Compassionate Overdose Response Summit
Intro Talk
- The Book of Death talks about the cruelty of a paramedic giving a full dose of Naloxone from the user’s perspective and the excruciating withdrawal symptoms it brought
- Pharmo_capitalists have lied about the effectiveness of naloxone distorting or misrepresenting overdose reversal and response data to justify new and changed formulations of opioid antagonists
The Proper Care (There is no alternative)
- Consider the Context
Can you provide post-overdose care? What substances are in the person’s system? What about their health and psychology? Can you get access to EMS without law enforcement coming?
- Stimulate Research has shown that stimulation can be as effective as Naloxone. The EMS profession has prioritized naloxone for speed not efficacy.
- Check Airway
- Perform Rescue Breathing Rescue breathing can bring people back. An overdose is the depression of the drive to breath until a person simply stops. They die from lack of oxygen.
- Only after all steps above, apply Naloxone
Start low, intramuscular .4 mg/1ml or 2mg intranasal, stop additional naloxone when breathing is restored - Place person in recovery position
- Care for person until help can arrive
Negative overdose reversals contribute to more deaths in the long term and could be the key stemming the tide of what has become an overdose endemic in the US
Healthright 360 Cleo Jenkins(OPC)
- pop-up tents for safe use
- have emt’s on site
- upset they wasted their last 20 dollars, is the most frequent response
New York Study
New York research study showed no difference in survival rates between 4mg and 8mg and widthdrawal rates were higher with 8m
Prevention Point Pittsburgh
95 percent of OD in the area are fent
Limitations
Data from reversal reports when people come back for a refill
Misouri Research Study
Who administered? Friends was highest ranking
Michigan On Point
Acute vs sub-acute OD.
- Sub-acute experience hypoxia
Oxygen should be the first step even in non-clinical settings
used IM naloxone in less than 17 percent of the cases, the rest was oxygen
deprioritize naloxone, and prioritize oxygenation, agitation, and monitoring
UK Research Study
people discharged themselves and seeked drugs after naloxone
overdosed caused by reduced breathing and reduced consciousness that progress to cardiac arrest
main treatment is stimulation
All naloxone should be titrated
benzos and xylazine are not effected by naloxone so first aid and rescue breathing are the solution
heroin is slow and hypoxia, fentanuyl effects muscles and other systems?
A Conversation with a Paramedic from Plum
Addicts will wait 5 hours in the ER and discharge themselves, most likely to use again. They need a warm hand off.
Don’t Use Alone Hotline
hotline, hold space while using 9 OD, less than 1 percent of calls
Medic from PGH
zofran for nausea
also BUP
user will use within 1 hour after OD recovery even with naloxone
xylezine can be reversed with naloxone, but… it’s complicated
Q and A
Research on breathing is biased towards white men, don’t use breathing rate to determine OD