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Heroin Overdose Prevention STAY ALIVE ’TIL HELP ARRIVES. Ronald RJ Johnson Health Educator Drug Use & HIV/AIDS Prevention HIV/AIDS Program Public Health – Seattle & King County

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heroin overdose prevention stay alive til help arrives

Heroin Overdose PreventionSTAY ALIVE ’TIL HELP ARRIVES

Ronald RJ Johnson

Health Educator

Drug Use & HIV/AIDS Prevention

HIV/AIDS Program

Public Health – Seattle & King County

Thanks to:

SF Needle Exchange

CHAI Project, New Brunswick, NY April 2002


86 people interviewed (needle exchange & on the street)All injected heroin alone or in combo

  • Sex: 58%M 42%F
  • Race: 54% White 7% Nat Am / Alaska Nat

27% Black 4% Multiple race / other

9% Latino

  • Age range: 22-61 (mean: 35.8)
  • Age started injecting: 11-40 (mean: 20.6); >½ started <20
  • # injections/day: 3 (n=25, 29%), 3-5 ( n=54, 64%), mean: 4.2
understanding the heroin culture experience
Understanding the Heroin culture EXPERIENCE
  • OD in last 6 mos.3 (3%)
  • witnessed OD in last 6 mos.30 (35%)
  • knew someone who died from OD 61 (71%)
understanding the heroin culture risk behaviors
Understanding the Heroin cultureRISK BEHAVIORS
  • 36% usually or always shoot alone
  • 7% shoot alone ½ time
  • 30% usually use same amount after a break
understanding the heroin culture risk knowledge
Understanding the Heroin cultureRISK KNOWLEDGE
  • < ½ identified  tolerance as risk
  • 62% identified EtOH as risk
  • 44% identified benzos as risk
understanding the heroin culture response knowledge
Understanding the Heroin culture RESPONSE KNOWLEDGE
  • 62% thought calling 911 is a life-saving response

[only 9 out of 30 actually called 911]

  • 60% identified most obvious sign of OD

[cyanosis – turning blue]

  • 38% identified response strategies of ? or

negative efficacy

  • 17% rescue breathing
  • 4% clear airway
  • 1% recovery position  
understanding the heroin culture action
Understanding the Heroin culture ACTION
  • > ½ had never talked to a friend about

OD plan

  • 6 (7%) had plan in place
how and why overdose happens
How and Why overdose happens
  • Overdose happens when you take too much of a drug OR a combination of drugs
  • Anyone who uses drugs can overdose

[From first time users to the veteran]

  • Some combinations can be DEADLY

[Heroin & Alcohol; Heroin & Downers]

overdose risk
  • Not knowing quality of drugs
  • Not knowing body tolerance
  • Mixing drugs (poly-drug use)
  • Using alone (no one to rescue you may  death)
recognizing overdose
Recognizing Overdose
  • Respiratory depression

very slow and ultimately no breathing

  • Cyanosis

turning blue on the lips and fingertips first

  • Extreme somnolence

hard to awaken: sleepiness

  • Hypotension
  • The cure for a Heroin Overdose is


  • Breathing support
  • Airway control
how to talk with clients about overdose prevention
How to talk with Clients about overdose prevention
  • Basic overdose protocol: Stay calm, ABC

Airway control

Breathing & Pulse  Rescue breathing

Call911 know what to say Recovery position

  • Overdose DON’Ts

DON’Tput a person in a cold water bath

DON’T leave someone who has just overdosed

three main factors in a drug overdose are
Three main factors in a drug overdose are.
  • Quality
  • Tolerance
  • Mixing drugs


tips for preventing overdose
  • Have an OD plan with the people you get high with.
  • Do test shots, smaller dose than usual, "you can always do more, but you can't do less".
  • Be careful if you switch dealers.
  • Ask around, drug strength will vary.
  • Prepare your own drugs–so you know how strong you've made it and exactly what's in it.
  • Avoid mixing heroin with other drugs.
  • Avoid shooting alone.
tips for gettin high alone
Tips for gettin' high alone
  • Call up someone you trust and get high while on the phone.
  • Don't lock your door while getting high so roommates or paramedics can get to

you, quickly if need be.

  • If you're getting high in a public place (ie. a restaurant/bar bathroom, space toilet, park

bathroom), let a friend know where you are.

creating an overdose plan
When should someone take action?

What’s preferred regarding 911?

What should be done after the person resumes breathing?

Is it ok to remove friend’s identification if he or she has outstanding warrants ?

The more you plan out in advance, the less room there is for error and panic in the event of an overdose.

Creating an overdose plan
summary what to do if an overdose happens
SummaryWhat to do IF an overdose happens
  • Stay CALM
  • A B CAirwayBreathing & PulseCall 911
  • Not breathing? Do Rescue Breathing:2 quick breaths every 5 seconds
  • Recovery Position: Protect from choking on vomit & blockingthe airway
summary what not to do
SummaryWhat NOT to do
  • DON’T put the person in a bath or shower – they could drown!
  • DON’Tinject them with salt water, milk, or other drugs (like cocaine or speed).
  • Ice won’t help. Neither will tea, coffee, or alcohol.
make a plan ahead of time
Make a Plan ahead of time!

If someone goes down


Tell them if the person is conscious or not breathing.

Save a Life!