Narcan

1. 1st Responder Nasal
Naloxone

2. Objectives – By the end of
this program the participant
will:
 Define & give
examples of opiates &
opioids;
 Understand the
history &
epidemiollogy of
opiates & opioids in
the US & MA
specifically;
 Describe what an
opiate/opioid overdose
looks like.
 Explain what naloxone
is and how it works on
an opiate/opioid
 Dispel common myths
about reversing an
opiate/opioid overdose;
 Articulate the
opiate/opioid treatment
modality using nasal
naloxone;
 Demonstrate proper
assemblage &
administration of nasal
naloxone to an
opiate/opioid overdose;
 Explain the
Department’s Policy for
maintaining, administrat
ing, replacing, and

3. History
 Poppy to Opium to Heroin  Harrison Narcotic Tax Act
1914
 Controlled Substance Act
1970
 FDA / DEA

4. Opiates vs. Opioids
 Poppy Plant
 Natural to Semi-
synthetic
 Central Nervous
System Depressant
 Slows down
Breathing, pulse, overall
metabolism
 Pain reduction
 Similar to opiates
 CNS Depressant
 Fully Synthetic

6. DEA vs. FDA
 FDA
 Department of Health &
Human Services
 Science & Medicine
 DEA
 1973 Executive Order 11727
 Department of Justice
 Full Authority for Scheduling
& Enforcement
 Drug Scheduling (I – V)
 Schedule I
 Very High Abuse Potential
 Very High Dependence
Potential
 Very High Public Risk
 NO CURRENTLY accepted
medical value
 Schedule V
 Very Low Abuse Potential
 Very Low Dependence
Potential
 Very Low Public Risk
 High Medical Value

7. Massachusetts Nasal Narcan
History
 Narcan part & parcel of Paramedic
Treatment (IM, IV, IO)
 Antagonist to Opioids (Mu Receptor)
 2004 Statewide Treatment Protocols added
Nasal for Paramedics
 2005 started process 2006 approved SPW
BLS Narcan / CAS & BEMS
 CAS: Data 24 months= 105 BLS uses
5 protocol outliers
 2007
 Statewide BLS SPW Approval must
follow CAS or BEMS
 Revere Fire Department
 EMS 1st Responders

8. Mass. Nasal Narcan Hx. Con’t
 2007 Outside of EMS
 Mass DPH Public Narcan
Responder Program
 July 2010 Presentation
to DPH
 CAS & BEMS
 2011 – approved as
standing orders for 2012
Statewide protocols
 2012 – SWTP Service &
Medical Director Option
for BLS Nasal Narcan!

9. 0
200
400
600
800
1000
1200
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Deathsperyear
All Poisoning Deaths Motor Vehicle-Related Injury Deaths
The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health
Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths,
MA Residents (1997-2008)
More Opioid Overdose Deaths than MVA
Deaths in Massachusetts

10. 0
200
400
600
800
1000
1200
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Deathsperyear
All Poisoning Deaths Opioid-related Poisoning Deaths Motor Vehicle-Related Injury Deaths
The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health
Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths,
MA Residents (1997-2008)
More Opioid Overdose Deaths than MVA
Deaths in Massachusetts
Rate of opioid-related fatal overdoses in MA in 2006 was 9.9 per 100K

11. What is Driving the Increase
in Overdose?
 New Drug Use Patterns
New Initiates to prescription drugs
Oxycontin to Heroin
 Heroin Availability/Purity/Lethal Mixture
Heroin is the leading drug threat in New England
From ‘93-’10 Heroin reported as primary drug
increased from 20% - 40% of treatment
admissions in MA
 Prescribing Patterns
Number of Schedule II Opioid prescriptions has
more than doubled in the past decade

12. Strategies to address overdose
 Prescription monitoring programs
 Paulozzi et al. Pain Medicine 2011
 Prescription drug take back events
 Safe opioid prescriping education
 Albert et al. Pain Medicine 2011; 12: S77-S85
 Expansion of opioid agonist treatment
 Clausen et al. Addiction 2009:104;1356-62
 Safe injection facilities
 Marshall et al. Lancet 2011:377;1429-37

13. 2010
States w/ OENDs 15
Programs 188
People enrolled 53,032
OD rescues 10,171
Wheeler E et al. Morb Mortal Wkly
Rep 2012;61:101-5.
Overdose Education and Naloxone
Rescue Kits

14. Mass: where & who
 Boston, Brockton, Cambridge, Fall
River, Gloucester, Holyoke, Hyannis
, Lawrence, Lowell, Lynn, New
Bedford, North
Hampton, Provincetown, Quincy, S
pringfield
 Lowell’s site:
 Lowell House Inc.
555 Merrimack Street
 Lawrence’s site:
 Greater Lawrence Family Health
Center 100
Water Street

15. Opiate Overdose
 Narcan Treatment
 Antagonistic Agent to Opiates
 Higher but short lived affinity for the
Resp. Receptor sites
 IV, IM, Nasal = MAD device
 Rx when:
 AMS or Resp. Depression
 List off the S & S of the above:
 Prehospital Rx
 SAFETY / BSI / O2 / Monitor / IV
 Urban Myths: “Screwed My High” /
“Street OD Education”
(c) Jeffrey M. Stewart - 2001 - update 2011
15

16. Intranasal Medication
Administration
(c) Jeffrey M. Stewart - 2001 - update 2011
16

17. How to assemble nasal naloxone

18. Urban Myth – “Screwed my High…”
 CNS Depressant
 Hypo-oxygenated to Hyper-oxygenated
 Survival Instinct!!

19. Department Specific
Policies & Procedures
 Paperwork / process for
 Storage
 Usage
 Replacement post usage
 Documentation for use
on patient
 Replacement for
 Expired
 Broken
 Lost