1 of 98

Coping with overdoses

1

2 of 98

Round table

2

3 of 98

3

Our collective commitments

We raise our hands, we do not interrupt each other, etc.

***TRIGGERS WARNING***

4 of 98

Training objectives

Following this training, participants will be equipped to implement a coordinated approach to prevent and manage overdoses, and to help reduce associated deaths

.

​

4

5 of 98

Schedule of the day

5

Introduction

8 :30 – 9 :30

BREAK

Prevent

9:45 – 10:45

BREAK

11 – 12

LUNCH ON SITE

​

​

Act

1 -2

BREAK

2:15-2:45

Restore balance

2 : 45 – 3 : 15

BREAK

3:30 - 4

EVALUATION

6 of 98

Form and documents

6

Participation form

7 of 98

ICE BREAKER

7

Learning objective: Understand the stigma that can be experienced around substance use

8 of 98

8

9 of 98

9

10 of 98

ICE BREAKER

10

Reminder:

  • Everyone uses for their own reasons
  • Stigma related to substance use exists across all settings and regions

11 of 98

11

PREVENT

12 of 98

12

BEST APPROACHES

Learning objective: Understand approaches that can help reduce stigma related to substance use

13 of 98

13

HARM REDUCTION

    • Reduction of the negative consequences associated with opioid use rather than just eliminating the behaviour.

​

    • Improved management of substance use

14 of 98

14

« NO WRONG DOOR »

Anyone needing help should be properly supported with the most

appropriate services for them within the community no matter what route is taken.

Overdose is everyone’s business! Every door is the right one!

15 of 98

15

BEST APPROACHES

​

Reminder:

<

- Harm reduction is a key approach to reducing overdoses and risks associated with substance use.

  • Every door is the right door – these isn’t just one place to seek help

16 of 98

16

17 of 98

17

SUBSTANCES 101

Learning objective : Know the different categories of substances and their main effects. Understand the law of effect.

​

18 of 98

Your turn !

18

Cannabis

Champignon

Kétamine

LSD

MDMA

PCP

Alcool

GHB

Héroïne

Amphétamine

Cocaïne

Méthamphétamine

19 of 98

19

UPPERS

DOWNER

HALLUCINOGENS

Increased heart rate

Ex : Cocaïne, café, tabac, MDMA, etc.

Relaxation, reduced anxiety

Ex : Opioïdes, alcool, benzo, etc.

Reduced sensations

Ex : Cannabis, LSD, Kétamine, etc.

Risk :

Cardiac arrest

Risk :

Respiratory depression (overdose)

Risk :

Impaired judgement and or motor coordination

20 of 98

20

NEW REALITIES

What do you experience in your communities?

21 of 98

21

LAW OF EFFECT

22 of 98

22

ADMINISTRATION METHOD

Injection

Snorting

Administration Method

Onset and intensity of the effects

​

Duration of effect

Oral

Smoking

Rectal

Through skin

Opioids can be used in different ways:

​

  • Oral (by mouth)
  • Smoking
  • Snorting (intranasal)
  • Injection
  • Transdermal patch (through the skin)
  • Rectal use

23 of 98

23

SUBSTANCES 101

Reminder: The law of effect refers to the correlation between three factors that determine the effects of the substance: the individual, the context, and the substance

​

  • Be mindful of the individual: biological/physiological factors such as sex or gender, body weight, age, height, overall health, etc.
  • Be mindful of the context: the setting, whether people around are known or unknown, whether the environment is safe or stressful, first-time use or after a period of abstinence, etc.
  • Be mindful of the substance: purity, route of administration, source, contamination, mixing with other substances, etc

24 of 98

24

HIGH-RISK OVERDOSES SITUATIONS AND PROTECTIVE MEASURES

Learning objective: Identify risk factors and strategies to provide a safety net

25 of 98

25

Risk

Protective measure

Isolate and lock yourself up to use

Let a friend know, call a remote supervision service (ex: NORS), avoid using at the same time as other who are present

After a recent period of abstinence, voluntary or involuntary (hospital, prison, detoxification, etc.)

Use small doses at a time

Health issues

Follow the prescribed dosage

Change of the administration method

Be well aware of the speed and the intensity associated with the chosent administration methode

Using several substances at the same time

Learn about the effects of mixing substances, reduse doses

Unknown substance of substance that the body is not accustomed to

Use drug-checking services if available, use a small amount first to see how you feel before taking your usual dose

HIGH-RISK SITUATIONS- PROTECTION

Context, individual, substance

26 of 98

26

PRESCRIBED SUBSTANCE RISK

PRESCRIPTIONS: NEVER WITHOUT RISK!

What to keep in mind

Protective measures

  • The way the prescription was made

​

  • The way people use it

​

​

  • Try to follow the prescribed dosage and be transparent with your doctor or pharmacist if you have difficulty adhering to it
  • Store substances in a secure place, out of reach of children and adolescents.
  • Return all expired or unused substances to the pharmacy to prevent misuse. Do not flush medications down the toilet or pour them down the sink.

​

27 of 98

27

SELECTIVE PREVENTION - IDENTIFY

Prevention that aims to identify people who are

considered to be more at risk of overdose

​

28 of 98

28

FAITES VOUS VOTRE PROPRE

BOÎTE À OUTILS

  • Context: (e.g., surgery, breakup, job loss, stressful period, performance anxiety, adapting to a new social environment).

​

  • Individual: Pay attention to behaviors that may be concerning or atypical (e.g., isolation, increased risk-taking) as well as physical signs (e.g., pinpoint pupils, agitation).

​

SELECTIVE PREVENTION: IDENTIFY

29 of 98

29

RELAPSE PREVENTION

  • What does a relapse mean to you?

​

  • What does relapse prevention involve?

​

​

30 of 98

30

31 of 98

31

RELAPSE PREVENTION

    • Increase awareness of the risks to the person

​

    • Work with the person on all areas of their life to make sure their is a safety net

​

    • Normalize relapse and what it involve

32 of 98

32

EXAMPLES OF PREVENTION METHOD MATERIALS

  • Circulate Public Health “Alerts.”
  • Train all workers and users (e. g. treatment centres) in the prevention and management of overdoses.
  • Have access to naloxone and know how to use it.
  • Distribute awareness tools.
  • Know all the prevention services available in your community

33 of 98

33

PROTECTIVE MEASURES

What protective measure have uou put in place?

34 of 98

34

BUILD YOUR OWN TOOL BOX

Resources are available :

​

​

​

​

35 of 98

35

USING VIGNETTES!

​

36 of 98

Mr. Tremblay was prescribed a long-acting opioid for one year for chronic pain by his family doctor.

​

For some time now, he has been realizing that the effectiveness is gradually decreasing and that the pain is returning.

​

Thinking he is optimizing the effect, he decides to cut the tablets and to take them more often…

​

​

​

36

1. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Monsieur Tremblay

37 of 98

2. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Marilou has been using drugs since she was 17 years old.

​

She likes to experiment. Her new boyfriend offers to inject heroin with her.

​

Marilou, who has already smoked heroin a few times, feels confident and

agrees to inject with him…

37

Marilou

38 of 98

3. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Eric tore his anterior cruciate ligament (ACL) in his right knee while playing football. He had surgery and was given Dilaudid to take for 7 days, following his operation.

Back home, he takes a pill to manage his pain. The pain remains unbearable despite the medication.

Six hours later, he immediately decides to double the dose to manage his illness

because, tonight, he is going to the party of one of his friends from university

and knows that he will not take any more medication until the next day.

Indeed, the doctor warned Eric that he should not mix his medication with alcohol.

During the evening, thinking that it's been long enough since he took his medicine, he drinks beer and a few shooters…

38

Éric

39 of 98

4. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Two friends go to their usual dealer to buy their heroin.

​

The dealer tells them that he has a great “batch of smack.” He says that, as it is “better than usual”, to be careful, and that’s why he asks them for $5 more.

​

They go to the first public toilets they find at a gas station. They do their injection together because they can't wait to get buzzed

39

Two friends

40 of 98

5. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

During his holidays, Martin sprained his ankle while camping.

​

Far from it all, his friend Sylvain suggested that he use some Empracet

he brought with him.

​

Sylvain means well but he doesn't know that Claude suffers from

hepatitis C…

40

Martin

41 of 98

6. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Steve leaves a treatment centre on weekends for progressive reintegration into the community. So it has been a few weeks since he has “Dilaudid”used and “coke.”

​

As soon as he returned to his home environment, he met friends he had not seen for a long time. They ask him to try Fentanyl with them.

​

Excited, he agrees to use Fentanyl because he has never been addicted to it, so he feels less at risk of relapse.

41

Steve

42 of 98

7. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Mrs. Bernier fell on the ice and has difficulty moving because of the pain. Luckily, Mrs. Bernier has Tylenol with codeine that she uses when her arthritis hurts.

​

She is currently using it to reduce pain.

​

On the day when she wants to run errands Mrs. Bernier feels very anxious about going out because she’s afraid of falling again.

​

She therefore uses a Rivotril that her doctor has prescribed and that she can take if necessary when she is too stressed and has difficulty functioning.

42

Mrs. Bernier

43 of 98

8. EXAMPLE OF A HIGH-RISK OF OVERDOSE SITUATION

Maya, a 20-year-old college student goes to a music festival with her friends, as she does every summer.

​

It's the only time in the year she uses Ecstasy.

​

Unfortunately, this time, without her knowledge, her tablet was cut with Fentanyl…

43

Maya

44 of 98

44

HIGH-RISK SITUATIONS AND PROTECTIVE MEASURES

Reminder: Zero risk does not exist

​

  • Test your substance
  • Do not use alone, or plan a safety net(ex. : NORS).
  • Harm reduction: stay informed and access available ressources.
  • MetPut prevention measures in place and create your own toolbox tailored to your needs
  • Prescriptions are not without risk
  • Alway carry naloxone or keep it within reach

45 of 98

45

46 of 98

46

ACT

47 of 98

THE STEPS

HOW TO ACT IN AN OVERDOSE SITUATION

47

SECURE the environment where the person is found.

RECOGNIZE the signs and symptoms of a possible opioid overdose.

CONFIRM THE OVERDOSE by trying to make the person react with noise or pain.

NO RESPONSE = ACT

  1. Call 911 (report if the person is unconscious or not breathing).
  2. Administer 1st dose of naloxone.
  3. Administer CPR (if you are trained to do it, otherwise do only compressions).
  4. Administer a 2nd dose of naloxone (repeat if the person is still unconscious).

48 of 98

ACT IN AN OVERDOSE SITUATION

48

49 of 98

ACT IN AN OVERDOSE SITUATION

49

Learning objective: Know the steps to follow to ensure your own safety and to protect the person you are assisting in a potential overdose situation

50 of 98

50

True or false? I find an unconscious person in a park, and their dog is preventing me from approaching. I should still intervene directly with the person?

​

False !

If you are not safe, you do not intervene. Call 911 and explain the situation to emergency services.

51 of 98

ACT IN AN OVERDOSE SITUATION

  • Drowsiness
  • Very slow, difficult, almost non-existent breathing
  • Snoring, strange breathing noises (gurgling, choking, etc.)
  • Blue lips and fingertips
  • Cold or clammy (wet) skin

51

Learning objective: Recognize the signs and symptoms of an opioid overdose

52 of 98

52

True of false? If a person is making unusual breathing sounds, they are not overdosing because it means they are breathing.

​

​

FALSE!

Hearing noise does not mean the person is breathing effectively.

53 of 98

If signs of overdose are present: STIMULATE the person. �Get the person to react to noise, THEN to pain.

53

ACT IN AN OVERDOSE SITUATION

Learning objective: Know how to stimulate a person who may be experiencing a potential overdose

54 of 98

54

True or false? Putting a person under a cold shower or in an ice bath is an effective way to wake them up.

​

FALSE!

The person could slip and seriously injure themselves or go into shock.

55 of 98

ACT IN AN OVERDOSE SITUATION

55

Learning objective: Know how to call 911 and provide the key information needed to support first responders

​

56 of 98

ACT IN AN OVERDOSE SITUATION

56

LITTLE or NO RESPONSE = ACT IMMEDIATELY

  1. Call 911
  2. State that the person is unconscious and not breathing
  3. Stay calm and answer the dispatcher’s questions clearly and accurately

57 of 98

57

True or false? The police question me because I witnessed an overdose. I am protected from potential charges related to simple drug possession, even if I was not the one who called  911.

​

TRUE !

​

The Good Samaritan Drug Overdose Act protects individuals who seek emergency help during an overdose, as well as those who are present at the scene — even if they did not personally call 911. This protection is intended to encourage people to act quickly without fear of minor charges, such as simple possession of drugs.

​

58 of 98

58

WHAT IS NALOXONE?

59 of 98

ACT IN AN OVERDOSE SITUATION

59

Learning objective: Understand how naloxone works and know how to administer it

60 of 98

WHAT SUBSTANCES IS NALOXONE USEFUL FOR?

60

It is an antidote that is administered in case of an opioid overdose:

​

  • It is a very safe medication, which has few/no side effects.
  • It works ONLY with opioids.
  • If used for an overdose other than opioids = no danger
  • Its use does not cause any buzz!

​

​

​

​

61 of 98

HOW DOES NALOXONE WORK?

  • Naloxone binds to the same neural receptors as opioids
  • This causes the TEMPORARY withdrawal of opioids:
  • Works about 3 minutes after administration
  • Works for 20 to 90 minutes depending on the strength of the� opioid (quantity, purity, presence of Fentanyl or not, etc.)
  • Its effect still lasts less than that of opioids.

​

WARNING!

Refrain from using for the rest of the day or night.

​

​

​

​

​

61

62 of 98

ADMINISTRATION OF NALOXONE

END OF THE OVERDOSE

OVERDOSE!

62

63 of 98

NALOXONE : AVAILABLE IN QUEBEC

Nasal or intramuscular?

​

In any case administer what you have on hand!

​

What ? Ampoules, vials or nasal spray, syringes, alcohol swabs, gloves, CPR mask, reminder. In pharmacy, one can fetch up to 8 doses per person per day max.

.

63

64 of 98

WHERE TO ACCESS� NALOXONE

  • In community pharmacies

​

  • In several community-based naloxone redistributors

​

  • CAMI – Injection equipment access centres
  • SCS – Supervised consumption site
  • Harm reduction organization
  • Through the public health and social services network

​

​

  • Addiction treatmet centers
  • Hospital
  • Penal institutions
  • CHSLD

Online resource for accessing naloxone: https://sante.gouv.qc.ca/en/repertoire-ressources/naloxone/

​

https://www.inspq.qc.ca/sites/default/files/cartes/naloxone/index.html

64

65 of 98

65

66 of 98

66

ADMINISTRATION EXERCISE

67 of 98

HOW TO ADMINISTER A NALOXONE BY INJECTION �

Ampoule :

​

  1. Tip the liquid to the bottom of the ampoule.
  2. Break the ampoule.
  3. Take all the naloxone.
  4. Inject the naloxone (at 90 degrees) into the shoulder muscle OR the side of the thigh.

67

68 of 98

HOW TO ADMINISTER NALOXONE NASALLY

Nasal

  1. Place the person on their back. Tilt their head back, supporting the neck.
  2. Remove the vaporizer from the packaging. Do not test it!
  3. Insert the tip into the nostril (either one).
  4. Press firmly with your thumb.

68

69 of 98

LAST WORD ON NALOXONE

    • Naloxone is sensitive to heat and cold
      • Store between 15 and 30 degrees C
      • Protect from light
      • Do not put in the freezer
      • Leave the spray in its box until it is being used
      • Do not prepare the syringe in advance
      • Take note of the expiry date
        • Renew the kit or missing items with :
      • A pharmacy or a community group
      • Do not forget to complete and submit the tracking form

​

69

70 of 98

ACT IN AN OVERDOSE SITUATION

70

71 of 98

COMPRESSIONS = FAST AND HARD (LIKE A BICYCLE PUMP)

***rescue breaths: Only if you are trained

CPR

71

72 of 98

WHAT TO DO ABOUT OTHER TYPES OF OVERDOSES?

Warning

If in doubt, call 911 and act!

Unconscious = Ambulance

Person is uncounscious= same protocol!

Person is conscious, but is visibly in distress:

If you fear for the safety of yourself or of the person, or any other person: call for help immediately !

Do not encourage the consumption of additional drug(s) as an intervention to the overdose. (For example, using a stimulant, like cocaine, to respond to a depressant/opioid overdose.)

72

73 of 98

REMEMBER THAT OPIOID OVERDOSES :

  • Make people iuncounscious.
  • Can be instantaneous or may occur several hours after the last use.
  • If the substance is strong, they are more likely to occur suddenly
  • Signs and symtpoms are similar to overdose from other downers (ex: alcool, GHB)

Warning

If in doubt, call 911 and act!

Unconscious = Ambulance

73

74 of 98

WHAT TO DO WHEN THE PERSON GAINS CONSCIOUSNESS

The person WAKES UP : WE LET THEM SPACE.

  • Explain to them what just happenned
  • Wait with them until help arrives

​

WARNING, IF THE PERSON:

  • Feels sicks and show signs of throwing up
  • Uses right after

​

DO NOT LEAVE THE PERSON ALONE : if possible, stay with them. Otherwise, call a loved one, refer them to a harm reduction service, ask them to keep you updated, etc.

​

74

75 of 98

Stay with them

IF THE PERSON REFUSES TO WAIT FOR THE AMBULANCE AND GO TO THE HOSPITAL

If the person does not want to stay with you

​

  • Remind them that they can go back into overdose and talk to them about their safety plan if they choose to use again within the next 24hrs in order to reduce risks.

​

If you can not stay with them:

​

  • With their conscent, accompany them to a harm reduction service and explain the situation to the staff.
  • Bring the person to someone they trust

​

75

76 of 98

YOU ARE ALONE AND WITHOUT A PHONE WITH A PERSON WHO HAS OVERDOSED

WHAT TO DO WHEN

76

  • Risk–benefit balance: In a crisis, carefully weigh the risks and benefits of leaving the person to go get help.
  • Naloxone administration: There is no maximum number of naloxone doses. Continue giving doses as needed until help arrives—even if the person seems unconscious or not breathing.
  • Continue interventions: Keep providing resuscitation measures until emergency services arrive, even if the person appears to be in critical condition

77 of 98

77

True or false? If I freeze and don’t know what to do, I can move the person outside, onto the sidewalk or into an alley, and someone else will cal 911.

​

FALSE!

STAY WITH THEM while waiting for the first responders. Their life may depend on you

78 of 98

I AM UNDER INFLUENCE AND HAVE SOME SUBSTANCES WITH ME

THE GOOD SAMARITAN LAW PROTECTS YOU

WHAT TO DO WHEN …

78

79 of 98

THE GOOD SAMARITAN LAW

​

  • Since 2017, the new “Good Samaritan Drug Overdose Act” protects anyone calling for medical/police assistance in an overdose situation from possible charges related to drug possession

​

  • It also applies to anyone present on the premises, not just the person who calls 911. We still advise you not to leave drugs in plain sight.

​

  • If you can’t stay, leave at least a card with the health and using information of the person in overdose, and leave the door ajar or unlocked.

79

80 of 98

ACT IN AN OVERDOSE SITUATION

80

81 of 98

81

YOUR TURN

Overdose simulation

82 of 98

82

WHAT TO DO IN AN OD SITUATION AND HOW TO INJECT NALOXONE?

Vidéo par :

Réalisation et direction

Marie-Josée Audet

Mathieu Davoine-Tousignant

Chantale Perron

​

Comédien

Jeffrey Farrer

Jean Philippe Bilodeau

Jasmin Leblanc

René Lépine

Wayne Empson

​

Tournage et montage

Marc Howard

​

Et aussi…

Marie-Ève Goyer

Chantale Perron

https://www.youtube.com/watch?v=ec4BT2Sss3s&t=483s

83 of 98

83

RESTORING BALANCE

84 of 98

84

​

To foster hope and build tools to support the process of regaining balance

The next slides address experiences of grief and emotionally charged situations

If you feel the need to step away or speak with someone, please do not hesitate to do so

​

​

​

WHY TALK ABOUT IT?

85 of 98

85

THE LOSS OF BALANCE

For those who intervened – and those who did not!

WHAT COULD WE FEEL?

  • Anger, feelings of injustice and helplessness
  • Difficulty functioning, significant changes in behavior
  • Sleep issues are often the most common and most intrusive symptoms.

​

WHAT ARE WE GOING THROUGH ?

Occurs when events prevent us from regaining our individual and/or collective balance

​

86 of 98

THE LOSS OF BALANCE

Reminder :

​

  • The loss of balance is unique to each individual.

​

  • Any event can lead to this loss, regardless of the context, the person’s level of involvement, or perceived severity of the situation

87 of 98

87

CONTEXTS :

  • Intervening in an overdose situation or witnessing it;
  • Learning that someone close to you has experienced a fatal or non-fatal overdose;
  • Learning about the death of a loved one in a traumatic context (including overdose)

FEELS:

  • Facing an event that leaves lasting impacts
  • Having difficulty identifying what you’re feeling, and experiencing guilt;
  • Sometimes emotions emerge after multiple incidents, or surface days after the event.

​

THE IMPACTS OF AN OVERDOSE SITUATION

88 of 98

THE IMPACTS OF AN OVERDOSE SITUATION�

Reminder :

​

  • It is possible to respond to an overdose without feeling affected at first, and then find it more difficult after multiple interventions

​

  • Sometimes emotions emerge after several situations, or surface days later

​

  • We never truly know how we will react to an overdose - whether we intervened or not. These situations should never be minimized, even if they are part of our daily reality

​

89 of 98

GRIEF RELATED TO USE AND OVERDOSES

  • Relational grief (grieving the loss of a relationship)
  • Disenfranchised grief (often accompanied by stigma and isolation)
  • Grief in a traumatic context
  • Stigma and isolation
  • Relational detachment
  • Complexity related to the multiple dimensions of grief

​

90 of 98

GRIEF RELATED TO USE AND OVERDOSES

Reminder :

  • Grief is not a linear process and does not follow a fixed timeline.

​

  • People should not be defined by their loss (e.g., the friend of the person who died)

91 of 98

91

  • MOMENT OF INTROSPECTION: Take a moment to reflect on what helps you feel well.�
  • MOMENT OF SHARING: Individual strategies for getting through tougher moments — what do you do?

​

SELF CARE STRATEGIES

92 of 98

92

  • Normalize and welcome the emotions you are experiencing

​

  • Identify available ressources that meet your needs

​

  • Create spaces that allow you to care for yourself and honor those who are not with us anymore

RESTORING BALANCE THROUGH SELF-CARE

Each person experiences grief in their own way, and it is important to give yourself permission to take care of yourself throughout this process.

​

93 of 98

93

  • MOMENT OF INTROSPECTION: Take time to reflect on what supports your well-being as a team.
  • MOMENT OF SHARING: Collective strategies for getting through more difficult moments - what do you do together?

​

​

​

COLLECTIVE CARE STRATEGIES

94 of 98

​

  • Create group discussion spaces to identify and normalize the emotions being experienced.
  • Honor losses collectively and publicly.
  • Be well informed about available resources and ensure the information is accessible

​

94

RESTORING BALANCE THROUGH COLLECTIVE-CARE

95 of 98

  1. Specify prevention strategies
  2. Specify action strategies
  3. Specify the "post-event" support strategies for the people who have intervened, the users, their families and friends
  4. Make sure that the protocol is being followed

​

95

OVERDOSE RESPONSE PLAN OR OTHER COMPLEX SITUATION

96 of 98

96

EVALUATION

Go around: what you liked most and least

We want to hear you!

97 of 98

Evaluation form: your responses are anonymous and help us improve the training !

​

97

EVALUATION

98 of 98

Thank you!

98

https://www.profan.ca/fr/

info@profan.ca