain and review Drug Overdose Prevention Program
records including quarterly training records, inventory of
supplies and materials, and reversal forms
PROGRAM ADMINISTRATION (CONT)
 The Health Care Professional Will:
 Serve as a clinical advisor and liaison concerning
medical issues related to the Drug Overdose
Prevention Program;
 Provide consultation to ensure that all trained Overdose
Responders are properly trained;
 Adapt and approve training program content and
protocols;
 Provide liaison with local emergency medical services
and emergency dispatch agencies, where appropriate;
 Review reports of all administration of an opioid
antagonist
Section 1
Naloxone Administration
Reporting Form
THIS FORM IS TO BE
COMPLETED WITHIN
FIVE (5) BUSINESS DAYS
OF NALOXONE
ADMINISTRATION.
CONDITION OF PERSON
STANDING ORDER
TRAINING CURRICULUM & MATERIALS
 Describe the qualifications of individuals who can provide the drug
overdose prevention training ( including the use of naloxone) to
potential responders;
 Describe the duration and frequency requirements to training;
 Describe any required supervision or monitoring of drug overdose
responders and program trainers;
 Use available reference material to enhance training content;
 Describe the training oversight responsibilities of the program’s
official designee and HCP.
 Utilize resource materials on DHS/DASA website – DOPP
 DOPP webinar and slides are welcomed to be copied
 Drug Overdose Prevention Program email:
 [email protected]
 (email all forms to this email)
 Seth Eisenberg, M.D.
 [email protected]
 Rosie Gianforte
 [email protected]
 312-814-2136
 Anatomy of an Overdose
https://www.youtube.com/watch?v=DhS9M2ni2yE
 Administering Nasal Atomizer Naloxone Bystander video
 http://adaptpharma.com/news-events/press-kit
 Administering injectable naloxone
 https://vimeo.com/197652566/ce41306803
 https://vimeo.com/197650414/4916741e17 (Spanish)
 Recognizing an overdose & Reversing an overdose
 https://www.youtube.com/watch?v=FZpgjRBby_M
 M.A.T. Treatment
 https://youtu.be/ht7EpK2UF4I
News + research on overdose prevention
 Publications and Resources
Prescribetoprevent.org
 Law Enforcement Naloxone Toolkit at the
GetNaloxoneNow.org
Bureau of Justice Assistance’s National
Training and Technical Assistance Center
(link is external)
preventionalliance.org
 Naloxone Injection at MedlinePlus
Opioid overdose prevention education
 Opioid Overdose Prevention Toolkit – 2014
Stopoverdose.org
Family support
GRASP: Grief Recovery After a Substance
Passing
 Grasphelp.org
 Learn2cope.org