[0:00] I wanted to welcome you all to the [0:01] Nlloxxone training today. It's brought [0:03] to you by an organization called the [0:05] Steve Rmer Hope Network. My name is [0:07] Justin McNeel. I'm a person in long-term [0:09] recovery. I'm also a person who's in [0:11] recovery from opioids. I've personally [0:13] responded to over a dozen overdoses um [0:16] in active use and then also at a [0:18] part-time job I have at a homeless [0:19] shelter in South Minneapolis where there [0:21] was a lot of overdoses happening. And so [0:23] in recovery, I have real life stories [0:25] that I'm going to tie into this. Um, [0:27] show of hands of who's heard of Steve [0:29] Rummer Network? Anybody? Well, a few [0:31] people here, right? So, they're the [0:32] state's leading provider in overdose [0:34] education, awareness, advocacy. They're [0:37] the reason why we're able to have this [0:40] and it's legal to carry. There's [0:41] something out there called Good [0:42] Samaritan laws that protect us during [0:44] overdose, and we're going to get into [0:46] that in a minute. They were really big [0:47] at getting that to happen. So, just as [0:49] something as few as 15 years ago, this [0:51] was illegal for us to carry. Now, it's [0:53] perfectly legal to carry, perfectly [0:54] legal to respond. Today we're going to [0:56] be learning about a couple different [0:58] versions. So, we have a nasal version [0:59] that just squirts up someone's nose. I'm [1:01] going to show you how to use that and we [1:03] have an interuscular version where we [1:05] fill little vials with these syringes [1:08] using a new syringe each time. And it's [1:10] going to go interuscular, not into [1:12] veins. You will sometimes hear of a [1:14] third way that nlloxxone is used, and [1:16] that would be an IV. And that would be [1:18] if you've taken so many opioids that no [1:20] matter how much of this you're putting [1:21] in someone's body, it's not lasting. And [1:23] so when you get to a hospital, they [1:25] would actually hook you up to an IV [1:26] saline solution with nlloxxone to do [1:28] that. Show hands here. Who has [1:31] experience with overdose? Ever seen one? [1:33] Ever witnessed it? What about knowing [1:36] someone who's overdosed? Right. Usually [1:39] when I do a big training, almost [1:40] everyone raises their hand. So we call [1:42] it degrees of separation. How many [1:44] people between you and a person that's [1:46] overdosed are there? There's actually [1:48] like zero degrees of separation now [1:50] where someone knows almost everyone [1:52] knows someone who overdosed or a family [1:54] member or a friend. And it's because [1:55] overdose is the leading cause of [1:57] accidental death in our country, killing [1:58] just over 100,000 people a year. And so [2:01] that surpasses gun deaths, car, you [2:04] know, accidents, anything that's [2:05] accidental. This is number one. And then [2:07] if we talk about people who are uh [2:10] incarcerated coming into the community [2:12] or the ages of 15 to 19, there's [2:14] statistics out there stating it's the [2:16] leading cause of death for them. So [2:18] number one thing killing people, not [2:19] accidentally period, just killing people [2:21] is this. And it's predominantly because [2:23] of drugs like fentanyl. Call them [2:26] synthetic opioids. Anyone ever heard of [2:28] this drug? So 50 to 100 times stronger [2:31] than heroin. And then they have another [2:34] one called carfentanol that they're [2:35] using for the little blue pills that [2:37] they're pressing that is a hundred times [2:39] stronger than fentanyl. And so I don't [2:41] have a pen on me, but if I were to show [2:43] you a lethal dose of heroin is about the [2:45] surface of a dime. A lethal dose of [2:48] fentinol is the tip of a pen. So if I [2:50] just had a pen and click the tip out, [2:52] that little tiny metal piece that pops [2:54] out is a lethal dose of fentanyl. And [2:56] carfentinyl, which is 100 times stronger [2:58] than fentanyl, grain of sand. And what's [3:02] really scary about this drug is it's [3:04] being cut with whatever people are [3:06] finding and using to fill it up because [3:08] if you were to just try to give someone [3:10] this much and say use that and don't [3:12] die, they more than likely overdose. Is [3:14] that they're cutting it with stuff, but [3:15] it's not cutting appropriately. So in [3:17] one bag of drugs, I may take a dose from [3:20] the right side and a dose from the left [3:21] side, exact same size. This one over [3:24] here kills me and this one over here is [3:26] a perfect high. And so it's just not [3:27] mixing right. Fentanyl's been around for [3:30] a really long time. Normally it comes in [3:31] a patch that releases through your [3:33] system over 12 hours. The stuff they're [3:35] doing is they're ordering it right from [3:37] Mexico putting or Mexico or uh China and [3:40] they're putting all the parts together [3:42] and then making themselves and there's [3:44] no rhyme or reason. And so they're not, [3:46] you know, pharmacologists and so they're [3:49] overdosing. And what's really scary [3:51] about an overdose is when someone [3:52] overdoses, they have no idea it [3:53] happened. One minute you're fine, the [3:54] next minute you've overdosed. And so if [3:57] you try to use alone, which most people [3:59] do, that's why people are dying. Is [4:01] they're using alone, there's no one [4:02] there to revive them. If you always use [4:04] with someone and they're with you [4:06] watching you and you have this [4:07] medication, the likelihood of you having [4:09] a fatal overdose is very low. Now, the [4:12] problem is getting people to do that [4:13] because you cannot nlloxxone or narcan [4:16] yourself. And so you'll hear some names. [4:19] Nlloxxone is the scientific name for [4:21] this medication. You normally hear it [4:23] when it's a syringe version. If you ever [4:25] hear the word Narcan, that's a [4:26] pharmaceutical company monetizing it. [4:28] And so that's Narcan is the nasal [4:31] version. They're both Nlloxxone [4:33] medication. Just Nlloxxone, Narcan, just [4:36] two different names you may hear. And [4:38] so, you know, I talked a little bit [4:40] about the opioid overdose crisis that [4:43] we're in right now. They're calling it a [4:45] crisis because over 100,000 people are [4:47] dying a year. Kind of happened in three [4:48] waves. It started with the [4:50] overprescription of opioids such as [4:52] Oxycontton. And they were actually [4:53] marketing it as non-addictive, [4:55] actually saying that it could not get [4:57] addicted to it. It would be good for [4:59] toothaches, headaches, muscle aches, you [5:01] name it, they were prescribing it. Turns [5:03] out it was more addictive than any other [5:05] opioid prescription ever made. And [5:07] people, what happened is they got [5:08] heavily addicted to it. And then their [5:10] doctors pulled away their prescription. [5:12] And so that created the second wave. [5:14] People started buying their pills on the [5:16] streets. They couldn't afford that [5:17] anymore. So people moved to using [5:19] heroin. We went from pills to heroin [5:22] which created the second wave and now [5:24] we're in the third wave which they call [5:26] the fentanyl crisis because now fentanyl [5:28] is everywhere. And to paint a picture if [5:29] I set a five gallallon bucket on this [5:31] table that's about enough to kill the [5:33] entire city of Minneapolis in one five [5:35] gallon bucket. People are why is [5:37] everyone using fentanyl now? Think about [5:39] how much easier that is to get over a [5:41] border through a shipment. So quite [5:43] literally a five gallallon bucket of [5:46] fentanyl would be pretty close to [5:47] equivalent to an entire semi or [5:50] something like that of heroin. And to [5:51] make heroin you got to grow a poppy [5:53] field. You've got to harvest it, break [5:55] it down, clean it, do all these things [5:58] where you can just mix a bunch of [5:59] chemicals together and make a synthetic [6:01] like fentanyl. And now it's wild. Me [6:04] being an opiate survivor, opiate use [6:06] survivor is I I don't even hear about [6:09] people being able to find heroin [6:11] anymore. You can't even find it on the [6:12] streets. Everything is fentanyl. And [6:14] what's really scary for people is, [6:15] especially even here in Anoka County, [6:17] over 60% of our overdoses are actually [6:19] people using meth. So people get meth [6:22] and then they overdose on fentanyl [6:24] because it's contaminated. People are [6:25] cutting it into meth. They're cutting it [6:27] into cocaine. They're cutting it into [6:29] Molly and other club drugs. Very often [6:32] when kids are buying pills, they buy [6:34] them online. They think they're getting [6:35] a Xanax, an Adderall, some other type of [6:38] thing that's not supposed to give them a [6:39] high like fentinyl and it's a fentanyl [6:41] pill. Eight out of 10 pills are fentanyl [6:43] pills now, even if they're marketed as [6:44] something else. So, what this is doing [6:46] is it's creating a crisis for anyone [6:48] who's experimenting with substances. So, [6:51] back when we first started using and we [6:53] were experimenting, it usually wasn't a [6:55] death sentence. pretty strong death [6:57] sentence for people, especially kids, if [6:59] they get a hold of a pill that has [7:00] fentanyl in it, especially their bodies [7:02] being smaller, too, being much harder to [7:04] process something so strong. Um, when we [7:07] used heroin, when I was using it, we [7:09] would smoke it on tinfoil and it would [7:12] gradually get you higher and the idea [7:13] that you would overdose would be very, [7:15] very small. Now, people take one hit of [7:17] fentanyl on tin foil and they're [7:19] overdosing, dying, right on the floor. [7:22] And so, it's just showing you how strong [7:23] this is. And it's so dangerous because [7:25] you can't even experiment with other [7:26] stuff. And so what's scary why they're [7:29] doing this is just so you become [7:30] dependent on it. If you use an opioid [7:32] for three, four or five days, you [7:34] actually get a physical withdrawal [7:35] symptom if you try to stop. You get [7:37] really sick, you crave the drug, um [7:39] really strongly, restless legs, [7:42] diarrhea, constipation, feeling so [7:44] terrible that you would use the [7:46] substance you're trying to get off of to [7:48] feel well. Uh, best way to put it too, [7:50] it's very similar how when people try to [7:52] get off alcohol and they get shakes and [7:53] they get withdrawal symptoms. Opioids is [7:56] very similar to that. And so [7:59] what does it look like when someone uses [8:01] opioids? When opioid hits your system, [8:04] it's a downer. It's just going to make [8:05] you feel down. You're going to be [8:07] sleepy. A lot of times people are just [8:09] nodding off. If you're driving by an [8:12] encampment, you may kind of see people [8:14] acting like zombies stumbling like this. [8:17] very common one, which is wild to me, is [8:19] this lean back thing. You know, people [8:21] like this and they catch themselves [8:23] right before they fall. They're very, [8:24] very high on opiates. You try to wake [8:26] someone up, they're mumbling, they're a [8:28] little coherent. Um, they're just [8:31] really, really high. You can look at [8:32] their pupils and their pupil is almost [8:34] non-existent, but usually that's the [8:36] telltale signs is this groggy voice, [8:39] this slow demeanor, this hard to wake [8:42] up, constantly falling out. uh pretty [8:45] good sign they're on an opiate. And then [8:48] when that gets a little bit further and [8:50] they get into overdose, it just gets a [8:53] step above what we talked about. So that [8:55] drowsiness, you're unable to wake them [8:57] up. You're literally grabbing someone [8:58] and shaking them lightly, moving their [9:00] head around, you're saying their name, [9:02] and they're not responding. Sometimes [9:04] they do a really weird snoring thing. If [9:06] they're sitting up, it's this loud, [9:08] erratic snoring, and you're shaking them [9:10] and they're literally not waking up. Uh [9:12] you don't slap them. you're not going to [9:14] punch them. It doesn't help. Is you try [9:16] to gently wake them up, maybe a sternum [9:18] rub, and they're completely [9:19] unresponsive, more than likely an [9:21] overdose. Some other telltale signs, [9:23] their pupils, like I mentioned, shrunk [9:25] to nothing, and then they're going to do [9:27] a whole lot of weird breathing stuff. [9:30] So, gasping, gurgling. That could be if [9:34] I just sit down in this chair because I [9:36] passed out in a compromising position [9:37] like this. You can already hear it's [9:39] harder for me to talk. um big reason why [9:44] they could be gasping and gurgling. They [9:45] could have had some trauma because let's [9:47] say I'm smoking something right here or [9:49] injecting something and then I overdose. [9:52] I just fall out right over to the side. [9:54] I might hit my head on a table, a [9:56] toilet. So there could be some head [9:58] trauma really hard to wake up. And then [10:00] one of the really freaky ones is color [10:03] discoloration. So what happens when [10:05] someone overdoses is your body's ability [10:08] to breathe. You forget how to breathe. [10:11] So what happens is your breathing gets [10:12] slow and shallow, gets more and more [10:15] shallow till it eventually stops which [10:17] stops your heart and stops your brain. [10:19] And so what happens in that process of [10:21] your body being starved of oxygen is you [10:23] start to change color depending on what [10:25] ethnicity you are, what the color of [10:27] your skin is. It's anywhere from gray to [10:29] purple. Usually a gray or bluish kind of [10:32] color. Very scary. I've walked up on [10:34] people on overdoses and they literally [10:35] look like a smurf. Bright blue. It's [10:37] because they're starved of oxygen. Rule [10:39] of thumb is the more color discoloration [10:42] from what I've noticed when I've [10:43] responded to overdoses is the longer [10:44] they've been there without oxygen. If [10:46] they just started to get into overdose, [10:48] it'll start at their fingertips, the [10:50] inside of their nostrils, inside of [10:52] their ears, or their lips, and then it [10:54] spreads out. Um, I always try to tell [10:57] people, you have time when you respond [10:59] to an overdose. Just get in the motions [11:01] of doing what you have to do. If they've [11:03] changed a lot of color, you're going to [11:04] have to act a little bit faster just [11:06] because that means they could have been [11:07] there for a while. And it gets really [11:09] scary is if their eyes start to glass [11:11] over and they're blue, they're getting [11:13] really close to death because that's [11:15] another sign is just this distant look. [11:17] And I always say responding to an [11:20] overdose and doing it successfully is [11:21] one of the most terrifying and [11:22] fascinating things you'll ever do. On [11:24] one hand, it's terrifying because this [11:25] person's life's in your hands. They're [11:27] almost gone. But if you successfully [11:29] revive them, just seeing someone from [11:31] almost dead to alive in a short 10, 15 [11:34] minutes is just a wild thing to see. So [11:36] remember to try to keep yourself calm. [11:38] Very common reaction for us as the [11:40] responder. The first couple times you're [11:42] going to be shaky because of the [11:43] adrenaline. You don't realize it. [11:45] Especially being in recovery. When I was [11:47] high and doing this was a little [11:48] different. When I was in recovery, it's [11:51] you you actually have to debrief with [11:52] someone afterwards because it's a lot to [11:54] handle. Can bring up old memories for [11:56] you if you were a drug user or you lost [11:57] friends. You know, I know every time I [11:59] respond to an overdose, I think everyone [12:00] I've lost I've lost so many people in my [12:02] life to this that um I think that's why [12:05] I'm so passionate about doing these [12:06] trainings. I do them every week. It's [12:08] it's we're in a crisis right now that [12:10] can be very easily averted if everyone [12:12] was trained and carried this medication. [12:14] And so that's an important segue is [12:15] there's a law out there called Steve's [12:17] law that protects you when you respond [12:19] to this. It makes it 100% legal to carry [12:22] whether it's nasal or interuscular. No [12:24] matter how much you have, you can carry [12:26] it. 100% legal to respond. And let's say [12:29] I respond and someone gets harmed from [12:31] my rescue breathing. Someone gets harmed [12:33] in a way where I wasn't able to revive [12:34] them and they passed away. I am not [12:37] subject to I have criminal immunity, [12:39] civil and criminal immunity. So the [12:41] family can't sue me, the state can't sue [12:43] me. The reason they did this rule law [12:45] was because people were leaving people [12:47] to die. So the laws before Steve's law [12:50] were the police could charge you a [12:51] secondderee manslaughter or attempted [12:53] manslaughter. So you would respond to an [12:55] overdose and maybe you were using with [12:57] the person, maybe you weren't, they come [12:58] after you criminally and so when someone [13:00] would overdose, let's say you overdose, [13:01] sir, the rest of us would leave you. And [13:03] so people were getting left to die. [13:05] People were getting dumped off outside [13:06] of emergency rooms instead of brought [13:08] in, kind of like you see in the movies. [13:10] And so they created this law to turn [13:11] that around. And they did it all over [13:13] the country. So almost every state has a [13:16] good Samaritan law. The rules behind it [13:18] vary. Ours is called Steve's law. And so [13:22] now we have laws that protect us. Bring [13:23] people in the emergency room. Call 911. [13:25] If you call 911, you're protected and [13:28] the person who overdosed is protected. [13:30] And what I really like about this law is [13:32] it protects the drug user. So if we were [13:34] in active use together, or you and I, [13:37] let's say, and you overdosed, if you had [13:38] up to five grams of any drug on you, and [13:41] so did I, the police can only take them. [13:43] They can't arrest me. And if I was on [13:46] felony probation and you were on [13:48] probation and technically that will get [13:49] me a probation violation, I can't get a [13:52] probation violation for my PO because I [13:54] was responding to an overdose and saving [13:56] a life. And that's why we're doing this. [13:58] It's we create these laws and we give [14:00] you civil immunity for some drugs and [14:02] stuff like that so we don't leave people [14:03] to die. When I was in active use, I [14:05] actually responded to an overdose. The [14:07] cops came and they took my drugs and [14:09] then they left. And I didn't know about [14:11] seizel at the time and I was so blown [14:12] away. I thought I got one up on the [14:14] police and like they just didn't pick me [14:15] up or throw me in and then in recovery I [14:18] found out about the rule. And so we're [14:20] going to get into the actual how do we [14:22] save a life? If I miss any information, [14:25] you have any questions, stop me. We can [14:27] answer questions at the end. We're going [14:28] to learn interuscular and the nasal [14:30] version here. Just know this stuff will [14:33] freeze. You keep it at room temperature. [14:35] In the winter time, don't keep it in [14:37] your car. So I keep some in my backpack, [14:39] at my office, in my car, all over the [14:41] place. I have some. If it does freeze, [14:44] these vials, you can put them in your [14:46] mouth for 1 minute and it'll thaw it [14:47] out. The nasal stuff has to sit out for [14:50] about a half hour, 45 minutes to thaw [14:52] out. It can freeze and thaw out multiple [14:55] times without barely losing any [14:56] efficacy. I actually found a paramedic [14:58] van in an environment where it froze and [15:00] thawed out that had nlloxxone in it. [15:02] After 30 years, it only lost 1% of its [15:05] efficacy. Sunlight can damage it a [15:07] little bit. That's why when you get your [15:09] kit, it comes in UV bags. And so, room [15:13] temperature, be mindful. It has a [15:14] three-year expiration date, yet it never [15:16] expires. Medications are required to [15:18] have expiration dates. If you're working [15:20] for a company or working here at [15:21] Recovery Cafe, recommend you keep [15:23] up-to-date stuff for insurance policies. [15:25] As a community member, you can have [15:27] expired stuff. You don't get in trouble [15:29] if you get someone expired stuff. When [15:31] we talk about the kits, you see them in [15:33] bags like this. They've got a QR code [15:36] that will take you to Steve Rumler's [15:37] website give you a ton of information. [15:39] And they also have a thing on there [15:40] called Nlloxxone access points where [15:42] here at Recovery Cafe, you're one that [15:44] that purple thing at the entrance with [15:46] all the Nlloxxone in it. That means that [15:48] anybody can come here at any time, no [15:50] questions asked when the hours are open [15:52] obviously, and get in the lock zone. [15:54] We're beginning a new one as well. And [15:55] they have a map on their website. And so [15:57] if you run out of this stuff and want [15:58] more, you go anywhere on that map across [16:00] the state. You find the closest one to [16:02] you. just walk in and say, "Hey, I need [16:03] more." And they help you. Just so you're [16:06] aware, each kit. So, if we're talking [16:09] about nasal, it's going to come with two [16:11] of these. [16:13] And these are the nasal versions. These [16:15] are $20 a piece. You're going to get [16:16] them free through the Steve Rumler Hope [16:18] Network. If you were to buy them over [16:19] the counter, they made nasal nlloxxone [16:22] over the counter at any store where you [16:24] can buy medication country nationwide. [16:27] It also comes with how to reverse the [16:29] overdose in four different languages. [16:31] English, Spanish, Som, Spanish, Somali, [16:34] and Mung. And then each one has a little [16:37] breathing barrier, [16:39] which is once you tear it open from a [16:41] little piece of plastic like this, it's [16:43] just got a cute little face on there so [16:45] you know how to do it, where it goes. It [16:47] doesn't confuse you how it works. [16:49] And then obviously gloves for [16:51] protection. And we're going to talk [16:52] about that in a minute. [16:54] The inner muscular comes with the [16:57] gloves, the instructions, [16:59] three syringes, [17:02] three vials, and three alcohol pads. [17:05] That's to clean up before and after. [17:08] And so [17:10] how this works, whether I have a nasal [17:13] or an inner muscular, is I have to [17:14] determine it's an overdose first. And so [17:17] remember, I look for the signs. The [17:19] color discoloration, gasping and [17:21] gurgling, maybe foam coming out of the [17:23] mouth. One thing I forgot to talk about [17:25] is you're going to get some weird [17:26] breathing stuff. Depending on how long [17:28] they've been there besides gasping and [17:29] gurgling, you may hear someone go [17:32] hold their breath for 30 seconds, then [17:34] exhale, hold their breath again. Or you [17:36] just are listening and you barely see [17:38] their chest going up or down. Um, it [17:41] could be fast breathing, it could be [17:42] slow, just really funky breathing stuff, [17:45] just nothing normal because remember [17:47] they're forgetting how to breathe. Their [17:48] brain is not sending the signal. So, [17:50] what happens is you have these opioid [17:52] receptors in your brain and they just [17:54] get flooded and that's what causes it to [17:56] the point of overdose. This medication [17:58] operates on those same receptors and it [18:00] comes in, it says, "Hey, there knocks it [18:02] off and binds much more firmly for 30 to [18:06] 90 minutes to that opioid receptor." [18:08] important to remember that window [18:09] because if someone refuses medical [18:11] services, you have to keep an eye on [18:12] them because they could actually go back [18:13] and overdose after 30 to 90 minutes. And [18:16] so I always recommend get them to go [18:17] with paramedics. So I look for those [18:20] signs, the breathing, the small pupils, [18:22] the skin changing, gasping, gurgling, [18:26] panting, holding your breath, barely [18:28] going up and down, any of those signs. [18:30] Try to shake them. They don't wake up. I [18:32] always say give them a sternum rub. [18:34] They're unresponsive. You can try to put [18:35] a little bit of cold water on their [18:37] head. What they did before there [18:39] medication was available was would put [18:41] ice packs on people or in bathtubs full [18:43] of ice. So if you have a ice pack, you [18:45] could put it in vital spots like the [18:46] underneath the armpits, the groin, [18:48] underneath the breast, might flash them [18:50] awake. I always say if if they're really [18:52] high and you're shaking them and they're [18:54] responding, do not give them this [18:56] medication. It puts them into withdrawal [18:59] and you are going to be the number one [19:01] reason for that when they wake up or if [19:03] they come to that. So, if you're talking [19:05] to them and they're mumbling and they're [19:06] still talking, make them drink some [19:08] water. Just stay with them. Try to keep [19:10] them awake. Um, only want to give this [19:13] to them when they're unresponsive [19:14] because then they wake they they know [19:16] what you've just done versus they kind [19:18] of wake up and are confused at first. If [19:19] they know what you've done, they're [19:20] going to be really really crabby. And um [19:23] it's just how it is, you know, pretty [19:25] ungrateful. It's just because people are [19:27] caught up in their addiction. And we'll [19:28] get into more what that looks like. So, [19:30] the first step is you got to get to [19:32] them. So what I say is before I even [19:34] touch a person, I'm going to put on [19:36] gloves. Why am I going to do that? [19:39] Because people who use hard drugs, [19:41] especially in particularly heroin, [19:42] fentanyl, risky behavior, whether that's [19:45] sharing syringes, hanging out with other [19:48] people that may have bloodborne [19:49] diseases. Um you you take chances when [19:53] you're constantly getting high and you [19:55] have risk in your life. And so remember, [19:57] someone could have hit their head. They [19:59] could have lost bodily function from [20:00] hitting their head or overdosing. So, [20:03] you know, [20:05] um, someone could have gone to the [20:06] bathroom. There could be saliva. There [20:08] could be blood. There could be drugs. I [20:10] want to protect myself. Another telltale [20:13] sign it could be an overdose is you walk [20:15] into the scene and they got a needle [20:17] tied off on their arm. There's a little [20:19] black piece of tin foil on the ground [20:21] with a bunch of black dots. That's what [20:22] it looks like when they smoke fentanyl. [20:23] or it's like a snake on the tin foil [20:25] where they're following this chunk and [20:27] it's zigzagging powder. Know that unless [20:30] you have a break on your skin, fentinol [20:32] is not deadly to touch. Despite common [20:35] belief like you see in sensationalized [20:37] news articles, you I could pick up [20:38] fentanyl right now, a handful of it, and [20:40] rub it in my hands and it would [20:41] literally do nothing to me unless I had [20:44] a cut or something in my hand and it [20:45] worked its way into the bloodb brain [20:46] barrier. So still respond if you see [20:49] powders there. So I'm going to get to [20:51] them. One of the first things I want to [20:53] do is you I want to determine it's an [20:54] overdose. Sometimes you're going to have [20:56] to get to them. You're have to kick open [20:57] a bathroom door, crawl underneath a [20:59] stall. Um just get to the person. And I [21:03] usually will drag them somewhere by [21:04] getting underneath their arms and I'll [21:06] drag them and get them flat on their [21:07] back and tilt their head back so their [21:10] airways open so I know that they're [21:12] breathing properly. I may have to take a [21:13] backpack off of them, whatever it may [21:15] be. Then I'm going to check for the [21:16] signs of an overdose. Once it's [21:19] determined it's an overdose, I'm going [21:20] to call 911. [21:22] And so what that may look like is if I'm [21:24] in a house and there's multiple helpers, [21:26] I may work on the person. I may say, [21:28] "Hey, can you call 911 for me?" I may [21:30] have to do it all together. And that's a [21:32] little overwhelming. Talking to 911, [21:34] trying to respond to an overdose. You [21:36] may have to do that. One of the first [21:37] things I'll do if it's an overdose and [21:39] there's people is I'll get a helper. So [21:41] you're going to help me. And sometimes [21:43] you may need to say, "I need you to give [21:44] me six feet of space." Because when [21:46] someone's overdosed in public, often [21:48] everyone wants the help and you're [21:49] crowding a person. That's when mistakes [21:51] happen. So, everyone give me space. I [21:52] only need one helper. And if you don't [21:54] have a helper, you're going to do it all [21:55] on your own. You're going to call 911. [21:59] They're going to ask you a whole series [22:00] of questions. Where are you? What do [22:01] they look like? How long they've been [22:02] there? Have you given them any [22:03] medication? Just do your best to answer [22:06] those questions. Then, once I've got [22:08] them on their back, if I haven't done so [22:10] already, I'm going to make sure I open [22:11] up that airway so that they're breathing [22:13] properly. I'm going to pinch their nose, [22:16] have to breathe through their mouth two [22:18] times. Two rescue breaths before you [22:20] begin. If you do not want to surprise [22:23] kiss a stranger lip to lip, we have this [22:25] breathing barrier and you just go [22:27] through the white area. Pinch their [22:29] nose. Pinching the nose is super [22:31] important because otherwise the air will [22:33] just blow out their nose when you're [22:34] doing it. No compressions. We're not CPR [22:37] trained. Just doing the rescue breasts. [22:39] Why? Brain damage. They've been sitting [22:41] there without oxygen for a minute. The [22:43] longer they sit there, the more brain [22:44] damage, the more likely they could pass [22:46] away. And so we just start by getting [22:47] air in them. And then before we do [22:50] anything else, we get the air in them. [22:51] And then we're going to administer our [22:52] first dose. If it was a nasal version, [22:55] you see how I hold these just like this. [22:56] This is just a tester one with a spring. [22:59] There's only about a half inch sticking [23:01] out here. All I would do is just cram [23:03] that up there till my fingers touched [23:04] like that. And I'd squirt. This squirts [23:08] about this high. It's not going to blast [23:10] them in the brain. And a lot of people [23:11] think that it absorbs in your nasal [23:13] cavity. So all it's going to do even if [23:15] someone sounds like a lot of people ask [23:16] what if they have a cold still going to [23:18] work. Just sits there and their head's [23:20] tilted back and it absorbs slowly. Why I [23:22] like these is my opinion they may work [23:24] just a little bit faster because [23:26] remember this medication has to break [23:27] the bloodb brain barrier. Where is your [23:29] brain when we squirt this? You know, [23:30] right here. So it doesn't have to work [23:31] through much versus inner muscular has [23:33] to go through a muscle up to your heart [23:35] to your brain. And so I squirt that up [23:38] someone's nose. And then here's the [23:40] equation. One rescue breath every 5 [23:44] seconds for two minutes. So what that [23:47] looks like is, you know, I got this [23:48] little sheet on their face. Again, I [23:50] pinch their nose. I may hold their chin [23:52] so their head doesn't bobble. [23:55] One, two, three, four, five [23:59] for two minutes. Now, two minutes when [24:02] someone's dying and your adrenaline [24:03] jacked feels like a lifetime. What if [24:06] you give it to them in one minute or [24:08] four minutes because you counted too [24:10] long? You don't have a timer or you just [24:13] think it's been two minutes and a lot of [24:14] times, like I said, two minutes could [24:16] feel like an eternity and so you just [24:18] keep rushing yourself. Still going to be [24:19] good. The equation, the all the [24:21] statistics and the data says two minutes [24:23] is the best window. If you wait be if [24:25] you go too soon or you wait after, it's [24:27] still going to be effective. It's okay. [24:30] You're not making a big mistake. Just [24:31] try to get as close as you can. So, if [24:33] you have a partner helping you, they can [24:34] count. We have smartwatches. We have [24:36] timers on our phone. It should be easy [24:38] to navigate. So, one rescue breath every [24:41] five seconds for two minutes. And then [24:43] I'm going to administer my next dose. [24:45] And what we do is right nostril, left [24:47] nostril. And we keep doing that every [24:49] two minutes until paramedics get there. [24:52] That's why the second step is to call [24:53] paramedics. So, by the time you're like [24:55] ready to be done with this and just [24:57] hoping the person gets revived, they get [24:59] there. And the good news is, but if they [25:01] haven't gotten revived, by the time [25:02] paramedics get there, they have other [25:04] means to revive them. The only other way [25:05] to wake someone up is oxygen. So, very [25:08] rarely do paramedics ever give them more [25:10] nlloxxone if you've given them a lot. It [25:12] doesn't take much to revive someone. It [25:14] just has to work its way through [25:15] someone's system. And so, they're going [25:17] to just hook up an oxygen tank or put a [25:19] tube down their throat and start [25:20] breathing for them if they're really far [25:22] gone and hopefully be able to revive [25:24] them. Uh, like I said, of all the [25:26] overdoses I've done, I've been able to [25:27] arrive revive people. Usually when it's [25:30] not successful is when someone's been [25:31] there unattended to for quite some time. [25:35] And when someone gets revived, it can [25:37] happen in 30 seconds all the way up to [25:39] 15, 20 minutes. Same with when someone [25:42] can die. So when someone overdoses, an [25:45] overdose can happen immediately all the [25:46] way up to a couple hours. And then you [25:48] have a little bit of a window of time [25:50] anywhere from five minutes to a half [25:52] hour I would think where someone could [25:53] expire in that time depending on how [25:55] much they've taken. Now with the needle [25:58] version, it's still that same equation [26:00] where I start with two rescue breaths. [26:02] You know, I try to wake you up. I [26:04] determine it's an overdose. That's the [26:06] first step. I call 911 and make sure [26:08] you're on your back with your airway [26:09] open. I give you two rescue breaths with [26:12] the breathing barrier. And then I'm [26:13] going to inject you. And there's a [26:15] little more steps with this. And the [26:17] reason why I'm going to show this today [26:18] is you're going to have you have nasal [26:20] interuscular here is that with this [26:23] injectable version, this is the version [26:25] you see most commonly on the streets [26:27] because this is so expensive for most [26:29] people to get. So, we're going to use a [26:31] new syringe every time. [26:33] They just pop out the back piece of [26:35] paper. [26:37] And so, these syringes, you got to be [26:39] careful. If I twist, the tip comes off. [26:42] That's okay because if it comes off, all [26:44] I do is twist it back on. You want to [26:48] pull. And I'm never going to do this [26:50] game to put it back on because I could [26:52] stab myself. This is pretty risky. We're [26:53] always going to do stuff off of a [26:55] surface [26:57] where we just scoop it up and cap it [26:59] when we're done. [27:02] Basic syringe [27:04] information. These numbers are [27:06] milliliters or cc's. This can hold up to [27:09] three milliliters. In this vial is 1 [27:12] milll of fluid. If you were to look at [27:15] this little window on the back, it's [27:18] only about a quarter way full. It didn't [27:19] evaporate. You didn't lose any. This is [27:22] how much is in one dose. Same with these [27:24] vials. They got a little orange cap that [27:26] comes off. Once they come off, they [27:28] don't really go back on. It just comes [27:29] right off. [27:31] It won't fall out. So, if your cap's [27:33] broken in yours, it's not contaminated [27:35] or anything. It just fell off. [27:38] Normally these syringes, this one's an [27:40] inch long, are an inch and a half long. [27:43] So, they're supposed to be longer. Still [27:44] going to be fine with an inch. Inch and [27:47] a half ones, you could stab the bottle [27:48] and it would reach the bottom here. And [27:50] there's a way you can fill it up [27:51] different than I'm going to show you. [27:52] I'm not going to show you today because [27:54] it will confuse you. There's a vacuum [27:56] method where I can pump air into this [27:57] and it will automatically fill the [27:59] syringe. I can't do that because this [28:01] tip doesn't reach the bottom. So, I'll [28:03] show you a different way. Also, this tip [28:06] is about three times the thickness of a [28:08] regular syringe. I could go right [28:09] through my jeans. I could go right [28:10] through this jacket right here. Um, [28:12] ideally [28:14] muscle, big leg, maybe a down here if [28:17] you really couldn't with thighs, butt, [28:20] arm is where you want this to go. [28:22] Interuscular. So, if they have a really [28:23] fatty butt, you want to try to get it [28:25] more in a thick muscle. It's the whole [28:27] point of it. It'll go right through [28:28] their clothes. You don't have to expose [28:30] skin. If you do expose skin, great. The [28:32] only time I ever take clothes off is if [28:34] they got a car heart, a sweatshirt, a [28:36] thermal, you know, a bunch of layers [28:38] where this might not get all the way [28:40] through. And so, you just want to be [28:42] careful about that. And this is going to [28:43] go absorb through the muscles of their [28:45] in their body into their heart into [28:47] their bloodstream to their heart and to [28:49] their brain to those opioid receptors. [28:51] So, the only way to fill these up with [28:53] these syringes is you're going to stab [28:55] the bottle off of the the ground or a [28:57] chair. Never do it in your hand. You're [28:59] going to stab yourself if you do that. [29:01] And then I just flip it upside down. And [29:03] if everyone sees, there's a little [29:05] window on the back of this. You can turn [29:07] the bottles of the window so you can see [29:08] the needle in there. And then all I do [29:10] is I've just pulled that syringe to the [29:14] edge of this silver cap right here. You [29:16] see how I'm shaking it and moving it [29:18] around and the bottle isn't dropping [29:20] back down? That rubber stopper holds it [29:22] right in place. Once I get it to where [29:23] it needs to be, I don't have to hold [29:25] this at the same time. So now where it's [29:27] at, all I do is I just draw it out till [29:29] all the fluid comes out. [29:31] Now, one thing um that you guys should [29:34] remember as well is if I were to try to [29:39] just fill this up now that the bottle's [29:41] pressurized, it's a little different. If [29:42] I were just stabbed this syringe in here [29:44] and try to draw the fluid out this way, [29:46] if it was long enough, they're almost [29:47] pressurized negatively where it keeps [29:50] sucking the stopper back down. You can't [29:52] seem to draw out the fluid. And the [29:54] first time I ever responded to an [29:55] overdose, it took me two minutes to try [29:57] to fill up the syringe. And all I needed [29:58] to do was tip it upside down and bring [30:00] the syringe up to draw the fluid out. [30:03] Now, let's say the fluid was in there. [30:06] All I would do is just kind of hold it [30:07] like a cigarette. You can do it that [30:09] way. And if this was someone's leg, I [30:11] just go like this. I push it in and just [30:14] like that. And you just go slow. You [30:16] don't need to slam. Just go real slow [30:17] pushing in it. I actually prefer this [30:19] method a little more holding it in three [30:21] or four fingers because you can get a [30:23] little more of a push. You don't have to [30:25] go really hard. They're sharp. And then [30:27] I can push it with my thumb. Just like [30:29] that. And so I can show that one more [30:32] time though. Just stabbing it in there, [30:34] turning it upside down. [30:37] And then I'm going to make sure I know [30:38] where it's at. The needle's right at [30:41] that silver cap. I draw it out. [30:45] Now, what if I did something like that? [30:47] You see how there's a like let's say I [30:50] put a ton of air in there. I pulled it [30:52] back too far and I got all this air [30:53] floating around. All you do is you point [30:55] the needle side up and you see there's [30:57] air from here to here and just push it [31:00] out a little bit. If a little squirts [31:01] out, a little squirts out. Also, this is [31:03] going in muscles, not veins. So, if you [31:05] get some air in them, not really going [31:07] to harm them or kill them. Same thing [31:10] after I've injected that into somebody. [31:12] One rescue breath every 5 seconds for [31:14] two minutes to give them another dose. [31:17] And same thing, what they say with this [31:19] is work your way down the leg or go from [31:21] right to left. You can do arms, too. I [31:25] almost always do the leg because if I [31:26] feel right here, I already feel a bone [31:28] just barely touching it. I'd rather not [31:30] have to worry and just stick this all [31:31] the way in you. They don't feel it. They [31:34] have no idea. And I forgot to mention [31:36] that Nlloxxone only works on opioids. [31:38] So, if they were drunk, they took some [31:40] other drug, you didn't know what was [31:42] going on, you're still going to be able [31:44] to revive or um it won't do any damage [31:46] to them and that the paramedics by the [31:48] time they get there will be able to [31:49] figure out what's going on with that [31:51] person. It causes no harm. It only acts [31:53] on opioids. So if they like woke up, [31:55] "Why did you just stick me with a [31:56] needle?" Like, "Oh, I thought you [31:57] overdosed." They wouldn't get sick. They [31:58] wouldn't have a weird reaction. There's [32:00] a hundth of a chance they can have an [32:02] allergic reaction such as hives, swollen [32:04] throat, things like that. Still give [32:06] them the medication. Still going to be [32:08] beneficial if it's an overdose. [32:10] Another scary thing we ever heard of, [32:12] xylazine. Any of you guys? They're [32:14] cutting xylazine in the fentanyl to make [32:16] the high last longer. It's a horse [32:18] tranquilizer. Uh, so you get an elephant [32:20] tranquilizer and a horse tranquilizer [32:22] all wrapped up in one. How sweet, right? [32:24] Uh, this does not work on xylazine. [32:27] That's not an opioid. And people can [32:29] overdose on xylazine. Paramedics will [32:31] have to deal with that when they get [32:32] there. Be careful, too. Xyloine can [32:35] cause wounds. People are walking around [32:36] with muscles and bones exposed because [32:38] it causes infections in the skin that [32:41] can't heal. And so people kind of like [32:42] crocodile, if anyone know when that was [32:44] around, there's a drug called crocodile. [32:46] It's eating people's skin. Very similar [32:48] to that. [32:49] Except it's not eating them. It's just [32:51] an infection that won't heal. Yeah. And [32:53] so you keep doing this until someone [32:55] wakes up. Like I said, it can take a [32:57] couple minutes up to 15, 20 minutes. [32:59] They may not wake up till paramedics get [33:00] there. [33:02] Wide gambit of reactions that can [33:04] happen. One is like what I call the [33:06] breath of life. They shoot straight up [33:07] and they just look bewildered and it's [33:10] like all like all of a sudden they just [33:11] remember how to breathe and oxygen hits [33:13] them. They sit up and one minute [33:14] remember this. One minute they were high [33:16] maybe with their friends having fun. The [33:18] next minute they're surrounded by [33:19] paramedics, police officers, or some [33:21] stranger who's been hitting them with a [33:22] needle or squirting stuff up their nose. [33:24] And so people can get very emotional. [33:27] They deny overdosing when you tell them, [33:28] "I didn't use any drugs. I don't know [33:30] what you're talking about." People start [33:31] crying and apologizing profusely because [33:33] it's such a scary experience. They feel [33:35] very embarrassed. And then one that [33:38] shouldn't deter you is sometimes people [33:40] get a little aggressive, especially [33:41] guys. You they wake up and some [33:43] stranger's there. They they see that a [33:45] lot of times when people get high, their [33:47] friends rob them before they take off. [33:49] So their drugs are gone, their money's [33:51] gone, their stuff's all spread out. Uh [33:53] they panic or they see police officers, [33:55] sober house managers, paramedics, they [33:56] think they're in trouble, and so they [33:59] may get up, do this kind of thing. They [34:00] may get aggressive with you. So some of [34:03] the things you can start to look for [34:05] besides someone shooting up is the [34:08] breathing starts to normalize. All of a [34:09] sudden, instead of like their chest not [34:11] going up and down, it's going up and [34:12] down in a normal pattern, that color [34:14] discoloration, you start to see rosiness [34:17] in their cheeks again. You just take a [34:19] step or two back and just wait and wait [34:21] for them to wake up and then talk to [34:23] them. If they're unresponsive and you [34:25] woke them up, maybe from some blunt for [34:27] trauma or being under the influence of [34:28] other drugs, you want to roll them on [34:30] their left hand side. And what that [34:32] looks like is the recovery position. So [34:34] that's just their knee and their arm on [34:35] their side like this. And that's in case [34:37] once we're sure they're breathing again, [34:39] if they get sick or throw up or [34:41] something, they're not choking on it on [34:43] their back. And so whole wide reaction, [34:47] variety of reactions that can happen for [34:49] the person. And [34:53] don't let any of them be a reason to do [34:55] that. This is also not your time to [34:57] insert your recovery conversation. You [34:59] really messed up, man. You should go to [35:01] back to treatment. Uh they're not [35:03] hearing you right now. A big reason why [35:06] is that it puts people in something [35:07] called precipitated withdrawal. So they [35:09] get the maximum effects of opioid [35:11] withdrawal in a minimum amount of time. [35:13] And so they'll wake up and they may be a [35:14] little happy, a little high at first, [35:16] and then within five or 10 minutes they [35:17] start to notice that something's off. [35:19] They're getting hot flashes, cold [35:21] flashes, massive cravings, restless [35:23] arms, restless legs, diarrhea, [35:25] constipation, you name it, and they're [35:28] blaming you. So don't expect someone to [35:30] say, "Thank you so much for saving my [35:32] life." They're going to more likely say, [35:34] "Why the heck did you ruin your high? I [35:36] was completely fine. I wasn't [35:38] overdosing. Why did you do this to me? [35:40] Uh, now I'm going to have a big hospital [35:42] bill." There's a lot of things they say. [35:44] You did the right thing. You saved a [35:46] life. Dead people can't recover. Dead [35:48] people don't get a chance at a second [35:50] chance at life. And uh, dead people [35:53] don't get to spend more time with their [35:54] family members and loved ones. And so, [35:56] you gave someone a chance regardless of [35:57] how upset they are. I always tell them [35:59] too when they're looking for their [36:00] drugs, even if you use those, it won't [36:02] work for 30 to 90 minutes. It will [36:04] literally block their receptors. This [36:06] could also be the catalyst, the event [36:09] that causes someone to decide, I want [36:12] help. I want to go to treatments. I want [36:14] to find a way to change my life. Those [36:16] sort of things. And so, you may, if you [36:18] know the person, talk to them a day or [36:19] two later. Just make sure they're okay [36:21] that day. [36:23] So, that's what I got for the [36:24] presentation.