Information on Opioids & Responding to an Overdose

 

Overdose Data to Action (OD2A)  

The Quinnipiack Valley Health District (QVHD) was awarded the Overdose Data to Action grant through the Department of Public Health (DPH) in March of 2020. In collaboration with the New Haven Health Department (NHHD) this new grant will allow us to expand our efforts to address the surging opioid crisis in the greater New Haven area. Working with the state DPH and other local partners, we aim to enhance our response to drug overdoses, strengthen public health interventions to prevent the misuse of opioids, improve protective behaviors, increase our communities awareness and reduce drug overdose morbidity and mortality. 

The United States Opioid Epidemic

Accidental drug overdose is now the leading cause of death for Americans under 50. According to the CDC, drug overdoses killed more than 81,000 people in the United States between May 2019-May 2020. In 2020, 1,359 fatal overdoses occurred within the state of CT alone ( 78 cases are still pending review), reflecting a 13.3% increase in overdose deaths compared to 2019. The Opioid Epidemic was officially declared a national public health emergency in October of 2017. Fentanyl continues to be a major driver of deaths, involved in 85% of events as of December 2020. Fentanyl and other fentanyl analogs are contaminating an increasing array of drug supplies; including heroin, cocaine, methamphetamine, and counterfeit pills. 

See below for everything you should know about Opioids, Naloxone- the Opioid Overdose Reversal Drug, How to Reverse an Overdose, Risk Factors & Treatment Options for Substance Use Disorder. 

WWW.CONNECTGNH.ORG is our new website that contains all of the below plus more! 

Para información sobre opioides en español:

What are opioids?

Opioids are a class of narcotic medications that a doctor may prescribe to relieve pain- Oxycontin, Codeine, Morphine, Vicodin, Demerol & Percocet are all legal medications. Illegal opiates include street drugs like Heroin and synthetic opiates, Fentanyl & Carfentanil. 

While pain relievers are generally safe when taken for a short period of time, under a doctors supervision, they are frequently misused. Regular use of these pain killers, even when prescribed by a doctor, can result in dependence. 

Why are opioids dangerous? 

Opioids are designed to relieve pain, but when taken in excess the body's automatic drive to breathe is diminished. Mixing an opiate with alcohol and/or benzodiazepines, can be fatal as these substances also slow your respiratory system.

Fentanyl, a synthetic opioid 100 times more potent than morphine, is a major driver of recent opioid overdose deaths. Fentanyl is responsible for at least half of the 64,000 deaths that occurred in 2016, because it is often mixed into drugs like heroin or cocaine without warning. 

Misconceptions about Opioids

Children and teens often perceive prescription drugs to be safe because they are legal medications that parents are commonly seen using. However, prescribed medications are to be taken in proper doses only by the person who received the prescription from a doctor. Opiates do not work the same way for everyone and can lead to serious health problems or accidental death. Only one in five Americans consider prescription pain medication to be a serious safety threat. (NSC, 2015)

Hear from three Yale Medicine experts on other common misconceptions surrounding Opioid Use Disorder at the following link:3 Major Myths About Opioid Addiction 

Getting the RIGHT help for Opioid Dependence or Withdrawal- important things to keep in mind- click here! 

What is Naloxone (also known as Narcan)?

Naloxone, also known as Narcan, is the lifesaving opioid overdose reversal drug. It is a short acting medication that can reverse a lethal dosage of opioids by temporarily blocking the effects of the drug. This revives the person, allowing time to access medical attention. Narcan can be administered into the muscle or as a nasal spray, which is fairly simple to administer. The price of Narcan varies depending on the source. With insurance coverage, most customers end up paying a small co-pay between $10-$25. Naloxone is available to anyone who wants it.

Friends, neighbors, family members are encouraged to receive training and carry a kit.

Forms of Naloxone

Naloxone Nasal Spray is the version you will typically receive from a pharmacist or community distributer. Naloxone comes in two forms, one which requires assembly.

Watch the videos below to become familiar with the medication, to learn how to use the Nasal Spray’s and clarify any questions or concerns.

• Narcan Nasal Spray- No assembly required: https://www.youtube.com/watch?v=0w-us7fQE3s
• Naloxone Nasal Spray- Assembly Required: https://www.youtube.com/watch?v=WoSfEf2B-Ds&feature=youtu.be  

Is Naloxone safe?

Naloxone has little, to no side effects if administered in error. Naloxone is harmless because it will only  function when an opioid is present within the body.

Where to get Naloxone:

Naloxone is now available to everyone; the following pharmacies are certified to prescribe to those who ask. The pharmacist will review signs of an overdose and how to properly administer Naloxone right at the pharmacy. Most insurances cover the medication for a small co-pay. 

**TIP: Call the pharmacy prior to arrival, while all pharmacies listed below are certified to prescribe, Naloxone is not always in stock** 

Quinnipiack Valley Guide to Narcan 

 Map of Pharmacies Certified to Prescribe Naloxone:  https://opendatact.github.io/narcanmap/

FREE Naloxone Resources: 

• New Haven Syringe Exchange Program: Yale’s School of Medicine’s Community Health Care Van, a mobile medical clinic, provides primary care services along with a variety of others. Services include free Naloxone kits, clean needles, substance abuse treatment, and mental health services. The van travels around New Haven, aiming to reach the uninsured/under-insured populations. Patients are seen free of charge and no appointment is required. The van’s schedule is listed below. Contact Rolo Jr. at (203) 823-0743 for Home Syringe Service Delivery & Disposal Pick Up. 

• AIDS Network: AIDS CT, located in Hartford, also distributes free naloxone. The program assists with co-pays and even helps people who would like to avoid obtaining Naloxone through their personal insurance. Contact Number: 860-247-2437

• Other Naloxone Distribution Programs throughout CT listed here: http://www.ct.gov/dph/cwp/view.asp?a=3137&q=570548

**NOTE: Yale’s Community Health Care Van has taken over the Nalxone Distribution program from New Haven’s Health Department ** 

Naloxone Training Opportunities

QVHD will continue to host training events within our four towns of Bethany, Hamden, North Haven and Woodbridge. To date we have trained over 150 community members on how to reverse an overdose and therefore, save a life. Everyone is encouraged to get trained. Stay tuned for upcoming training dates, follow our twitter account: @QVHD or Facebook page @ Quinnipiack Valley Health District for the latest news. 

If you would like more information or to arrange an onsite Naloxone training, please contact Kara Sepulveda at (203)-248-4528 or KS@qvhd.org

Reporting Use of a Naloxone Kit:

If you reverse an opioid overdose, congratulations! Report back to the agency who you received the kit from so you can receive another, OR email CORE@qvhd.org

Good Samaritan Laws: You are protected

With the goal of saving lives, a law known as the 911 Good Samaritan Act was passed in 2011 aiming to persuade people who may be reluctant to contact emergency personnel when witnessing a drug overdose. The law protects individuals who reach out to authorities, giving them immunity despite the presence of illicit drugs or paraphernalia present on the scene. In 2014, the law was expanded to protect the individual administering Narcan from civil liability & criminal prosecution. 

*Note: The Good Samaritan law does not protect someone from other charges or pre-existing warrants. 

For more information visit: http://www.ct.gov/dmhas/cwp/view.asp?a=2902&q=509650

Signs of an Overdose: CLLT- Check, Listen, Look, Touch

• Check for deep sleep, shaking won’t wake you or minimal response
• Listen for snoring that sounds like choking, gurgling, or snoring, stopped breathing or really slow breathing such as once every 5 seconds or less than 10 breaths per minute
• Look for blue or gray face, lips or finger nails, pinpoint pupils
• Touch for sweaty or clammy skin
• Other evidence: known opioid user, track marks, syringes, pills or pill bottles, information from bystanders

How to Respond to An Overdose: 

Tip: Always call 911 before administering Naloxone so medical attention can be provided in a timely manner. An individual can overdose again, the effects of Naloxone wear off 30 to 90 minutes after administration.  

• Try to rouse the person
• Call their name & shake them: check for a pain response by rubbing up and down the persons sternum with your knuckles
• If no response - Call 911: Provide as much information as possible including an exact location, if the person is breathing, or if they’re having trouble breathing. This makes the call a priority.
• Start rescue breathing & administer naloxone:
• Rescue Breathing: Head tilted back, chin lifted, pinch nose
• Look, listen and feel to see if chest rises/ falls
• Give 2 normal size breaths and then 1 breath every 5 seconds
• After a few quick breaths, administer naloxone (infographics below)
• Continue rescue breathing until they respond to the naloxone or EMS arrives
• If no response is seen within 2-3 minutes of Naloxone administration, give a second dose (all kits come with two doses)
• Most people are dazed, confused, or wake up feeling sick, not realizing that they’ve overdosed
• After administering Naloxone, place the person in recovery position (see "Steps for placing someone in recovery position" below)

Infographics- Visual aids on how to respond to an overdose 

Steps for placing someone in recovery postion: Click Here 

How to administer Naloxone Nasal Spray: Click Here 

How to administer Naloxone nasal, assembly required: Click Here 

Treatment for Opioid Use Disorder

Substance Use Disorder is recognized as a chronic brain disease caused by a combination of behavioral, environmental and biological factors. Like cancer and diabetes, substance use disorder requires treatment. Providing support to people with substance use disorder is critical.

Stigma, the negative perception commonly associated with addiction, often prevents people from seeking help. Addiction is a treatable, chronic disease that can be managed successfully. Multiple evidence based approaches have been identified.

Check out Quinnipiack Valley Health Districts Treatment Guide for Opioid Use Disorder here

• Treatment Options Include:
• Medication Assisted Treatment (Methadone, Buprenorphine) Click here to learn about the gold standard of treatment, MAT 
• Individual and group counseling
• Inpatient and residential treatment
• Intensive outpatient treatment (IOP)
• Partial hospital programs
• Case or care management
• Recovery support services
• 12-Step fellowship
• Peer supports

• Help Lines & Links to Treatment Finders

• The Substance Abuse & Mental Health Services Administration (SAMSHA) has a National Helpline, open 24 hours a day, 7 days a week. Call 1-800-662-HELP (4357) or 1-800-487-4899 for free and confidential information, available in English & Spanish, for individuals and family members facing substance abuse and mental health issues.
• The Department of Mental Health & Addiction Services (DMHAS) also has a help line open 24/7, 365 days a year that provides screening and referalls to appropriate levels of care to clients who are uninsured or those on state medical insurance. The service communicates with treatment providers and even arranges transportation services for detox, if necessary. Call 1-800-563-4086 for more information.
• Click here to view Daily Bed Availability for various Detox Programs, Residential Treatment Programs & Recovery Homes provided through the Deparment of Mental Health & Addiction Services. The site is updated daily.
• Click here for a full list of CT Opioid Treatment Options
• Click here for Medication- Assisted- Treatment Practitioner Locator
• Click here for a map of Medicaid MAT Providers 

Support Groups 

• Clifford Beers "Creating Community" Group is for friends & family members (16 and older) who have a loved one struggling with substance addiction. Beginning on November 1st, the group will be held every Wednesday from 5:30-7:00PM at 93 Edwards Street, New Haven. Click here for more information. 
• SMART Recovery Substance Use Support Group offers both a teen support group AND a family and friends support group that are run at the same time, in separate spaces. Meetings are held weekly at The Children's Center of Hamden, Wakeman Hall, Building #1 every Monday starting 1/29/2018 from 6:30-7:30PM. For more information click here for the flyer or visit www.smartrecovery.org
• Addiction & Mental Health Support Group. The first Tuesday of every month at Mildred A. Wakeley Community & Recreation Center, 7 Linsley Street, North Haven from 6:30-8:30PM. The group is open to anyone seeking support including non-residents, groups are free of charge. Co- Facilitated by Shalyn Rose, LCSW 203-376-0220 & Lauren Goodkin 203-584-0366 Click here for more information! 
• Nar-Anon, A 12 Step Support Group for Friends & Families of Addicts "Courage to Change" December Schedule: Thursdays 7:00PM Harborside Health Care-Arden House, 850 Mix Ave (Board Room) Hamden, CT Contact: Rose (203)-641-9380 or Maxine: (203)-215-6961 Click here for their website. 
• Narcotics Annonymous- All groups listed below are Open to everyone 

• Mondays: New Haven Living Clean, 7:30PM-8:45PM at Church of the Redeemer, 185 Cold Spring Street, New Haven, CT. 
• Tuesdays: The Masks Have To Go Group, 6:30PM at Montowese Baptist Church, 201 Quinnipiac Avenue, North Haven, CT. 
• Hope Without Dope, meets 7:30-8:30PM Tuesdays at Grace & St. Peter's Episcopal Church, 2927 Dixwell Ave, Hamden, CT. 
• Wednesdays: Miracles Happen Group of NA, 6:30PM Montowese Baptist Church, 201 Quinnipiac Ave, North Haven, CT. Click here for more information
• Thursdays: New Generation, 7:30PM United Church Parish House, 323 Temple St. New Haven 
• Fridays: Right Step into the Weekend, 12:00PM Episcopal Church of St. Paul & St. James, 57 Olive Street. Corner of Chapel Street, New Haven, CT. 
• Saturdays: Southern Exposure, 10:30AM-11:45AM Our Lady of Assumption, 1700 Litchfield Turnpike Rt. 69 Woodbridge
• Sundays: No Excuses, 10:30AM-11:45AM Yale Health Center, 55 Lock Street New Haven 

• Local Treatment Providers For Adolescents 

• The Children's Center of Hamden, 1400 Whitney Avenue, Hamden CT, 06517, (203)-248-2116 Open Monday-Friday 8:30-5:00pm. Wakeman Hall's Substance Abuse Treatment program provides outpatient treatment, intensive outpatient treatment, and community based after care for teens 12-17 years old. Click here for more information. 

• Local Treatment Providers for Adults 

• The APT Foundation has multiple locations around New Haven. All Locations are accessible via CT Transit Bus system. Central Call Center Number: (203) 781-4600 Open: Monday – Friday 5am-3pm, Saturday 6am-3pm select locations. APT provides both outpatient and intensive outpatient treatment, primary health care, outpatient Medication Assisted Treatment, family counseling, mental health services and adult education/vocational services to men and women 18 and older. Admission is on a first come first serve basis, must be seen at the Access Center (1 Long Wharf Drive) to become a client. 
• Walk in Hours: Monday- Friday 8:30am-11am. The APT foundation accepts Medicaid, Charter Oak, Medicare and most private insurances. For uninsured or under-insured individuals, the APT foundation has a generous policy of free or reduced cost care to those who need it. Click here for more information 
  • 1 Long Wharf Drive- New Haven – Walk in Access Center Hours: Monday- Friday 8:30am-11am.
  • 495 Congress Ave- New Haven; Methadone Clinic 
  • 352 State Street- North Haven; Intake: (203)-781-2736
  • Orchard Hill Treatment Center- 540 Ella T Grasso Boulevard New Haven
  • 425 Grant Street- Bridgeport CT 
• Chemical Abuse Services Agency (CASA), 426 East Street New Haven, CT 06511 (203)-495-7710. CASA provides Medication Assisted Treatment using methadone or buprenorphine, in addition to other behavioral health services to inner city, traditionally underserved populations. Services are provided in both English & Spanish. Walk in Hours: Monday-Friday 8am-2pm, Doc Hours: Tuesday, Thursday Friday (varies) Click here for more information 
• New Era Rehabilitation Center (NERC), 311 East Street New Haven, CT 06511 (203)-562-2101. NERC is a private, comprehensive substance abuse treatment facility that specializes in methadone maintenance. NERC also offers buprenorphine treatment (Medication Assisted Treatment), intensive outpatient counseling (IOP), among a number of support groups. You can walk in, no appointment necessary or book an appointment via their website here 
• Cornell Scott Hill Health Center has a number of locations throughout Southern CT. They offer an array of treatment options for individuals seeking help for substance abuse issues including both inpatient and outpatients services. Services include inpatient detox, ambulatory detox, methadone maintenance, twelve step education (AA & NA meetings) and individual or group therapy. To book an appointment at their access center - 232 Cedar Street New Haven, call, (203)-503-3300 or visit there website here. Full list of locations are listed below: 
• 232 Cedar Street, New Haven- Access Center 
• 400 Columbus Avenue, New Haven
• 226 Dixwell Avenue, New Haven
• 122 Wilmot Road, New Haven
• 60-62 Grant Street, New Haven
• 911-913 State Street, New Haven
• 285 Main Street, West Haven
• 121 Wakelee Avenue, Ansonia 

Safety Precautions

• Talk to your doctor about alternatives to opiates
• Take opioid prescription pain killers for the shortest length of time possible, and at the lowest dose
• Understand the risks, especially the risk of addiction

Who is at risk?

• Children/Adolescents/Adults who access unsecured medications
• Teenagers experimenting/partying
• Seniors prescribed multiple medications, who may have cognitive & other medical issues
• Chronic pain patients on long term opioids
• Medicaid patients prescribed more opioids
• Young Adults (18-25) who use at higher rates

 A typical OD victim in CT in 2016 was a non-Hispanic white male between the ages of 30-59 who was using opioids, probably fentanyl/heroin & other substances. On the day he overdosed, so did two other people.

Overdose Risk Factors

• Decreased tolerance: Regular use builds tolerance to the drug, discontinuing use decreases tolerance
• Using alone
• Mixing Opioids with benzodiazepines &/or alcohol
• Quality/ Strength of the drug can be unpredictable
• Other health issues: Asthma, liver and heart disease, malnourishment
• Previous Overdose
• Route of Administration: Intra-venous & smoking increases risk
• Age: older age & longer drug history can result in more fatal ODs

Safe Storage & Disposal  

• Prevent any opportunity for abuse, NEVER share your medication, even with friends or family - 70% of opioid pain killer users do not know that sharing painkillers is a felony (National Safety Council, 2015) 
• Clean out your medicine cabinet as often as possible and properly dispose of any left over or expired medication. Take advantage of national medication take back events that occur locally, typically on the 3^rd Saturday of April & October each year.
• Never flush medications down the toilet, they can cause water pollution and negatively affect the environment. Watch this video from the Department of Mental Health & Addiction Services to learn more about proper disposal of meds at home: click here!  
• Safely dispose of unused drugs by dropping them off at a local medication drop box. These boxes are located in the lobby of Police Stations and are typically open 24 hours. 
• Local Medication Drop Boxes (No Questions Asked) Include:
•  Bethany CSP Troop 1, 631 Amity Road, Bethany CT 
•  Hamden Police Station, 2900 Dixwell Avenue, Hamden CT 
•  New Haven Police Station, 1 Union Avenue, New Haven CT
•  North Haven Police Station, 18 Church Street North Haven CT
•  Woodbridge Police Station, 4 Meetinghouse Lane, Woodbridge CT 
• Follow the link for a full list of CT Medication Drop Boxes: http://www.ct.gov/dcp/cwp/view.asp?q=501922
•  **NOTE: Drop Boxes do NOT accept: Thermometers, hypodermic needled and sharps, bloody or infectious waste, hydrogen peroxide, non-prescription ointments and lotions, aerosol cans, or inhalers**

OR 

• Pick up a Medication Deactivation Pouch from Quinnipiack Valley Health Districts front lobby (limited supply). The environmentally friendly disposal pouches allow residents to safely dispose of leftover drugs in the comfort of their own home. 
•  Watch this video to learn more about the Drug Disposal Pouches: https://www.youtube.com/watch?time_continue=11&v=lkQ4RlOVZ24