and use of naloxone

and use of naloxone

OverdOse InfOrmatIOn

Greater Manchester West Mental Health NHS Foundation Trust

This information could help you avoid overdose and know what to do in the event of someone else overdosing.

It includes information on how you could use the drug naloxone to reverse overdoses. Greater Manchester West Mental Health NHS Foundation Trust (GMW) has pioneered distribution of naloxone to opiate users. This has saved a number of lives already.

GmW - empOWerInG users and carers tO save lIves.

OverdoseOverdose is now the largest single cause of death amongst injecting drug users. Understanding the risks of different drugs and their combinations can reduce the likelihood of overdose and if it does occur, knowing how to respond can prevent it leading to death.

Remember: In case of an overdose phone 999

O v e r d O S e I N F O r m a T I O N a n d u s e o f n a l o x o n e

Mixing substances that depresses the functioning of the central nervous system increases risk to life. These include:

opiates or their substitutesHeroin – the strength or purity of heroin is highly variable. This has been a major factor alone in overdose deaths in recent years as batches of higher purity heroin reach British streets.

methadone – Long acting opiate substitute that is involved in many overdoses on its own. In combination with other depressants and or alcohol, presents a very high risk of overdose. It lasts longer in the system than other opiates and can lead to overdose even after naloxone has been administered. The naloxone can temporarily reverse the effects of the opiate, but if it is still in the system when the naloxone wears off, the risk of overdose continues.


codeine preparations – i.e. Dihydrocodeine, co-codamol. Shorter acting opiate, still presents high risk if used with other depressants. Some preparations include paracetamol and this is toxic to the liver if taken in high doses.

Other opiates; MXL, oramorph, oxycodone/OxyContin, MST.

alcohol - Alcohol depresses the central nervous system and also disinhibits behaviour which can increase the likelihood of taking risks with other drugs. Associated confusion can make it difficult to keep track of dosages. These risks increase if used in conjunction with other drugs, including stimulants.

Benzodiazepines – Diazepam (Valium), Temazepam, Nitrazepam. All benzodiazepines used with other drugs and or alcohol have a high mortality rate and significantly increase the risk of overdose.Some benzodiazepines obtained from overseas suppliers are of dubious quality and are often not benzodiazepines at all. There have been deaths as a result of bogus benzodiazepines used on their own. Please beware!

some anti-depressants – such as amitriptyline/dothiepin, are the older type of anti-depressants and are not commonly prescribed, but present as high risk in overdose situations as they have additional sedative effects that increase the risk of overdose. This is one of the main reasons they are hardly prescribed any more!


One plus One = threeA simple formula may help illustrate the point of using a combination of substances: (1 + 1 = 3) That is to say that one depressant plus another depressant used at the same time will not merely give twice the sedative effect, but up to three times as much.

• Respiratorydepressionand sedation are the most dangerous factors in causing death from an overdose of opiates

• Injectingishigherriskthansmoking/chasing

• Changesinpurityofheroinincreases risk of overdose

• Drugstakenorallywillhavea delayed and unpredictable onset. E.g. take oral methadone, 15 minutes later inject heroin, 30–60 mins later when methadone absorbed = Overdose

• Anythingthatmaycausedrowsinessorsleep,increasesthedanger of aspirating (breathing in) vomit because you don’t wake up when you’re sick

• Somedrugsmayincreasetheeffectsofopiatesbyinterferingwith the body’s mechanism for excreting opiates e.g. cimetidine

• Followingaperiodofabstinence,toleranceisreduced.Thisisa high-risk time. To use the same amount the individual may have used pre detox could result in overdose. This risk is also true for people who are new to intravenous opiate use who have previously smoked the drug

• Usingaloneorusingwithpeopletheydon’tusuallyusewithincreases risk of overdose


What not to do When someone Overdoses: some common myths“treat an opiate overdose by giving a stimulant e.g. amphetamine” This is unlikely to have any benefit and may make matters worse by increasing the speed of absorbtion. An overdose needs immediate medical attention and treatment- do not delay by administering black coffee, amphetamines etc.

“Walking people around helps” This may also make matters worse, again it wastes time and there is the additional risk they may fall, or get dropped. It is also possible that the drugs are absorbed into the bloodstream more quickly as the heartbeat increases.

“putting people in a cold bath helps” If the client has heard of people who have come round after being put in a cold bath it was because they hadn’t taken a lethal dose. This practice is dangerous for a number of reasons mainly it takes time to run a bath and they could easily drown or die from the cold.

“Hurting, hitting or burning someone brings them round” It is important to establish if someone is sleeping or unconscious. You can use a far less dangerous method – rub your knuckles on the middle of their chest. If this doesn’t rouse them, chances are they’re unconscious and you need to call an ambulance.

“Inject them with saltwater” This is a dangerous practice. It wastes time, time that could be used putting someone in the recovery position and calling an ambulance. It could be possible in the panic, to infect the individual with hepatitis or HIV. (This myth may have come from the practice of seeing friends in hospital on a saline (salt) drip. The fact is that this practice is used to keep a vein open so medication can be administered. Salt does not affect an overdose at all.


“don’t call 999 because the police will turn up and arrest you” There used to be a common practice of police attending with paramedics/ambulance crews when an overdose was reported. This was in part due to the fact that suicide was illegal. This is no longer the case, so the police do not attend as a matter of course. The Greater Manchester area operates on an agreed policy of no automatic police involvement in the event of an overdose being reported to the ambulance service.


naloxoneWhat is naloxone? • Alsomarketedunderthetradename-Narcan

• Apureopiateantagonist–antidotetoheroin

• Canbeusedtocountertheeffectsofoverdosingonheroinormethadone

• Temporarilyreversestheeffectsofanopiateoverdose

• Willhavenoeffectonoverdosesfromotherdrugs

• Howwellitworksdependsonwhatused,howmuchtakenandwhat else used (alcohol, other drugs)

• Shortacting–wearsoffquickly.

• Overdosecanlastfor8hrsormore–naloxonecanbegintowearoff in 20 minutes

phone 999 prior to using

• Naloxonebringsonawithdrawal–recipientmaywanttousestraight away and can become aggressive

effects of naloxone • Shortacting

• Blocksandreversestheeffectsofopiates

• Noopiate–noeffect


naloxone as part of managing an opiate overdoseHow to recognise opiate overdose • Personunconsciousandcannotbewoken

• Cyanosis–bluelipsortongue

• Notbreathingatallorbreathingslowly/snoring–noneorlaboured breathing

• Pinpointpupils

What to do if you discover someone who has overdosed 1. Check environment is safe and that there are no hazards around

(e.g broken glass)

2. Try to rouse – by talking (loudly) ‘Can you hear me?’, ‘Open your eyes’ and gently shaking their shoulders. If you get no response apply gentle pressure to the sternum (upper middle of the front of the chest).

3. If person wakes, make sure airways are clear then phone 999

4. Stay until the ambulance arrives

5. If you are unable to wake them phone 999

6. Check Airways (no tongue/no vomit)

7. Check Breathing (look/listen feel for breath)

8. Ifnotbreathing–basiclifesupport–Ifbreathing–recoveryposition – wait for ambulance

9. Administer Naloxone


The Recovery Position • Opentheirairwaybytilting

the head back and lifting the chin

• Straightenthelegs

• Placethearmnearesttoyouat right angles to their body

• Pullthearmfurthestfromyouacross their chest and place the back of their hand against the cheek nearest to you

• Getholdofthefarleg,justabove the knee, and pull it up, keeping the foot flat on the ground

• Keeptheirhandpressedagainst the cheek and pull on the upper leg to roll them towards you, and onto their side

• Tilttheheadbacktomakesure they can breathe easily

• Makesurethatboththehipand the knee of the upper leg are bent at right angles.

RECOVERY POSITION WHAT IT LOOKS LIKE

11WWW.NALOxONE.ORG.UK / WWW.SDf.ORG.UK10

RECOVERY POSITION HOW TO DO ITTHE RESUSCITATION COUNCIL (UK) RECOMMENDS THE fOLLOWING SEQUENCE Of ACTIONS TO PLACE A CASUALTY IN THE RECOVERY POSITION:

/ Remove the casualty’s glasses (if worn).

/ Kneel beside the casualty and make sure that both their legs are straight.

/ Place the arm nearest to you out at right angles to the body, elbow bent with the hand palm uppermost.

/ Bring the far arm across the chest, and hold the back of the hand against the casualty’s cheek nearest the ground.

/ With your other hand, grasp the far leg just above the knee and pull it up, keeping their foot on the ground.

/ Keeping the hand pressed against the cheek, pull on the far leg to roll the casualty towards you onto their side.

/ Adjust the upper leg so that both the hip and knee are bent at right angles.

/ Tilt the head back to make sure the airway remains open.

/ Adjust the hand under the cheek, if necessary, to keep the head tilted.

/ Check their breathing regularly.

Important: Ensure you have dialled 999. Stay with the casualty until help arrives. Always look after your own safety too – look around you and make sure you are in a safe position, e.g. not in close proximity to a road or dangerous equipment. Be vigilant about potential needle stick injuries.

Say ‘hi’

Lift my leg

Support my face

Roll me over

1/ 2/

3/ 4/

8/7/















Say ‘hi’

Lift my leg

Support my face

Roll me over

1/ 2/

3/ 4/

8/7/















Say ‘hi’

Lift my leg

Support my face

Roll me over

1/ 2/

3/ 4/

8/7/















Say ‘hi’

Lift my leg

Support my face

Roll me over

1/ 2/

3/ 4/

8/7/


naloxone administration A drug worker can demonstrate the preparation of naloxone for injection using water ampoules . You may be experienced in injecting, but it is a different process drawing up an injection from an ampoule... especially in a stressful life threatening situation.

Please note naloxone is in ampoule form and no longer in mini-jet preparation

• Naloxonecanbegivenintravenouslyhoweverintramuscularinjection is recommended. You must first phone 999

• Injectintoamuscle-upperouterbuttock,outerthighareaorupper arm

• Holdneedle90degreesabovetheskin

• Insertneedleintomuscle

• slowly and steadily push plunger all the way down

A single injection of naloxone buys time for the ambulance to arrive - its effects may wear off in as little as 20 minutes. Naloxone has a short duration of action; therefore:

continued medical treatment is essential. It is Important to stress that naloxone alone is not enough

If bleeding appears after administration, apply pressure.

Naloxone has a limited shelf life please check use by date!

If an ambulance isn’t called the person may overdose again, shortly after the effects of the naloxone wears off.

Any used needles should be disposed of in a sharps bin (paramedics will have one).


Where should naloxone be stored?• Carryontheirperson,oraspecificplaceathomeortheplace

they use - Let others know where it is

• Keepawayfromstronglight

• Keep out of reach of children

You will be given the opportunity to familiarise yourself with the naloxone pre filled syringe and you can practice fitting the needle to the barrel.

You may be familiar with injecting paraphernalia, but using it in a different more relaxed setting and very rarely using intramuscular. The situation of someone you know overdosing will be very stressful and this may make the administration process very difficult to remember or carry out.

practIce!

Offer this information to partners/family members/friends you live or use with - It may save your life.

please feel free to ask for information leaflets/dvd re overdose and naloxone

We will check before issuing naloxone to you that you have an understanding of the information here, this is for your safety.

Please ensure that you have signed your consent form prior to arranging take home naloxone.

This is not an exhaustive list and you should ask the case manager about one to one or group training.

If you have any questions about the material in this leaflet or have any questions after reading it please speak to a member of staff.

stay safe


Informed consent to treatment/receipt of advice to accompany naloxone prescription

I (insert your name).....................................................................................................................................................................................

have had the opportunity to discuss with a member of staff the take home naloxone scheme and I feel I have a clear understanding of the circumstances where naloxone should and should not be used.I have been offered literature /and discussed:

• Signsandsymptomsofoverdoseandhowtorecognisethem.

• Potentialdrug&alcoholinteractionthatmayleadtooverdose.

• Whatnottodoineventofoverdose.

• Whatthecorrectproceduretofollowintheeventofoverdose.

• Howtousenaloxonecorrectlyintheeventofoverdose.

• TheliteratureIhavereceivedincludes:

• NaloxoneandgoingoverDVD

• Overdosedetoxandyouleaflet

• Recoverypositioncard

• Takehomemethadoneoverdosepreventioncard

• Appointmenttoattendoverdosepreventionformyselfand/orfamily member/s

I feel confident in using the take home naloxone where appropriate and will attend the group programme on: / / (dd/mm/YY)

Signed: (client)...................................................................................................................................................................

Signed: (worker)...................................................................................................................................................................

Date: / / (dd/mm/YY)

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and use of naloxone

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