Concerns and FAQ in Overdose Response Training
Q. Does Naloxone work on Suboxone overdose?
A. A Suboxone overdose is unlikely in a healthy adult because of its “ceiling effect” with regard to respiratory depression. Children, people concurrently using other drugs (especially benzodiazepines), and people whose health is compromised are at a higher risk. Community based naloxone will not reverse an overdose from Suboxone, but rescue breathing can keep the person alive until they receive medical attention. Medical protocol for an overdose on buprenorphine (the active ingredient in Suboxone) involves a continuous IV drip of naloxone.
Q. Should I administer CPR in a drug overdose situation?
A. CPR is often taught now with minimal emphasis on rescue breathing. In most opiate overdoses someone gradually stops breathing over 1 to 3 hours, prior to the heart stopping. Administering chest compressions in a opioid overdose situation takes valuable time that you could be using to administer rescue breathing. If you believe this to be an opiate overdose, focus on rescue breathing.
Q. Isn’t cocaine an opiate?
A. Cocaine is a narcotic, not an opiate. The word narcotic is used to describe a drug or medication with a numbing effect, thus “narcotic” can be used to describe both cocaine and opioids.
Q. Is Ultram/Tramadol an opiate and can Naloxone reverse an overdose from it?
A. Ultram/Tramadol is a partial opiate agonist (similar to Suboxone) but Naloxone will not be effective in reversing an overdose from it. Sometimes people combine Ultram/Tramadol with opiates or it is mixed, unbeknownst to the consumer, with heroin and can make Naloxone much less effective in reversing the overdose. A common symptom of Ultram/Tramadol overdose is seizures and these should be responded to as any other seizure through positioning the patient to avoid striking their head and calling 911.
Q. Will someone become violent if given Naloxone?
A. This is often reported in medical settings where a significantly larger amount of Naloxone is administered. This is very unlikely at the doses we recommend. Doses administered through community based programs are typically enough to pull someone out of an overdose without throwing them into full withdrawal.
Q. Can I give myself a dose of Naloxone if I believe I may be about to overdose?
A. Yes, but it is unlikely you will know that you are going to overdose.
Q. Can you overdose on marijuana?
A. No (This question can quickly draw the conversation away from the subject being presented and the trainer should abruptly end this discussion)
Q. I don’t plan to hang out with “those people” anymore…. (“those people“ who use opiates)
A. With the number of people dying from opiate overdose and the majority of those overdoses being caused by prescription medications, it is almost impossible for you to avoid being around people at risk for overdose.
Q. Doesn’t this just encourage people to use more drugs than they normally would because they now have a “safety net”?
A. 1. Anybody who has ever had an overdose reversed with Naloxone will describe it as a highly unpleasant experience and will not want to experience it again. People using opioids often do everything they can to avoid withdrawal, and naloxone works through withdrawing the opioids from their brains receptor sites.
2. People often spend a lot of money, time, and effort acquiring the opiates they use. They do this expecting a certain effect from those opiates. Naloxone negates the effects of those opiates.
3. Being rescued or rescuing someone from overdose is often a traumatic and life-changing event. The person(s) involved are often prompted to make other positive health choices later on because of the reversal of that overdose. An overdose death not being prevented is a life-ending event, the person will not be making any health choices following that event.
4. This question has actually been well studied in the scientific literature, and the opposite has actually been found to be true; that providing harm reduction services to people actively using drugs not only does not tend to increase drug use, but rather the opposite is true, that forming positive relationships with people while they use drugs can facilitate access to treatment when they are ready.
Overdose Training FAQ v.2015.09