 Hello, everyone. I see you all trickling into the Zoom room. So we're going to give you all a chance to do that. While you are all joining, I just want to thank everyone so much for joining this important webinar today, where we are strongly encouraging all nightlife venues, staff and patrons to get this free overdose prevention training and to make sure that there are Narcan kits behind every bar. For those of you who don't know, I'm Ariel Palitz. I'm the executive director for the office of nightlife. We are a dedicated non enforcement liaison between the city and the nightlife industry and community. In addition to our focus on safety and harm reduction, we also work to support the nightlife businesses by navigating you through city bureaucracy, improving quality of life issues and relationships with residents and work to promote and preserve nightlife culture and economy. So if you are experiencing any issues with the city, a neighbor next door, please never hesitate to reach out to us. I believe our. Email is not on this fun card, but it's super easy nightlife at media.nyc.gov. So now the purposes of this webinar today is to bring you resources and training as part of the city's harm reduction efforts to combat the growing opioid overdose epidemic. As you all likely know, there is an overdose crisis in New York and the unintended presence of fentanyl in the drug supply continues to drive these overdose deaths. In just the first nine months of this year, there were over 1950 overdose deaths in New York. That is literally an overdose every three hours. Now we know the stigma of substance abuse, substance use in nightlife can be particularly challenging, but the fentanyl crisis is not an issue exclusive to nightlife. Substances may be present in a variety of work settings and gathering places. It's not just in nightlife. The fact is, is that more than two thirds of overdoses happen in private homes and less than 1% of overdoses happen in venues. But regardless, when it does, you need to be prepared like you already are for any emergency. Like you, the safety and well-being of the nightlife community is a top priority for the office of nightlife, which is why we created the Narcan Behind Every Bar initiative with our partners at the Department of Health to help provide venue staff security with this free life-saving training and to get you the free overdose kits. Because we know that venues are places where people look out and protect each other, look out for and protect each other. So we see that the venues and the staff and the patrons as our partners. And so this is really what we're doing here today. Every venue and promoter is encouraged to have at least a few doses of Narcan on hand behind the bar in the kitchen, in the office, just in case of a suspected overdose. Many of you probably know that it just has to be a suspected overdose. Whether someone is having an overdose or not, you are able to administer the Narcan dose, and it would not have an adverse effect. Having these kits are much like having a CPR kit or a first aid kit or like the free condoms that the city provides. It's another harm reduction tool. And it's there to help save lives. But before we get to the training. I'm very excited to have a special guest with us here today, our partner. I want to introduce my friend, my colleague. City who's in the city council, council member, he's been a strong partner with for us and advocate on this issue. He recently wrote a bill that will become law this week to codify this program and ensure that we can continue our work to get you naloxone training and free kits to nightlife venues. So I want to thank Chi and his colleagues at the city council for their partnership and commitment to addressing this crisis with us. We look forward to implementing this legislation. Everyone, please welcome a huge nightlife advocate, former promoter. Council member. Thank you so much. Ariel and good afternoon, everyone on this call. Again, I'm city council member Chi. Oh, say, and I represent the 36 districts, which includes the neighborhoods of Bed Stuy and northern crown Heights in Brooklyn. I just want to give all my thanks, not only to the department of health and mental hygiene and the office of nightlife, but Ariel for all of us. She brings to this job every single day and the amazing creation of the Narcan behind every bar program without Ariel. I don't think this bill would even exist. You know, you really set the standard for what harm reduction should look like here in New York City. And this is one of the, you know, first of its kind in the country. That is, is, is going into, law in a major city that is, is approaching overdoses and harm reduction in a, in a non-carceral way. So I want to give you all the thanks and to everyone on this call that that made this program happen. Because now tomorrow we are finally signing this bill into law with the mayor. I know many of you may know a little bit about the program. And we'll learn more about it on this call, but the fact that we'll be able to, you know, codify this law in this program that has been running successful in the city for some time now is so important because we'll know that the funding will be there, that the access will be there, that the training will be there for all of our nightlife establishments that want to opt into this program. So I'm so excited to be part of this program. And New Yorkers that care about how important and influential nightlife is and also how important the comeback of nightlife in this industry is in a post-pandemic world. And the fact that we are working as partners in governments through agencies and through the council and making sure that people can party safe and making sure that businesses stay open. So I'm so proud and honored to be a part of this team to help make these businesses, make these businesses, make these businesses very safe and making sure that businesses stay open and protecting their patrons is just such a proud feat, not only of mine, but all of us that are working for, say for New York city. So thank you so much for having me here this afternoon. Thank you so much for letting me be the vessel that, that can make this wonderful program go into law. this law so that we can make this city a safer city. Thank you so much. Thank you so much, Council Member. I appreciate everything you said and everything you do, and we have so much work to do, and this is just one really big important step and continued commitment to work together to continue to support this amazing industry that gives so much to our city. Now with that said, we can start with this training so that you can learn how to become a certified opioid overdose responder and receive a free kit. This training will be conducted by our colleague. Oh, and there goes Mao of my talking points. Oh, I'm so sorry. That was me. I'm sorry. That's okay. Yeah, there you go. No, that's fine. I just wanted to properly introduce you. So this training will be conducted by my colleague at the Department of Health, Herbert Quinones. Thank you, Sheryl. Overdose Prevention Trainer. And I just wanted everyone to know if you have questions, you can put them in the Q&A feature in the Zoom and we will be addressing everyone's questions after the presentation, perhaps even throughout. And we are also recording this. We will be sharing it in our newsletter, on our social. You can share it with your staff and share it with anyone who needs this important information. So take it away, Herbert. Thank you so much. All right, so I can go ahead and share the slides now. Yes, please do. Okay, all right. All right, good afternoon, everyone. Thank you all so much for taking time out of your busy schedules. And so thank you, Ariel and thank you, Councilperson. And I'm gonna go off screen because I am no Denzel Washington. So folks, let's do this, please. If you get a chance to grab something to write with and something to write on or access your notes app because there are a couple of things that are not in the slides that I do wanna share with you, okay? All right, so. So folks, just to be clear, we are gonna be talking about substance use. And so as the representative of the New York City Department of Health and Mental Hygiene, please know that our top priority is your physical and emotional wellbeing. So in the context of talking about opioid use, specifically street opioids and also be mindful of all the challenges that are happening in our city with the migrant crisis and the issues of public safety. Folks, please know that we offer this training three times a month every month. You can reach out directly to Ariel for our links for the training because today is not a good day for whatever reason. Today is not a good day. Please know it's not the only day, all right? And once again, your physical and emotional wellbeing are our top priority. Okay, so folks, we're gonna look at some data and then hopefully that'll go quickly and painlessly. I am not a data person, but folks, what I love about data is it answers the question, why are we here, okay? And then we'll look at a relationship between this medication called naloxone. Some of you may have heard of it as Narcan and we'll talk about what the difference is between naloxone and Narcan and its relationship to an opioid overdose. And then we'll get into the meat and potatoes. Ooh, oh my goodness, all right. What did I do? I'm sorry, I'm sorry, I'm sorry. Okay, hold on, Herbert. Okay, okay, sorry about that, folks. Let's see, what did I do wrong? Okay, I don't see, does anybody see the PowerPoint slides or? No, we don't see it, but I think Francesca and Jose can help you technically. Okay, I think I may have accidentally closed it. Okay, I'm so sorry, folks. All right, hold on, hold on, hold on. And here we go, Office of Nightlife. Okay, all right. Hey, what's the training without some technical issues, right, everybody? Okay. It's all good, we're all used to this by now, that's for sure. All right, cool, cool, cool, cool. And slide show from the beginning and here we go. All right, so we did that. All right, and then we'll talk about, right, how to respond to an opioid overdose and then we'll share with you a link for requesting that naloxone be mailed to your either place of business or your private residence. All right, so folks, for the purpose of our presentation today, when we talk about opioids, we're defining them as pain relievers, which includes- We don't see your presentation yet. I don't know. Okay, hold on, hold on, hold on. If you want, you can also share it via email to Jose and then- Hold on, yeah. Wow, wow, wow, wow, wow, all right. Let's see, let's do this and let's do that and how about now? I see key terms. Yes, all right. But there's no key terms. There they are. Okay, rock and roll. Okay, thank you so much. Teamwork makes the dream work, everybody. Yes. So yes, for the purpose of our presentation, we're defining opioids as pain relievers, which as you know, includes prescription painkillers, for example, oxycontin, but our focus will be on street opioids, such as heroin and fentanyl. And for our purposes, we're defining fentanyl as a highly potent, fast-acting opioid. And folks, at the end of the day, we want to encourage everyone to consider having Narcan behind every bar. And so we also use the term naloxone. Now, what's the difference between Narcan and naloxone, Herbert? Folks, marketing 101. Narcan is the brand name and naloxone is a generic name. Folks, for the purposes of our presentation, we always try to use the terms interchangeably. So you become more and more comfortable with the concept that naloxone and Narcan are the exact same medication. And folks, it's a medication that only activates if opioids have been consumed. So a few minutes ago, I asked you all to reach for something to write with and something to write on or your notes app. And here's why. Please write down the following. Mato, M-O-T-T-O number one. Mato number one. So here's a scenario, folks. Some of you might be saying to yourself, but Herbert, what if I don't know what the person took? And this is what Mato number one addresses, folks. This is what I would like for you to write down. When in doubt, when in doubt administer the Narcan, when in doubt administer the naloxone, because once again, folks, if the person who's experiencing the medical emergency did not repeat, did not, one more time, did not consume opioids, we will cause no harm, okay? So when in doubt administer the Narcan, when in doubt administer the naloxone. So real quick, folks, some data for us. Here's the bottom line, folks. In 2020, we lost an average of four New Yorkers every day, right? So we lost someone every five hours. I believe Ariel has the most recent data. So that's down now to three hours. So three into 24 goes what? What, five? No, about six, seven, right? Seven folks a day, right? No, eight, right? Three into 24 goes eight, right? So folks, we lost an average of eight folks every day in 2020 or 2021, okay? And so thank you again for taking time out of your busy schedules and consider carrying naloxone at your establishment. So real quick, folks, here's the main takeaway. You'll notice that the shade of blue is pretty much pervasive throughout the entire city. And that's the point, folks. No matter where you work, where you live, or where you play, folks, accidental fatal overdoses are occurring citywide. Real quick, just to point that the areas that are darker colored shades of blue, these are neighborhoods that have historically struggled with issues of poverty and substance use. Some of them we all are familiar with, such as the South Bronx, which would be Hunts Point, Modhaven, places like East Harlem, also known as El Barrio or Spanish Harlem, and parts of Northern Staten Island. But again, the main takeaway, particularly for our colleagues in nightlife, we all know that nightlife exists throughout the city. And of course, again, to reminder that no matter where you work, live, or play, accidental fatal overdoses are occurring citywide. Folks, just for clarification purposes, this is not Long Island. It's Far Rockaway, which is a part of Queens. So here's where we are, folks. Let me move this, okay. Heroin or fentanyl were involved in nearly all opioid overdoses in 2020. So what does this mean, folks? Out of 85%, right? Of folks who had consumed an opioid, they consumed any opioid, which of course begs the question, well, Herbert, which ones? And if you look at line number two, the predominant opioids were heroin or fentanyl. Real quick, folks, these numbers will never equal 100 because of a term now used. It's called polyuse. The old school term was mixing drugs. And so we know that the average consumer of product from the street or the internet tends to consume more than one product. So a person may consume cocaine and heroin, for example. So, right? Everybody join me here at the bottom. 77% of drug overdose deaths involve the consumption of fentanyl in 2020. And so that makes fentanyl the most common substance involved in drug overdose fatalities. So here we go, folks. There's technically two types of fentanyl, everybody. The fentanyl we're finding in street drugs, we classify as non-pharmaceutical fentanyl, which if you'll indulge the slang term, it's bootleg, counterfeit fentanyl, manufactured by the cartels, not a pharmaceutical company. Sabia, who's that? Did you know that fentanyl can be prescribed by a doctor for something like chronic pain, okay? And so, folks, we're gonna make that distinction and I'm gonna emphasize that in a quick second. So fentanyl, 5,200 times stronger than morphine and 30 to 50 times stronger than heroin, right? So again, the fentanyl we're finding in street drugs, we classify as non-pharmaceutical fentanyl. And you'll notice here it says not patches or lollipops and this goes back to my comment about fentanyl being able to be prescribed by a doctor. So, of course, we know that if a doctor prescribes fentanyl, let's say for something like chronic pain, right? The patient has to go to the pharmacy and when the pharmacist fills that prescription, they hand over the fentanyl as everybody, a patch or a lollipop. You'll notice the word not. Again, to identify that this is not, not not the fentanyl we're finding in street drugs, okay? The fentanyl we're finding in street drug, once again, we classify as non-pharmaceutical fentanyl. Now, in the spirit of transparency, everyone, we know that the fentanyl patch can be misused, but once again, the majority of folks who are encountering fentanyl are encountering it through the purchase of street drugs. So now, folks, we're finding that fentanyl is being mixed into heroin, fentanyl is being mixed into cocaine with a powder or a crack and therein lies a wrinkled, excuse me, because cocaine, everybody is not an opioid. Cocaine is a stimulant. Cocaine comes from the coca leaf and we know that opioid comes from the poppy plant. So consequently, here's a scenario for you, right? A person consumes cocaine and cocaine only, they'll think that they don't need naloxone because naloxone only activates when what has been consumed, everybody, opioids. And once again, cocaine is not an opioid and herein lies the wrinkle, folks, people who consume cocaine, we need to inform them that they need to be aware that their product, whether powder cocaine or crack cocaine can be mixed with what, everybody? Fentanyl, fentanyl, fentanyl. Counterfeit pills, folks, we define those as pills that, again, are purchased on the street or the internet where we don't know their source. So we now find that these pills sold on the street or the internet, in some cases are mixed with what, everybody, fentanyl. We're also finding it in ketamine, methamphetamine. So obviously the main takeaway is anyone that consumes product from the street or the internet needs to be mindful that their product could be mixed with what, everybody, fentanyl, fentanyl, fentanyl. Real quick, everybody, no risk of overdosing from just touching fentanyl. Real quick, folks, so after this training, I'm going to share these slides with my colleagues over at the Office of Nightlife, Jose and Ariel, and I'm missing someone else, but I love you anyway. So folks, you're gonna get a copy of these slides and please consider checking out these references. The American College of Medical Toxicology and the American Academy of Clinical Toxicology, it addresses accidental and occupational and exposure to fentanyl, okay? Because we know there's a lot of information in our case for the Department of Health, a lot of misinformation regarding exposure to fentanyl, such as touching it does not lead to an overdose. Any questions so far? Please pose them in the Q&A portal. Any questions so far? Okay, let me check real quick, nothing, nothing. So remember, folks, if you have a question, please feel free to pose it in the Q&A portal and I'll be checking in with you periodically, okay? All right, so folks, let's be clear though that opioids do have medical value, right? If anybody out there like me has had surgery, you may have been given an opioid derivative to manage your post-surgical discomfort, right? So opioids connect to the receptors in the brain, right? And again, opioids do have value, right? They relieve pain, they relieve withdrawal symptoms, they produce feelings of happiness and physical comfort, but they have side effects, right? Constipation, nausea, folks, a lot of time you might hear the slang term nodding, oh, look at person X over there in the corner, they're nodding. What people really mean, folks, is that opioids cause drowsiness and if a person consumes too many opioids, okay? Opioids can lead to what we call respiratory depression. So in this case, hypothetically, let's say person X here is overdosing. We define an overdose as a person consuming more product than their body can handle, right? So again, person X here is overdosing and here's what happens in the brain. So the person consumes more opioids than their body can handle. So the brain sends a message to the lungs, hey, stop breathing, respiratory depression, right? The lungs send a message to the heart, hey, we're not gonna send you any more oxygen. And we all know that after a certain period of time, the heart will stop if it does not receive enough oxygen. And folks, that's what leads to an accidental fatal overdose. Everybody, please join me here on top. The process of an overdose can happen over the course of minutes to hours. And it is this window, everybody, that gives us an opportunity to save someone's life by administering a lock zone or by calling for an ambulance in time. So folks, one of the things we wanna do is plant a seed regarding our language around substance use. I suspect many of you may have already started reading the terms on the left. And a lot of these terms are still very common, right? You still hear people use the word attic or junkie, doping folks, tecato and tecata are Spanish pejoratives, which basically mean junkie and doping, right? So you still hear people say, yeah, well, my cousin Herb is a doping tecato, he's just gotta get clean, right? Or he's just gotta stop doing drugs and getting high. What we realize folks that these terms create a barrier for people who consume. So consequently, we would like to advocate gently, of course, that people consider using the terms on the right. These are more compassionate person-centered terms. So in other words, instead of saying, yeah, well, you know, a lot of the people that come to my club, I know they're a bunch of junkies and doping, consider saying, I know a lot of my patrons, maybe people who use drugs or people living with a substance use disorder. And again, the whole idea here is that these terms are more person-centered and compassionate and may create a dynamic where a person who consumes may wanna talk with you about their consumption and I'm gonna tease that out momentarily. Okay, let me check for questions again. Nothing, nothing, nothing. Okay, once again, folks, feel free to pose your questions in the Q&A portal. Thank you. All right, so folks, once again, if you order naloxone, you'll be receiving the nasal spray formulation, but we, the New York City Department of Health and Mental Hygiene work with some organizations who prefer the intramuscular formulation, which is administered via syringe. But again, folks, you will be receiving if you order naloxone from us, you'll be receiving the nasal spray formulation. And remember, folks, naloxone only works on white drugs, only opioids. So remember our motto from earlier, right? Hey, I don't know what the person took, Herbert. My toe number one says, what everybody went in doubt administered the Narcan, went in doubt administered the naloxone. Because once again, folks, if the person, if the patron experiencing the medical emergency did not repeat, did not consume an opioid, Narcan, naloxone will not activate, and thus we will cause no harm, okay? Folks, I see two questions in Q&A. Let me check those out real quick. All right, Michael, what are the early signs of an opioid overdose? Michael, hold that thought. We're gonna cover symptoms. Laura may have missed it, how do we place the order? Okay, don't worry about that, Laura. You're actually early. We're gonna talk about accessing naloxone before we end. Okay, excellent questions, everybody. So once again, Michael, hold that thought and Laura, hold that thought, okay? Nice, nice, nice, nice. All right, so how does naloxone work, right? So remember earlier, we defined an overdose as a person consuming more opioids than their body can handle. So let's assume person X here is overdosing and we're gonna administer everybody the nasal spray formulation, which means it goes where everybody? That's right, in the nose, right? So folks, naloxone activates within two minutes. Again, if opioids are present and folks, watch the screen carefully, please. Watch the screen carefully. Within two minutes of administering naloxone, watch what happens. Did you see that? Right, the naloxone bumps the opioids off of the receptors, prompting the person to start breathing. Folks, the key issue when someone is overdosing from opioids is to get them to start breathing. That's our main objective, okay? So once again, naloxone bumps the opioids off of the receptors, prompting the person to start breathing. Now, question for the class, did the opioids disappear? No, they did not. So again, everybody join me on the left-hand side, please. Join me here on the left-hand side. Naloxone stays in the body for 30 to 90 minutes, okay? Blocking the opioids from reconnecting with the receptors because yes, I know what some of you are thinking. Herbert, does this mean that after the naloxone wears off, a person can experience another overdose? And the answer is everybody, all together now, yes. But remember, naloxone stays in the body for 30 to 90 minutes. That should hopefully be enough time for the individual to receive medical attention. Okay, so here we go, folks. All right, so please keep in mind that despite the fact that many of us COVID exhausted, COVID is not done with us, so please consider washing your hands or using an alcohol-based hand sanitizer before and after responding. And once again, folks, we will be sharing these slides with you, okay? All right, so respiratory depression, right? Opioids affect breathing. So breathing will be some of our predominant symptoms, right? So the person will have stopped breathing or slow to the point where it seems like they've stopped. They will be unresponsive and, folks, physically, our lips and fingernails change colors if we're not receiving enough oxygen. However, you may also hear some snoring sound or gurgling, folks, gurgling as in gasping for air, not gargling as in mouthwash, gurgling as in gasping for air. And if the person consumed a product that contains fentanyl, you may notice some muscle stiffness or rigidity. But, folks, this training is designed for folks like us, non-medical professionals, so we focus on the top three symptoms, not breathing, not responding, and lips and fingernails change colors. So, folks, here we go. I'm gonna come online for this part to animate it, all right? So let's talk about this, right? So you have Narcan behind the bar, right? And someone comes up to you and say, hey, someone in the bathroom is experiencing a medical emergency, right? Okay, the first thing we want you to do, okay, is to shout at the person. Why? If you shout at someone, right? If you shout at me and I wake up, yo, why are you yelling? Am I overdosing? Ah, keep that thought in mind. Keep that thought in mind, right? So the first thing we want you to do is to shout, again, to provoke a response, okay? Now, here's where it gets a bit more challenging. If the person doesn't respond to the shouting, folks, inside the Narcan kit, inside the Naloxone kit are a pair of latex gloves, okay? Everybody, if you feel comfortable, make a fist for me. So in this instance, right? After you do the shouting to provoke a response and there is no response, you would put on the Naloxone kit glove and folks, using these knuckles that we knock on a door with, right? The knuckles we knock on a door with, grind the middle of your chest as hard as you feel comfortable, all right? You should feel something and that's the point. Folks, the middle of the chest is called the sternum. Everybody, check out the diagram to your right, please. So this is you conducting the sternum. This is you conducting the sternum rub, right? With the knuckles that you're not gonna do it with, you press on that sternum and you rub it as hard as you can up and down, again, to provoke a response, all right? Folks, here, of course, you would put on your Naloxone kit gloves, all right? So the sternum rub is located in the middle of the chest, also known as the breastbone, okay? So first we shout and then we rub. First we shout and then we rub. If the person does not respond to the shouting or the rubbing, please consider that a medical emergency and it's time to, hold on a second, right? So folks, regarding someone responding, right? If someone responds to the shouting or the sternum rub, even verbally, try to keep them alert and monitor closely, right? Because an overdose is still possible, but you do not administer the Naloxone. You keep the Naloxone nearby, okay? Because someone, everybody joined me here on top, someone might be high and we define high as feeling the effects of their opioids, but not yet overdosing, okay? So once again, you keep the Naloxone nearby, right? You do not administrate and if you can, stay with them or have someone on your staff, stay with them, okay? Until an ambulance, we were still encouraging to call for an ambulance, right? Folks, this is my favorite part of the training, okay? When in doubt, call for medical assistance, okay? So folks, let's deconstruct what we just talked about, right? Because that was a lot, right? So think about this, right? In New York City, shouting out a stranger, right? Really Herbert, in light of all the craziness, but now, mind you, this is someone inside your establishment, okay? So yes, first we want you to shout to provoke or respond, right? Because if they respond while you're yelling at me, they're not overdosing, right? We just wanna monitor them, okay? If you feel comfortable, still call for an ambulance just to play it safe, all right? So here's what I, right? And then if they don't respond to the shouting, right? Think about this, right? We're gonna take our fists and grind it into their chest to save a life. So we understand everybody that that's a lot to ask, right? I'm sure some of you are sitting there going, I know my staff ain't gonna do all that, which is okay because folks, here's the secret. Technically you don't need naloxone to save a life. What Herbert, what are you talking about? Folks, calling for an ambulance can be just as effective, okay? As administering naloxone. So if you're sitting there and you're saying, I don't know if my staff will feel comfortable, do know that you can just call for an ambulance because everybody, there's a script for that, right? There's a script that we want you to follow when calling for an ambulance, all right? But once again, if you do have naloxone behind the bar, first you shout, no response, then we do the sternum rub. If they don't respond to the shouting and the rubbing, then we call officially for an ambulance. And here we go, folks. First of all, don't say overdose, okay? Because we're not medical professionals and technically we don't know, right? What you do say is your location. Hey, I'm at Herb's Lounge, right? At the 1313 Mockingbird Lane and this person is not breathing, right? Their lips and fingers are changing colors and they're not responding. You give your location and the symptoms, okay? Again, we encourage you not to say overdose because we're not medical professionals, all right? Just give the dispatcher the address, right? The location and then the symptoms. The person is not breathing, they're turning colors and they're unconscious or unresponsive, right? Folks, reasons to call for 911 for a medical assistance and may not be an overdose, right? People can stop breathing because of a heart attack. How about preexisting conditions and an overdose, right? Potential medical complications. And lastly, folks, sometimes if a person's been consuming a lot of opioids, they may require more than the two doses of naloxone that come in a kit, all right? And we all know that an ambulance carries a lot of doses of naloxone, all right? Okay, so here we go, folks, right? So first we shout, no response. Then we did the sternum rub, no response. We call for an ambulance. Do we say overdose? No, we do not. What do we say? We give the location, right? Herbs lounge, 1313 Mockingbird Lane and the symptoms. Hey, this person's not breathing. Their lips and fingernails are changing colors and they're unresponsive. Once you hang up with the dispatcher, it's time to administer the naloxone, right? Folks, inside the kit are two doses of naloxone, okay? We start off with one dose. Folks, front of the blister pack and back of the blister pack. And there in the back is a little tab. Do you see that little tab right here? Okay, so we peel that, peel that back, right? Everybody, peace fingers, everybody, show me your peace fingers, right? Those peace fingers go at the base of the nasal spray. Okay, keep the thumb away from the plunger, insert the nozzle inside the person's nostrils and we press the plunger one time and it releases the entire dose. One dose, one nostril, one nostril, one dose, okay? So everybody, let's review. We peel, we place and we press, right? Peel the back of the blister pack, place the nozzle inside the person's nose and press the plunger one time, okay? Folks, let's do this all together. At the count of three, right? We're gonna say peel, place and press. At the count of three, one, two, three. We peel, we place and we press. How many times do we press the plunger? Just once. How long it take the locks on to be effective? Two minutes and we save a life and we save a life and we save a life, okay? All right, everybody, join me at step four. I'm gonna go off camera now. So if after two minutes the person does not wake up, you give a second dose and how do we do that, everybody? Remember at the count of three, let's say peel, place and press. One, two, three. We peel, we place and we press. How many times we press the plunger? Just once. How long it take the locks on to be effective? Two minutes. Now folks, I know what some of you were thinking. Herbert, do I place the other dose in the opposite nostril? Folks, if you remember, yes. But we don't want folks getting flustered and go, oh, did I do the left nostril or the right? The goal, folks, to get that naloxone inside that nose, okay? But yes, if you administer a second dose, it would be ideal if that second dose went in the opposite nostril. But the key point here is to get that naloxone inside the person's nose, okay? All right. Okay, so the person becomes responsive, folks. Here we go. They might be confused or afraid because everyone, keep in mind, please, that the consumer does not know that they overdosed. The last thing they remember was consuming their opioid of choice, okay? So if you feel comfortable, have your staff introduce themselves. Hey, my name is Herbert. Hey, you were overdosing. I gave you naloxone, okay? And I called for an ambulance, okay? So you explain to them what happened. Now, folks, keep in mind that opioids, right? That naloxone reverses the effect of opioids. Sometimes an individual may go into what we call withdrawal, right? They're no longer feeling the effects of their opioids, and that can be very uncomfortable. Consequently, the person may say, hey, thank you for saving my life, but I don't feel well, I'm going to consume again. At that point, it might be a good to remind them person that, hey, naloxone wears off in 30 to 90 minutes, which means if you consume, right? If the consumer consumes opioids within this window, they're not going to feel anything because once again, the naloxone is still active, okay? All right. So let me come back online, folks, okay? So here's a scenario, right? I'm bartending at your place, and someone comes up, say, hey, there's somebody, something's happening in the bathroom, right? I go in and I notice that the person's lips and fingernails are discolored because that I can proudly observe from about six feet away, right? What's the first thing we want you to do? Shout, hey, wake up, hey, are you all right? Hey, I got naloxone, hey, I'm going to call Why are we shouting to provoke a response, right? In this context, folks, they do not respond to the shouting. The next thing I do is I go into the naloxone kit, which I should carry with me into the bathroom, right? And I put on my non-lake text gloves and I do the sternum rub again to provoke a response, okay? In this context, the person does not respond to the shouting or the rubbing. What's the next thing we should do? Call for an ambulance. Do we say overdose? No, we should not do so because we're not medical professionals. There's two things we should do. The location, hey, I'm at Herb's Lounge, 1313 Mockingbird Lane and give the symptoms. The person's not breathing, they're not responding and their lips and fingernails are changing colors, right? So ambulance is en route and I administer my first dose in the naloxone. How do we do that, everybody? Remember, peel, place and press. How many times do I press the plunger just once? How long it take naloxone to be effective? Two minutes, no response. That's okay because that's when I remember two doses coming to kit. I start off with one dose, right? I administer that, two minutes later, there's no response. I administer the second dose. And how do we do that, everybody? Remember the three Ps, we peel, we place and we press. Ideally at the opposite nostril, yes. And how many times do we press the plunger just once? How long it take naloxone to be effective? Two minutes, three minutes, four minutes. Oh my goodness, no response. And the ambulance has not arrived yet. Folks, here's the deal. If your staff, no CPR, now, now, now would be the time to administer CPR, okay? If your staff does not know CPR, that's okay. You don't have to mandate them to go to a training, okay? Because inside the kit, folks, is a white envelope and inside that envelope is a rescue breathing shield. Okay, right? This shield goes over the victim's face and the responder, right? In this case, I'm responding at your establishment. I breathe through the white filter, okay? And I make sure I pinch the nose on the outside to make sure that what I breathe in the filter goes inside the person's lungs. Everybody look at the diagram on the right please as I go off camera, okay? So this is the responder, right? The rescue breathing shield is between them and the victim. The responder blows through the filter and pinches the nose on the outside of the shield to ensure that what they breathe in the filter goes in the person's lungs, okay? Folks, just do regular breaths. Just start off with two regular breaths, wait five seconds and if the person doesn't start breathing then one breath every five seconds until they start breathing or EMS arrives, okay? If the person does start to breathe before EMS arrives, if possible, right? If physically capable, have your responders put them on their side in what we call the recovery position. That would be the head nestled on the interior elbow with the exterior elbow and exterior knee almost touching folk. This saves the person if they happen to vomit they won't choke on what they regurgitate, okay? All right, let me, hold on a second, let me do this. All right, let me check. All right, so Michael, the early signs of an opioid overdose, right? Not breathing, not responsive and lips and fingernails change colors. Laura, okay, we're gonna talk about getting naloxone momentarily. Marisol, if the person isn't fully conscious will the spray still work? Yes, but again, if they're not fully conscious but they're animated, right? They're groggy, don't administer the naloxone just yet Marisol and everybody, right? We just wanna monitor the person, okay? Laura, does each, okay, does each plunger contain one dose? Does each dose, yes, does each, right? Does each formulation contain one dose? Yes, it does everybody, Laura, yes. Does each formulation, right? Does each packet, let me come online just to be clear what we're talking about. Cause Laura, you said the plunger, the plunger is what we press. This is the dose, okay? This is the nasal spray, all right? So each kit comes with two nasal spray formulations, okay? All right, okay, okay, okay? All right, excellent, excellent, excellent, excellent. Okay, good, nice quick, good questions, everybody. All right, so here's where we are. Of course, keep in mind that again, please practice COVID guidelines. Again, I'll defer to you to read the slide, okay? In the interest of time. All right, so folks, things to consider, okay? Monitor, assess and communicate, right? When you talk with your staff at the next staff meeting, if this comes up, it's important that you have someone monitor, ideally monitor and assess and communicate back to management what's going on, okay? Call 911 and create a response area. That might mean if the incident, excuse me, is occurring in the bathroom, you may have to have folks use the communal bathroom or what will not become the communal bathroom, okay? Until the situation is addressed. Administer the naloxone, remember, first you do the response steps, right? First we shout, then we rub, we call for an ambulance and then we administer the naloxone, right? Peel, praise and bless, peel, place and press. How many times do we press the plunger just once? How long it take naloxone to be effective, two minutes? All right, the person wakes up and we wanna engage with them, all right? Maybe ask them, hey, do you remember where you are? Okay, maybe ask them their name and form them what happened. Hey, you were overdosing, we gave you naloxone and we called for an ambulance, okay? When EMS and NYPD or maybe even FDNY show up, please make sure you're engaged with them and give them a status report, okay? Persons in the bathroom, they were not responsive so we administer naloxone and we called you, okay? Folks, follow up if you can, please report back to the office of nightlife, okay? And they will report back to us because folks, we can document the fatalities because those are easy. Unfortunately, the folks who died from an accidental overdose end up in the coroner's office. We wanna record the lifesaving events. We wanna record the lifesaving events, okay? So if you can, please follow up with the office of nightlife and let them know, hey, Friday night, my bar tender Herbert saved somebody with naloxone, okay? And they will let us know, all right? Cause again, we wanna document those lifesaving events. Okay, so shared access or communal naloxone kits. All right, so here we go, folks. I wanna come online. So let's say you order one kit, right? That you're gonna keep behind the bar, right? Or with the first day kit or maybe in the kitchen, all right, folks, if you order just one kit, here's the wrinkle, that kit we call a communal kit. Communal implying that everybody should have access to it because of an emergency. Here's the wrinkle for you. If you order just one kit, right? Technically then a communal kit, please, please, please. When you get a chance inside the naloxone kit is an educational pamphlet. Please have your staff review this pamphlet so that they know how to administer the naloxone so that they know what you're learning today, okay? So once again, if you just order a kit or two to keep in a communal area, like the first day kit or behind the bar, then you must train your staff. I'm sorry, let me recalibrate. You must train everybody that has access to that kit, that access to the communal kit. It's on you, we're asking you to be a partner with us and train your staff at minimum, have everybody who has access to that kit, read the educational pamphlet so that they have a basic concept of what goes on, right? Shouting and rubbing, calling for an ambulance, administering the naloxone, peel, place, and press just like we did in this training, okay? All right. So folks, right now, Jose, can you, folks, I think my colleagues over at Nightlife can put in the chat portal, please, the link for accessing the naloxone. So the link of folks you put in your name and address, also please include your email in case we have to reach out to you and please allow 10 business days for the naloxone to arrive after you've submitted your request, okay? So Jose, can you put in the link for the naloxone? Folks, there's also a new resource called fentanyl test strips. We talked about fentanyl, right? A highly potent, fast-acting opioid. So you may want to also consider along with the naloxone kit, having fentanyl test strips available somewhere discreetly like the bathrooms. What the fentanyl test strips do is it allows the consumer to test their product for the presence of fentanyl, okay? And it's similar to a pregnancy test. It just says yes or no. It doesn't say how much fentanyl so that the person can make an informed decision about their product, okay? So again, you may want to also consider having fentanyl test strips in discrete areas like the bathrooms, if you will, for consumers to test their product prior to consumption to see if fentanyl is present and then to make an informed decision, okay? So, cool, cool, cool, cool, cool, all right. All right, so we just did this. Once again, hopefully inside the, check the chat portal for the link for naloxone to order naloxone and also for the link to order fentanyl test strips, all right? All right, folks, let me check the Q&A portal before I continue and let's see what we have. Um, Michael, can our account expire? Yes, we're gonna talk about that, all right? We're gonna talk about that. So hold that thought, Michael. Vincent, how many kids will we get at location and are we able to get extra? Yes, Vincent, that's why you access the link for naloxone and order, we would say, no more than 10 kids, please, please don't order any more than 10 kids but you can order up to 10 kids, okay? And remember, if in this context, you're thinking about every staff person will have their own kit, please make sure everybody reviews the educational pamphlets that they know how to handle the naloxone, okay? Thank you, Vincent. Danielle, how long do the sprays last? 30 to 90 minutes, Danielle, 30 to 90 minutes, okay? And the expiration date, we're gonna talk about that. Can you elaborate on liability? Okay, everybody, so real quick, if you order just one kit, right? And you're gonna keep that behind the bar, folks, every kit comes with a blue card, okay? When you get your kit, once again, if you're doing a communal kit, listen carefully, here where it says name, you put the word communal and you put the date on it and you keep the card inside the kit. Folks, this allows anybody who has access to that kit liability protection in New York state, okay? So again, for those of you who are gonna get just one or two kits and you're gonna keep them in a communal setting, right? By the first aid kit, behind the bar in the kitchen, okay, make sure you put the word communal on the card and you put the date, you receive the kit, keep the card inside the kit, please. And this card will provide liability protection for all of your staff, okay? If you order individual kits for your staff, then everyone will have their own blue card because they'll have their own kit, right? And make sure they put their name and date that they receive the kit, keep the card inside the kit and this person say, Herbert, your bartender, right? I put my name, Herbert Quiñones, the date I got my kit, I keep it inside my kit and I have New York state liability protection. This card certifies me to carry naloxone, administer naloxone, okay? Excellent question on the liability, all right. All right, so real quick everybody, this is what a kit looks like, right? It comes in a blue pouch, right? With two doses of naloxone, right? The rescue breathing shield is in a white envelope. You have a pair of non-late-takes gloves. Here's a copy of the educational pamphlet that again, if you're gonna do a communal kit, folks, have everybody read this pamphlet please, okay? To ensure that everybody's on the same page. And then inside the kit will come the blue card, right? Right, here we go, folks. So here, right, if you do a communal kit, here's where you write the word communal and the date that you receive the kit. If you're gonna give kits to individual staff, then of course everybody's name goes on, you know, the individual person. So if I'm your bartender, okay, this will say, this certifies that Herbert Quiñones, okay, has been trained technically by you from the Department of Health. All right, and please encourage everybody to put the date on the card and keep the card where everybody inside the kit, okay? All right, expired naloxone, all right. So I'm coming back online. So folks, remember earlier, I asked you all to write, you know, get something to write with or access your notes app. And we wrote down motto number one, right? For those of you who may have just joined us, motto number one, M-O-T-T-O number one. Here's the context. Herbert, I don't know what the person took. What should I do? Here's motto number one, M-O-T-T-O number one, when in doubt administer the Narcan. Folks, if the person overdosing or experiencing the medical emergency did not repeat, did not, did not consume an opioid, we will do no harm. Naloxone Narcan will not repeat, not activate if opioids are not present, okay? Expired naloxone, motto M-O-T-T-O number two, motto number two, some Narcan is better than no Narcan. So let me explain what that means, right? So let's say you have your communal kit and fortunately haven't had to use it until maybe sometime in 20, let's say October 2023 and you look and go, oh my goodness, it says expired. Folks, still administer the naloxone. Some naloxone is better than no naloxone. Some Narcan is better than no Narcan. But this also underlines and highlights the importance of calling for that ambulance, all right? But yes, if you have expired naloxone, still administer it. Some Narcan, some naloxone is better than none. Okay, folks, all right. Let me check Q and A. Okay, can a Narcan expire? Yes, Michael, right? But remember, some Narcan is better than no Narcan, so still administer it, okay? And make sure you call for that ambulance. Danielle, how long do the sprays last? 30 to 90 minutes, Danielle and everybody. What is the typical expiration on them? About 24 months, but check the expiration date when you receive your kit. But right now, I think what we're sending out expires in late 2023 or early 2024, excellent. Laura, the test strip link has great info but nowhere to audit the strips. Double check, please double check. There should be somewhere a prompt in there where you can order a fentanyl test strip, okay? All right? Laura, if you have anybody out there, if you're having difficulties with the fentanyl test strips, please notify my colleagues in the Office of Nightlife, Ariel and Jose. Ariel, Jose, get the names of these folks and I'll follow up with them directly, okay? Michael, if you don't have test strips with you, is there any possible way you can get, you tell that a drug is laced with fentanyl? No, Michael, no, you cannot tell if a particular product is laced with fentanyl, okay? Unfortunately, that's why we encourage the fentanyl test strips, all right? So before we have fentanyl test strips, all we have was Narcan, so let's go with that, okay? All right? Laura, it's just a place where you can buy them, but are they available? Yes, the link is for free fentanyl test strips, Laura. Okay, so again, anyone having difficulties accessing or submitting a request for the fentanyl test strips, please notify my colleagues at the Office of Nightlife, right, Jose, Ariel, and I think I'm missing one more person, I'm so sorry, and get their name and email address and I'll follow up, okay? Marisol, it looks like it doesn't offer free chest strip, you have to purchase them. No, everybody, everybody, time out, time out, time out. The link I shared with you is for requesting free naloxone and free fentanyl test strips, okay? Any issues, please let my colleagues at the Office of Nightlife know, right? Give them your name and email address, they will forward your information to me and I will follow up with you, but these links are for free naloxone and free fentanyl test strips, okay? All right, okay, just all right, Laura again. Okay, Laura, send it to my colleagues at the Office of Nightlife, okay? I can't take down your email right now because we're in the middle of the training, okay? Nolan, can we reorder in the future with the same link? Yes, please hold on to the link for the naloxone and technically the fentanyl test strips in light of what people are sharing. Yes, Nolan and everybody, you can use the same link to reorder naloxone, excellent. Okay, let's see, let's see, all right, wow, okay. All the questions, okay, cool, cool, cool, cool, cool. All right, everybody, nice, nice, nice, nice, all right. Okay, okay, so once again, folks, if you're having issues with the fentanyl test strip link, okay, email my colleagues over at Nightlife, Jose, Ariel, and I'm so sorry, I can't, I forgot to- Francesca, it's Francesca. Yes, Francesca, thank you. Email them, everybody, with your name and email address. They will forward your request to me and I'll follow up with you. But again, these links are for free naloxone and free fentanyl test strips, okay? All right, everybody, I see two more questions in Q&A and oh, you're very welcome and what's the email for Nightlife Office? Okay, Francesca, Ariel, and Jose, Barbie needs the email address for the Office of Nightlife, okay? I would say post it in the chat portal, okay? Thank you, Barbie, appreciate that. Okay, folks, let me do a quick time check and let's see how we're doing. We're okay, right? How we doing on time, folks? We're doing fantastic. Thank you so much, Herbert, for your incredible enthusiastic, helpful, informative, compassionate presentation. This is such imperative information. I wanna just deeply thank you and the Department of Health Council member, Chiyose, and to everyone who showed up today and for your questions and for your love of the industry and for the people who work and go out in it while we're really encouraging everyone, there's our website and our email is on the screen, while we're encouraging every bar to get naloxone, anybody who goes out can have a kit in their pocket, in their pocketbook and can be prepared to save a friend anytime, anywhere, not just in Nightlife venues and I really recommend to the owners, this video will be, is being recorded. You can just have a staff meeting, sit everybody down, make them watch it, it's only an hour and they can get a lot more information. There is the packet, but you can play this video at a staff meeting. This is really, really, really important to be proactive here, you don't want to wish you had done this too late and so we just encourage everyone, it's not a mandate, but this is something we should all be doing and talking about and destigmatizing. And so as we also close, I just wanna highlight that we know how hard it is to work in this industry, it's extremely challenging and we, because of this, the Office of Nightlife also developed the Elevate Nightlife Mental Health Initiative with our partners at Backline. We provide dedicated one-on-one personalized mental health plans and additional resources for Nightlife workers. So it goes from free to sliding scale to provide affordable services and personalized mental health plans. So we really recommend that you give that a try. This is not an industry for the faint of heart, you're all rock stars. Thank you so much for everything. I have one more thing. Yes, Herbert. Right, so folks, just one last thing. Folks, 2022, nobody, nobody has to die from an accidental opioid-induced overdose, okay? We now have a medication, we now have strategies to save that life. So again, folks, in 2022 forward, no one has to die from an accidental opioid overdose. Thank you everyone. Thank you Ariel, Francesca and Jose. Thank you, Herbert. And thank you everyone for everything you do. If you have any questions, reach out to us nightlifeatmedia.nyc.gov. We'll be doing this again and reach out to us directly and we'll make sure you get any further questions answered. Thank you again to Council Member Chioce, making this program codified into law. And again, thanks to everyone. Thank you so much.