Overdose awareness training

Overdose response training is a potentially life-saving intervention that should be offered to injecting drug users and their families and friends, and we have published the Exchange Supplies OD training course outline here, to make it easier for services or freelance trainers to build a course of their own.

Sessions should be run by an experienced drug worker and a qualified first-aid trainer (usually a paramedic, as this builds useful links with the ambulance service).

Other than in-patient and residential settings, and where the session is part of an education programme, it is good practice to pay people for their time in attending. Payment should be in cash, and the recommended sum is £10 - £20. If you think this might be a problem, please read the short article in the drug issues and debates section, by clicking here.

This is a plan for a 1 - 2 hour overdose response training session for drug users.

The length of time a course takes will vary according to how many attend, how well you know the clients, the environment the course is taking place in, and the number of questions/amount of discussion.

Recommended audience is about 8 participants, maximum is usually 12 (although in residential groups, or groups that know each other well, it could be up to 16).

The following notes are written for trainers, and detail things to cover, and the sorts of things I say when running the course. Any experienced trainer, with experience of working with drug users, and a thorough understanding of the issues and who has read the OD campaign briefing paper carefully should be able to run the course.

Course Plan

• Open the session

• Welcome the participants.

• Give the background to the session:

• National increase in OD deaths from less than 100 in 1990, 3000+ in 1999.

• Local experience numbers of overdose deaths

• Investigations into what's going on have shown that most overdoses are witnessed

• This course is part of a national programme of OD prevention workshops that aim to give drug users the information they need to respond to OD situations.

Ground Rules
Session will run for no longer than 2 hours;
happy to have discussions and answer questions as we go along;
but it will be easier if we just talk one at a time;
and bear in mind that I may have to cut discussion down at times just so we can get through everything;
hope that's OK with everyone.

also cover fire exits, toilets and smoking

Introduce yourself.

Introduce your qualified first-aid trainer.

Get the group to introduce themselves with their name, and then ask for some additional information to get people talking. What you ask the group for will depend on the number of people there, and how well you know them, and how well they know each other.

Additional information should help get the session going, and discuss the subject. Suggestions are:

Smaller groups, groups that know each other/the trainer, something like:
tell us briefly if you've seen an overdose where someone was saved
(not process the stories now, move on if taking too long - max 1-2 mins. per person)
would be appropriate.

For larger groups, groups that don't know each other/the trainer, something simpler like
how many times you've seen someone really OD, go blue?
might be more appropriate.


Going Over video
The Going Over video may be more useful in settings where the participants know each other well, and the trainer should consider whether the more upsetting scenes in the video will focus the group or upset people who might then decide to leave.

You can buy and watch online 'the going over video' here.

If the video is used, introduce it carefully, explain that the voices are of 4 real drug users telling stories of their overdose experiences, with a dancer demonstrating the recovery position in between. The people you see on screen are actors, but the voices are real.

It is important to let people know that it can be upsetting, but that we're showing it because it reminds us of why we're here, and the footage of the dancer putting themself in the recovery position is a really helpful way of remembering what to do.

But give participants permission, if it is too much, to feel free to get a coffee, and come back in a couple of minutes, when we get down to talking about what causes OD and how to respond.

If you're not going to use it, go straight to the flip chart exercise.

Key messages
On the flipchart write up and say that the key messages from the video/from the session are:
Dial 999
Put people in the recovery position

and we're going to talk about first aid in a minute, but first I want to talk about what people actually do…

1st exercise:
Can you give me a list - to write up on the board - of the things people actually do when they see someone overdose?

before you end, make sure the list includes the most common dangerous responses:

• Walking people around

• Inflicting pain (long list of ways helps)

• Bath/cold water

• Injecting salt

• Running away

Discuss once you've got the whole list.

Key points:

Deal with inflicting pain first
Explain OD is a pharmacological process (in some ways like a general anaesthetic, if you've had an OD there is nothing anyone can do to wake you up - in surgery they cut you open!)

if they come round during pain infliction, it is because the body is metabolising the drugs.

stimulus can only rouse people from semi-consciousness, and it can be used to assess consciousness only. Explain that this should be done by
pinching the ear
shouting or
a gentle slap to the cheeks

walk people around
as above + speeds up absorption of any drugs/alcohol taken orally

bath/cold water
as above + risk of hypothermia, increasing core blood levels and risk of drowning

inject salt
as above + risk of viral transmission.

run away
risk of death. Most overdoses happen more than 3 hours after the heroin use!


First-aid
OK, practical bit.
First-aider to demonstrate
1. Recovery position.
2. Assessment of need for CPR
3. CPR

If possible get everyone to put someone in the recovery position, and be put in the recovery position. Also, everyone to have a go on the little Annie resus doing mouth-to-mouth and CPR.


finish off.

OK, to finish off, I just wanted to go over the main risks for overdose deaths - these are;
mixing drugs, particularly alcohol and opiates, benzos and opiates.
injecting.
being a longer term user (most OD's are people in late 20's and early 30's)


idea to change the way people react.
stuff in these packs is to help you do that with everyone you know.
highlight the tear off cards.
give out packs

Thanks, and close with

Text for a Certificate of attendance
A certificate of attendance saying something like "this certificate confirms that …………………… has attended an overdose awareness and first aid training session at…………………… on………………..” signed………………… project manager. Will add to the status and positive feelings that participants have about the course.

Evaluation form (it is good practice to pay people to attend these sessions, and payment is normally handed over in return for a completed evaluation form at the end of the session)

Handouts:
Od campaign booklet and DVD
Overdose cards