FAQ sheet

What can I do to save a person I think is Overdosing?

1. Call 911- this is the most important step. 2. Check for breathing: 2a. If the patient is not breathing, begin CPR or direct someone else to begin CPR. If you can, direct someone else to administer Narcan. If you are alone, CPR is the most important thing you can do. 4. If the person is breathing abnormally but is unresponsive, administer Narcan. If there is no response in 2-3 minutes, administer another dose. Repeat until EMS arrives or breathing returns to normal 4. If a patient initially has normal breathing, or begins breathing normally after CPR/Narcan, place them into the recovery position. Remember that CPR is more important than administering Narcan. If you administer Narcan but the person's heart is not beating, the Narcan will not be effective.

What is Narcan's success rate?

A New York City overdose prevention and naloxone administration training program reported an 83% success rate of people who survived when naloxone was administered. Source Efficacy of reversal following naloxone administration by laypersons is high, having been reported at 75-100%

Where could I buy an AED kit?

AED kits are sold online through Amazon and other websites.

1If the person is breathing abnormally, do you give them CPR?

Abnormal breathing would be if their breaths are under 10 per minute, they are inconsistent, and/or they are not breathing at all. "Gasping, or agonal respiration is an indicator of cardiac arrest. When these irregular breathing patterns occur, it's a sign that the victim's brain is still alive and that you must begin uninterrupted chest compressions or CPR immediately."

How much does Narcan cost?

About $140 for a 2-dose box. As a reminder, our program will send Narcan free of cost to anyone who attends our training sessions.

What are some common opiates?

According to the CDC, the most common opioids used in opioid overdoses are fentanyl, heroin, and prescription opioids that are prescribed in order to manage patient pain. Common prescription opioids that are used in opioid overdoses are Methadone, Oxycodone (ex. OxyContin), and Hydrocodone (ex. Vicodin).

Can someone be allergic to Narcan?

According to the Food and Drug Administration, Narcan or Naloxone hydrochloride contains itself, the antagonist as well as many inactive ingredients. EDTA which is a stabilizer, sodium chloride which is a salt, hydrochloric acid to adjust pH, and purified water. Many of these ingredients are found in products we use everyday making Naloxone hypersensitivity extremely rare.

How is fentanyl created and who creates fentanyl and similar potent substances?

According to the National Institute On Drug Abuse, opioids are usually found in the plant known as the opium poppy plant. Fentanyl is a powerful synthetic opioid that is used in medical settings to treat severe pain. However, fentanyl is also developed illicitly in labs including China and Mexico. Fentanyl created in these labs is responsible for the rise in overdose deaths due to contamination with other substances and lack of regulation.

How are we able to get more Narcan?

After a participant uses their Narcan, they can fill out the anonymous survey which is listed on the box where they can indicate that they would like another kit with Narcan.

Is Michigan the only state with Good Samaritan Laws?

All states have Good Samaritan Laws, but laws differ state to state. Generally, they cover any unintended consequences from CPR. The amount of personal drug possession varies. Related to performing CPR or other types of medical treatment: Any individual that performs CPR on another individual is not liable for any resulting damages, as long as that individual acts in good faith. This law also covers damages related to using an AED. Related to seeking medical help for an overdose: In Michigan, you are protected from prosecution for personal drug possession if you seek medical attention for yourself or another person. This can include reporting a drug overdose to law enforcement, calling 9-1-1, poison control center, a medical provider, or assisting someone in reporting a drug overdose or other overdose emergency

If a person is on a bed, do you move them to the floor before administering Narcan or performing CPR? What would you do if you find them passed out in a car or something? uncomfortable position?

Ask the 911 operator about this question. While CPR should be performed on a hard surface, ideally the ground or floor, there may be other reasons why we would not want to move them, such as injury. The 911 operator is trained to coach you in these situations, make sure to tell them exactly what is happening and where the emergency is taking place.

When attempting the provide care what should we do if a person is too heavy to move?

At this point you are going to want to be on the phone with 911. The operator is trained to coach you through the situation. Make sure you tell them they are too heavy to move, as well as other important information, like your exact location. You will be told what to do from there.

What to do for babies experiencing withdrawal?

Babies suffering from withdrawal are irritable and often have a difficult time being comforted. -Swaddling, or snugly wrapping your baby in a blanket, may help comfort your baby. -Babies also may need extra calories because of their increased activity and may need a higher calorie formula. Intravenous (IV) fluids are sometimes needed if your baby becomes dehydrated or has severe vomiting or diarrhea. Some babies may need medications to treat severe withdrawal symptoms, especially for seizures. Specific drugs for treating withdrawal are: -methadone for heroin and other opiate withdrawal -benzodiazepines (for alcohol withdrawal)

Is the dose the same for all ages?

Because doses as high as 0.4 mg/kg have been administered to newborns without ill effect,3 it is felt that the higher dose poses no increased risk. Naloxone doses ranging from 0.005 to 0.4 mg/kg have been reported in the pediatric literature.2-10 Individual doses up to 0.4 mg/kg3 and constant intravenous infusion of 0.16 mg/kg/h for 5 days4 have not been associated with naloxone-related adverse effects. The average half-life of naloxone in premature newborns is 70 minutes. Narcan nasal spray should be used the same for adults as for children.

What is carfentanil?

Carfentanil is a synthetic opioid. It is 100,000 times more potent than Morphine and 100 times more potent than fentanyl.

Do chest compressions pump blood throughout the body?

Chest compressions are designed to pump the heart to get blood circulating and deliver oxygen to the brain until definitive treatment can stimulate the heart to start working again.

Please talk about drug use and COVID 19 not being a good combination. How does this make things even more difficult?

Data has shown that during the COVID-19 pandemic, there has been an increase in fatal overdoses. There is also an increased risk in experiencing severe health outcomes from COVID-19 with those who have substance use disorder, as well as concerns of increased risk among those who use substances.

What does ACT do outside of community trainings?

Day to day, ACT members engage in community outreach strategies and facilitate overdose rescue training sessions. Members demonstrate hands-only CPR as well as how to administer the life-saving medication, Narcan.

After an overdose, how long do physicians have to rescue the person until the overdose becomes fatal?

During an opioid overdose, a person's breathing has slowed or stopped. After someone has stopped breathing, brain damage or death can occur in four to six minutes. This is why community first response when performing CPR and giving Narcan is crucial.

What states have a standing order for Naloxone?

Every state except Idaho, Nebraska and Oregon

Can fentanyl be absorbed through your skin?

Fentanyl can not be absorbed through the skin. This is a common misconception that has deterred some individuals from intervening during overdose emergencies. There is no risk of exposure to fentanyl through the skin, so please decide to help. Perform CPR and administer Narcan when you come across an overdose emergency.

What about Fentanyl and ODs?

Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It has approved medical use in patients that are in severe pain and is often used during and after surgery. Since fentanyl is an opioid, Narcan will work to reverse an overdose caused by fentanyl. It is important to note that fentanyl may require more Narcan due to its potency. It is becoming increasingly common for fentanyl to be used to cut other drugs, including heroin, cocaine, meth, and MDMA. In these cases, people are not usually aware that there is fentanyl mixed in. That is one reason it is so important to encourage people to administer Narcan even if they don't think the person has opioids in their system.

What about ice or cold showers?

Ice down the pants or cold showers can slow down the respiratory system and can send someone into shock or hypothermia. This is not a recommended strategy to use when responding to an overdose emergency. Rather a safer, quicker, more likely to work action is to call 911 and give naloxone/narcan.

Do you start CPR first then Narcan or vice versa?

If you are alone and the person is not breathing, you want to start chest compressions right away. The Narcan will not work if their heart is not pumping blood throughout their body. If the Narcan is near you, you can quickly administer it and then go back to doing chest compressions. If the Narcan is not within reach, just continue doing chest compressions until medical first responders relieve you. If there is another person present, one person can do chest compressions while the other person retrieves the Narcan and administers it. If the person doing chest compressions gets tired, the other person could also take over and keep the cycle going until medical first responders relieve you and can take over. If solo, AND you have an AED, you could administer Narcan while the AED charges/prepares.

Is there anything I need to do to certify myself as a community first responder? And, is there a way to keep in touch with other community first responders?

If you would like additional first responder training, the Red Cross provides trainings on adult and child CPR, first aid, and AED use. Both live and virtual trainings are available throughout the metro Detroit area. We have additional resources on our website, and you can stay in touch with us through our social media sites.

What is the concern or risk of touching someone who is overdosing if you think they may have used fentanyl?

In 2017, the American College of Medical Toxicology released a position statement titled " Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders". Here is a quote from this statement: "Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low. To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity. For routine handling of drugs, nitrile gloves provide sufficient dermal protection."

If we help people avoid overdoses, how will they ever learn how dangerous drug use is/hit "rock bottom"/ get a "wake up call"?

In Scott's words: Dead people can't seek treatment. It is not our job to judge someone, whether it's their first time experiencing an overdose or their 10th time experiencing an overdose. The idea that someone must hit rock bottom before they will correct their behavior is an idea we need to move away from.

If a person overdoses while in the hospital after the first dose of Narcan has worn off, is there an IV form that can be administered?

In a medical setting such as a hospital, Narcan can be administered through an IV, as well as through other routes not available to bystander first responders. Whenever possible, it is important to get additional medical assistance for someone who has experienced an opioid overdose, even if the Narcan you administered restored normal breathing.

What are the CPR Ratios?

In conventional CPR using chest compressions and mouth-to-mouth breathing, a ratio of 30:2 chest compressions-to-breaths is appropriate for adults. Source. However, both the Red Cross and the American Heart Association recommend that bystander first responders use hands-only CPR instead of conventional CPR. Studies show that hands-only CPR has better results when given by a bystander, because the time to start CPR was shorter and there were a greater number of chest compressions with fewer interruptions in the first few minutes, when compared to bystander administered conventional CPR.

If someone wakes up after CPR, in what position should they be put in?

In the recovery position, the patient is positioned on one side with the far leg bent at an angle. The far arm is placed across the chest with the hand on the cheek. The goal is to prevent aspiration and help keep the patient's airway open. The position also keeps the patient still until emergency personnel arrive. So it is not recommended to move them until EMS arrives

How far up does the Narcan nozzle have to go up someone's nose?

Insert the nozzle into one of the person's nostrils. You want to insert the nozzle until your fingers are up against the bottom of the person's nose.

Does it matter which side we put the patient on in the recovery position?

It generally does not matter which side you lay the patient in the recovery position. However, if the patient is pregnant, you should place them on their left side. If this is not possible, place a towel or cushion under their belly to support them. This is to ensure proper blood flow to the baby.

Does nasal congestion affect the delivery of Narcan?

It is not known how nasal problems such as congestion, a runny nose or nasal polyps will impact how Narcan works. However, it is still recommended that Narcan is administered if an opioid overdose is suspected. In studies on the delivery of other nasal medications, rhinitis has been shown to have a minimal effect on absorption

Can someone overdose on Naloxone?

It is not possible to give so much naloxone so as to harm a person. However, if a person is dependent on opioids (including people without substance use disorders, but on chronic pain medication) or has a habit, the more naloxone they get, the more uncomfortable they will be because of withdrawal symptoms. Vomiting is a possibility - be sure they don't aspirate (inhale) the vomit - that is very dangerous. If the person gets too much naloxone, try to explain to them that the withdrawals or "dopesickness" will begin to fade in a half hour or so.

Should a person be alarmed if they are giving CPR and they hear the individual's ribs crack?

It is not uncommon for ribs to break during CPR. About 30% of patients who have CPR performed on them end up with a broken rib or sternum. However, the benefits seem to outweigh the costs for giving CPR, and it is still recommended you perform hands-only CPR.

What is AmeriCorps?

It's a national network of independent programs that all incorporate community service as a key strategy for addressing critical community challenges. It is supported by funding from the federal Corporation for National and Community Service (CNCS).

What are the benefits of joining AmeriCorps?

Living stipend, education award, serve with others in your community, gain awareness of local challenges and setbacks for communities within the Tri-county area.

Is there a certain position the person would need to be in to receive Narcan? Would lying down be okay or do they need to be sat upright? Does position play a role in effectiveness?

Mayo Clinic instructs that you lay the person on their back to give them Narcan. However, if this is not possible due to space or injury, give them the Narcan in whatever position they are in, as long as the Narcan is in their system. Try to tip the head back when administering if possible.

Can I buy Narcan over the counter?

Michigan has a Naloxone standing order law. This allows a pharmacist to dispense Naloxone without an individual prescription and without identifying a particular patient.

When was the Good Samaritan law established?

Michigan's Good Samaritan Law was passed in 2016.

Does the dose of Narcan differ according to the number of opioids taken?

Multiple doses of naloxone may need to be administered per overdose event because of fentanyl's high potency relative to other opioids.

What is the risk period for an OD to reoccur after giving Naloxone?

Naloxone /Narcan is active for about 30 - 90 minutes in the body. Since many opioids remain in the body longer than that, a person can experience an overdose after the 30-90 minute time period. Each person's body reacts differently, and some people may initially require more than one dose of Narcan to reverse their overdose. This is why it is so important to call 911 immediately. Someone who seems to be recovering from their overdose after receiving Narcan could easily overdose again.

Is there an injectable form of Narcan? Is the nasal spray the only way naloxone can be administered For example a shot?

Naloxone comes in two FDA-approved forms: injectable and prepackaged nasal spray. Both forms are still available, however, most people find the nasal spray easier to administer than the auto-injector.

Will Narcan hurt someone who is not overdosing?

Naloxone has no effect on someone who has no opioids in their system. It will not help anyone who is not in an OD, but it will not hurt them either.

Naloxone only works with heroin overdose, not fentanyl overdose correct?

Naloxone works with all opioids, including fentanyl. If more Naloxone is required because of the amount of opioids in the system, it is okay to administer more if available.

How does Narcan work?

Naloxone/Narcan reverses an opioid overdose. Naloxone/Narcan works by blocking the effects of opiates on the brain. Naloxone will only work if a person has opiates in their system. It will not work with other drugs. A person cannot get "high" from using naloxone/narcan, and it is safe for practically anyone to use.

Is Narcan given as a treatment for those looking to stop opioid abuse?

Narcan is a medicine that rapidly reverses an opioid overdose and can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. But, Narcan is not a treatment for opioid use disorder

Would Narcan be helpful for a Ketamine overdose?

Narcan is an opioid agonist that rapidly reverses opioid overdoses. Ketamine is a general anesthetic, not an opioid. Therefor, Narcan would not be effective in reversing an overdose from Ketamine.

Is there a place where Narcan is not legally allowed?

Narcan is not a controlled medication. A person cannot become addicted to it. There have been no areas where Narcan has been banned. It is encouraged that business owners and work settings actually have Narcan on hand in case of an opioid emergency.

Does Narcan help with other types of overdose? (cocaine, meth, alcohol)

Narcan only works on opioid overdoses. If you suspect a non-opiate drug (e.g., cocaine) was laced or cut with an opioid such as fentanyl, giving Narcan will help. If you are unsure of what someone took, it is best to administer Narcan because it will not hurt the person.

If a person experiences an overdose, is there a time period in which Narcan is the most effective in reversing an overdose's effects?

Narcan should be given as soon as it is suspected that the person is experiencing an opioid overdose. This is to prevent serious outcomes from occurring, such as brain damage or death from lack of respiration.

Can Narcan help or harm someone with epilepsy?

Narcan will neither help nor harm someone with epilepsy. Narcan will not stop an epileptic seizure. It only treats people experiencing an opioid overdose.

How long does it take for Narcan to work?

Narcan works in 2-3 minutes. If the person does not respond in that time, administer a second dose.

If you find someone overdosed in a car, do they have to be removed from the car or lying down in order to administer Narcan?

No - Narcan can be administered to a person who is sitting or laying. However, CPR can only be used on an individual who is laying flat on a hard surface.

Does ACT have any other training sessions for other medical issues?

No we do not. However, the American Red Cross and the American Heart Association are good resources for training for other medical issues. There are also resources on their sites for events specific to your area. Here are there websites: www.redcross.org and www.heart.org

Is crack or meth considered an opioid?

No, crack cocaine and methamphetamines are not considered opioids; these substances are stimulants. Opioids are depressants, and in medical settings are usually used as pain relievers. Some examples of opioids include heroin, Vicodin, Oxycontin, morphine, fentanyl, etc. However, if you suspect an overdose from any substance, administer Narcan anyway. Due to contamination and polysubstance use, you can never really be sure what substances the person has ingested.

Can you develop immunity/tolerance to Naloxone?

No, people will not develop tolerance to naloxone - it can be used as effectively on the first overdose as on the 8th overdose, for example.

Is the number of Narcan limited to households?

No, there is no limit to the number of fills that can be obtained.

Does ACT take Narcan or syringes back ?

No, we do not take them. Expired Narcan as well as expired/unused medication can be returned to certain pharmacies across the nation. Many CVS and Walgreens as well as local pharmacies will accept your unused/expired medications. Select community locations like police departments will also accept unused/expired medication as well. Always make sure to call the location and confirm that they will be able to accept it since not all pharmacies and community areas are designated to take back unused/expired medications.

Is Narcan the only opioid antagonist?

No. But, the two most commonly used acting opioid receptor antagonists are naloxone and naltrexone. Naloxone is a full antagonist that is used in the event of an opioid overdose. Within 2-3 minutes, naloxone knocks opioids off opioid receptors restoring normal breathing and consciousness of a person who is overdosing. Naltrexone is a type of MOUD that is administered orally or in a monthly injection called Vivitrol. This medication keeps people from achieving a high if they use opioids.

Should we do a finger sweep of the mouth?

No. If a blockage is visible at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Don't try a finger sweep if you can't see an object.

Is Narcan available only through prescription?

No. In 2016, Michigan passed a Naloxone standing order law. This allows a pharmacist to dispense Naloxone without an individual prescription and without identifying a particular patient. With this, the "prescription" comes from the standing doctor's order from the State. Although individual doctor prescriptions still work for this, as an alternative, family, friends, or others can now obtain Naloxone to use in an emergency without an individual prescription.

Do big-box stores or other businesses have someone who is trained on using Narcan?

Not necessarily. Many organizations are working to train community members to respond to opioid emergencies. Some of these community members may be employed at public sites where they can use their training to save someone's life.

Who were these OD deaths; long term users or people getting doses with fentanyl and stuff? New users without tolerance? The earlier stated populations with those reduced tolerances?

Our data is provided by MDHHS, and unfortunately does not contain that amount of data, but current potency and contamination of much of the drug supply leads to more accidental overdose deaths among those without/low tolerance.

Is the box the Narcan comes in descriptive of what it contains?

Our packaging does state that the contents inside include Narcan. The mailing package however will not indicate that it is Narcan.

Is there a target audience for our trainings?

Our trainings are open to anyone who wants to attend them. For the time being, we are leading training sessions in Wayne, Macomb, and Oakland county. During the Covid-19 crisis, our training sessions have gone virtual and are open to the public!

What should we put for the training location when filling out the post training survey?

Put the location in which the training took place. If it is a virtual training, you can put "virtual" or "Zoom" as the training location.

Have you noticed an increase in opiate overdoses since the pandemic started?

Researchers at University of Michigan have seen a 15% rise in suspected opioid overdose deaths across most of Michigan since March, compared with the same time last year, and a 29% rise in first responders' use of naloxone.

Does the dose have a weight limit?

Since Narcan comes in a standardized dose, there is no technical weight limit. There is no "low dose" or "high dose" you can administer for Narcan nasal spray. The effects will be similar on people of all ages and sizes (newborns, children, and adults). For newborns and children, it is vital that 9-1-1 is called because the 4mg dose may precipitate severe withdrawal symptoms and remain in their systems longer. If overdose symptoms do not improve after 2-3 minutes, more Narcan is needed. Depending on a person's metabolism and the amount of opioids taken, overdose symptoms can return if there are still opioids in the person's system. In this scenario, more Narcan will be needed. Metabolism is dependent on many factors, including muscle mass which can impact how many doses of Narcan are required.

Why is there such a difference between the mortality rate for the black population and the white population in regards to opioid overdoses?

Societal factors stemming from systemic racism have prevented communities of color from having equal access to the resources needed to be healthy. Poverty, adverse childhood events, intergenerational trauma, and intergenerational substance use can impact both people's underlying health and their access to healthcare, and are influenced by systemic racism. The health inequities experienced by communities of color, as a result of social determinants of health and systemic racism, result in overdose death disparities for communities of color.

What if the caller/overdose patient has more than person drug possession activities such as selling at their home?

Still encourage 911 to be called. This is a personal choice that people have to make in this situation. Refer to Good Samaritan laws.

What is considered extreme temperature?

Store at controlled room temperature 59°F to 77°F (15°C to 25°C). Excursions permitted between 4°C to 40°C (39°F to 104°F). Do not freeze. Protect from light.

Is Narcan effective past its expiration date?

Studies have been done that show Narcan can remain effective beyond 10 years. However, most pharmacies are willing to exchange expired Narcan for a new dose. Throwing expired Narcan out is not recommended since having some Narcan is better than having no Narcan.

Is the syringe version of Naloxone effective past the expiration date?

The 2 most well known Naloxone products are Narcan and Evzio. Narcan comes in a nasal spray form and Evzio comes in an injection form. Research has shown that they are both effective well past their expiration date.

Where can we find more training for CPR?

The American Heart Association website allows you to search for CPR classes near you. Link. The American Red Cross also offers CPR courses.

Can someone be fired from work for seeking treatment for substance use disorder?

The Americans with Disabilities Act or the ADA provides vast coverages in these instances. You as an employee cannot be fired for reasons related to your treatment process, even if it causes you to miss work. Moreover, under the Family Medical Leave Act of FMLA an individual can take up to 12 weeks of time off for issues that include addiction disorders each year, although in most cases this would be unpaid.

What is the difference between Narcan and an epipen?

The EpiPen is an easy way to administer epinephrine to people who are suffering life-threatening allergic reactions to bee stings or food. Narcan administers naloxone to counteract the life-threatening effects of an opioid overdose. They use different medications to treat different conditions.

How can the domestic violence program promote Narcan to empower their survivors?

The domestic violence program can advocate to all their survivors and members about the free training sessions that are being led by the ACT program. No one is immune to the disease of addiction. Having Narcan allows anyone to act in a situation where someone has overdosed and could potentially save a life.

Does the mixture of COVID-19 and drugs make that person's immune system weaker/more at risk?

The opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for families and communities. Opioids use affects respiratory and pulmonary health, which may make those with opioid use disorders more susceptible to COVID-19. In addition, chronic respiratory diseases are already known to increase overdose mortality risk among people taking opioids, and decreased lung capacity from COVID-19 could lead to similar health effects.

Is it true that after administering Narcan the individual may become violent, meaning physically aggressive due to disorientation?

The person may be confused or agitated, but it is not very common for people to be combative when revived, especially when the Narcan was administered by someone they know and trust.

Will the powerpoint be mailed to us?

The powerpoint will not be mailed, but you will receive a summary review sheet with the information covered in the training. Additionally, we can send the CPR and recovery position videos.

Why is checking for a pulse unreliable?

The pulse check performs poorly when used as a diagnostic tool by lay responders. Such an error will lead at once to failure to diagnose cardiac arrest, failure to start CPR, and failure to assess the arrest rhythm for VF(irregular heartbeat) for approximately 10% of victims of cardiac arrest.

Can you address the legal/liability issues for use by law enforcement?

The risk of liability for a law enforcement officer or their employer resulting from naloxone administration is low. From a legal standpoint, it would be extremely difficult to win a lawsuit against an officer who administers naloxone in good faith and in the course of employment. Overdose response activity is no different from any other good faith effort to provide assistance in an emergency. Additionally, Michigan's Governmental Tort Liability Act states that, as a general rule, government agencies -- and the people who work for them -- are immune from civil lawsuits "if the governmental agency is engaged in the exercise or discharge of a governmental function." Sources: MCL 691.1407,

How much time should be given till the 2nd dose of Narcan is administered?

The signs and symptoms of an opioid overdose can return after Narcan is given. If this happens, give another dose after 2 to 3 minutes using a new spray device and watch the person closely until emergency help is received.

How many doses come in one box?

There are 2 doses in boxes purchased/received from a pharmacy. For our program and training sessions, our kits come with one Narcan nasal spray which contains one 4mg dose of the medication.

Is Narcan stocked in schools?

There are organizations working on this. Alliance (in Oakland County) has ensured that every school in Southfield has 3 Narcan kits per school (as well as 3 trained staff members) to respond to an overdose emergency that occurs on site.

If you are in the community, how do you know that someone is experiencing an overdose and not experiencing unconsciousness due to another reason?

There are some telltale signs of opioid overdose. Some examples are: slow/shallow breathing (less than 10 breaths per minute) that sounds raspy or gurgly, blue/gray lips or fingertips, and they do not respond to stimulation. A sign that is unique to opioid use is small or pinpoint pupils. There may also be clues in the environment, such as syringes or pills/pill bottles, or if you know they take pain killers.

Why is there only one dose of Narcan in the kit?

There is limited access due to funding (which is why we accept donations).

Do you know of any support groups for people who have lost someone to SUD?

There's a list of resources at our website: https://www.stopoverdosedeaths.org/community-resources

Is it common for an opioid user to OD?

This number is hard to gauge because of data collection issues, however, According to recent data, in 2019 1,768 people died of opioid overdose in Michigan. Opioid overdoses that do not lead to death are several times more common than fatal overdoses. Harm reduction practices such as using sterile injection equipment, carrying Narcan, testing substances and not using substances alone decreases harms (like overdose and death) related to opioid use.

Is Valium considered an opioid?

Valium is not an opioid. Valium belongs to the drug class of benzodiazepines which are depressants. They lead to sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures. The most common Benzodiazepines include Valium, Xanax, Halcion, Ativan, and Klonopin. While Valium is not an opioid, people sometimes take benzodiazepines in addition to opioids like heroin. Taking benzodiazepines in conjunction to opioids is very dangerous because this can lead to additional slowed breathing that can lead to an overdose.

Do you (ACT) host anything else?

We are open to hosting additional private trainings and we also do public trainings

Is there a deadline to complete the post-training survey?

We ask that you complete the survey as soon as possible, generally within 24 hours of the training. The sooner you complete the survey, the sooner we can process your information and have Narcan mailed to you.

Is there data/statistics from the opioid epidemic that correlates with domestic violence survivors?

We do not have any specific data on whether there is an association in domestic violence survivors and the opioid epidemic. If that is something that interests you, we can look into it and get back to you with more information.

Are there guidelines for breaking car windows for access?

We do not have specific instructions to give in this kind of event. In an overdose situation, call 911. Explain exactly what is happening and the operator will instruct you on what to do next.

Are Narcan kits on campus? Are they easily accessible?

We indicated that each campus would have to contact us to inquire about the availability of Narcan on campus. NaloxBoxes (naloxbox.org) are becoming more popular and it would be great if they could become as standard as and stored with AED.

Can you expand on how overdoses can occur after 1-3 hours after the substance has entered the system?

While each opioid is different, this is due to the peak effect of opioids typically occurring between 1 hour and 3 hours after consumption.

How long does it take to get the Narcan through the mail?

With Covid-19, the expected mailing dates are delayed. We cannot give an estimate of when you will receive your kit but it should hopefully not take too long!

If a person is unconscious can we still administer Narcan?

Yes, if a person is unconscious you can still administer Narcan. As long as the person is breathing so it can circulate through their system. If they are not breathing, Narcan will not be effective because it won't circulate. In this situation CPR is most important, though if there is another person nearby, then one person can perform CPR while the other administers Narcan.

Does Narcan interact with other medications?

Yes, it is possible for Naloxone to have a mild interaction with other medications. However, in an overdose emergency, the risk of brain damage and death is higher. Make sure to call 911 before intervening so EMS can deal with any effects that occur after the overdose has been reversed.

Can you overdose on insulin?

Yes, it is possible to overdose on insulin. Insulin overdose leads to hypoglycemia, which can have a range of outcomes, including death. It is important to acknowledge, however, that insulin is NOT an opioid. Therefore, Narcan cannot be used to reverse an insulin overdose. Narcan is only effective in reversing opioid overdoses.

Is our contact information on the box?

Yes, our website (CUS/STOP) is listed on the box and resource cards. The website has more contact information about the program, how you can get involved and much more. If you would like to speak to one of us, our phone number is also listed on the website.

Does the Good Samaritan Law still apply to those that are visiting the state of Michigan?

Yes, this law applies to anyone in the state at the time.

Is Buprenex the same as Buprenorphine?

Yes. Buprenex is the brand name for an injectable form of buprenorphine.

Can I get another Narcan through our program if they used their first dose?

Yes. If they have used their 1st dose up, they can fill out the post questionnaire(link on the box) where they can indicate they would like another kit. Generally, each training participant will receive one kit (limited by grant requirements); In some cases, we can provide an additional kit that will remain on-site at the location (e.g., a group kit to keep in a shared office). *Be sure to complete an extra attendance slip* If it's a single/individual, let them know about upcoming public training.

Is Narcan safe for children?

Yes. It is safe and effective when given to children. For infants repeatedly exposed to opioids, giving Narcan/naloxone can induce more serious withdrawal symptoms.

Can a second dose of Narcan be given in the case the first one was expired and not effective?

Yes. Narcan works in 2-3 minutes. If the person does not respond in that time, administer a second dose. You can administer as many doses of Narcan as you have if the person needs it.

Does the person go into withdrawals once this is administered because it blocks the receptors?

Yes. Somebody who is dependent on opioids will have a tolerance. If there is not an amount of opioids in their system that is equal to their tolerance level, they will experience withdrawals. When Narcan is administered, the blocked receptors prevent any opioids from attaching to them, preventing them from feeling the effects of the substance, therefore causing them to enter withdrawal.

Does Narcan have an expiration date?

Yes. Studies have been done that show Narcan can remain effective beyond 10 years. However, most pharmacies are willing to exchange expired Narcan for a new dose. Throwing expired Narcan out is not recommended since having some Narcan is better than having no Narcan.

Do you aim for the sternum, for chest compressions, the actual bone or the 'hole' below it?

You are aiming for the center of the chest. Place the heel of your hand on the breastbone (sternum) at the center of the person's chest.

Do you have to give Narcan on an inhale?

You can administer Narcan if the person is not breathing, so it does not have to be on an inhale.

Does it matter which nostril you administer Narcan in?

You can administer Narcan in either nostril. If breathing does not return to normal or if breathing difficulty resumes, after 2-3 minutes, give an additional dose of Narcan using a new device in the alternate nostril. Repeat doses may be necessary.

How much Narcan can be administered?

You can administer as many doses of Narcan as you have if the person needs it. The hope is that EMS will arrive before you need to administer a second dose

Can Narcan be stored in a car?

You can keep the Narcan in your car, but be mindful of extreme temperatures. So if it gets too hot or too cold, then we recommend storing it inside

Will we be getting a certificate for this training?

You can opt for a certificate in the post training survey.

How do we get this training for organizations that we are a part of?

You can request a private training through our website: stopoverdosedeaths.org. You can also personally email me at (presenter's name)[email protected]. Or give us a call at (313) 681-5207.