Opioid Task Force hosts Narcan training workshop

[November 03, 2017] 

LINCOLN

On Thursday, October 26th, the Abraham Lincoln Memorial Hospital Community Health Collaborative Opioid Task Force hosted a workshop with the topic being the use of Narcan as a counteractive treatment for drug overdoses. The guest speaker for the day was Chris Schaffner from the Human Service Center from Peoria.

Human Service Center representatives Sue Tinsdale and Jessica Kinsel had attended a task force meeting last month and shared that their agency, which serves a number of counties in the region including Logan County, had received a grant for distribution and training on the use of Narcan. Schaffner said they would be interested in doing community service trainings in Logan County in the future.

Though the first training session was for task force members only, CHC Director Angela Stoltzenburg said the task force will work to offer additional sessions open to the public in the near future.

On Thursday Schaffner opened the day by talking about opioids versus opiates. He explained that opioids are synthetic drugs that mimic opiates, which are natural drugs made from opium, a derivative of the poppy plant.

Examples of opiods include prescription pain killers such as Fentanyl, Hydrocodone, Oxycodone, Methodone, and more.

Schaffner explained that the drug Fentanyl is commonly prescribed for severe pain. It is 50 times more potent than heroin. He also mentioned a drug called Carfentanil, which is 100 times more potent than heroin. He said the drug is showing up in the northern part of the state, but has not reached this area yet. He said it is a death sentence drug that will literally kill an elephant, so it is extremely dangerous and life threatening.

Schaffner went on to explain how these drugs work in the brain, and how they can lead to addition.

The human body produces dopamine and seratonin, which have the same impact as an opioid on the brain. He said that because of this, when opioids enter into the body the brain does not recognize them as a foreign substance that shouldn’t be there. Instead what happens is the brain creates “receptors” to store the additional drug. With the additional receptors, the body soon comes to require the additional dopamine and serotonin to fill the receptors, and will accept the opioid as the same thing. But, because there are sufficient receptors to hold the amount of drug last taken it has little effect, so more of the opioid is needed to create the “pleasurable experience” from the last time.

Schaffner said the body produces its own dopamine and seratonin to produce pleasure. He named several activities from eating to drinking to sexual activity that can increase the dopamine and serotonin naturally and give the person a very nice “feel good experience.” But he said with drugs such as Fentanyl that feel good experience is magnified by 100 times.

Schaffner also talked about how the drug dependency can start. Using a teenage male athlete as an example, he said perhaps it could begin with something as simple as a sprain or pulled muscle in the shoulder. The teenager is in pain, and his parents take him to the emergency room. The doctor identifies the problem and prescribes an opioid based pain killer.

It takes care of the pain, and the youngster is able to cope with the discomfort of the injury. While on the drug, he notices that that he “copes” with other things better as well. He’s not bothered as much when his parents squabble, or when they get on him to do something. Tests at school don’t stress him out, and all in all, he’s just happier and more laid back. But then. The shoulder is healed, the prescription is gone, and the stress returns.

The youngster knows it was the pain meds that made him feel good, so the answer may be to have that injury return. He tells mom his shoulder is bothering him and could she maybe call the doctor for more pain pills. She does, and the cycle begins again. But eventually, getting that prescription becomes too difficult, and word around town is that he can buy what he needs from other sources, and its cheaper.

With no prescribed dosage and no time schedule, the youth will take what he thinks he needs, and if he doesn’t achieve that good feeling, he takes more. All the while the brain, believing the drug is a naturally manufactured product, continues growing more receptors, and therefore, it takes more and more of the drug to achieve the desired conclusion. Eventually, Schaffner said, “the brain recognizes that what it is getting from the drug is better than what it can make itself,” so it quits making endorphins and the road to drug dependency is complete. The child is now an addict.

With the brain relying completely on the opioid now, the youngster begins suffering the impact of a lack of endorphins.

When the drugs wear off, the young man or woman experiences severe pain, nausea, terrible flu-like symptoms, and a mood crash. Schaffner said that six months to one year into this process, the drug is no longer something the youngster takes to feel better, it becomes something he takes to feel “normal.”

Overdoses can then occur when the addict takes more and more, and feels nothing, so he takes more. He finally overloads the brain, feeding it more drug than the receptors can handle.

Another means by which the overdose can occur is if the youngster can’t get his drug of choice and opts for an alternative drug. The brain tolerance for the new drug is not the same as the old, and it reacts negatively.

Once parents are aware of the drug addition, most times after a near death experience and a trip to the hospital, they may opt to send a child to a treatment facility. Schaffner said that facilities that provide “treat and release” service is not good enough. Addicts will return to their dug of choice because they don’t have the support of an ongoing program.

Overdoses will then occur more quickly because the youngster may know that before treatment, he needed 15 pills to get his “feel good.” But now that he’s gone through treatment, that many pills are way too many for the brain to handle at one time, because during treatment the receptors having not been fed, have died.

Schaffner said that 90 percent of addicts who seek treatment will have at least one relapse back into drug usage. This is why the Narcan product is so important. He said the addict, if he wants to quit may eventually be able to, but until he does, the goal has to be to try and keep him alive.

To do this, there are some “nasty” realities that his loved ones have to accept. He said that when the addict returns to society, those around him need to be prepared for that next overdose. They also need to have a talk with the addict. He said this was “icky” because what mother is going to say to their kid, “When you go to get high, let me know, so I can be ready.” But the reality is, that is what is needed.

He said loved ones should discuss, not doing drugs behind locked doors, and not hiding to do drugs.

Moving on, Schaffner began talking specifically about how to use Narcan and how it works. He said first, remember that Narcan is used only to restore reparation, and it will not reverse the effect of the drug in the system. So when a person is revived with Narcan, they are still high, and may act accordingly. They may come awake confused, agitated, and even combative, so the people with them should be prepared to safely restrain and calm the addict while waiting for first responders.

Signs of overdose include extreme sleepiness, inability to awake, breathing problems, fingernails and lips turn purple/blue, extremely small “pinpoint” pupils, slow heartbeat and/or low blood pressure.

Schaffner shared the S.C.A.R.E. M.E. acronym.

S – stimulation - if the person is not responsive to attempts to arouse, then proceed with the reset of the acronym.

C – call an ambulance.

A – airway – check for obstructions to the airway.

R – rescue breathing – mouth to mouth resuscitation, with protection such as a Kleenex between your mouth and the victim.

E – evaluate – see if the person is breathing on their own and beginning to come around. And if not:

M – muscle injection.

E –evaluate again. And repeat the processes of assisted breathing, then injection.

On Thursday, each person in attendance received an injectable Narcan Kit. Schaffner illustrated how to use the kit.

Each kit comes with three needles and three vials of Narcan. He said the caregiver will recognize the symptoms of overdose and determine that the addict is not breathing. The first step will be to call 9-1-1. He said, statistically, first responders generally arrive within six to seven minutes. In that time, the caregiver will administer up to all three vials of the Narcan.

After calling 9-1-1, checking the airway, and beginning the rescue breathing (mouth to mouth resuscitation), if the victim is still not responsive, administer the first vial.

Draw the fluid into the needle, and inject into a fleshy part of the body, the upper arm, thigh, or buttock are ideal. The drug will take a few minutes to work.

The caregiver should do mouth to mouth breathing while waiting. If the addict does not revive within three minutes, administer the second vial and return to mouth to mouth. If the addict still doesn’t revive within two to three minutes, administer the final vial, and return to assisted breathing. By the time the third vial is administered, first responders should be on the scene, and will be able to take over.

Schaffner said that caregivers should not be intimidated by the drug they are administering. It is totally safe, so safe that the nasal products are now available without a prescription at drug stores such as Walgreens locally. He explained that if the person is not in overdose, the drug will have no impact whatsoever.

Schaffner also shared that there is a free application for mobile devices that will walk a person through the process of overdose identification. The app is called OpiRescue and is available for IOS and Android devices.

At the end of the meeting Stoltzenburg asked each person in attendance to think of and reach out to one group or organization that could benefit from the training. She is hopeful that there will be workshops open to the public in the near future.

[Nila Smith]