The Weekly Wrap: April 7, 2024

This week, my University offered opioid overdose and Narcan training for anyone who was available to attend. While this has not been an issue at our library, it is a concern for every library. The training was presented be HIPS, a local harm reduction non-profit, and it provided a comprehensive look at this issue. 

I am going to share my (lengthy) notes from the training. I have removed the DC specific information but I guarantee there is a local organization near you that would be happy to provide training. Whatever your views on the drug crisis, it's never a bad decision to save a life. (Note - Narcan is the brand name for naloxone.) 
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• Fentanyl is often mixed into other drugs without the user knowing it; Fentanyl is so prevalent that it's most of the supply - when people think they are getting meth/cocaine, it's mostly fentanyl
• OD on opioids causes respiratory depression - that's the symptom which kills
• Fentanyl is 10-50x stronger which is what makes it more dangerous; this is particularly dangerous for older users who are used to less potent drugs
• Naloxone ONLY reverses opioid overdoses; it does not work on other drugs

• A new drug, tranq, is making fentanyl worse by "giving it legs" - makes it harder to revive with Narcan but Narcan can still work; Tranq is also causing necrosis in those who use it

• Narcan will bring someone back AS LONG AS they are still alive; The timeline depends on how far gone they are - the faster you can use Narcan the better; In some cases, you can bring someone back, but they may have permanent brain damage

• "Fentanyl is no fun." - people are mostly doing the drug to avoid withdrawal

• The stats we have on ODs and how many people are saved by Narcan are undercounted because most revivals are not reported; drug users don't like to call 911

• Massive jump in 2019-2020 from ODs due to pandemic impacts (i.e. people using alone) and increase of fentanyl in the drug supply
• You are more likely to die if you are medically vulnerable - unhoused, food insecure, preexisting conditions, etc.
• There is no age that is too young to do this training - a lot of kids save their family or caretakers lives
• "If it's not coming out of a pharmacy, it's probably fentanyl."
• Needle/intramuscular naloxone is more effective but nasal is much easier to give and people are less squeamish; if giving by needle - in the muscle - arm or thigh is best

• Narcan is roughly $50 OTC
• 5 Steps to Administer Narcan
  • Assess responsiveness
  • Call 911
  • Administer Narcan
  • If necessary, perform rescue breathing
  • Place person in recovery position
• If someone is responding - mumbling, moving - they are NOT overdosing 
• Look for grey, purple, or blue nails, doesn't wake up, difficulty breathing or not breathing, cold/clammy skin
• Assess: Call verbally by name if you can, loudly say "I'm going to Narcan you of call 911 if you don't respond."; assess physically - sternum rub or rub knuckles over upper lip - assessing should take 5-10 seconds total

• Call 911 (or dose with Narcan first then call 911)

• DON'T SAY drugs or overdose when calling 911
  • Cops will show up first if you say drugs or OD
  • Instead say, "I can't wake them up," "Someone is not breathing," just ask for an ambulance
• To administer
  • Peel open package
  • Tilt person's head back
  • Place in nostril and firmly press plunger
  • IF NO response repeat after 2-3 minutes with second dose (second dose is in same package)
• Narcan DOES NOT HARM - even if the person is not ODing or using drugs, it is safe for everyone

• Rescue breathing is rarely needed - 2 breaths every 5 seconds until EMS arrives (chest compressions not necessary)

• Place in rescue position - lay person on their side in a supported position so that they cannot roll over (to prevent choking should vomiting occur)

• MYTHS: Fentanyl cannot be absorbed through the skin or aerosolized (unless there is NO air movement)

• If you do touch fentanyl - stay calm, wash your hands thoroughly with soap and water, avoid touching your face (The myths are designed to scare people)

• Half-life of naloxone is 30-90 minutes, it is possible that a person can OD again from the same original OD since the drug has a much longer half-life; Encourage person not to use again and get medical attention - if person refuses medical attention, stay with them for 3 hours
  • It can help to tell people they won't get high anyway while naloxone is still in their system
• Naloxone has no side effects - but withdrawal symptoms from the opioids can occur which feels like side effects
• Naloxone is safe to take during pregnancy

• Narcan has no known drug interaction

• People don't remember ODing - they may be confused, scared, emotional; Overdoses can be stressful on everyone, and support is available for both users and caregivers

• Bringing someone back is not enabling drug use - you are always doing the right thing by saving a life

• Storage: Don't freeze it; store at room temperature - but is better to have with you so you can use it
• Narcan gets a little weaker but it does not go bad - even weaker, it is still effective, you just may need to use both doses; Studies show that Narcan works 30 years past the expiration date with minimal lose of effectiveness
• Dispose of used Narcan in the trash

• You are protected under the Good Samaritan Law (further protections may exist under local or state law, varies by location)

• Anyone can carry and administer naloxone

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