1. INTRODUCTION TO OPIOID
OVERDOSE PREVENTION
PRESENTATION TO WGDSC HARM REDUCTION FORUM MARCH 2013
Presentation property of Preventing Overdose Waterloo Wellington

2. WHAT WE WILL COVER
• What is an opioid overdose?
• Who is at risk for an opioid overdose?
• How to recognize an opioid overdose
• Myths and Facts about overdose
• How to respond to an opioid overdose

3. WHAT IS AN OPIOID OVERDOSE?
• The Central Nervous System and the effects
of psychoactive drugs
• Depressants
• Overdose Defined
• Types of Overdose

4. The Central Nervous System
Consciousness,
Memory, and
Emotion.
Three main effects:
Breath,
Movement, and 1.depressant,
Balance.
2.stimulant
Hearing
Sight,
3.hallucinogen
Smell,
Taste, and
Touch

5. Depressants
Depressants cause the central nervous system to slow
down - breathing and heartbeat are affected.
Desired depressant effects
 Relaxation, a sense of calm and drowsiness
 Pain relief
 Lowering of inhibition
Examples of depressants
 Opioid drugs (heroin, morphine, pethidine, codeine,
methadone, dilaudid, fentanyl, hydromorphone)
 Alcohol
 Benzodiazepines or ‘benzos’ (diazepam/valium)
 Cannabis (grass, weed, dope)
 Inhalants (aerosols, cleaning agents, solvents and gases)

6. Uppers (Stimulants)
Stimulants cause breathing and heartbeat to speed up.
Desired upper effects:
 Increased energy and alertness
 Increased confidence
 Ability to stay awake over long periods of time
Examples of uppers
• Amphetamine (speed) and methamphetamine (ice),
• Cocaine,
• Ecstasy (MDMA),
• Nicotine ( tobacco)
• Caffeine (tea, coffee, cola drinks)

7. Hallucinogens (psychedelics)
These drugs distort what people hear, think and see.
Desired hallucinogenic effects
An altered sense of the world, time, the body, other
people, thoughts, and emotions
Examples of hallucinogens
‘Magic’ mushrooms
LSD (‘acid’, ‘trips’)
Ketamine (‘Special K’)
Cannabis (grass, weed, dope)

8. Overdose Defined
Overdose is the use of a drug (or drugs) in
an amount or way that causes
acute harmful
mental or physical effects.
Overdose may produce
short-lived or lasting effects,
and can sometimes be fatal.

9. TYPES OF OVERDOSE
 Depressant overdose: slows the central nervous system
down to the point where several systems may stop working.
 Stimulant overdose: speeds the central nervous system up
to the point of overworking certain functions leading to
failure.
 Toxic overdose: organ damage or failure (heart, lungs,
kidneys etc.) from taking an excessive amount of a drug.
For today, we will be focusing on opioid overdoses, which fall
into the depressant category

10. After-effects of Non-Fatal Overdoses:
After an overdose a person can be left with serious, sometimes
permanent, health problems as a result of the overdose itself
 brain damage due to lack of oxygen as a result of seizure, stroke
or heart attack
 lung damage or pneumonia resulting from vomit/ fluid entering
the lungs during a period of unconsciousness
 muscle damage due to a long period of unconsciousness
especially if a limb is trapped under the body reducing its blood
supply.
 Serious complications can include paralysis, limb amputation or
kidney failure, broken bones due to falls, burns from exposure to
heaters or cigarettes, or physical assaults.

11. WHO IS AT RISK FOR AN OPIOID
OVERDOSE?
Overdose doesn’t discriminate, but there are some
key factors and patterns of use that have an
increased risk;
• Demographics
• Prescription Patterns
• Mixing Drugs
• Patterns of Use

12. OD RISK: DEMOGRAPHICS
A B.C. Review of Coronor Data from 2006-2011 allowed them to pull
together a profile of risk factors for overdose related death.
Most overdose deaths:
•Are accidental versus suicide (86%),
•occur in persons under the age of 60 (87%),
•have a documented source of chronic pain (82%),
•almost half have a documented co-morbid mental health diagnosis
(45%).
•are the result of taking at least one other non-opioid class of
medications(93%),
•Are not the result of “multi-doctoring” - almost all are taking medications
prescribed by a single doctor or clinic.
•Happen everywhere – no geographical or population density correlation

13. OD RISK: PRESCRIBING PATTERNS
• a 2009 Ontario study in the Canadian Medical Association Journal
linked the 850% rise in oxycodone prescribing with a quintupling in
oxycodone-related fatalities.
• Among the highlights:
• 66.4% had visited a physician in the month before death;
• 56.1% had filled a prescription for an opioid in the month before
death.
• Approximately 50,000 Ontarians are addicted to opioids and many
more are dependent
• Canada has the highest per capita rates of opioid consumption in
the world.
• A 2009 CAMH study indicated that more youth in Waterloo-
Wellington had consumed opioids for non-medicinal purposes
than tobacco (20%), the highest rate in Ontario. Most of them got
it from home.

14. OD RISK: PATTERNS OF USE
Overdose doesn’t discriminate, but there are some
key factors and patterns of use that have an
increased risk;
• Mixing Drugs
• The Way a Drug is Taken
• Low or Reduced Tolerance
• Using Alone
• Long-term use

15. OD Major Risk Factors: Mixing Drugs
Different drugs take different amounts of time to
leave the body.
New drugs can combine with drugs that may
have been used hours earlier.
Drugs may still be in the body long after a person
can’t feel their effects.
The majority of overdoses involve the use of a
combination of drugs.

16. The way a drug is taken:
How you take a drug can effect how fast and
how strong the effect is. The quicker the drug
enters the bloodstream, the higher the risk of
overdose.
Injection into a vein: Very fast absorption
Injection into a muscle or under the skin: Fast absorption
Smoking: Very fast absorption
Snorting, shafting: Fast absorption
Hooping: Slower absorption
Swallowing: Slowest absorption

17. Major Risk Factors: Reduced tolerance
Tolerance can take some time to develop -
weeks or months - but will reduce
far more quickly.
As little as three or four days without certain drugs
can be long enough to lower tolerance to the point
where there is a higher risk of overdose.
• The risk of overdose is high when individuals do not
take into account that their tolerance may be
lower than usual.
• Changes in how strong/pure a drug is could lead
to a person using more of a drug than they can
tolerate by accident.

18. Major Risk Factors: Reduced Tolerance
Times when tolerance will be low or reduced
• After drug detox or a rehabilitation program;
• After being in custody or jail;
• After a period when the drug of choice was not
available;
• Being a new or casual user;
• Following a period when use of a drug has reduced
or ceased for any reason
Just because a person’s tolerance for one drug is high
doesn’t mean that it will be high for a different drug!

19. Major Risk Factors: Using alone
For a person using alone an overdose could be fatal,
as the situation might not be noticed. Using with
others does not guarantee that an overdose will be
handled well though.

20. Major Risk Factors:
Being an experienced, long-term user
 It is not just new users who overdose - in fact experienced or
older users are at greater risk.
 Long-term users are more likely to mix drugs;
 Cycles of abstinence and return to drug use result in more
frequent periods of reduced tolerance;
 The law of averages - the more a person uses the greater the
likelihood of overdose;
 A belief that ‘It won’t happen to me’. If a person has used
drugs over several years and not suffered an overdose, they
could become over confident and take more risks.

21. How to Recognize an Overdose :
Is it an Overdose, or are they just really high?
If someone is extremely high, and they are using
depressants, they may:
 have contracted/small pupils;
 have slack and droopy muscles;
 be “nodding out”;
 scratch a lot due to itchy skin;
 have slurred speech and/or be “out of it”
However, they will respond to outside stimulus

22. How To Recognize an Opioid Overdose:
Signs and Symptoms
Person may be awake, but unable to talk
Body is very limp
Face is very pale or clammy
Fingernails and lips turn blue or purple
Breathing is very slow and shallow, irregular, or has
stopped
heartbeat is slow, strange, or not there at all
Choking sounds, or a gurgling noise (“death rattle”);
Loud, uneven snoring
Vomiting/throwing up
Loss of consciousness/passing out
Person does not respond to noise or pain

23. OVERDOSE MYTHS AND
FACTS

24. Overdose: The Myths and Facts
Myth
People collapse (‘drop’) immediately after
injecting.
Fact
Some do. However, overdose can take place
over one to three hours.

25. Overdose: The Myths and Facts
Myth:
Purity and/or taking too much of the drug are the
main causes of overdose.
Fact:
They are factors but definitely not the main
reasons. The main reasons are mixing with other
drugs and using when tolerance is low or absent.

26. Overdose: The Myths and Facts
Myth:
• It is young, inexperienced users who mostly
overdose.
Fact:
• It is more likely to be an older user, someone in his
or her early 30s who has been using for a long
while.

27. Overdose: The Myths and Facts
Myth:
Being on methadone means it’s impossible to
overdose.
Fact:
Being on a methadone program will reduce the
risk of overdose in the longer term, however, in the
first few days the risk is higher (the body is still
developing a tolerance to the methadone). Even
after being on a methadone program for a long
time it is still possible to overdose.

28. Overdose: The Myths and Facts
Myth:
If the person doesn’t die, they’ll be alright.
Fact:
Even when an overdose is not fatal, there can be
serious health effects.

29. Overdose: The Myths and Facts
Myth:
Injecting Cocaine or Crack will stop an OD
Fact:
•Injecting crack will make the OD happen faster
•Crack speeds up your heart rate so the body
needs more oxygen
•Heroin slows down breathing

30. OVERDOSE: THE MYTHS AND FACTS
Myth:
Most overdoses happen when someone is alone
Fact:
A UK report showed that over 50 out of 100
overdoses happen with another person in the
room

31. Overdose: The Myths And Facts
Myth
If someone ODs you should walk them around
Fact:
•This is a waste of time
•There is a chance that the person will fall over,
bang their head and cause a head injury
•Then they’ll be suffering from an overdose and
a head injury

32. Overdose: The Myths And Facts
Myth
Injecting salt water will stop an OD
Fact:
•NO it won’t!
•NOR will injecting milk, water, orange
juice
•All will only add to the problem

33. Overdose: The Myths And Facts
Myth:
If someone is snoring they’re ok
Fact:
If someone has been using depressants
and they are snoring – it is a sign that
they are struggling to breathe

34. Overdose: The Myths And Facts
Myth
If a friend ODs, you should put them in the
bath
Fact
•You can change the body temperature really
fast and put them into shock
•They could drown
•It can be a slippery and wet nightmare trying
to get an unconscious person out of a bath
tub

35. Overdose: The Myths And Facts
Myth
Making someone vomit will slow down an OD
from ‘Down’
Fact
•This will just increase the chances of them
choking to death
•Depressants stop the gag reflex which makes
it more likely that you’ll choke

36. HOW TO RESPOND TO AN OPIOID
OVERDOSE
• Call 911
• Ensure safety and
infection control
• CPR
• Naloxone

37. Responding to an Opioid Overdose:
Calling an Ambulance
If the person is conscious:
try to keep them awake and talking as much as possible while you call
911. Moving them around could risk a fall.
If the person is unconscious:
Put them in the recovery position and call 911 for an ambulance.
The Recovery Position:
Places the person securely on their side
to ensure that they cannot choke on
Vomit or other fluids

38. Responding to an Opioid Overdose:
The Recovery Position
Once in the Recovery Position:
• Call 911 if you haven’t already done so
• Ensure Safety: check the scene
• Use stimulation to check if they respond
• Check for breathing
• Begin CPR if the person is not breathing

39. CALLING 911
 If there is someone else in the room have them call 911. Ask the
person who calls 911to come back and tell you they have
called the ambulance. That way you are sure that ambulance
has been called. If no one else is there, make the call yourself.
 In most communities, police will be dispatched at the same
time. Police will attend with an ambulance. For many this is the
reason they will not call 911, however saving lives always has to
be the first priority.
 When you call the ambulance they will ask a series of questions.
This is to brief paramedics on the situation before arrival. Stay
on the phone if you can.

40. Ensuring Safety: First Steps
You can’t help someone if you need help yourself
In the event of any emergency, including an overdose, make sure
safety comes first.
 Check the scene for anything that could be of danger to you, other
people or the person experiencing the overdose.
 Respond to any other emergencies and ensure the safety of the
environment.
 When ANY bodily fluid is present, such as blood, vomit, or saliva,
always put a barrier between the fluid/victim and yourself such as
gloves, or a face mask. Always avoid contact with the fluid(s) and
wash hands thoroughly immediately after giving first aid.

41. CPR : COMPRESSIONS, AIRWAY,
BREATHING
Remember:
Opioids slow the central nervous system down.
The person needs to be breathing to bring in oxygen, and the
heart needs to be pumping to circulate the oxygen to the brain.
In many communities,
6-8 minutes is an
average response time
once 911 is called.

42. CPR: COMPRESSIONS, AIRWAY,
BREATHING
Chest Compressions:
CPR involves chest compressions at least 5 cm deep and at a rate of at
least 100 per minute in an effort to create artificial circulation by
manually pumping blood through the heart.
Rescue Breathing:
The rescuer may also provide breaths by either exhaling into the subject's
mouth or nose or using a device that pushes air into the subject's lungs.
This will only be effective if the airway is clear.
• Current recommendations place emphasis on high-quality chest
compressions over artificial respiration; a simplified CPR method
involving chest compressions only is recommended for untrained
rescuers.
• Chest compressions alone can at least circulate existing oxygen in
the blood. A full first aid response to an opioid overdose includes
chest compressions and rescue breathing.

43. Responding To An Overdose:
Opioid Overdose Reversal
 IF you are trained in the administration of
Naloxone (Narcan) and have it available to
you, administer the recommended dosage by
injection or intra-nasally and continue CPR.
 If the person is still not breathing on their own
after 5 minutes, re-administer the dose and
continue CPR.
 If the second administration does not stimulate
breathing independently, it is not likely an
opiate overdose. Continue CPR. Naloxone
does not
 Continue CPR and wait for paramedics to replace medical
arrive. intervention, but
 Always dispose of needles in the closest it does buy
biohazard box. life-saving time!

44. Questions? Comments?
Preventing Overdose Waterloo Wellington
http://www.preventingoverdose.ca/
preventingoverdose@gmail.com
Find us on Facebook and Twitter