Dr. A. Orkin ‘Overdose Training and Naloxone Distribution’


Dr. Aaron Orkin’s Power Point Canadian Emergency Care Conference Feb 22, 2016 ‘Overdose Training and Naloxone Distribution’ Dr. Orkin co-author 2015 AHA CPR guidelines Part 10:3 opioid OD See Slide page 16a below??

My moderated comments 2015 AHA & ILCOR guidelines BLS 891 ‘Opioid Overdose Response Education’  https://youtu.be/Oxr1vXf_6d8

Copy of Power Point by Dr. Orkin

Dr. Orkin et al teaching untold tens of thousands chest compression’s only for OD??Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’   CJPH 2013;104(3)e200-4  http://journal.cpha.ca/index.php/cjph/article/view/3788

My response above  ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature

‘Opioids: clinical use as anesthetic agents’
Quote “allowing administration of enormous doses intraoperatively when the patient’s ventilation is supported mechanically [rescue breathing layperson]”
Response Anaesthesiologist ODs patient usually with Fentanyl (it’s short acting) kept alive ventilation’s. Awaken stop drug flow keep ventilated [rescue breaths layperson] rarely uses antidote


Slide page 1  (see fine print) Guidelines Update: the Science of Changing Lives   Quote #5 “Trained providers should administer naloxone to respiratory arrest patients with suspected opioid overdose”  Response:  Laypersons must follow standard medical practice to any respiratory emergency patient.  Humankind has known since the invent of opium 5,500 years ago, overdose death you stop breathingPer all medicine supply respiratory assist essential (rescue breathing) to all respiratory emergency patients.

Slide page 5a (see fine print hyperlink)   Overdose: Worse than the road toll 

Quote p.1 “Non-fatal overdose, where someone has stopped breathing, can lead to hypoxic brain injury, caused by a lack of oxygen to the brain.  These brain injuries can cause coma, seizures and, in worst case scenarios, brain death.  The long-term consequences of hypoxia depend on how long the brain is starved of oxygen. In severe cases, brain injuries from overdoses can leave people in a vegetative state.”

Response: Opioid overdose is a respiratory emergency, not a cardiac arrest until brain dead lack of oxygen.  Chest compression’s only is just going to make sure you stay dead

Slide page 5b  Note link to  Drug Free  Response: My opinion “dysfunctional civilization a cause of drug use and abuse”

Slide page 6 Response: That is an x-ray of pulmonary edema, under ventilate any respiratory emergency patient pulmonary edema can kill you days later.  The second slide same page perpetuating fear of HIV/AIDS??  The coughing picture does that represent someone’s who’s alveoli sacs have been ruptured (pulmonary edema) and now the patient is spewing blood and pus??
http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html Slide page6 Pumonary edema

Slide page 6b (see fine print) Gomes, Tara et al. “The burden of premature opioid-related mortality.” Addiction 2014;109(9)p.1482-1488
Response Article has no direct mention cause of death

Slide page 8a
Recognize overdose.
Respond to overdose with:
– BLS  [Basic Life Support rescue breathing italics mine]
– Naloxone

Slide  page 8b  Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, Ruiz S, Ozonoff A.
Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.   BMJ. 2013;346:f174    Quote p.1 “providing rescue breathing, and delivering naloxone”

Slide page 9a  Exploring the life-saving potential of Naloxone 
NCBI December 2015;(26)12, Pages 1183–1188    Quote p.1184 “because of ethical concerns related to denying control participants access to a life-saving medication” “reverse opioid overdoses when properly trained”  p. 1185 “The content of training interventions was similar across each study and largely comprised of training in recognition, prevention and management of overdose, including life support and naloxone administration”
p. 1187 “However using naloxone does not always equate to saving a life as some people may survive without it” “Given the variability of these training characteristics between the studies included in this review we elected not to include any analysis which explored how they might mediate success or not. RCT-level research comparing different THN training structures to determine the most effective delivery methods should be prioritised.”  “Therefore the PoU (proportion of use) should be taken literally, not implied as a proportion of success”

Slide page 9b Angela K. Clarke et. al. ‘A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs’ Journal of Addiction Medicine January 2014 8(3):153-63

Quote p.153 “Patients that overdose are in a life threatening situation that requires an immediate medical intervention”  “…..respond correctly to witnessed opioid overdose?”  P.155 “…appropriate responses to overdose events, such as contacting emergency medical personnel, instructions on rescue breathing…”

Slide page 10a Rebecca E Giglio, Guohua Li and Charles J DiMaggio Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis
http://link.springer.com/article/10.1186%2Fs40621-015-0041-8#/page-1  Quote p.1 ” Naloxone has been the standard treatment for overdose effects like respiratory depression, sedation, and hypotension in the emergency department setting for the past 3.5 decades…”  p. 2 “…overdose response strategies, such as calling 911 or using rescue breathing.” 

Slide page 13  (see fine print) Seal KH, Downing M, Kral AH, Singleton-Banks S, Hammond JP, Lorvick J, Ciccarone D, Edlin BR ‘Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area J. Urb. Health 2003 Jun 80(2): 291-301
Quote p. 294 “…Standard definition for heroin overdose that consisted of “stopped breathing” and “turning blue” p.297 “…we found the most common response to an overdose was an attempt lay remedies that had little or no physiological basis…”
“…possessing naloxone does not guarantee survival after an overdose because peers might not be able to locate the naloxone, or might fail to use it properly or soon enough.”  p.298 “Even when 911 is called, a short response time of 5 minutes could result in irreversible brain injury..”

Response: As in near drowned 4-7 minutes till sever brain death, heart stops secondary to respiratory arrest.  Chest compressions only has no affect.

Slide page 14b Response: These conditions need rescue breathing also  – Drowning – Anaphylaxis – Choking – Snake Bites – Hypothermia – Cardiac arrest [Chest compressions only is for a sudden witnessed cardiac arrest only] Quote  Dr. Gordon Ewy World expert on chest compression’s only “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases.”

Quote Dr. Orkin “We should prevent overdose rather than treating it.”  Response: Does that mean let OD’s die?  Case reports women and children Naloxone ineffective kept alive rescue breathing.  Read my comment Marcia L. Buck  ‘Naloxone for the Reversal of Opioid Adverse Effects’ Pediatric Pharmacotherapy 2002;8(8)p.1-5 http://www.medscape.com/viewarticle/441915_4

Slide page 16a Quote “Full CPR Naloxone and AED” Response: AED only works for dysrhythmias Ventricular Fibrilation and Ventricular Tachycardia.
Naloxone has no role in the management of cardiac arrest. Simple logic – patient is dead cardiac arrest.  http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

Slide page 17a Health Canada Statement on Change in Federal Prescription Status of Naloxone http://news.gc.ca/web/article-en.do?nid=1027679
Quote “training would be required for those potentially administering the drug”

Response: Rescue breathing is essential.

Slide page 17b Liberal MP’s bill proposes ‘Good Samaritan’ immunity during overdoses  http://www.cbc.ca/news/politics/mp-drug-overdose-bill-1.3454146
Quote “we need every tool in the toolbox and this is one of those tools that we could use”  “spending much of the rest of your life in a vegetative state”
“come up with some new actions, some new activity, some new interventions.”

Response: Appropriate response essential”  “rescue breathing essential”  “vegetative state severe brain hypoxia lack of oxygen”
“intervention opioid OD has been know for over 5,000 years you stop breathing”

Slide page 20a Quote “No standard first aid strategy”
Response:  All 70+ references from 2015 CPR guidelines on opioid overdose and comments  ALL SAY RESCUE BREATHING NO MENTION ANYWHERE CHEST COMPRESSIONS ONLY


Dr. Aaron Orkin, P. Leece ‘Opioid Overdose Fatality Prevention’ JAMA 2013;309(9)873 Quote “Opioid users deserve the same high-quality, evidence-based practice as other patients.”

My letter Emergency Medicine News Dec. 2015

Dr. Aaron Orkin co-author  ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ Can. J. Public Health 2013;104(3):e200-4 http://journal.cpha.ca/index.php/cjph/article/view/3788

My response to above article  https://jgarythompson.wordpress.com/2016/07/04/response-cjph-20131043e200-4/

One of my moderated comments in the 2015 AHA & ILCOR resuscitation guidelines “Opioid overdose response education’ https://jgarythompson.wordpress.com/2016/07/06/opioid-overdose-response-education-bls-891/
Such an honour to receive a like on the above post from Dr. Richard Wilmot who spent years doing street outreach in disenfranchised neighbourhoods. Treating physical and mental health issues.   ‘American Euphoria: Saying ‘Know’ to Drugs’ By Richard Wilmot

Letter from Heart & Stroke Foundation Chest Compression’s only for a “sudden witnessed cardiac arrest”

Letter H&S Foundation Good  

Harm Reduction Coalition Chest Compression’s only  http://harmreduction.org/wp-content/uploads/2012/02/alert-hands-only-cpr.pdf  Simple logic breathing problem gets rescue breaths only

Canadian Red Cross Chest compression’s only http://www.redcross.ca/training-and-certification/first-aid-tips-and-resources-/first-aid-tips/compression-only-cpr

Dr. Gordon Awy the world expert on chest compression’s only.  He phoned me “Gary don’t stop what you are doing”
Quote “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases [any asphixia or poisoning etc].”

http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_475604_CPR-Learn-More.jsp   CPR Resources Click 2016 Hands-Only CPR Fact Sheet Word

Public Health can’t even read the instructions from the manufacture of Naloxone Hydrochloride Monograph http://www.drugs.com/monograph/naloxone-hydrochloride.html
“Administration should be accompanied by other resuscitive measures such as administration of oxygen, mechanical ventilation, or artificial respiration.”

Dec 28 2015 Metro News http://www.metronews.ca/news/toronto/2015/12/27/harm-reduction-partnership-irks-community.html   “So much of this is perceptions rather than the truth,” Thompson said

Toronto Star Jan 17, 2016 http://www.thestar.com/opinion/editorials/2016/01/17/fast-track-this-life-saving-antidote-editorial.html  Quote “These drugs kill by shutting down a victim’s breathing”

Alberta Feb 2, 2016 http://globalnews.ca/news/2493651/29-alberta-clinics-now-offer-naloxone-kits-for-fentanyl-overdose-treatment/ Quote “teaches mouth-to-mouth breathing and how to administer naloxone”

Letters from Public Health etc. and medical consensus https://jgarythompson.wordpress.com/

Don’t Forget to Breathe @GaryCPR

St. John Ambulance 2016.  Hundreds of causes of respiratory emergency all require respiratory assist (rescue breathing) breathing emergency is not a cardiac arrest.



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EMN 2015; 37(12):31 http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx Article in the 2015 AHA & ILCOR guidelines 'Opioid OD' https://youtu.be/PX0HQuaNS_I

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