Aaron Orkin MD Overdose Treatment

I was at this conference common quotes from people with more authority then myself “Orkin is a dangerous sociopath”  Original power point here https://www.dropbox.com/sh/dhnvt2urjf3lc52/AADqExB7H-J2lE591k8RYev6a/Monday%20Feb%2022%20Sessions/Overdose%20Training%20and%20Naloxone%20Distribution.pdf?dl=0

See the only moderated comment on Heart & Stoke Foundation’s Official site. Post by AliasCPR same info as below https://youtu.be/Wy3eEES511E

Slide 1-2

Orkin, Aaron et al ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ Can. J. Public Health 2013;104(3):e200-4

Response:  https://jgarythompson.wordpress.com/2016/07/04/response-cjph-20131043e200-4/

Slide 2 Question ‘The First Aid Paradox”

Response: Scripture quotes rescue breaths https://aliascpr.wordpress.com/2016/10/23/scripture-rescue-breaths/

Self evident truth anyone showing the signs of overdose proves heart is beating dying acute respiratory failure.

Slide 2 (fine print) ‘Guidelines Update: the Science of Changing Lives’ http://3mg34c37ntii24dmio2yy6o5.wpengine.netdna-cdn.com/wp-content/uploads/2015/10/2015-Guideline-Special-CircumstancesUpdate-Infographic1.pdf

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 breathing. Per all medicine supply respiratory assist essential (rescue breathing) to all respiratory emergency patients.

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Slide 3-4

Financial
– None.
-Non-financial
– 2015 American Heart Association Resuscitation Guidelines opioid overdose writing group.

Aaron Orkin et al Part 10: Special Circumstances of Resuscitation
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
http://circ.ahajournals.org/content/132/18_suppl_2/S501

Response:  All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing only’
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

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Slide 5-6

The Opioid Epidemic

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Slide 7-8

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Slide 9-10

Slide 9 (see fine print hyperlink) http://www.overdoseday.com/wp-content/uploads/2013/07/Factsheet-Greater-than-the-Road-Toll-KE-FINAL-15-August-2013.pdf

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”

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Slide 11-12

Response: That is an x-ray of pulmonary edema, under ventilate any respiratory emergency patient pulmonary edema can kill you days later. Perpetuating the fear of HIV/AIDS. Coughing image patients alveoli sacs ruptured (pumonary edema) now spewing blood and pus??
http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html

cf. fine print hyperlink Gomes, Tara et al. “The burden of premature opioid-related mortality.” Addiction 2014;109(9)p.1482-1488.
http://pubmedcentralcanada.ca/pmcc/articles/PMC4171750/pdf/add0109-1482.pdf

Response: No direct mention cause of death

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Slide 13-14

Slide 14

Prevent overdose
Recognize overdose
Respond to overdose with:
– BLS [Basic Life Support rescue breathing italics mine]
– Naloxone

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Slide 15-16

Quote “First aid training for people who are likely to witness overdose”

Response:  First aid training can save the lives of anyone suffering a respiratory emergency.

50,000 Ontarians are poisoned each year 28,000 are children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html

2010 American Heart Association Guidelines Part 12.7: Toxic Ingestions http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80

Toxidromes “Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“

Response: Any of the hundreds of causes respiratory emergency can mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.

Slide 16

Walley, AY. et al
‘Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.’
BMJ. 2013;346:f174 http://www.bmj.com/content/346/bmj.f174

Quote p.1 “providing rescue breathing, and delivering naloxone”

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Slide 17-18

McAuley, A. et al ‘Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users.’ December 2015;(26)12, Pages 1183–1188 http://www.ncbi.nlm.nih.gov/pubmed/26508033

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 18

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
https://www.researchgate.net/publication/264004247_A_Systematic_Review_of_Community_Opioid_Overdose_Prevention_and_Naloxone_Distribution_Programs

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…”

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Slide 19-20

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 20

“If your teenager misused opioids, would you keep Naloxone in the house?”

Response:  Anyone can overdose Grandmother your child anyone!  Pet eats a poison or drug Veterinarian will give rescue breathing then antidote continue rescue breathing. Not torture them with chest compression’s. Why do we allow this to our women and children??

Case reports women and children Naloxone ineffective kept alive rescue breathing.

Buck, M. L. “Naloxone for the Reversal of Opioid Adverse Effects”  Pediatric Pharmacotherapy. 2002;8(8)1-5  https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/200208.pdf

Quote bottom page 1 “The first case involved an accidental ingestion of 100 mg normethadone by a 1 year old. The patient was initially treated with multiple bolus doses of naloxone, but when respiratory depression recurred, an infusion of 0.04 mg/kg/hr was started. The infusion was continued for 2.5 days. The second infant, a 3 day old, received an inadvertent morphine overdose of 5 mg due to a dosing error while hospitalized. This patient was given 4 naloxone boluses, followed by an infusion of 0.16 mg/kg/hr. The infusion was continued for 5 days, during which repeated attempts to wean the infusion resulted in further worsening of respiratory function. In both cases, the patients were discharged without sequelae.”

Response: Ventilations kept these children alive, Naloxone ineffective.

More case reports Naloxone ineffective kept alive ventilations (rescue breaths).

Medscape  ‘Naloxone for the Reversal of Opioid Adverse Effects’ http://www.medscape.com/viewarticle/441915_4 Read my moderated comment This link has timed out video copied here  https://youtu.be/PX0HQuaNS_I

‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
Part 1 https://youtu.be/aZ2SPcHUsvA  Case report Jake @7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oximetry 97%

 

Slide 19-20
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Slide 21-22

Response:  Common sense there is no evidence use Naloxone in cardiac arrest situation, heart not beating therefore no blood flow.  Patient has most likely suffered sever brain death.

Roberts, James R.  ‘InFocus: Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions’ EMN 2011; 33(10)16-18
http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

Quotes “Don’t confuse post- or pre–arrest toxicologic interventions with the actual cardiac arrest event” “This quote from the guidelines says it all: “There are (still) no data to support the use of specific antidotes in the setting of cardiac arrest” from any toxin.” ” Pharmacologic insults are just so massive and normal metabolism and physiology so deranged that no mere mortal can make a meaningful intervention. The seriously poisoned who maintain vital signs in the ED have the best, albeit never guaranteed, chance of rescue from a modicum of antidotes and intensive supportive care.”  “In a patient not in cardiac arrest and following ventilation and airway control, naloxone may be considered. Because it essentially reverses respiratory depression and coma, the ED part of the opioid code is about finished when the endotracheal tube is placed [Rescue breathing stops complications and keeps patient alive italics mine]”

Slide 22

Protocol increases mental and physical illness, drug use and abuse.  Loss of trust in medical profession, harm reduction and addictions councillors, dysfunctional society.

 

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Slide 23-24

Slide 24

What the heck “Don’t pay taxes!!”

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Slide 25-26

Rebecca E Giglio, Guohua Li and Charles J DiMaggio ‘Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis’ J. Urban Health 2003; Jun 80(2):291-301
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.”

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Slide 27-28

 

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Slide 29-30

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Slide 31-32

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Slide 33-34

Slide 33

‘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 34

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”

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Slide 35-36

Slide 36 nice list of breathing emergencies which mimic signs of drug OD

We should prevent
– Drowning
– Anaphylaxis
– Choking
– Snake Bites
– Hypothermia
– Cardiac arrest
Not treat it!

Response: The layperson is eagerly treating all the above with chest compressions.  Question Give chest compression’s only near drowned; Give EpiPen and chest compression’s;  Chest compression’s only choking; Give antivenin and chest compressions; Hypothermia and chest compression’s ad fin item breathing emergencies???

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Slide 37-38

Slide 37

breathing emergencies

Slide 38

Protocol is for a sudden witness cardiac arrest only See below letter from Heart & Stroke Foundation

Dr. Ewy (The world expert chest compression’s only) 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] NOT TO BE GIVEN TO CHILDREN.”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html 

Email from Dr. Ewy https://aliascpr.wordpress.com/2016/06/25/email-dr-gordon-awy/ 

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Slide 39-40

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Letter H&S Foundation 001

 

 

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Published by

@GaryCPR

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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