Facilitator’s
Manual
Preventing and Responding
to an Opioid Overdose
THREE-SESSION
TRAINING
PRAXIS IS A PROGRAM OF THE
200 Reservoir Street
Needham Heights, MA 02494
Telephone: 617 467 6014
Fax: 617 467 6015
Email: [email protected]
Website: www.center4si.com/Praxis
PRAXIS STAFF
Cheryl Gagne, project director [email protected]
Marc Dones, trainer
Ann Young, project coordinator
ACKNOWLEDGEMENTS
Praxis would like to acknowledge Jim Hogan and Mindy Domb who developed the curriculum
while working for SPHERE, a program of Health Imperatives.
FEEDBACK
Praxis would like to know about your experience using this curriculum. We would like to hear
from you with any suggestions for improving it. Email or call with your feedback.
NEED HELP?
Praxis is available to help BSAS-funded programs and providers to use this training curriculum.
Technical assistance is available by contacting [email protected] or call 617 467-6014 x 226.
2
TABLE OF CONTENTS
Introduction to the training..........................................................................page 4–5
Session One Overview ........................................................................................page 6
Session One Outline ........................................................................................page 7–9
Session Two Overview ......................................................................................page 10
Session Two Outline ................................................................................... page 11–14
Session Three Overview ...................................................................................page 15
Session Three Outline ................................................................................ page 16–21
Opioid Overdose Prevention Handout ................................................... page 22-23
Pre–Group Evaluation .......................................................................................page 24
Post–Group Evaluation .....................................................................................page 25
Post–Group Evaluation–Answer Key .............................................................page 26
Optional Additional 4th Session:Naloxone Responder Training ...............page 27
How to Access Naloxone through Pharmacy with a Standing Order ......page 28
List of Resources ................................................................................................page 29
3
INTRODUCTION TO THE
THREE-SESSION OPIOID OVERDOSE TRAINING
PURPOSE OF THE TRAINING CURRICULUM
This training curriculum delivers three 60-minute sessions and focuses on preventing and responding to opioid overdoses. The increasing problem of opioid overdoses underscores the need to educate participants in drug and alcohol treatment programs about the opioid overdose prevention
and responding to an opioid overdose. This training curriculum is designed for use in treatment
programs, correctional facilities, homeless shelters, HIV service organizations and other health and
human service settings.
BENEFITS OF THE TRAINING
• Support people at risk for opioid overdose. Program participants are potentially
at an increased risk for an opioid overdose if they relapse and use opioids after a
period of abstinence.
• Support witnesses/bystanders: Program participants may, if they witness an overdose have the opportunity to intervene and prevent an overdose death. They may
also have an opportunity to educate others about the risks of opioid overdoses.
LEARNING OBJECTIVES
As a result of this training, group participants will be able to:
•
•
•
•
Name three risk factors for an opioid overdose
Name two risk reduction strategies
Recognize the signs of an opioid overdose
Describe or show three actions that respond to an opioid overdose
WHO SHOULD USE IT?
This training curriculum should be used by providers who facilitate educational groups with people
WHERE SHOULD IT BE USED?
This three-session curriculum can take place anywhere educational groups are held. Some settings
that have used this curriculum include:
•
•
•
•
•
•
•
•
Community corrections programs
Jails or prisons
Methadone treatment programs
Outpatient programs
Residential treatment programs/recovery homes
Relapse prevention programs
TSS or CSS programs
Peer education groups
4
ORGANIZATION OF THE CURRICULUM
The session is organized into a table describing the activity with curriculum notes with the
estimated time frame for that activity. The table’s Activity/Curriculum Notes column provides
guidance on conducting the session. Activities used include:
•
•
•
•
•
Presentation
Card game
Group brainstorm
Small group discussion
Key questions
MATERIALS NEEDED
Facilitators will need to prepare materials for the training session. Materials include:
•
•
•
•
Opioid overdose prevention card game
Flipchart
Opioid overdose prevention handout
Referral cards
PREPARING FOR THE THREE SESSIONS
participants. Facilitators need to have:
•
•
•
•
•
Experience conducting educational groups with program participants
Training with Praxis on how to facilitate this group
An opportunity to review the curriculum before the training
Experience with the Opioid Overdose Prevention Card Game
Familiarity with local resources for opioid overdose prevention and health
BEFORE THE SESSIONS BEGIN
Print Opioid Overdose Prevention Handout (pages 22 &23)
Print post group evaluation (page 26)
Review the Opioid Overdose Prevention Card Game Facilitator’s Guide
Review resource list at end of curriculum (page 29)
Prepare referral cards for group members
Bring pens!
POST GROUP EVALUATION
There is a post-group evaluation included on page 26. This is to test participants’
acquisition of facts presented in the training.
5
DEATHS
FROM
OPIOID
SESSION ONE:
OVERDOSES
OVERVIEW
ACTIVITY OVERVIEW
TIME
1 Welcome, overview
5 minutes
2 Presentation: Opioid overdoses: Why is it important?
5 minutes
3 Opioid Overdose Card Game
25 minutes
4 Presentation: What are opioids?
5 minutes
5 (A–B) Discussion: Reason to Talk or Not Talk about Overdose
15 minutes
6 Wrap up and summary
5 minutes
BEFORE THE SESSION:
Print Opioid Overdose Prevention Handout (pages 22–23)
Print group evaluation, pages (24–25)
Review resource list at end of curriculum (page 29)
Prepare referral cards for group members
Consider scheduling a Naloxone Responder Training (page 27)
Bring pens!
6
ACTIVITY/CURRICULUM NOTES
STEP 1
(5 minutes)
WELCOME AND OVERVIEW
Tell the participants:
• Three 60–minute sessions, today we will:
• Discuss the public health problem of opioid overdoses
• Consider the pros and cons of talking about opioid overdoses
• Learn more about opioids
Ask: What are your experiences with opioid overdose?
People may have witnessed or responded to an overdose. The purpose is not to go
into all the details of the experience but to acknowledge that people are brining personal experiences to the training.
STEP 2
(5 minutes)
PRESENTATION: THE PROBLEM OF OPIOID OVERDOSES
Facts about opioid overdoses:
• Deaths from unintentional opioid overdoses continue to increase
• The drug overdose death rate has more than doubled from 1999 through 2013
• Drug overdose was the leading cause of injury death in 2012.
• Among people 25 to 64 years old, drug overdose caused more deaths than
• Most drug overdoses are caused by opioids, either prescription or illegal
STEP 3
(25 minutes)
CARD GAME:
To test what we know about opioid and overdoses.
Here are the directions:
1. Divide into groups (small group sizes depends on size of whole group)
2. Each group gets deck of cards-each card has a statement about opioids or opioid overdose
3. 10 minutes to review cards and decide as a group if statement is true, false or not sure
or no consensus
4. Put cards into 3 piles-one is true, the next is false and the third is we’re not sure or we
can’t agree.
Begin the game.
Ask participants to read statements from the pile of cards that they were unsure of or
couldn’t reach consensus. Consult the Opioid Overdose Card Game Facilitator’s Guide to
review facts with participants.
After the card game, summarized key points.
Key Points:
• All opioids suppress the part of the brain that controls breathing
• Opioids cause a fatal overdoses by stopping a person’s breathing
• People die from lack of oxygen-no breath-no oxygen-no life
7
ACTIVITY/CURRICULUM NOTES
STEP 4
WHAT ARE OPIOIDS?
(5 minutes)
Ask participants to call out names of opioid drugs
• Opioids are pain relievers both prescription and illegal
• Name some prescription opioid drugs-Vicodin, Percocet, OxyContin, Opana, morphine, codeine, methadone
• Name some illegal drugs: heroin, opium.
STEP 5
(15 minutes)
A) GROUP DISCUSSION: CHALLENGES OF TALKING
ABOUT OPIOID OVERDOSE
Some people are concerned that talking about overdose prevention to people in drug
and alcohol treatment is not supportive, helpful or appropriate. They are reluctant to talk
about overdose prevention to people in treatment.
Ask: What are the reasons to talk about opioid overdose prevention or reason not to talk
about it in treatment?
B) FACILITATOR DIRECTIONS
Flip Chart # 1: Reasons to Talk/Not Talk about Overdose
• Ask participants to share their ideas
• Try to engage everyone in the group
• Review the list
Suggested comments:
Reasons not to talk about overdose:
• It could be perceived as encouraging drug use and relapse
• It could be seen as a lack of faith in a client’s recovery
• It could make people remember sad experiences about witnessing an overdose
Reasons to talk about overdose
• Learn that any abstinence leads to loss of tolerance to an opioid. Recognizing that
this increases the risk of death from an opioid overdose
• Overdose prevention might reinforce relapse prevention
• Program participants may witness an overdose or be a bystander. The can use this
information to save a life. Most overdoses are witnessed
• Program participants can share this information with people they know who may
still be using.
at risk for dying from an opioid overdose by training people in the community in
opioid overdose prevention
8
ACTIVITY/CURRICULUM NOTES
STEP 6
(5 minutes)
SUMMARY AND ADJOURN
• The number of opioid overdose deaths in Massachusetts is increasing
• Opioids are prescription and illegal painkiller drugs that can also suppress breathing leading to death over time
opioid overdose prevention in drug and alcohol treatment programs
9
OPIOID
OVERDOSE
RISKS
SESSION TWO:
AND RISK REDUCTION
OVERVIEW
ACTIVITY OVERVIEW
TIME
1 Welcome, review
5 minutes
2 Group Brainstorm: Who Overdoses?
10 minutes
3 (A–B) Group Brainstorm: Naming and Understanding Opioid
Overdose Risk Factors?
10 minutes
4
10 minutes
5 (A–B) Small Group Discussion: Reducing the Risk for an
Opioid Overdose
15 minutes
6 Wrap up and summary
10 minutes
7 Post-group evaluation
5 minutes
BEFORE THE SESSION:
Flip chart # 2 Who Overdoses?
Flip chart #3 T chart: Overdose Risks
Flip chart #4 T chart: Risks and Risk Reduction
Review facilitator’s guide for the session
Review resource list at end of curriculum (page 29)
Prepare referral cards for group members
Bring pens!
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ACTIVITY/CURRICULUM NOTES
STEP 1
(5 minutes)
WELCOME EVERYONE
Review Previous Session
• Many factors contribute to opioid overdoses: strong product, lower tolerance,
using alone
Today we will talk about what puts a person at risk for an opioid overdose
sonal experiences to the training.
STEP 2
(10 minutes)
GROUP BRAINSTORM: WHO OVERDOSES?
Show: Flipchart # 2: Who Overdoses?
1. Ask participants: “Who do you think overdoses?
Use words like “young person,” “older person,” “new user”
2. Anyone who uses opioid could overdose but there is research that suggests
that the following groups are at higher risk for an opioid overdose:
• Experienced user (on average people who overdose have been using for
over 5 years)
• People recently discharged or released from treatment, prison, hospital
(loss of tolerance)
• People who relapse after a period of abstinence (loss of tolerance)
• People who mix drugs
• People who have overdosed before and survived
(Smoking and hepatitis)
Ask participants: Why do you think more experienced users are at a higher risk?
Answers might be:
• Experienced users have a high tolerance and believe that their bodies can
handle higher doses.
• They may have chronic health problems that increase the risk of an
opioid overdose.
STEP 3
(10 minutes)
A) GROUP BRAINSTORM: NAMING AND UNDERSTANDING
OPIOID OVERDOSE RISK FACTORS
Ask: What are things people do or believe that can put them at risk for an
opioid overdose?
11
ACTIVITY/CURRICULUM NOTES
B) FACILITATOR NOTES:
2. Use list to reveal the factual overdose risks
3. Circle the factual overdose risks
4. The list should include:
• Using alone or being left alone
• Using too much
• Mixing opioids with other substances (alcohol, benzodiazepines, cocaine)
• Not knowing the product
• Having a lower tolerance (due to abstinence, illness, hospitalization,
treatment, incarceration, aging)
• Having overdosed before and survived (due to feelings of invincibility
and the large amount of the drug used)
• Using in an unfamiliar setting
STEP 4
(10 minutes)
DISCUSSION QUESTION: EXPLORING IDENTIFIED RISKS
Ask the following discussion questions:
RISK FACTOR
DISCUSSION QUESTION
Using alone/Being left alone
Why would someone use alone? What makes it hard to stay
with a person who’s using opioids? (fear of police, shame)
Not knowing where the opioid comes
from/what’s in it or buying drugs
from an unknown source
Why would this create a risk? (Substances could be
stronger than expected, not knowing the drug’s strength
or composition)
Having a lower tolerance-due to
abstinence, aging, incarceration
What causes periods of abstinence? (treatment stay,
recovery, hospital stay, incarceration
Having overdosed before and survived
Why do you think it might be true (amount of drug person
Using in an unfamiliar setting
Mixing opioids with other
substances
Why would this be true? (don’t know product, use too quickly,
no time for a tester, use in a hidden place)
Why does mixing increase risk?
breathing)
12
ACTIVITY/CURRICULUM NOTES
STEP 5
(10 minutes)
A) SMALL GROUP DISCUSSION:
REDUCING THE RISK FOR AN OPIOID OVERDOSE
1.
2.
3.
4.
Form small groups (3-4 people)
Small groups will identify strategies for each risk factor
Small groups could choose a person to write down the strategy
Small group could choose someone to recite the list to the whole group
Reconvene to the larger group
Ask each group to share its strategies for each risk factor. (You’ll start to hear
duplicate strategies. Collect all the novel suggestions.)
B) ACTIVITY
2. Review each risk and ask group to name risk reduction strategies for that risk.
3. Write the strategy in the right column
4. Review
RISK FACTOR
DISCUSSION QUESTION
Using alone
Talk with someone in advance to stay with the person who
is using, make a contract for a phone call, Kitestring
Not knowing where the opioid
comes from
Determine the strength of the substance before using by
doing a tester shot, buy the drug from the same source,
Having lower tolerance
Use a smaller dose, take a tester shot
Having overdosed before
Encourage person to follow all harm reduction strategies,
use less, take care of health
Using an unfamiliar setting
Determine strength of substance before using, better to
use in a familiar place where a person is not going to be
rushed
Mixing opioids with other substances
Consider not mixing drugs, especially not mixing opioids,
alcohol, and benzodiazepines
13
ACTIVITY/CURRICULUM NOTES
STEP 6
(10 minutes)
WRAP UP
Ask: What is something that you’ll take from today’s session?
Key messages:
• The main risk factors for dying from an opioid overdose are: using too much of
the drug, mixing drugs, using alone, changes in tolerance
• There are ways to reduce the risks of an opioid overdose
• Knowing the risk behaviors help us choose risk reduction strategies
• People can prevent unintentional opioid overdoses.
Ask: Any questions?
Next session’s topic:
Recognizing and Responding to an Opioid Overdose
STEP 7
(5 minutes)
POST-GROUP EVALUATION
Handout evaluation and pens. Collect from everyone. Can read it aloud if some mem-
14
REVERSING
AN
SESSION THREE:
OPIOID OVERDOSE
OVERVIEW
ACTIVITY OVERVIEW
TIME
1 Welcome, Review
5 minutes
2 Discussion: What does an opioid overdose look like?
5 minutes
3 Presentation: Signs and symptoms of an opioid overdose
10 minutes
4 (A–G) Group Brainstorm: Responding to an opioid
overdose: Actions and challenges
25 minutes
5 (A–B) Presentation: Reversing an opioid overdose: Naloxone
(Narcan) (If you have scheduled the optional 4th session with
naloxone responder training, then make this section very brief)
10 minutes
6 Wrap up, Key Messages, Additional Questions, and Evaluation
5 minutes
BEFORE THE SESSION:
Flip chart # 5: Signs and Symptoms of an Opioid Overdose
Flip chart # 6: T-chart: Responding to an Opioid Overdose: Dos and Don’ts
Flip chart # 7 T-chart: Response challenges and strategies to address them
Review facilitator’s guide for the session
Review resource list at end of curriculum, page 29
Prepare referral cards for group members
Post-group evaluation
Bring pens!
15
ACTIVITY/CURRICULUM NOTES
STEP 1
(5 minutes)
WELCOME
Review previous session
• Review risk factors and risk reduction
• Remind participants that for today’s discussion, it’s important to remember
Answer: Opioids suppress respiration or breathing. Too high a dose will lead to death
by suppressing breathing
STEP 2
(5 minutes)
PRESENTATION: SIGNS AND SYMPTOMS OF AN OPIOID OVERDOSE
What does and overdose look like?
Ask participants:
• Let’s imagine that we are witnessing an opioid overdose, how would we know
it’s happening
STEP 3
(10 minutes)
MAKE FLIPCHART # 5: SIGNS AND SYMPTOMS OF OPIOID OVERDOSES
Signs and Symptoms of an Overdose
• Unresponsive-person cannot be woken up when you shout the person’s name
or when you give a sternal rub (Demonstrate sternal rub)
• Shallow, irregular or no breathing
• Clammy pale skin
• Slow, weak pulse
• Deep snoring, gurgling sound, “death rattle”
Tell:
An overdose happens over time-1-3 hours after using. Instantaneous overdoses (needle
in the arm) are rare. There is usually time to intervene.
16
ACTIVITY/CURRICULUM NOTES
STEP 4
(25 minutes)
GROUP BRAINSTORM:
RESPONDING TO AN OPIOID OVERDOSE: ACTIONS AND CHALLENGES
A) BACKGROUND
This discussion addresses participants in their possible future roles as overdose
bystanders. As such, the discussion focuses on what they can do to intervene and
respond to an overdose, and possibly, reverse an opioid overdose and save a life
Ask participants:
• What can someone do if they recognize these signs and decide they are witnessing an actual overdose?
• How can someone overcome some of the challenges they might face when
responding to an opioid overdose?
B) FACILITATOR NOTES:
Directions
1. Write and review all responses
2. Place the responses that are recommended in the RIGHT column and those that
are not recommended in the LEFT column
3. Stress that the RIGHT column includes recommended steps
C) PRESENTATION: OVERDOSE RESPONSE
•
•
•
•
•
•
•
Shout the person’s name
Do a sternum rub (demonstrate and have participants try it on themselves)
Call 911
Perform rescue breathing
Give naloxone (if available)
Stay with the person
If you have to leave the person, put person into the recovery position (See page
2 of handout on page 23.)
17
ACTIVITY/CURRICULUM NOTES
D) REVIEW FLIP CHART # 6, (which should have the recommended responses circled)
Reinforce the group
• All of these measures are safe for the person and will cause no injury
• Remind the group gain that too many opioids can cause a person to stop
breathing and that reversing the overdose means that we have to help the person to start breathing
• In order to reverse an opioid overdose, the person need oxygen. When considering an action to reverse an overdose, consider if it will restore oxygen.
Stress:
Steps you can take to take to reverse an overdose should”
• Not harm or injure the person
• Not waste time
• Help the person breath and restore oxygen
E) GROUP BRAINSTORM
Ask participants:
• What would be hard about responding to an opioid overdose?
es? (for example, consider why a person might not call 911?)
-
Reinforce participants:
We will now explore strategies to make it more possible for people to respond to
overdose.
18
ACTIVITY/CURRICULUM NOTES
F) FACILITATOR NOTES:
2. For each response, ask the group what they could do to address that challenge
3. Write those strategies in the appropriate column
OVERDOSE
RESPONSES
POSSIBLE CHALLENGES
Don’t want to call the police
Don’t want to invite trouble
STRATEGY
• You can say, “My friend is not
breathing”
• Give address
Call 911
•
•
Give naloxone,
if available
• Don’t have naloxone available
• Don’t know how to use naloxone
• Not trained as a naloxone
responder
• There are programs where people can
be trained as a naloxone responder
Perform rescue
breathing
• Uncomfortable doing mouth-tomouth breathing
• Afraid to hurt the person
• Don’t know how to do it
• Consult handout and practice steps
for rescue breathing
• Get trained as a naloxone responder
Put person in
recovery
position
• No space to maneuver
• Afraid to hurt the person
• Don’t know how to do it
• Consult handout and practice the
steps
•
Stay with
the person
• Don’t want to run into the police
•
•
Leave the door to the room
unlocked so that medical personnel
can get to the person
Leave person in recovery position
if you have to leave
Stay as long as you can.
19
ACTIVITY/CURRICULUM NOTES
G) ACTIVITIES AND DIRECTIONS
To address the actions that were listed but not recommended share this
“rule of thumb:”
When responding to an opioid overdose, avoid anything that wastes time or could
cause injury to the person. The person needs oxygen
• Do Not put the person in a shower
• Do Not put ice on the genitals
• Do Not punch, pinch or slap the person
Rescue breathing can help keep the person alive until emergency medical personnel arrive and use naloxone (Narcan) to stop and reverse an opioid overdose.
Review these key points:
1. Opioid overdose can happen over a 1-3 hour time period
2. Over that time, the person who is overdosing will appear to have slowed breathing and s/he may appear pale or bluish
3. They need oxygen
4. The most important action to do when witnessing an overdose is call 911
5. In Massachusetts you don’t have to wait for 911 to arrive in order to try and
reviews the overdose because you can be trained as a naloxone responder
STEP 5
(10 minutes
A) PRESENTATION: REVERSE AN OPIOID OVERDOSE
WITH NALOXONE (NARCAN)
Ask participants:
• Has anyone ever heard of or know about naloxone (Narcan)?
Facts
• There is a medicine called naloxone or Narcan that can be used to reverse an
opioid overdose and is available through a special program across Massachusetts
• Naloxone stops the overdose, allowing the person to breathe again.
receptors for 30-90 minutes, allowing the person to breathe again.
• In Massachusetts, people can become trained to become naloxone responders
• When you’re trained as a naloxone responder, you get naloxone that is administered through the nose. This can be used to reverse an opioid overdose
• In other states, naloxone responders may use injectable naloxone. In other states
naloxone is not available to the public and only used by medical personnel.
Remember: In the Massachusetts naloxone program, the nasal form of Narcan is
those receptors and the person can breathe again because the brainstem is working,
less impaired by opioids.
If you schedule a naloxone responder training, as an optional fourth session, you can skip
the following section as this information will be covered in the naloxone responder training
20
ACTIVITY/CURRICULUM NOTES
B) COMMON QUESTIONS ABOUT NALOXONE
1 Can naloxone hurt a person?
No. No matter what substance a person used, naloxone will not cause harm. It may
cause withdrawal symptoms in people who are dependent on opioid
2 Can a person get high from naloxone?
No. No matter how much naloxone is used, a person cannot get high from naloxone.
3 How long does naloxone last?
Naloxone lasts from 30-90 minutes. A person can go back into an overdose after
doses of naloxone.
4 Where can a person get trained as a naloxone responder?
There are naloxone training and distribution programs across Massachusetts.
These programs provide naloxone responder training. A web link to a listing of
these programs is included on page 29 of this Guide.
STEP 6
(5 minutes
WRAP UP
Ask: What are the most important pieces of information about opioid overdose that
you learned in this session?
Key Messages:
1. There is adequate time to respond to an overdose
2. If you witness an overdose: call 911, stay with the person, perform rescue
breathing,
3. Naloxone will reverse an opioid overdose
4. Even if a person has naloxone, he/she should call 911. The person needs medical attention
5. Don’t waste time taking actions that do not restore breathing or ones that may
injure the person
6. If you have to leave the person, even for a moment, place them in the recovery
position so they don’t choke on vomit or saliva.
Evaluation:
1. Distribute group evaluation forms for participants
2. Collect evaluation forms
If applicable:
Preview the Naloxone Responder Training
OR:
Refer to Naloxone Responder Training in the community
21
22
23
PRE-GROUP EVALUATION
Please circle the correct answer.
1. After being in a drug treatment program or being incarcerated in a jail, a person can be at
increased risk for an opioid overdose, if they pick up and use again.
TRUE
FALSE
NOT SURE
2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose.
TRUE
FALSE
NOT SURE
Please respond to the prompts below:
3. Name two signs of an opioid overdose.
4. Describe what you would do if you saw someone in an overdose.
5. What was the most important thing you learned in this training?
24
POST-GROUP EVALUATION
Please circle the correct answer.
1. After being in a drug treatment program or being incarcerated in a jail, a person can be at
increased risk for an opioid overdose, if they pick up and use again.
TRUE
FALSE
NOT SURE
2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose.
TRUE
FALSE
NOT SURE
Please respond to the prompts below:
3. Name two signs of an opioid overdose.
4. Describe what you would do if you saw someone in an overdose.
5. What was the most important thing you learned in this training?
25
POST-GROUP EVALUATION ANSWER KEY
Please circle the correct answer.
1. After being in a drug treatment program or being incarcerated in a jail, a person can be at
increased risk for an opioid overdose, if they pick up and use again.
TRUE
FALSE
NOT SURE
2. Mixing drugs (opioids, benzodiazepines, alcohol) increases the risk of an overdose.
TRUE
FALSE
NOT SURE
Please respond to the prompts below:
3. Name two signs of an opioid overdose.
Not responsive to noise or pain
Slow or no breathing
Bluish skin and nail beds
Drooling
Snoring
4. Describe what you would do if you saw someone in an overdose.
Call 911
Begin rescue breathing
Make sure person isn’t choking
Stay with person until medical personnel come
Administer Narcan
5. What was the most important thing you learned in this training?
26
OPTIONAL ADDITIONAL 4TH SESSION:
NALOXONE RESPONDER TRAINING
Praxis recommends that programs schedule naloxone (Narcan) responder training with
participants from the one-session training. To schedule training, contact the training program near you.
http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone-info.pdf
PARTICIPANTS OF THE NALOXONE RESPONDER TRAINING WILL:
• Learn how to administer naloxone and use the nasal naloxone applicator
• Receive two doses of naloxone
• Complete appropriate paperwork with trainer
BENEFITS FOR PROGRAMS TO SET UP NALOXONE RESPONDER TRAINING
• Programs will have a higher number of naloxone responders
If unable to schedule a training in your program, refer people leaving
the program to Naloxone (Narcan) Responder Training Programs!
27
HOW TO ACCESS NALOXONE FROM A
PHARMACY WITH A STANDING ORDER
THERE ARE TWO WAYS TO ACCESS A NALOXONE RESCUE KIT FROM A PHARMACY:
1. Obtain a prescription from your prescriber and take it to a pharmacy that stocks naloxone.
2. Go directly to a pharmacy with a naloxone standing order and request a naloxone kit.
For pharmacies with naloxone standing orders, a prescription is not needed.
PHARMACIES WITH PHYSICIAN STANDING ORDERS FOR NARCAN
Many pharmacies across the whole state have orders to distribute Narcan kits to customers. Many
insurance companies, including Mass Health will cover the cost of the Narcan kits but some require
a small co-pay. For a list of pharmacies with standing orders for naloxone visit:
http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits
ACCESS CHECKLIST
Have your insurance card ready if you have one
Bring an ID if you have one
If yes, Indicate to the pharmacist if you prefer nasal or injectable
The pharmacy tech will input your information and the pharmacist will check the order
If the pharmacy declines the request please ask politely if they are familiar with
the standing order
another pharmacy on the list.
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LIST OF RESOURCES
NARCAN TRAINING PROGRAMS
Bureau of Substance Abuse Services information on Naloxone Responder
Training with List of Training Programs
http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone-info.pdf
List of Pharmacies with Standing Orders for Naloxone by Town
http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits#Pharmacy%20Standing%20Order
VIDEOS ON OPIOID OVERDOSE PREVENTION
Staying Alive on the Outside (18:58)
The Center for Prisoner Health and Human Rights
http://www.prisonerhealth.org/videos-and-fact-sheets/overdose/
Bunny and the Wolf: An Animated Guide to Opioid Overdose (4:22)
Hungarian Civil Liberties Union (HCLU)(in English)
Take Home Naloxone (9:22)
and Spanish subtitles. Includes personal stories.
http://www.youtube.com/watch?v=V6NVeA7aSC0&feature=youtu.be
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