The opioid crisis plaguing the United States is one that’s ever-growing. In 2016, 20,101 overdose deaths were caused by heroin or another opiate-induced drug. Unfortunately, it’s an issue that hasn’t shown any signs of slowing down and a solution is desperately needed. Despite funding attempts and public awareness campaigns about the opiate epidemic, numbers still reflect the rising problem at hand as hundreds of individuals lose their lives every month from a Heroin overdose.
If we can prevent you or anyone else from being a part of the statistics that we will and this is why we’ve put together a guide of answers to some of the most common questions about “overdoses”. Making such information readily available to the community is a way to educate others and may help to prevent the occurrence of an overdose. This is our hope and the hope of many that are coming together as a whole to combat the opioid epidemic.
Emergency first responders, overdose education instructors, and Naloxone distribution trainers are all highly experienced medical professionals that have extensive experience in the field of medicine. As such, the knowledge they have about “overdoses” can be beneficial for all to learn so the word can spread around; which will help to educate the community about the topic.
Below, we’re going to cover some answers to overdose related questions that were gathered from medical professionals that have extensive experience in dealing with opiate-induced overdoses.
Naloxone does not get injected into the heart or anywhere near there. While Naloxone does have an injectable form, it’s never injected into the heart. When it comes to the injectable form, it is administered either intravenously or intramuscularly. With that said – when it comes to the movie, the dramatized difference between the overdosing of the character after the injection is actually a possible outcome of Naloxone use.
Your liver is a very important organ as it’s responsible for processing and filtering all of the drugs that enter the body (one reason that alcohol is bad). If for any reason the liver malfunctions or stops working there’s a good chance that clogging of the drugs occurs in the body. This would result in an overdose. For individuals who suffer from liver damage or malfunction, they are much more susceptive to encountering an overdose and frequently.
Not only will drug use damage the liver and reduce its function but your chances of an overdose continually increase as you ingest more drugs (since your liver is less able to filter the drug’s properties).
Suboxone, also known as Buprenorphine, decreases the opioid cravings for its users and is used to stop the use of heroin and prescription pain killers. On the other hand, Naloxone’s purpose is to help individuals avoid abuse (injecting) Suboxone. One fact about Suboxone that all should know is that when Suboxone is taken underneath the tongue, the Naloxone will not get absorbed into the body. However, is the user injects the Suboxone; the Naloxone will reach the opioid receptors in the brain before the Buprenorphine which results in a diminished high.
The use of Buprenorphine to reverse the effects of opiates and/or an overdose isn’t something that has been explored or studied. Since Suboxone is intended to halt opiate cravings and not for preventing an overdose, studying its effectiveness in preventing overdoses hasn’t been determined. However, there have been some reports that taking Suboxone can overturn the effect of the opiates on the brain and body.
This is more than likely due to the fact that the Buprenorphine has a much stronger potency and is more attracted to the opioid receptors than the opioids found in heroin. Because of this, displacement of the opioids is made possible which meaning the brain’s receptors will not come in contact with the opioids.
In the few cases where Suboxone has been used to reverse an overdose, it’s more than likely due to the Buprenorphine and not the Naloxone as the amount of Naloxone in Suboxone quite small. Since Buprenorphine’s presence is more potent than of Naloxone, it’s believed Buprenorphine is what wakes up people out of an overdose.
Keep in mind that when it comes to an overdose everything has to do with timing and oxygen. Any efforts made for an overdose revival should not sacrifice any time whatsoever as life or death can occur or not occur in a matter of seconds.
Keep in mind that Suboxone preparation, when injecting, takes away precious time and waiting for a pill to dissolve will also consume valuable time. It’s always recommended that a shot or dose of Naloxone is carried as it’s the most convenient and easiest-to-use overdose reversal solution.
A common misconception is that speedballing is a solution to preventing an overdose. This is not true. Speedballing does not eliminate the risk of an overdose. Contrary to popular belief, it increases the risk of an overdose; especially when using cocaine as it can numb breathing abilities. If you’re not familiar with what “speedballing” is, it’s when an individual uses a combination of drugs including a stimulant (known as an “upper”) or a depressant (or downer) together at the same time.
A popular speedballing concoction is mixing heroin with cocaine or heroin with methamphetamine which most users inject into their veins. When stimulants are taken the body’s blood vessels become constricted which the increases heart rate. This can deplete the amount of Oxygen that you need to survive which can result in an overdose or worsen one.
The more drugs taken together is all the more the harder and more strenuous the addiction becomes on your body. Because users who speedball use the drugs more frequently than those who take the drug alone; speedballers are more prone to an overdose occurring.
Many people wonder if Naloxone is a solution that can overturn or reverse an alcohol-induced overdose. Some believe it can and it’s a misconception that Naloxone can do so. Naloxone is not effective at overturning an alcohol overdose, only ones that are caused by opioids. However, if alcohol and heroin were used together and an overdose occurs than Naloxone may be able to reverse the overdose (as the OD may have been caused by the opioids, not the alcohol).
It’s not a safe idea to carry Naloxone around for the treatment of an alcohol-induced OD as Naloxone’s effect would be non-existent.
First and foremost, Naloxone isn’t medicine that will reverse an overdose caused by crack or cocaine. Naloxone is intended to work for opioid-induced overdoses only. If the overdose occurred from cocaine but opiates were taken than Naloxone may be effective at reversing the overdose since the OD may have been initiated from the opioids and not the heroin.
Unfortunately, overdoses from cocaine use are extremely dangerous as the danger of the overdose isn’t dependent on how much of the drug was used. It’s a complicated medical emergency to say the least and should be tended to immediately by first responders (call 911!).
Actually, the answer is “neither”. First, make sure you don’t make the mistake that most do and confuse Clonidine with Klonopin (which is benzo). Clonidine is used to relieve users of withdrawal symptoms caused by opioids, alcohol, and even nicotine. However, when combined with other opioids the high is intensified (most recreational users do this).
However, doing so lowers blood pressure, your heart rate, and often time’s causes dizziness and drowsiness. Because the blood pressure falls to dangerously low levels when users combine Clonidine with opioids, many users end up falling which leaves them prone to injury. When it comes to clonidine and opioid combination the risk of an overdose is much more likely compared to taking the opioids alone.
An overdose is less likely to occur however when users combine opioids with benzodiazepines (such as Xanax).
Some people also refer to it as Finnegan or Promethazine. Phenergan is a drug used to fight against nausea and is also used as a sedative. It’s also used for motion and morning sickness and can be utilized to stimulate opioid activity. Here’s a prime example of what most users do; someone that takes high doses of opiate pain medication lowers the dosage of the pain killers and replaces it with Phenergan (which would result in a high).
The effects of heroin are also increased when users reduce the intake of opioids and exchange it with Phenergan.
It’s important to know that there’s a much higher risk of an overdose occurring when there’s a combination of Phenergan and opioids taken together rather than the opiates being taken alone. It’s less likely that an overdose occurs when opioids are combined with benzodiazepines. Surprisingly, mixing Phenergan with benzodiazepines isn’t believed to be habit-forming.
Fentanyl is a widely-discussed drug that has been mentioned quite a bit recently in the news. As it’s a popular drug used to “cut” heroin; many users end up overdosing due to this powerful, potent, concentrated, and lethal opioid. It’s not uncommon at all for heroin dealers to mix some Fentanyl powder in with their supply of heroin in an attempt to strengthen the potency or to improve the quality of a bad batch.
Unfortunately, for users of heroin, if the dealer doesn’t properly mix in the Fentanyl with the heroin an overdose is very likely to occur. This is why Fentanyl is to blame for the many deaths that have been surfacing in recent stories.
Fentanyl also comes in a patch form which you simply apply and stick to your skin. With a patch, the medicine is time-released and will be released to you throughout a certain time frame. Some people choose to apply the patch to the inside of the cheek as it allows for the medication to be released quicker which allows the body to absorb the medicine even quicker.
Some users go as far as extracting the gel from the Fentanyl patch and either snort or inject the gel. While it’s a strenuous process, users manage to turn the gel into an injectable solution.
Use of Fentanyl is extremely dangerous and an overdose is very likely to occur regardless of the dosage amount. It’s insanely potent and is short-acting which results in the brains receptors to become flooded nearly immediately. Fentanyl is chemically formulated to treat pain experienced by those who are already physically addicted to opioids as a pain-management solution.
Keep this in mind; Fentanyl is designed to treat severe pain, the kind of pain that’s hard to live with even for those who are already taking high doses of opioids.
Keep in mind that administering a salt shot will cause pain for the patient. For one, the injection itself causes pain and the salt water doesn’t make it any better as it stings and burns upon injection. If the person is responsive to pain, trust me, you’ll know it! Remember, when there’s life on the line, every moment and second is precious. There’s the time required when it comes to preparing a salt shot and this time could be better spent dialing 911, administering rescue breathing or dosing the victim with Naloxone.
While there have been those few rare occasions where a salt shot was effective it could have an adverse effect and cause damage. Using Naloxone is always the safest alternative.
Physically hitting someone isn’t the greatest idea. After all, doing so could result in injury. Punching, slapping, kicking, or dragging someone isn’t going to necessarily help our cause. When it comes to the “sternal rub”, you want to cause pain but you do not want to cause any sort of “harm”. If the victim is unresponsive to the sternal rub than waste no further time and dial 911. While waiting for first responders to arrive, do rescue breathing and administer Naloxone if accessible.
Depending on the individual, putting ice down their pants or a cold shower may, or may not, help with an OD. Remember that ice down the pants and a continual flow of very cold water can result in the respiratory system slowing down which can cause the victim to have hypothermia or perhaps may experience shock.
A safer course of action to take is to dial 911, provide rescue breathing, and administer Naloxone if available.
Yes, you’ll test positive for the presence of opioids. Remember, Naloxone rids the brains receptors of the opioids but not your system. Even if Naloxone is taken, the drug (opioids) will still be cycling through your system. It will show in a drug test.
Just as with any other possession of yours, your Naloxone kit is YOURS and as such, it should never be taken away from you. In the event that your Naloxone kit is ever confiscated from you, we advise that you get in touch with the place where you purchased the kit at (explain to them what occurred). There are some places such as homeless shelters, clinics, and recovery centers that do have policies mandating that visitors disclose to staff what medication(s) they have on their person.
If such policies exist, the protocol would require you to inform these officials that you have the Naloxone kit in your possession (but it should never be taken away).
Keep in mind that Naloxone is intended to stop an opiate-induced overdose. Because of this, police or other officials may look at this as a red flag figuring that you’re a heroin user or addict. Since Naloxone is a prescription medication, should you be asked if you possess any medications by authorities you will need to let it be known what you’re carrying the kit.
Typically, no you cannot. However, in some situations, you may run the chance of being arrested by being at the scene depending on a number of factors. Whether or not you get arrested comes down to the policies of the town/city you’re in and the culture of the police department in the region. One example is that some police departments have unofficial policies where they never arrest someone at the scene of an overdose just for calling in for help.
However, there are stricter cities out there that position themselves from a punitive standpoint that will search those at the scene of an OD. This of course increases the chances of being arrested as any little thing that they deem to be illegal could result in your arrest.
There are initiatives and bills that some states are currently trying to pass for this. There are new laws that may be passed that are known as the “911 Amnesty” and “Good Samaritan” bill. These bills becoming laws would prohibit the police and officials from arrest, prosecuting, and charging individuals with crimes over simply calling in an overdose. It would also fully decriminalize the possession of Naloxone kits.
Keep in mind that if you’re on probation, have a warrant out for your arrest or have any current open cases within the judicial system; calling in an overdose will more than likely result in an arrest as you may be required by police to identify yourself (and your outstanding issues will emerge).
Plan for the worst and hope for the best. By this, always expect that officials will visit the scene or your residence for questioning if you were a witness. Clear away any drugs or paraphernalia from plain view as you don’t want to give away any obvious signs that would prompt them to begin a search. The top priority for all officials is safety so be sure illegal items or drugs are not visible or even better not present.
Preparing for the official’s arrival is the best way to deal with the situation as it’ll make any interactions you have with authorities issue-free.
Emergency First Responders across the nation are now carrying Naloxone as it has become a mandate by the government that paramedics and police officers carry it. This is why the average dose of Naloxone has increased to $30-$40 from $1-$5 10 years ago. The use of Naloxone is nationwide as it’s the most effective medicine available that removes the opioids from the brains receptors making it possible for an individual to come out of an overdose.
Because of how well it works, it has been used for nearly 50 years and is extremely effective at reverting and stopping an overdose. Nasal Naloxone is distributed by many overdose prevention programs and in most states is used by all police officers and fire departments. The device used to administer naloxone through the nasal passages has a much stronger concentration of the drug.
It has a greater strength in this form as it’s compensating for the way the body absorbs the drug through this method.
Of the 5 main distributors that supply the doses of Naloxone, all are making a huge difference as thousands of lives are saved annually because of Naloxone.
Administering nasal Naloxone by injection isn’t the greatest idea as a higher dose of the Naloxone than what’s required would be received by the individual and will result in worsened withdrawal symptoms. It’s advised that injecting around one-fourth of the nasal Naloxone should be enough to help revive someone from an overdose.
Keep in mind that preparing an injection takes away precious time that could be used to administer the nasal Naloxone through the nose or by doing rescue breathing or dialing 911.
I recommend that you do your best to keep the nasal spray attachment with the Naloxone box at all time to eliminate the chance of losing it. This can simply be accomplished by using a rubber band that you can wrap around the sprayed piece to the box. This way, losing it is much less likely to occur.
In the event that you lose the nasal spray attachment and Naloxone is needed than do what must be done and inject a dose (or multiple doses if required) into the victim’s nose or alternatively, you can prepare an injection. When administering Naloxone without the nasal piece stick it in the person’s nose and when it comes out it’ll be more likely a stream rather than a spray.
As such, make sure the victims head is tilted as far back as possible so the medicine doesn’t run out of the nasal passages.
Of course, take a moment to call 911 so they can be on the way while you do what you can to administer the Naloxone. Time and oxygen are the two most important factors to consider when dealing with an individual that has overdosed.
Because muscle syringes have longer ends and points, use one as a replacement to the syringe that came bundled with your injectable naloxone isn’t the greatest ideas. Because muscle syringes are intended by design for the naloxone to reach the muscle, a normal syringe will not deliver the medicine as effectively since it won’t penetrate all the way into the muscles. However, if a muscle syringe isn’t available and a dose of Naloxone is needed using a normal syringe and administering the Naloxone is certainly better than nothing at all.
There have been studies that have shown that by administering a subcutaneous injection (an under-the-skin injection but above the muscle) can in some cases be just as effective as injecting the medicine into the muscle directly. Be extremely cautious with the dosage amounts that you measure out for the injection(s).
To start, you want to begin by measuring out and injecting 1cc of naloxone which should fill up a syringe if you’re carrying a 1cc-capacity syringe. While a subcutaneous injection can be useful, it’s not “as consistent” as an injection made by a muscle syringe but as previously mentioned, if one’s not available then use a traditional syringe. Under co circumstances, if a muscle syringe is available, do not replace it with a normal syringe.
Whether or not an overdose reoccurs for an individual after being administered Naloxone will come down to their metabolism as how quickly the medicine is processed determines the chance of an overdose. It’s also dependent on the amount of the drug(s) the user took and the half-life of the drug as well. For example, methadone’s half-life is much longer than that of heroin. Whether or not an OD occurs will also have a lot to do with how well the person’s liver is functioning.
After being administered Naloxone, the medicine will stay active in the body of the victim for a period of 30-90 minutes (depending on the factors mentions above). Let’s say you administer Naloxone to someone who had an overdose from opioids. If the Naloxone happens to wear off before the opioids do than an overdose may reoccur. This is why in some cases, 3-5 doses of Naloxone are needed to revive a patient.
Naloxone is effective as it blocs the opioids from interacting with the brains receptors. Because of this though, it can cause withdrawal symptoms in users who are dependent and addicted to opioids. As soon as an opioid-dependent individual receives a dose of Naloxone they may experience an abrupt feeling of dizziness, sickness, and cravings. These feelings will make the individuals crave the drug of choice and it’s extremely important that they do not use the drug again, especially within a couple of hours of the overdose.
Use of the drug again within a short period of time can reinitiate the overdose which of course we want to avoid at all costs possible. It’s best that overdose victims receive medical attention but if the victim is walking and talking alright after receiving the dose(s) of Naloxone than they’ll more than likely be alright. If Naloxone has been administered and the person is unresponsive, seek medical attention immediately and dial 911!
The new CPR guidelines that have been released are primarily intended for what to do when dealing with cardiac arrest; not respiratory arrests or overdoses. When a cardiac arrest occurs, respirations aren’t quite as important as chest compressions; especially during the first few minutes of an overdose. When dealing with a respiratory arrest, such as an overdose, respirations are what are important.
Now, if the respiratory arrest matures in to a full cardiac arrest than it’s in the best interests for the patient that they receive both chest compressions and rescue breathing since this will increase the chance of revival. When it comes to an opioid-induced overdose the main issue is a lack of oxygen which is different from that of decreased breathing from a heart attack.
If the patient is showing any signs of life such as short breaths of air or slight movement than rescue breathing will more than likely be enough to revive them as increasing their oxygen intake will enable them to start breathing. After reviewing the most recent AHA guidelines which include training for the Basic Life support method, instructions are included that advice the use of rescue breathing for overdoses as it can prevent cardiac arrest.
You can learn more about these guidelines at Harm Reduction Coalition’s.
If opioids are not present in the system ten Naloxone will have no effect(s) whatsoever. Furthermore, if opioids are in the system but the user isn’t overdosing, Naloxone will have no impact. On the contrary, it won’t hurt the individual either and can be used to wait until medical response arrives.
Overdosing on Naloxone isn’t possible and will not cause injury or harm if too much is provided or taken.
You do want to keep in mind though that the more dependent and addicted a user is to opioids the worse their withdrawals will be when receiving Naloxone. The more Naloxone an opioid addict receives is all the more intense their withdrawals and cravings will be.
In such a case, you can expect that the recipient of the Naloxone will vomit. In such a scenario, be sure the individual doesn’t inhale as this could be quite dangerous. Reassure the victim that within 30 minutes from the time the Naloxone was taken that the feelings of withdrawals, sickness, and nausea will subside.
No, this is not possible. Using naloxone on a person’s 10th overdose would be just as effective on them as the first dose they ever received. If overdoses occurred far and few between for a user and they’re now experiencing overdoses frequently, an internal complication may be occurring in the body and emergency responders should be called right away if an overdose occurs. There are many reasons why overdoses may start occurring more frequently; some more serious than others.
Naloxone has no effects when used if no opiates are present in the users system. When someone uses heroin or prescription pain pills, opioids are in their system and if Naloxone was taken it’d have an effect. When there are no opioids attached to the brains receptors, Naloxone, if used, will have no impact or negative side effects. While Naloxone doesn’t pose any risks if used by children there is a risk of harm when it comes to the applicator itself.
The naloxone nasal applicator consists of a small part that could potentially cause choking and the vial in which the medicine is stored is constructed from glass. Furthermore, inside of the plastic tubing of the naloxone applicator, there’s a small yet dangerously sharp needle that would be extremely dangers for a child to handle.
Because of these reasons, it’s best to keep Naloxone stored out of the reach of children even though the medicine itself isn’t hazardous or dangerous. The components and accessories alone pose enough danger to warrant keeping the Naloxone stashed away (if children are present).
If your naloxone has expired than you must get a new kit. Return back to the place in which you purchased the naloxone kit and bring the expired kit with you. Exchange the kit for a new one as the old kit in which you bring back will by the naloxone distributor as a demonstrator.
If your expired naloxone kit is all that you have on you and it needs to be used then use it. Using an expired naloxone kit on an overdose victim is much better than that victim not receiving anything at all. However, if you find yourself needing to use an expired naloxone kit, call 911 immediately so they can be on the way to the victim as naloxone starts to lose its effectiveness after expiration.
Expired naloxone doesn’t have any adverse effects if used; it’ll just be a bit weaker. Use rescue breathing in conjunction with the expired naloxone.
It’s situational. It should be the overdose trainers that ask the question about the program or clinic before conducting trainings. There are some programs out there that have policies that do not permit the possession of Naloxone on the premises.
If this is the case, we recommend speaking to the senior staff to help them create a program that would help everyone at the location to learn how to identify and respond to an overdose. Since naloxone cannot be used it’d be a good idea to educate those at the facility of how to respond to an overdose. Teaching others how to determine if an overdose has occurred, how to do rescue breathing, and how to position the victim are all approaches to saving someone’s life (without the use of naloxone).
There are some cities and states where regulations and laws exist that permit certain naloxone administrators to carry the medicine even on grounds where possession isn’t permitted. Before carrying naloxone to your facility/clinic check the local regulations. You want to ensure that you’ll be protected in the event that you get caught carrying it.
Naloxone being the cause of outrage, violence or aggression is a common misconception and isn’t true. However, one of the side effects of using naloxone can result in the victim becoming agitated and violent due to withdrawals. The more addicted an individual is to opioids the more violent they can become but not due to the naloxone; it’s due to the fact that naloxone removes the opioids from the brains receptors and when this happens the addict will experience symptoms.
Cravings can begin to occur nearly immediately and as such can turn the individual in to someone with a violent behavior.
Furthermore, the individual who suffered an overdose may not have realized that they overdosed. There’s a possibility that they feel enraged and angry when they realize their high has subsided. Adding in the withdrawals, discomfort, and feeling of sickness; most people who are revived from an overdose are not in the greatest of moods and should be dealt with in a cautious approach.
When it comes to seeking treatment at a facility for a drug user, abuser or addict there are many factors that go in to play. Making the chose to attend a drug detox or rehab facility comes down to the personal outlook of the abuser on their addiction. Many users don’t consider their addiction to be serious and as such aren’t concerned with finding treatment for their addiction.
As such, while it’d be easier in the long run for their health to simply receive treatment, many don’t attend treatments as there’s no desire to.
It’s true, the thousands of lives that are saved annually preventing or stopping overdoses is always on the news. This can give current drug users the reassurance that they’re safe when using drugs; even if an overdose occurs. Keep in mind that when someone dies from drug abuse or an overdose, typically, their closest friends who are also drug users aren’t effected to the point where they’re going to drop addiction because of it.
Emotional distress, such as a loss of a friend who died from an overdose can actually result in in an increase in use of the drug.
Despite knowing the adverse effects of continued drug use, many will continue use of their drug of choice. This means that even for those who have witnessed the dark side of drug abuse (death), their addiction and self-inflicted harm will continue (for most).
Through unique recovery approaches coupled with superior medical support and an experienced staff; the Detox of South Florida renders treatment services to individuals suffering from opioid addiction of all levels and severity.
Address: 608 NE 2nd Ave, Okeechobee, FL 34972
Phone: (863) 623-4923
Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.
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