Information on Opioids

Everything you should know about opioids and the opioid overdose reversal medication, Naloxone.

What are opioids?

Opioids are a class of drugs that act on the nervous system to relieve pain and come in both illegal and legal forms. 

Heroin and synthetic opioids such as fentanyl and carfentanyl are illegal forms, while prescription opioids are legal to obtain with a doctor’s prescription.  

Prescription opioids include Morphine, Codeine, Hydrocodone (Vicodin), Hydromorphone, Meperidine (Demerol), Oxycodone (Oxycontin, Percocet, Roxicodone), along with many more. While these prescribed opioid pain relievers are generally safe when taken for a short time under a doctors supervision, they are too frequently misused. Regular use of these pain killers, even when prescribed by a doctor, can result in dependence. 

Why are opioids dangerous? 

Opiates are sedatives, designed to relieve pain, but in high doses, opiates decrease a person’s ability to breathe. Mixing an opiate with alcohol and/or benzodiazepines, can be fatal as these substances also contribute to decreased breathing. 

Fentanyl, a synthetic opioid 200 times more potent than morphine, is a major driver of recent opioid overdose deaths. Fentanyl is often mixed into other drugs such as heroin or counterfeit oxycodone pills and is responsible for at least half of the 64,000 deaths that occurred in 2016. 

How are opioids affecting our community?

The opioid epidemic was declared a national public health emergency in October of 2017. Accidental drug overdose is now the leading cause of death for Americans under 50, with more than three out of five overdose deaths involving an opioid. In 2016, drug overdoses killed roughly 64,000 people in the United States, with 917 taking place in CT alone. The CT Medical Examiner predicts that in 2017, the state of CT will surpass 1,100 fatal overdoses. 

What is Naloxone (also known as Narcan)?

              Naloxone, also known as Narcan, is the lifesaving opioid overdose reversal drug. It is a short acting medication that can reverse a lethal dosage of opioids by temporarily blocking the effects of the drug. This revives the person, allowing time to access medical attention. Narcan can be administered intramuscularly, and now, intra-nasally which is fairly simple to administer. The price of Narcan varies depending on the source, however, with insurance coverage, most customers end up paying a small co-pay between $10-$25. Naloxone is available to anyone who wants it, friends, neighbors, family members are encouraged to receive training and carry a kit.

Is Naloxone safe?

              Naloxone has little, to no side effects if administered in error. Naloxone is harmless because it will only function when an opioid is present within the body.

Where to get Naloxone:

              Naloxone is now available to everyone; the following pharmacies are certified to prescribe to those who ask. The pharmacist will review signs of an overdose and how to properly administer Naloxone on site at the pharmacy. Most insurances cover the medication for a small co-pay. 

 Map of Pharmacies Certified to Prescribe Naloxone:  https://opendatact.github.io/narcanmap/

FREE Narcan Availability: 

  • New Haven Syringe Exchange Program: Yale’s School of Medicine’s Community Health Care Van, a mobile medical clinic, provides primary care services along with a variety of others, including free Naloxone kits, substance abuse treatment, clean needles, and mental health services. The van travels around New Haven, aiming to reach the uninsured/under-insured populations. Patients are seen free of charge and no appointment is required. The van’s schedule is listed below.
  • Van Schedule:
    •  Monday: 8am-1pm, Ferry Street and Grand Avenue 
    • Wednesday: 8am-1pm, 580 Ella T Grasso Boulevard
    • Tuesday & Friday: 8am-1pm, 1308 Chapel Street
    • First and third Thursday of the month 9-10am, 210 State Street, Ferry Street and Grand Avenue 10:30am-1pm
  • AIDS Network: AIDS CT, located in Hartford, also distributes free naloxone. The program assists with co-pays and even helps people who would like to avoid obtaining Naloxone through their personal insurance. Contact Number: 860-247-2437

**NOTE: Yale’s Community Health Care Van has taken over the Nalxone Distribution program from New Haven’s Health Department ** 

Forms of Naloxone:

 Naloxone Nasal Spray is the version you will typically receive from a pharmacist or community distributer and comes in two forms, one which requires assembly.

 Watch the videos below to become familiar with the medication, to learn how to use the Nasal Spray’s and clarify any questions or concerns.

Good Samaritan Laws: You are protected

With the goal of saving lives, a law known as the Good Samaritan Act was passed in 2011 aiming to persuade those reluctant to contact emergency personnel when witnessing a drug overdose. The law protects individuals who reach out to authorities, giving them immunity despite the presence of illicit drugs or paraphernalia present on the scene. In 2014, the law was expanded to protect the individual administering Narcan from civil liability & criminal prosecution. 

For more information visit: http://www.ct.gov/dmhas/cwp/view.asp?a=2902&q=509650

Signs of an Overdose: CLLT- Check, Listen, Look, Touch

  • Check for deep sleep, shaking won’t wake you or minimal response
  • Listen for snoring that sounds like choking, gurgling, or snoring, stopped breathing or really slow breathing such as once every 5 seconds or less than 10 breaths per minute
  • Look for blue or gray face, lips or finger nails, pinpoint pupils
  • Touch for sweaty or clammy skin
  • Other evidence: known opioid user, track marks, syringes, pills or pill bottles, information from bystanders

How to Respond to An Overdose: 

Tip: Always call 911 before administering Naloxone so medical attention can be provided in a timely manner. An individual can overdose again, the effects of Naloxone wear off 30 to 90 minutes after administration.  

  • Try to rouse the person
  • Call their name & shake them: check for a pain response by rubbing up and down the persons sternum with your knuckles
  • If no response - Call 911: Provide as much information as possible including an exact location, if the person is breathing, or if they’re having trouble breathing. This makes the call a priority.
  • Start rescue breathing & administer naloxone:
  • Rescue Breathing: Head tilted back, chin lifted, pinch nose  Example:               
  • Look, listen and feel to see if chest rises/ falls
  • Give 2 normal size breaths and then 1 breath every 5 seconds
  • After a few quick breaths, administer naloxone (infographics below)
  • Continue rescue breathing until they respond to the naloxone or EMS arrives
  • If no response is seen within 2-3 minutes of Naloxone administration, give a second dose (all kits come with two doses)
  • Most people are dazed, confused, or wake up feeling sick, not realizing that they’ve overdosed
  • After administering Naloxone, place the person in recovery position (see "Steps for placing someone in recovery position" below)

Infographics- Visual aids on how to respond to an overdose 

Steps for placing someone in recovery postion: Click Here 

Visual Aid for Responding to an Overdose: Click here 

How to administer Naloxone, Assembly Required: Click Here 

How to administer Naloxone Nasal Spray: Click Here 

Reporting Use of a Naloxone Kit:

  • If you reverse an opioid overdose, congratulations! Report back to the agency who you received the kit from so you can receive another, OR email CORE@qvhd.org

Treatment for Substance Use Disorder

Substance Use Disorder is recognized as a chronic disease caused by a combination of behavioral, environmental and biological factors. Like cancer and diabetes, substance use disorder requires treatment. Providing support to people with substance use disorder is critical. Stigma, the negative perception commonly associated with addiction, often prevents people from seeking help. Receiving proper treatment can often be challenging, with a number of factors including your support system, knowledge of treatment options, insurance status, and fear of stigma, playing a part. Addiction is a treatable, chronic disease that can be managed successfully. Multiple evidence based approaches have been identified. Treatment should be easily obtainable for anyone who may want or need it.

  • Treatment Options Include:
    • Individual and group counseling
    • Inpatient and residential treatment
    • Intensive outpatient treatment
    • Partial hospital programs
    • Case or care management
    • Medication Assisted Treatment (Methadone, Buprenorphine) 
    • Recovery support services
    • 12-Step fellowship
    • Peer supports
  • Local Treatment Providers For Adolescents: 
    • Community Partners in Action Connecticut, Recovery IS Empowering (RISE) Program. 995 Sherman Avenue Hamden, CT 06514 Open Monday-Friday 8am-5pm. RISE is a residential therapeutic community for integrated substance abuse treatment for young men ages 12-18. 
    • The Children's Center of Hamden 1400 Whitney Avenue, Hamden CT, 06517 (203)-248-2116 Open Monday-Friday 8:30-5:00pm.  Wakeman Hall's Substance Abuse Treatment program provides outpatient treatment, intensive outpatient treatment and community based after care for teens 12-17 years old.
  • Local Treatment Providers for Adults 
    • The APT Foundation has multiple locations around New Haven. All Locations are accessible via CT Transit Bus system. Central Call Center Number: (203) 781-4600 Open: Monday – Friday 5am-3pm, Saturday 6am-3pm select locations. The APT foundation provides both outpatient and intensive outpatient treatment, primary health care, outpatient Medication Assisted Treatment, family counseling, mental health services and adult education/ vocational services to men and women 18 years of age and older. Admission is on a first come first serve basis, and they do have a sliding scale payment policy so money shouldn't be a barrier to treatment.
      • Orchard Hill Treatment Center- 540 Ella T Grasso Boulevard New Haven CT Intake: 203-781-2736
      • 1 Long Wharf Drive- New Haven – No Appt. Necessary;  
      • 495 Congress Ave- New Haven;
      • 352 State Street- North Haven; Intake: (203)-781-2736
      • 425 Grant Street- Bridgeport CT 
    • Chemical Abuse Services Agency (CASA) 426 East Street New Haven, CT 06511 (203)-495-7710. Provides Medication Assisted Treatment using methadone or buprenorphine, in addition to other behavioral health services to inner city, traditionally underserved populations. Services are provided in both English & Spanish. 
    • New Era Rehabilitation Center (NERC) 311 East Street New Haven, CT 06511 (203)-562-2101 offers a private, comprehensive substance abuse treatment facility that specializes in methadone maintenance. NERC also offers buprenorphine treatment (Medication Assisted Treatment), intensive outpatient counseling (IOP), among a number of support groups. You can walk in, no appointment necessary or book an appointment via their website here 
    • Cornell Scott Hill Health Center has a number of locations throughout Southern CT. They offer an array of treatment options for individuals seeking help for substance abuse issues including both inpatient and outpatients services. Services include inpatient detox, ambulatory detox, methadone maintenance, twelve step education (AA & NA meetings) and individual or group therapy. To book an appointment call, (203)-503-3000. Locations are listed below: 
      • 400 Columbus Avenue, New Haven
      • 226 Dixwell Avenue, New Haven
      • 122 Wilmot Road, New Haven
      • 60-62 Grant Street, New Haven
      • 232 Cedar Street, New Haven
      • 911-913 State Street, New Haven
      • 285 Main Street, West Haven
      • 121 Wakelee Avenue, Ansonia 

Safety Precautions

  • Talk to your doctor about alternatives to opiates
  • Take opioid prescription pain killers for the shortest length of time possible, and at the lowest dose
  • Understand the risks, especially the risk of addiction

Who is at risk?

  • Children/Adolescents/Adults who access unsecured medications
  • Teenagers experimenting/partying
  • Seniors prescribed multiple medications, who may have cognitive & other medical issues
  • Chronic pain patients on long term opioids
  • Medicaid patients prescribed more opioids
  • Young Adults (18-25) who use at higher rates

  A typical OD victim in CT in 2016 was a non-Hispanic white male between the ages of 30-59 who was using opioids, probably fentanyl/heroin & other substances. On the day he overdosed, so did two other people.

Overdose Risk Factors

  • Decreased tolerance: Regular use builds tolerance to the drug, discontinuing use decreases tolerance
  • Using alone
  • Mixing Opioids with benzodiazepines &/or alcohol
  • Quality/ Strength of the drug can be unpredictable
  • Other health issues: Asthma, liver and heart disease, malnourishment
  • Previous Overdose
  • Route of Administration: Intra-venous & smoking increases risk
  • Age: older age & longer drug history can result in more fatal ODs

Safe Storage & Disposal Tips 

  • Prevent any opportunity for abuse, NEVER share your medication, even with friends or family - 70% of opioid pain killer users do NOT know that sharing painkillers is a felony (National Safety Council, 2015) 
  • Clean out your medicine cabinet as often as possible and properly dispose of any left over or expired medication -Take advantage of national medication take back events that occur locally, typically the 3rd Saturday of April & October each year.
    • Safely dispose of unused drugs by dropping them off at local medication drop boxes, located in the lobby of most Police Stations, typically open 24 hours. OR Pick up an environmentally friendly Medication Disposal Pouch from Quinnipiack Valley Health Districts front lobby (limited supply). Neverflush medications down the toilet, they can cause water pollution and negatively affect the environment. 
    • Local Drop Boxes Include: Bethany Trooper Station, Hamden Police Station, New Haven Police Station, North Haven Police Station, & Woodbridge Police Station. No questions asked.
 **NOTE: Drop Boxes do NOT accept: Thermometers, hypodermic needled and sharps, bloody or infectious waste, hydrogen peroxide, non-prescription ointments and lotions, aerosol cans, or inhalers**

Misconceptions about Opioids

Children and teens often assume prescription drugs are safe because they are legal medications that parents are commonly seen using. However, prescribed medications are to be taken in proper doses by the person who received the prescription from their own doctor. Opiates do not work the same way for everyone and can lead to serious health problems or accidental deathOnly one in five Americans consider prescription pain medication to be a serious safety threat. (NSC, 2015)

 Hear from three Yale Medicine experts on other common misconceptions surrounding Opioid Use Disorder at the following link:3 Major Myths About Opioid Addiction 

Naloxone Training Opportunities

QVHD will continue to host training events within our four towns of Bethany, Hamden, North Haven and Woodbridge. We have already trained 58 members of our community to reverse an overdose and therefore, save a life. Everyone is encouraged to get trained. Stay tuned for upcoming training dates, follow our twitter account: @QVHD for the latest news. 

If you would like more information or to arrange an onsite Naloxone training, please contact Kara Sepulveda at (203)-248-4528 or KS@qvhd.org

What is QVHD doing to address the opioid epidemic?

The Quinnipiack Valley Health District is one of five health departments in Connecticut that has received a grant to prevent addiction. Working with Connecticut Department of Public Health and YNHH Emergency Department, the CDC opioid prevention grant is dedicated to reducing death by overdose, eliminating stigma, and increasing access to medication assisted treatment (MAT) for opioid use disorder.

Questions/Comments? Contact Kara Sepulveda at (203)-248-4528 or KS@qvhd.org or CORE@qvhd.org