Overdose Awareness Day Alert - August 2013
ATODA eBulletin - www.atoda.org.au

Drug and Alcohol Overdose is a significant health concern globally, nationally and in the ACT community.  To mark 2013 Overdose Awareness Day, ATODA, the Canberra Alliance for Harm Minimisation and Advocacy (CAHMA) and Families and Friends for Drug Law Reform have developed this alert to support stakeholders to connect with recent developments in the area.

About Overdose Awareness Day

Held each year on 31 August, Overdose Awareness Day aims to raise awareness of overdose and reduce the stigma of a drug-related death, especially for those mourning the loss of family and friends. It also spreads the message that the tragedy of overdose death is preventable.
International Overdose Awareness Day is organized by Anex in Australia with support from the Organising Committee. For more information on the day or to get involved visit overdoseday.com

What is an overdose?

An overdose means having too much of a drug and/or alcohol (or combination of these) for your body to be able to cope with. There are a number of signs and symptoms that show someone has overdosed, and these differ with the type of drug used. For more information visit the Overdose Day website or see the Alcohol and Drug Services' signs of alcohol overdose card.

ACT Annual Remembrance Ceremony: Spring 2013

Each year in spring people are invited to gather to remember those who have lost their lives to illicit drugs at a Remembrance Ceremony organised by Families and Friends for Drug Law Reform (FFDLR) at Weston Park. This Remembrance Ceremony is held in memory of those who have died from the use of illicit drugs and who remain loved as friends and family members.

FFDLR felt that a memorial would help break a silence of prejudice and ignorance that has left many to bear their grief in isolation and shame. Some felt anger at the lack of help and at the pressures to abandon those we loved. There were also strong feelings that the death of most if not all those for whom we mourn should have been avoided. They met their death not so much from any inherent danger of the drugs involved but from policies and practices that shrouded the composition of the drug and forced on many the life of an outcast.

The ceremony is attended by around 100 people each year – family members, friends, and concerned people from the community. Names of those to be remembered are read out. It is a very moving ceremony and appreciated by those who attend. It also helps raise awareness about the need for better drug policies.

Further information will be available soon from FFDLR

Support Services

The number to ring if you need an ambulance in any State or Territory is 000. In the ACT, police will not be called to a drug overdose unless there is a threat of violence or the caller specifically requests their attendance. For more information see AIVL's factsheet about calling an ambulance.

Canberra and the surrounding region also have a range of support services for all people affected by overdose. Details can be found in the ACT Alcohol Tobacco and Other Drug Services Directory. Some available services include:
  • Family Drug Support 24 hour support line can also be contacted 24 hours a day on 1300 368 186 or online here
  • Lifeline can also be contacted 24 hours a day on 13 11 14

ACT Opioid Overdose Prevention and Management Program: Expanding Naloxone Availability

Australia’s first overdose prevention and management program that provides naloxone on prescription to potential overdose victims has been developed and is being implemented in the ACT.  This important public health program has been driven by the Canberra Alliance for Harm Minimisation and Advocacy (CAHMA) and the multidisciplinary Implementing-Expanded Naloxone Availability in the ACT (I-ENAACT) Committee.

The program aims to:
  • Increase effectiveness of interventions in opioid overdose management;
  • Provide comprehensive overdose management training to potential overdose witnesses;
  • Provide Naloxone under prescription to potential overdose victims; and
  • Reduce opioid overdoses through overdose prevention education.
For more information: Visit the ATODA website, contact CAHMA on (02) 6279 1670 or email Nicole Wiggins on nicolew@cahma.org.au

The Naloxone Website was officially launched on 15 June 2013. Naloxoneinfo.org is a place for harm reduction service providers to find the tools and resources they need to get naloxone — the safe, cheap and highly-effective antidote to opioid overdose — into the hands of the people who need it most: drug users, their families, friends, and other laypeople like outreach workers and staff of harm reduction services.

Opiod Overdose Risk Factors and Response

Here are some examples of the type of information provided in opioid overdose training programs.

Risk factors for overdose include:  

Mixing drugs:
Especially benzodiazepines and/or alcohol. For example, benzodiazepines can increase the risk of non-fatal overdose by 28 times compared to times when people inject heroin without benzodiazepines on board; 3 times is the equivalent figure for alcohol. Most overdose deaths are a combination of 2 or more drugs. Studies vary on the rate but show 75% to 90% of fatal overdoses are a combination of central nervous system depressants i.e. opioids such as heroin mixed with benzo’s and/or alcohol.

Source: Dietze, P., Jolley, D., Fry, C., Bammer, G., (2005) Transient changes in behaviour lead to heroin overdose: Results from a case-crossover study of non-fatal overdose Addiction 100 (5), pp. 636-642

Many drugs continue to have an effect on the body long after they have been taken, even if the individual thinks the effects have worn off.  Some benzodiazepines remain in the bloodstream for days after being administration.  The most dangerous drugs to combine are ‘depressants’ as they slow down the breathing. These include heroin, benzos, opioids and alcohol. When a person combined them, the effect can result in overdose.

Source: Goodman-Gilman, A., (1992) Goodman and Gilman's the Pharmacological Basis of Therapeutics. McGraw-Hill, Singapore.

Changing tolerance
If a person has a recent period of not using or abstinence, such as being in a detoxification programs or has been in prison, their tolerance to opioids has decreased and therefore they are at greater chance of overdosing.

Sources: Seaman, S., Brettle, R., Gore, S., (1998) Mortality from overdose among injecting drug users recently released from prison: database linkage study. British Medical Journal. 7;316(7129):426-8.
Darke, S., Zador, D., (1996) Fatal heroin 'overdose': a review. Addiction 91, 1765-1772.

Using alone
People who use drugs on their own don’t have anyone around to help them if they overdose. Many fatal overdoses occur because no-one was around to respond by ringing an ambulance, administering CPR and naloxone (if it is available).

Source: Darke, S., Zador, D., (1996) Fatal heroin 'overdose'. Addiction 91, 1765-1772

Route of administration
People who inject heroin are 16 times more likely to overdose than if they use via other routes. This is because injecting directly into the bloodstream means that the drug acts on the Central Nervous System more quickly.  

Source: Brugal, M.T., Barrio, G., De, L.F., Regidor, E., Royuela, L., Suelves, J.M., (2002) Factors associated with non-fatal heroin overdose: assessing the effect of frequency and route of heroin administration. Addiction 97, 319-327.  

Strength/amount/patterns of use
Overdose risk is also dependent on the amount and strength of the drug used, i.e. the higher the dose, the greater the risk.

Sources: Dietze, P., Jolley, D., Fry, C., Bammer, G., (2005) Transient changes in behaviour lead to heroin overdose: Results from a case-crossover study of non-fatal overdose Addiction 100 (5), pp. 636-642

General health
Fatal overdose is also linked to general health. Those in poor health are more likely to overdose than those with good physical health.

Source: Darke, S., Kaye, S., Duflou, J., (2006) Systemic disease among cases of fatal opioid toxicity. Addiction 101, 1299-1305.

What to look for

The following symptoms may be displayed if a person is experiencing an overdose:
  • Noisy breathing or snoring sounds;
  • Depressed or no breathing;
  • Turning blue (especially the lips);
  • Unresponsive.
What to do

If you suspect someone may be overdosing, it is important to act quickly. A fast response can be the difference between life and death. Call their name, squeeze their ear lobe, if you don’t get a response, call an ambulance immediately.

Further Information

CAHMA is keen to work in collaboration with the ATOD and community sector in making this program a success. Self or agency referrals can be accepted, and options to deliver the training in a range of settings are being further explored. CAHMA can meet with staff to discuss delivering the training at your agency or delivering a specific, tailored program for your client group.  Contact CAHMA for more details or to arrange a meeting.

For more information download the Overdose Prevention and Management Program flyer, or to provide a referral, contact CAHMA on (02) 6279 1670 or email Nicole Wiggins on nicolew@cahma.org.au.

Overdose deaths pass national road toll for first time
Herald Sun, 27 August 2013
A surge in accidental and prescription medicine overdoses has seen drug overdoses, exclusive Australian Bureau of Statistics figures reveal.
For more information: See the article
Our culture of drug denial is a matter of life and death
Canberra Times, 24 August 2013
‘We need to lose the stigma that still surrounds mental health problems such as depression, anxiety and sleeping disorders and the medications that help. The fact is there is a real chance we could die if we don’t’.
For more information: See the article
Warning on spike in synthetic drug overdose
Canberra Times, 27 August 2013
Canberra’s illicit drug users are increasingly ordering exotic products online, leaving doctors unsure how to treat suspected overdoses.
For more information: See the article

Contact ATODA:

Phone: (02) 6255 4070
Fax: (02) 6255 4649
Email: info@atoda.org.au
Mail: PO Box 7187,
Watson ACT 2602
Visit: 350 Antill St. Watson

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The Alcohol Tobacco and Other Drug Association ACT (ATODA) is the peak body representing the non-government and government alcohol, tobacco and other drug (ATOD) sector in the Australian Capital Territory (ACT). ATODA seeks to promote health through the prevention and reduction of the harms associated with ATOD. 

Views expressed in the ACT ATOD Sector eBulletin do not necessarily reflect the opinion of the Alcohol Tobacco and Other Drug Association ACT. Not all third-party events or information included in the eBulletin are endorsed by the ACT ATOD Sector or the Alcohol Tobacco and Other Drug Association ACT. No responsibility is accepted by the Alcohol Tobacco and Other Drug Association ACT or the editor for the accuracy of information contained in the eBulletin or the consequences of any person relying upon such information. To contact us please email ebulletin@atoda.org.au or call (02) 6255 4070.