This thread is about recognizing and managing an overdose that involves opioids. These are some common opioids: opium, morphine (MS Contin), codeine (Tylenol #3), thebaine, heroin, hydromorphone, hydrocodone (Vicodin, Norco, Lorcet- all w/ Tylenol), oxycodone (Percocet & Roxicet w/Tylenol, OxyContin), oxymorphone (Opana), buprenorphine (Suboxone, Subutex, Butrans), fentanyl (Duragesic, Actiq, Abstral), methadone (Dolophine, Methadose), meperidine (Demerol), propoxyphene(Darvon, Darvocet)
Opioid overdose is rarely instantaneous; people slowly stop breathing minutes to hours after the drug was used. While sometimes people have been “found dead with a needle in their arm,” there is usually time to intervene between when an overdose starts and before a victim dies. With opioid overdoses, the difference between surviving or dying depends on breathing and oxygen. These are some signs of overdose:
• Blue skin tinge- usually lips and fingertips show first
• Body very limp
• Face very pale
• Pulse (heartbeat) is slow, erratic, or not there at all
• Throwing up
• Passing out
• Choking sounds or a gurgling/snoring noise- this signal is often overlooked
• Breathing is very slow, irregular, or has stopped
• Awake, but unable to respond
These are steps to take if someone is having an opioid overdose:
Assess the signs
Is the person breathing? Is the person responsive? Can the person speak? What is the skin color (especially lips and fingertips)?
Stimulation
If the person is unconscious or “out of it,” try to wake them up. Call his or her name. If this does not work, try to stimulate him or her with mild pain by rubbing your knuckles into the sternum (the place in the middle of your chest where your ribs meet), rubbing your knuckles on their upper lip. If the person’s breathing is shallow or they tell you he or she has shortness of breath or a tightness in their chest call 911/999. If the person does not respond to stimulation and remains unconscious, or the condition appears to get worse, do not try a different or alternative form of stimulation.
Call for help
The bystander should call 911/999 in the case of an overdose because it is important to have trained medical professionals assess the condition of the overdose victim. Even though naloxone can reverse the overdose, there may be other health problems of which you may not be aware. In addition, people who survive any type of overdose are at risk of experiencing other health complications as a result of the overdose, such as pneumonia and heart problems.
What to say when calling 911/999 depends on the local emergency response to overdoses. In every community, it is important to report the victim’s breathing has slowed or stopped, he or she is unresponsive, and the exact location of the individual. If naloxone was given and it did not work, this is important information to tell the dispatcher. In many communities, the police respond along with the ambulance to all 911/999 calls. Often, when the police respond they do not arrest the bystander or victim at the scene of an overdose. There are always exceptions to this and thus the fear of arrest and police involvement is substantial. Overdose bystanders should try to learn what the real risk is by talking to people who have actually had an experience and not make assumptions based on hearsay.
Individuals who overdose can die because they choke on their own vomit (aspiration). This can be avoided by putting the individual in the recovery position. The Recovery Position is when you lay the person on their side, their body supported by a bent knee, with their face turned to the side. This position decreases the chances of the individual choking on their vomit. If you have to leave the person at all, even for a minute to phone 911/999, make sure you put them in the Recovery Position.
Rescue Breathing
For a person who is not breathing, rescue breathing is one of the most important steps in preventing an overdose death. When someone has stopped breathing and is unresponsive, rescue breathing should be done as soon as possible because it is the quickest way to get oxygen into the body. Steps for rescue breathing:
1. Place the person on his or her back.
2. Tilt chin up to open the airway. Check to see if there is anything in the mouth blocking the airway. If so, remove it.
3. Give 2 breaths.
4. Blow enough air into the lungs to make the chest rise.
5. Turn your head after each breath to ensure the chest is rising and falling. If it doesn’t work, tilt the head back more.
6. Breathe again every 5 seconds.
Administer naloxone
Nasal naloxone- formulation is 2mL of 1mg/1mL Assembly video here
1. Pop off two yellow caps and one red cap.
2. Hold nasal spray device and screw it onto the top of the plastic delivery device.
3. Screw medicine gently into delivery device
4. Spray half (1mL) of the medicine up one side of the nose and half up the other side.
Injectable naloxone- formulation is 0.4mg/1mL in either 1mL or 10mL vials Example at 5:50 of this video
1. Use a long needle: 1 – 1 ½ inch (called an IM or intramuscular needle)- needle exchange programs and pharmacies have these needles.
2. Pop off the top of multi or single dose vials or snap off neck of single dose ampoule
3. Draw up 1cc of naloxone into the syringe 1cc=1mL=100u.
4. Inject into a muscle – thighs, side of the butt, or shoulder is best.
5. Inject straight in to make sure to hit the muscle,
6. If there isn’t a big needle, a smaller needle is OK and inject under the skin, but if possible it is better to inject into a muscle with a longer needle.
If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while waiting for the naloxone to take effect. If there is no change in 3-5 minutes, administer another dose of naloxone and continue to breathe for them. Continue to rescue breathe until the victim breaths on his or her own, while you wait for help to arrive.
Evaluation and Support
Naloxone only lasts between 30 – 90 minutes & the effects of the opioids may last much longer. A heroin overdose may last as long as 4 hours and a methadone overdose may last longer. It is possible that after the naloxone wears off the overdose could recur. It is very important that someone stay with the person and wait out the risk period just in case another dose of naloxone is necessary. Also, naloxone can cause uncomfortable withdrawal feelings since it blocks the action of opioids in the brain. Sometimes people want to use again immediately to stop the withdrawal feelings, which also could cause another overdose.
Opioid overdose is rarely instantaneous; people slowly stop breathing minutes to hours after the drug was used. While sometimes people have been “found dead with a needle in their arm,” there is usually time to intervene between when an overdose starts and before a victim dies. With opioid overdoses, the difference between surviving or dying depends on breathing and oxygen. These are some signs of overdose:
• Blue skin tinge- usually lips and fingertips show first
• Body very limp
• Face very pale
• Pulse (heartbeat) is slow, erratic, or not there at all
• Throwing up
• Passing out
• Choking sounds or a gurgling/snoring noise- this signal is often overlooked
• Breathing is very slow, irregular, or has stopped
• Awake, but unable to respond
These are steps to take if someone is having an opioid overdose:
Assess the signs
Is the person breathing? Is the person responsive? Can the person speak? What is the skin color (especially lips and fingertips)?
Stimulation
If the person is unconscious or “out of it,” try to wake them up. Call his or her name. If this does not work, try to stimulate him or her with mild pain by rubbing your knuckles into the sternum (the place in the middle of your chest where your ribs meet), rubbing your knuckles on their upper lip. If the person’s breathing is shallow or they tell you he or she has shortness of breath or a tightness in their chest call 911/999. If the person does not respond to stimulation and remains unconscious, or the condition appears to get worse, do not try a different or alternative form of stimulation.
Call for help
The bystander should call 911/999 in the case of an overdose because it is important to have trained medical professionals assess the condition of the overdose victim. Even though naloxone can reverse the overdose, there may be other health problems of which you may not be aware. In addition, people who survive any type of overdose are at risk of experiencing other health complications as a result of the overdose, such as pneumonia and heart problems.
What to say when calling 911/999 depends on the local emergency response to overdoses. In every community, it is important to report the victim’s breathing has slowed or stopped, he or she is unresponsive, and the exact location of the individual. If naloxone was given and it did not work, this is important information to tell the dispatcher. In many communities, the police respond along with the ambulance to all 911/999 calls. Often, when the police respond they do not arrest the bystander or victim at the scene of an overdose. There are always exceptions to this and thus the fear of arrest and police involvement is substantial. Overdose bystanders should try to learn what the real risk is by talking to people who have actually had an experience and not make assumptions based on hearsay.
Individuals who overdose can die because they choke on their own vomit (aspiration). This can be avoided by putting the individual in the recovery position. The Recovery Position is when you lay the person on their side, their body supported by a bent knee, with their face turned to the side. This position decreases the chances of the individual choking on their vomit. If you have to leave the person at all, even for a minute to phone 911/999, make sure you put them in the Recovery Position.
Rescue Breathing
For a person who is not breathing, rescue breathing is one of the most important steps in preventing an overdose death. When someone has stopped breathing and is unresponsive, rescue breathing should be done as soon as possible because it is the quickest way to get oxygen into the body. Steps for rescue breathing:
1. Place the person on his or her back.
2. Tilt chin up to open the airway. Check to see if there is anything in the mouth blocking the airway. If so, remove it.
3. Give 2 breaths.
4. Blow enough air into the lungs to make the chest rise.
5. Turn your head after each breath to ensure the chest is rising and falling. If it doesn’t work, tilt the head back more.
6. Breathe again every 5 seconds.
Administer naloxone
Nasal naloxone- formulation is 2mL of 1mg/1mL Assembly video here
1. Pop off two yellow caps and one red cap.
2. Hold nasal spray device and screw it onto the top of the plastic delivery device.
3. Screw medicine gently into delivery device
4. Spray half (1mL) of the medicine up one side of the nose and half up the other side.
Injectable naloxone- formulation is 0.4mg/1mL in either 1mL or 10mL vials Example at 5:50 of this video
1. Use a long needle: 1 – 1 ½ inch (called an IM or intramuscular needle)- needle exchange programs and pharmacies have these needles.
2. Pop off the top of multi or single dose vials or snap off neck of single dose ampoule
3. Draw up 1cc of naloxone into the syringe 1cc=1mL=100u.
4. Inject into a muscle – thighs, side of the butt, or shoulder is best.
5. Inject straight in to make sure to hit the muscle,
6. If there isn’t a big needle, a smaller needle is OK and inject under the skin, but if possible it is better to inject into a muscle with a longer needle.
If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while waiting for the naloxone to take effect. If there is no change in 3-5 minutes, administer another dose of naloxone and continue to breathe for them. Continue to rescue breathe until the victim breaths on his or her own, while you wait for help to arrive.
Evaluation and Support
Naloxone only lasts between 30 – 90 minutes & the effects of the opioids may last much longer. A heroin overdose may last as long as 4 hours and a methadone overdose may last longer. It is possible that after the naloxone wears off the overdose could recur. It is very important that someone stay with the person and wait out the risk period just in case another dose of naloxone is necessary. Also, naloxone can cause uncomfortable withdrawal feelings since it blocks the action of opioids in the brain. Sometimes people want to use again immediately to stop the withdrawal feelings, which also could cause another overdose.
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