NALOXONE TRAINING

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NALOXONE TRAINING
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Aims of Guidance.

• To help clinical teams with training for use of
  Naloxone by staff and service users.
• To aid prescribing take home Naloxone for
  prison leavers with a history of opioid use.
• Guide for administering Naloxone following a
  suspected opioid overdose.

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Indication for Naloxone

• To reverse the effects of an opioid induced
  overdose

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Opiates and Opioids

• Opiates are naturally occurring.
• Opioid is a more general term that includes both
  naturally occuring opiates (like morphine and
  codiene), semi-synthetic opiates (like heroin)
  and synthetic drugs like methadone, pethidine and
  subutex.
• Opioids cause varying degrees of coma,
  respiratory depression, (slowed breathing) and
  pin point pupils

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What is Naloxone ?

• Naloxone is an opiate antagonist.
• It is indicated for coma or respiratory
  depression caused by opioids.
• Naloxone can reverse the effects of overdose if
  used within a short period following an opoid
  overdose.

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How long does it last ?

• It lasts at least 20 mins and up to an hour.
• It has a shorter duration of action than many
  opoids.
• Opioid reversing effects of Naloxone may end
  before the effects of the opioid end.
• Therefore a person may return to overdose state.
• Close monitoring is required for serveral hours
  after overdose.
• Monitoring should be carried out within a medical
  setting (e.g. hospital )

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Cautions.

• Mixed agonist/antagonist opioids such as subutex
  are only partially reversed by Naloxone ( but
  they are much less likely to cause respiratory
  depression in the first place ).
• Caution is needed with opioid dependant
  individuals because Naloxone precipitates
  withdrawal.
• Caution is also needed for those with known or
  suspected heart problems.
• N.B. Naloxone is short acting and these effects
  usually resolve quickly.

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Who can use Naloxone ?

• On 30th June 2005, Naloxone was reclassified
  under article 7 of Prescription Only Medicines
  Order, by Parliament.
• Naloxone is now on the list of prescription only
  medicines that can be administered parentally (by
  injection) by anyone for the purpose of saving a
  life.
• This means that Naloxone can be given by any
  member of the public (including all drug
  service/hospital staff) to a person suspected of
  having an opioid overdose.

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Opioid overdose information.

• Opioids include drugs such as heroin and
  methadone.
• Opioid overdose can occur in anyone using opioids
  and may lead to death.
• Opioid overdose deaths are frequently related to
  respiratory depression.
• There has been an increase in opioid overdose
  deaths in recent years.
• Most opioid overdoses are witnessed by others.

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Risky situations for overdose.

• Any planned or unplanned detoxification from
  opioids.
• Stopping opioids for a few days,
• Injecting opioids.
• Opioids in combination with other drugs or
  alcohol.
• Using alone.

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Overdose Information

• In first 2 weeks of release
• Male prison leavers are 29 times more likely to
  die
• Female prison leavers 69 times more likely to die

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Naloxone drug information.

• Can prevent death from opioid overdose.
• Reverses the effect of opioid overdose.
• Short acting so will begin to wear off after half
  an hour.
• Should be monitored in hospital as may need extra
  injections of Naloxone.

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How to Recognise Opiate Overdose

• Person unconscious, and cannot be
• woken UNROUSABLE
• CYANOSIS BLUE lips or tongue
• Not breathing at all or breathing
  slowly
• deep snoring.
• Pin point pupils

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Opioid overdose management including use of
Naloxone.

• Try to wake person if not responsive.
• CALL AMBULANCE say suspected opioid overdose.
• Check airway clear if blocked.
• Check breathing give 2 mouth to mouth breaths
  if not breathing.
• Place in recovery position if breathing.
• Inject Naloxone into muscle thigh, upper
  buttock or upper arms.
• Continue with basic life support until ambulance
  arrives.

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Actions on Discovering Overdose

• CALL AMBULANCE
  
• Check Airway clear if blocked, Check
  breathing.
• If breathing, place in recovery position
• If not breathing, begin basic life support or
  place in recovery position to maintain a good
  airway and prevent them from choking
• Administer naloxone

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Naloxone Administration

• Quickest route of injection is intravenous
• However INTRAMUSCULAR injection recommended as
  easier.
• Inject into a muscle
• Upper outer buttock, thigh area or upper arm.
• Hold needle 90 degree above skin
• Insert needle into muscle
• Slowly and Steadily push plunger all the way
• down

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Naloxone administration

• Remove all caps.
• Insert vial into minijet
• Attach needle and remove cover
• Hold at 90 degree angle over muscle
• Insert into muscle and press plunger
• Withdraw needle, discard in sharps container and
  wipe site with alcohol

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References

• BNF 49 published March 2005
• AWP/NHS Bristol Specialist Drug Service.
• Institute of Psychiatry at the Maudsley.
• Proff. John Strang National Addictions Centre.
• Kings College London.
• Farrell M., Marsden J. Acute risk of drug-related
  death among newly released prisoners in England
  and Wales. Addiction 2008 103 25155.

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Any Questions?