1 of 24

Fentanyl & Opioid Awareness & Overdose Prevention

2 of 24

I will learn to...

DESCRIBE WHAT OPIOID DRUGS ARE, INCLUDING FENTANYL, AND THEIR GENERAL EFFECTS ON THE BRAIN AND BODY.

IDENTIFY THE POTENTIAL HARMS AND REAL AND PERCEIVED BENEFITS OF USING OPIOID DRUGS.

RECOGNIZE AND KNOW HOW TO RESPOND TO SIGNS OF AN OPIOID OVERDOSE.

3 of 24

Warm-Up Activity

What do you want to know about opioids?

What have you heard about opioids and their effects?

4 of 24

Let’s Discuss!

Can anyone name some commonly used opioids?

There are natural opiates (found in nature), semi-synthetic opiates (partially human-made), and fully synthetic opiates (human-made)

5 of 24

Fentanyl, a synthetic opioid
Morphine
Codeine
Oxycodone (OxyContin/Percocet)
Hydrocodone (Vicodin)
Heroin

Examples of Opioids

Tip: Street access (including from friends) is dangerous

6 of 24

Drug Knowledge: Opioids

The opioids class of drugs has been in use since as early as 3400 B.C. to treat pain.

Opioid drugs have molecules which mimic the shape of naturally-occurring opioid system neurotransmitters in the brain.

Opioids may be taken orally, snorted, smoked or injected with a syringe (needle).

Talking Points:

Opioids have been around for a long time. As early as 3400 B.C., the Sumerians were using opium poppies to treat pain. As the plant spread, cultures around the world began using opium as part of medicinal treatments. Other derivatives of the drug, including morphine and heroin, were also created as medical remedies. In fact, Bayer, a German drug company, used to manufacture and sell heroin as a cough suppressant.

Opioid drugs, like heroin and oxycodone, have molecules which mimic the shape of the opioid system’s neurotransmitters. Our bodies have a naturally occurring opioid system that helps us manage pain and learn to repeat beneficial behaviors, like eating. When these neurotransmitters attach to opioid receptors, they help relieve pain or reinforce behavior by flooding the brain with dopamine which causes feelings of euphoria.

The way an opioid is taken can also increase harm. Opioids may be taken orally, inhaled through the nose, smoked or injected with a syringe (needle). We will discuss more in the coming slides.

7 of 24

Understanding Opioids: Drug Knowledge

Opioids work by mimicking the body’s natural pain relief system
Opioids can impair judgment and physical actions
Opioids are very addictive
All methods of use have some risk
Injecting is risky because sharing syringes can spread infections

8 of 24

The Effects of Opioids:

People Sometimes use Opioids to:

relieve pain and sedation
have feelings of euphoria, calm, or relief from anxiety
responsible use is when it is given in medical settings for severe pain

contracted pupils, loss of muscles and slurred speech.
nausea, constipation, fall asleep unexpectedly, and itchy skin.
erratic or slow breathing, or, in the case of an overdose, stop breathing entirely.

9 of 24

Potential Risks and Harms of Opioids

Overdose is common with any form of opioid, in any amount, and can be fatal.
Risk of overdose increases when opioids are mixed with other drugs.
Continuous use of opioids can lead to tolerance, which means someone has to start taking higher doses of an opioid in order to get the same effect.
Increased tolerance can lead to physical dependence or addiction

Talking Points:

Overdose is common with any form of opioid, and can be fatal. Risk of overdose increases when opioids are mixed with other drugs. This is risky because in addition to relieving pain, opioids also act on the respiratory system. Opioids can cause erratic breathing, slow breathing, or, in the case of an overdose, stop it all together.

The relaxed, euphoric feeling people get from taking opioids can be very addictive. Over time, the continuous use of opioids lessens their effect, building tolerance. Someone may start taking higher doses of opioids in order to get relief from pain or to get high.

Increased tolerance can lead to physical dependence, which means if someone stops using opioids they experience such strong withdrawal symptoms they feel physically sick.

Physical dependence, combined with a reliance on the feelings of comfort and safety opioids can produce, can lead to addiction.

10 of 24

Cycle of Addiction

Youtube video link here for the closed caption

11 of 24

What were some of the withdrawal symptoms that occurred?

Cycle of Addiction

12 of 24

Let’s discuss Fentanyl

Drug Knowledge: Fentanyl

13 of 24

Let’s discuss Fentanyl

Fentanyl is one of the most potent opioids approved for medical use
Fentanyl is a synthetic drug, and not from the poppy plant like other opioids
It is intended for treating severe pain or for chronic pain patients who have developed a tolerance to less potent opiates

What are the effects?

Fentanyl’s effects are generally the same as other opioids like heroin, but because of the drug’s potency, the effects often begin sooner and last for a shorter period of time.

Drug Knowledge: Fentanyl

However, fentanyl is often produced illicitly—outside of the legal regulatory system and has contaminated the broader drug supply.
It’s difficult to detect, smell, or taste

Illicit Fentanyl

Talking Points:

(Ask students): Before today, has anyone ever heard of fentanyl? If so, what do you know about it? (Pause for a few responses)

Fentanyl is perhaps the most well-known of the synthetic opioids (not made from the poppy plant). It is one of the most potent opioids approved for medical use, intended for treating severe pain or for chronic pain patients who have developed a tolerance to less potent opiates such as oxycodone or morphine and which no longer help them manage their pain.

However, recently fentanyl is often produced illicitly, outside of the legal regulatory system. It has also been found to have contaminated the larger drug supply. In fact, the DEA (US Drug Enforcement Administration) has released a statement saying that as many as 6 out of 10 fake prescription pills contain lethal amounts of fentanyl.

So, what are the effects of fentanyl? Fentanyl’s effects are generally the same as other opioids like heroin, but because of the drug’s potency, the effects often begin sooner and last for a shorter period of time.

Reference:

https://www.dea.gov/alert/dea-laboratory-testing-reveals-6-out-10-fentanyl-laced-fake-prescription-pills-now-contain

14 of 24

The Opioid Overdose Crisis

There were 112,000 drug overdose deaths in the US (2023).
Fentanyl and other synthetic opioids have begun to account for a large portion of these deaths
The opioid overdose crisis affects both people who use and don’t use opioids.

Talking Points:

In recent years, the opioid overdose crisis has worsened. The overall number of U.S. drug overdose deaths up to 112,000 in 2023.

Historically, opioid overdose deaths were mostly due to heroin use, but recently fentanyl and other synthetic opioids account for a large portion of these deaths. The opioid crisis is not just among those who are addicted. In fact, many who have died from fentanyl, especially teens, were NOT addicted and many had never used any illicit drug before.

The opioid overdose crisis affects both people who use and don’t use opioids. Even if someone does not use opioids personally, friends or family may use and can potentially overdose.

Reference:

https://nida.nih.gov/sites/default/files/images/2023-Drug-od-death-rates-1.jpeg

https://www.cnn.com/2023/05/18/health/drug-overdose-deaths-2022/index.html#:~:text=The%20109%2C680%20overdose%20deaths%20in,compared%20with%20109%2C179%20in%202021.

https://www.npr.org/2023/12/28/1220881380/overdose-fentanyl-drugs-addiction

15 of 24

The Opioid Overdose Crisis

Penny

Grain of Rice

Lethal Dose of Fentanyl

A lethal dose of fentanyl is equivalent to less than a grain of rice

16 of 24

Adulteration & Access

Seeking a drug that you are familiar with does not guarantee it is safe

Accessing substances from the street can be dangerous, as they are unregulated and can contain other substances (like fentanyl).

Do NOT obtain drugs from unknown sources (online or other people)

Talking Points:

We just discussed illicit fentanyl, so let's dive more into it. Due to the lack of regulation, all unregulated drugs pose a risk as it is impossible to determine or manage their contents, which may include harmful substances like fentanyl or they may have unknown drug quantities. Buying a drug off of the street (which can include getting a drug from friends) can be dangerous.

Even seeking a prescription drug that one is familiar with does not guarantee its safety. Illegally produced drugs may contain other highly potent substances that can cause an overdose. For example, if a teen asks for a Xanax to help them feel calmer, they might accidentally get a counterfeit Xanax that contains fentanyl! This is dangerous and can lead to overdose or death.

Fentanyl test strips for drug testing is a harm reduction strategy that can be used to see if the substance contains Fentanyl. We will discuss this next.

References:

https://www.thehubct.org/post/kids-can-buy-drugs-easier-than-you-think

17 of 24

Can you remember the signs of an opioid overdose?

Slow, shallow and erratic breathing
Pinpoint pupils
Snoring or gurgling sounds
Unconscious/unresponsive to

stimuli

Limp
Slow pulse/no pulse
Pale or ashen and clammy

Recognizing an Overdose

18 of 24

Understanding Signs of Overdose

Click the link here for the video with the closed caption

19 of 24

What to do in the event of an Overdose

Naloxone can reverse opioid overdoses and is carried by EMTs.

Does our school have Naloxone and if yes, where is it located?

Good Samaritan laws or 911 drug overdose laws protect people who call to report drug overdoses.

20 of 24

How to Administer Naloxone

Click here for the video with the closed caption

Talking Points:

(Play video):

How to Administer Naloxone (approx 2:40)

https://www.youtube.com/watch?v=-xTKsHFBXlI

(Tell students): There are four ways that naloxone can be administered. The first two are through the nose using a nasal spray. There is the yellow cap method, which you’ll learn more about in the video. There is also a brand name naloxone nasal spray you may have heard of called, NARCAN. There are examples of different nasal methods on this slide.

Naloxone can also be administered through injection. Auto-injectors need no assembly and can be injected in the outer thigh, even through clothing. In addition, naloxone can be used intramuscularly using a syringe. Even though there is a injection option, we are recommending just the nasal version for teens.

It is also important to know that you can administer Naloxone even if it is not an opioid overdose. So if you're not sure that the person is overdosing, it would be safe to give it to them anyway.

After administering naloxone, it is important to immediately call 911 and follow the dispatcher’s instructions.

21 of 24

How to Reduce Harm

Imagine you have a friend interested in trying opioids.

Based on what we’ve learned about how opioids work, what information would you want your friend to have?
If your friend was still determined to try opioids, what advice would you give them about reducing the harms of use?
Would you give them different advice if they were considering using prescription opioids versus heroin or illicit fentanyl? Why or why not?

REMEMBER: The best way to avoid harm is not to use opioids/fentanyl in the first place.

22 of 24

Reducing Harm among those using opioids

DON'T MIX SUBSTANCES

Mixing substances is risky and many drug-related deaths involve using more than one drug.

Mixing opioids and depressant drugs like alcohol, Valium, and Xanax may increase the chance of overdose death; both classes of drugs slow breathing.
There is also increased risk when opioids are mixed with the stimulant drug crack cocaine, a practice known as “speedballing.” Speedballing reduces the ability to recognize the symptoms of overdose of either drug.
It's dangerous when opioids are laced with other drugs

23 of 24

Dose and Dosage

Using opioids not prescribed by a doctor is risky because they sometimes have other substances added
For example, some people have overdosed and died after unknowingly using heroin laced with the much stronger drug fentanyl
Even using opioids for a medical purpose with a prescription can be dangerous

DO NOT use opioids unless they’ve been prescribed to you.
DO NOT give others your opioids.
Use opioids ONLY according to a doctor’s direction (dose and dosage).
Be aware of ordering drugs online that could be adulterated

Reducing Harm among those using opioids

Talking Points:

The best way to reduce the harms of opioids is to not use them unless they have been prescribed to you by a doctor another healthcare provider.

And even if they have been prescribed to you, you should use them according to a doctor’s directions – that means paying attention to dose and dosage instructions and not sharing your medication with others. Using prescription opioids carefully is important because their misuse is a major contributor to the U.S. opioid overdose crisis.

Note: Using illegal opioids is risky because they sometimes have other substances added. For example, some people have overdosed and died after unknowingly using heroin laced with the much stronger drug, fentanyl.

Even using opioids for a medical purpose with a prescription can be dangerous; people can still become addicted with a prescription.

24 of 24

Tony is passed out on the couch, breathing slowly. Next to him—and this is kind of gross—is a small pool of vomit. He doesn’t respond when you gently shake him.

Exit Ticket: What Would You Do?

Scenario

Should you call 911 to get help for Tony? Why or why not?

Yes. Tony is showing signs of either alcohol or opioid overdose.

What drug class do you think that drug was from?

Depressant or opioid.

If Tony were to overdose on the drug he took, would naloxone help him recover?

Yes, if the drug is an opioid.

Assuming that Tony has only used one drug tonight …