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Mathew Wong, RN BScN
Streetworks, Edmonton, AB
Alberta Harm Reduction Conference 2013
Stats
Our Program
Overdose Prevention
Around theWorld
911 Good SamaritanActs
Naloxone Kit Distribution andODTraining
IncreasingAvailability of Naloxone
Overview

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• Globally, in 2012, there were between 99,000 and 253,000 deaths
attributed to illicit drugs (UNODC, 2012)
• At its highest, that is 693 lives lost each day in the world
• Drug overdose is the second leading cause of accidental death after
motor vehicle collisions in the United States, with over 38,000 in 2010
• That is over 100 people dying each from accidental drug overdose (CDC, 2010)
• Fragmented reporting systems in Alberta report at least one drug
overdose death each day back in 2004 (Office of Chief Medical Examiner
Alberta Justice, 2009)
• Canada just recently surpassed the US to be number one in per capital
consumption of opioids (International Narcotics Control Board, 2012)
• To put some perspective on that, number 3, Norway, has a 40 percent lower usage
rate than us
Stats
This is a tragedy.
Began in 2005 (Dong et al, 2005)
First of its kind in all ofCanada
Modeled after the first NaloxoneDistribution
program in the US (ChicagoRecoveryAlliance
One physician prescribing exclusively to opiate
users
Training is completed by a Registered Nurse
who cosigns the prescription
Our Program

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To date:
• 206Trainees
• 22Overdose reversals
• an approximately 10% reversal rate
Involves and empowers communitymembers
to become active participants in the health
care of themselves and their community
Two Parts to OverdoseTraining
• Overdose PreventionTips
• Life Saving Measures
Our Program (Continued)
Overdose happens when a person takes more of a drug
or combination of drugs than the body can handle. As
a consequence, the central nervous system (CNS) is
not able to control basic life functions.
Overdose

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Preventing Overdose:
Never use alone!
If someone is there, that someone can
help call 911 and give Naloxone.
Preventing Overdose:
Know your source!
Know your dealer and buy from the same
source, that way you know how safe and how
pure the stuff you are getting.

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Preventing Overdose:
Don’t mix!
It’s much, much easier to overdose if
you’re mixing drugs, especially alcohol.
Preventing Overdose:
Do a tester (Use Slowly)!
The strength of the drug can differ.
Start small so you don’t use too much.

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Preventing Overdose:
Use less after a break!
After a short break from using (like being in
jail, hospital or detox), your tolerance can go
way down. Even as little as three days.
Preventing Overdose:
Eat/Snort/Smoke!
Injecting is the most dangerous as it
goes straight into your system and
can’t be taken out.

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Preventing Overdose:
Stay Healthy!
Not sleeping, not eating well, not
taking care of yourself – all of it makes
it easier to OD.
Preventing Overdose:
Get trained!
Know your stuff!
Prevent overdoses, spread the
knowledge, and save lives.

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LSD(acid)
Mescaline
PCP
Cannabis
Ecstasy
Salvia
Ketamine
Can lead to high blood
pressure, seizures, high
heart rate, high body
temperature.
Psychosis, kidney
damage
Realistically the
greatest harm would be
risk of self harm or
accidents
Overdose – Hallucinogens
Cocaine
Crack
Speed
Meth
Ecstasy
Anxiety, Psychosis,
Vomiting, Sweating,
Foaming at mouth,
Chest pain, Elevated
body temp
Overheating
Stroke
Heart attack
Seizures
Overdose – Ups (Stimulants)

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• Call 911
• Reduce stimuli:turn of sounds and
lights, crowd control
• Talk calmly and stay with the person
until help arrives
• If the person is overheating, use fans,
ice packs, cool sips of water,
If the person
is conscious
• Call 911
• StartCPR if certified
• If not place person in recovery position
If the person
is
unconscious
What to do in Stimulant/HallucinogenOD?
Cops show up
(Possession,
paraphernalia,
warrants)
Distrust of the
Healthcare System
Previous
experience of
person waking up
Confidence in
mythical street
antidotes
Fear of association
in OD
Why not call 911?

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Heroin
Methadone
Morphine
Oxycodone
Fentanyl
Dilaudid
Percocet
Tylenol 3, 4
Feelings of Euphoria and
analgesia, Gradual
decrease in the urge to
breathe and
responsiveness to
increasing levels of carbon
dioxide
Oxygen Starvation
eventually stops the vital
organs – the heart then
brain
Overdose – Down (Depressants)

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0.4 mg/ml single use vials
Can be given by intramuscular injection or
intranasal spray
Does not replace emergency medical
assistance
Only works for OpioidOverdose
Last 30-90 minutes
In Canada, approx. $13/vial
Naloxone (Narcan®)

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What to do in Opiate OD?
S – timulation Can you wake them up? If not, call
9-1-1!
A – irway Make sure there’s nothing in their
mouth that stops them from
breathing
V – entilate Breathe for them! (one breathe
every 5 seconds)
E – valuate Are they any better? Are you
trained to give naloxone?
M – uscular
injection
Inject 1cc of
naloxone into a muscle.
E – valuate
and
support
Is the person breathing on their
own? If they’re not awake in 5min,
another 1cc dose is needed.
Tell the person not to use any more
drugs right now – wait at least a
couple of hours.
911 Good
Samaritan
Acts
Provide
limited
immunity
from criminal
code when
calling to
save
someone’s
life
Naloxone
Kits and
OD
Training
Take Home
Naloxone
Programs
Overdose
Prevention
Education
Increasing
Availability
of
Naloxone
Over the
counter
Naloxone
Bystanders
carrying
Naloxone
Intranasal
Spray
Increasing
Awareness
International
Overdose
Awareness
Day – August
31
Around theWorld

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911 Good Samaritan Acts
“No one should go to jail for calling 911 to
save someone’s life”
Law in place to provide limited immunity
from the criminal code when calling 911
to save someone fromOD
New Mexico was first state in 2007
11 other states (WA, NY, CT, IL, CO, RI,
FL, MA, CA, NC and NJ) plus 2 (AK, MD)
as of May 2013
911 Good Samaritan Acts
November 2012 – Gov.Christie
of New JerseyVetoesGood
Samaritan Law
• Said he was afraid they would let drug
dealers off the hook, “How about if
they’re not a Good Samaritan?”
May 2013 – Gov.Christie signs
the OD prevention bill into law
• Said he was moved by the letters of
grieving parents who had lost children
to OD, including Jon Bon Jovi whose
daughter survived a heroinOD

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Naloxone Kits and ODTraining
Canada – BC, Ontario (Toronto), and
Edmonton
• Toronto’s program which began in 2011 has 580
trained and 68 reversals as of Feb 2013
• BC’s pilot project has distributed 350 kits and has
had 8 reversals as of Dec 2012
USA – 188 community based take home
Naloxone Programs
• 50,000Trained
• 10,000 Overdose Reversals
Germany, UK,Australia, Russia, Estonia,
Afghanistan,Cambodia and numerous
other countries
Naloxone Kits and ODTraining
Effective in Saving Lives
(Walley et al, 2013)
• 2912 trained and 327 in Massachusetts
• Significantly reduced rate of
overdoses
• Significantly reduced rate of overdose
deaths
Cost Effective
(Phillip, Coffin & Sean, 2013)
• Saves costs to health care
• Study did not account for reduced
drug use and healthier habits brought
on from the training

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IncreasingAvailability of Naloxone
IncreasingAvailability of Naloxone
Over the Counter
Naloxone – Italy
Specialized OD
Ambulances – Moscow
Doctors co-prescribing
Naloxone
Train Professionals – law
enforcement (NM, NY –
51 lives saved), EMTs
Train Bystanders
Massachusetts – has 2900
Trained
Intranasal Spray

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IncreasingAwareness
The Purple ribbon is an
International symbol of Overdose
Awareness
• The silver badge is the symbol for
OverdoseAwareness day onAugust 31
Streetworks Overdose Prevention
Newsletter
• Add your email to the mailing list!
Spread the word!
“Out beyond ideas of wrongdoing and rightdoing,
there is a field. I’ll meet you there.”
--Rumi

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• Anex. (2010). Lifesavers: a position paper on access to naloxone hydrochloride for potential opiate overdose witnesses. Apex: Melbourne
Australia.
• Anex (2011). http://www.anex.org.au/what-we-do/current-interests/access-to-naloxone/
• CDC. (2010). Death and Mortaility. Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/nchs/fastats/deaths.htm
• Dong K., Taylor M., Wild CT., Rose M., Salvalaggio G., Rowe BH. (2012). Community based Naloxone: a Canadian pilot program. Canadian
Journal of Addiction Medicine, 3(2):4-9.
• Hardeman S. (2011). How to save a life: overdose prevention and Naloxone training. Streetworks Alberta Harm Reduction Conference.
Edmonton, AB.
• LawAtlas. (2013). Public Health Law Research. Retrieved on May 6, 2013 from: http://lawatlas.org/
• Marteau, D., Wishart, S., Strang, J., Bird, S., and Parmar, M. (21 February 2011). Prison-based Naloxone-on-release pilot randomised controlled
prevention trial.
• Office of the Chief Medical Examiner Alberta Justice. (2009). Unclassified Manner of Death. Retrieved from:
http://justice.alberta.ca/programs_services/fatality/ocme/Publications_OCME/AnnualReviewOCME2009.aspx/DispForm.aspx?ID=38
• Phillip O., Coffin MD., Sean DS. (2013). Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversals. Annals of Internal
Medicine1, 58(1):1-9. doi:10.7326.
• The Network for Public Health. (2013). Legal interventions to reduce overdose mortality: Naloxone access and overdose good Sa maritan laws.
Retrieved from: http://www.networkforphl.org/_asset/qz5pvn/naloxone-_FINAL.pdf
• Towards the Heart. (2012). http://towardtheheart.com/
• UNODC. (2012). International Narcotics Control Board. The United Nations Office on Drugs and Crime. Retrieved from http://www.incb.org/
• Walley AY., Xuan X., Hackman HH., Quinn E., Doe-Simkins M., Sorensen-Alawad A., Ruiz S., Ozonoff A. (2013). Opioid overdose rates and
implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. British Medical
Journal, 346. doi: 10.1136.
References