1. No category

Facilitator’s
Manual
Preventing and Responding
to an Opioid Overdose
ONE-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 ........................................................................Pages 4-5
Overview of Training Page ......................................................................................... 6
Session Outline................................................................................................. Page 7-9
Opioid Overdose Prevention Handout ................................................... Page 10-11
Post Group Evaluation ......................................................................................Page 12
Post Group Evaluation-Answer Key ...............................................................Page 13
Optional Additional 2nd Session: Naloxone Responder Training ..........Page 14
How to Access Naloxone through Pharmacy with a Standing Order ....Page 15
List of Resources ................................................................................................Page 16
3
INTRODUCTION TO THE
THREE-SESSION OPIOID OVERDOSE TRAINING
PURPOSE OF THE TRAINING CURRICULUM
This 90-minute training curriculum 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 peo-
WHERE COULD THIS TRAINING BE USED?
This 90-minute, one-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
Markers
Opioid overdose prevention handout
Referral cards
PREPARING FOR THE SINGLE SESSION
program 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 SESSION:
Print Opioid Overdose Prevention Handout (page 10 & 11)
Print post group evaluation (page 12)
Topic # 1 OVERDOSE RISKS
Topic # 2 OVERDOSE SIGNS AND SYMPTOMS
Topic # 3 OVERDOSE RESPONSES
Review resource list at end of curriculum (pages 14-16)
Prepare referral cards for group members
Bring pens!
POST GROUP EVALUATION
There is a post-group evaluation included on page 12. This is to test participants’
acquisition of facts presented in the training.
5
THE BASICS OF OPIOID OVERDOSES
ONE-SESSION OVERVIEW
ACTIVITY OVERVIEW
TIME
1 Welcome, overview
5 minutes
2 Review: What do we know: Card game
20 minutes
3 Opioid overdose risks
10 minutes
4 Group discussion questions: What can be done to reduce
risks of opioid overdoses?
15 minutes
5 (A-B) Presentation: What a bystander needs to know: Responding to an opioid overdose
25 minutes
6 Wrap up and summary
10 minutes
7 Post-group evaluation
5 minutes
BEFORE THE SESSION:
Print Opioid Overdose Prevention Handout (pages 10–11)
Print post group evaluation (page 12)
Review the Opioid Overdose Prevention Card Game Facilitator’s Guide
Topic # 1 OVERDOSE RISKS
Topic # 2 OVERDOSE SIGNS AND SYMPTOMS
Topic # 3 OVERDOSE RESPONSES
Review resource list at end of curriculum (pages 14–16)
Prepare referral cards for group members
Bring pens!
6
ACTIVITY/CURRICULUM NOTES
STEP 1
(2 minutes)
WELCOME AND OVERVIEW
Tell the participants:
•
•
•
•
(3 minutes)
STEP 2
(20 minutes)
90–minute session
Review opioids
How to assess and reduce your risk of opioid overdose
How to respond to an overdose if you happen to be a bystander to an opioid
overdose
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 bringing personal experiences to the training.
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, but ideal
is 3-5 people)
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:
• 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.
• 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 3
(10 minutes)
PRESENTATION/DISCUSSION: RISKS FOR OPIOID OVERDOSE
Show: Flipchart # 1: Overdose Risks
Present main risks:
1. Using drugs alone or being left alone
2. Using too much drugs
3. Mixing drugs-mixing opioids with alcohol or is dangerous because all substances
4. Reduced tolerance after a period abstinence or due to poor health.
STEP 4
(15 minutes)
WHAT CAN BE DONE TO REDUCE RISKS OF OPIOID OVERDOSES?
Refer to the list of risks if participants have trouble naming risk reduction strategies.
Key Points:
• Don’t use alone. Make arrangements with someone to be with you or check on you
• Don’t mix drugs-benzodiazepines and alcohol and opioids all suppress a person’s
breathing
• Be aware of reduced tolerance after a period of abstinence-use less, take
a tester shot
• Be aware of reduced tolerance when you’re in ill health and use less
If there’s time have participants discuss how they might implement these risk reduction
strategies.
STEP 5
A) PRESENTATION: WHAT A BYSTANDER NEEDS TO KNOW TO RESPOND
TO AN OPIOID OVERDOSE
(10 minutes)
Ask: What might it look like if a person were in an opioid 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.
8
ACTIVITY/CURRICULUM NOTES
(15 minutes)
B) RESPONDING TO AN OPIOID OVERDOSE
Show: Flipchart # 3: Responding to an opioid overdose
1. Check to see if person is in an overdose. List or get the group to list the
following:
a. Take a close look at the person,
b. Shout person’s name,
c. Give sternal rub
2. Call 911.
3. Perform rescue breathing
4. Place person in recovery position if you have to leave the person at any point.
5. Stay with person and continue rescue breathing until medical personnel arrive,
if possible.
6. Give Naloxone
Key Point:
In Massachusetts, participants can get training to become a naloxone (Narcan)
responder. At the end of the training I will give you a card that lists organizations that
provide training in this region of the state.
STEP 6
(5 minutes)
WRAP-UP
Ask: Any questions?
Hand out Opioid Overdose Prevention
If you have time you can do a review with the group by asking the questions:
• What are some common opioids?
• What things increase the risk of an opioid overdose?
• How can you reduce the risk of an opioid overdose?
• What are the signs of an opioid overdose?
• How should you respond to an opioid overdose?
STEP 7
(5 minutes)
EVALUATION
Handout evaluation and pens. Collect from everyone. Can read it aloud if
9
10
11
ACTIVITY/CURRICULUM NOTES
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?
12
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?
13
OPTIONAL ADDITIONAL 2ND 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!
14
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.
15
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
16