 Hello everyone. Thank you so much for joining this important webinar today. I am Ariel palitz the founding director of the office of nightlife. For those of you who don't know, we are a dedicated non enforcement liaison between the city and the nightlife and hospitality industry and community. In addition to our focus on safety and harm reduction, which is the purpose of this webinar today. We also work to support nightlife businesses navigating through city bureaucracy, improving quality of life and neighbor relations between venues and residents, as well as elevating nightlife culture as an asset to the city at large. If you have any issues or questions about your venue. Or other concerns you can always feel free to reach out to us at nightlife at media.nyc.gov. Today's webinar is part of a new series of courses we created called night school or nightlife industry training and education, which will be held both virtually and in person with several different courses each month. This is a series to share resources and trainings for owners workers and patrons. We are discussing how to best engage with different city agencies and their resources to help open and operate nightlife businesses to improve proactive harm reduction and quality of life issues and more. So if you're interested in the entire curriculum, you can also find out more at nyc.gov slash night school that's nite school. I think we'll put that link in the chat. For today though really the safety and well being of the nightlife community is really a top priority for our office. With this, we created the Narcan behind every bar initiative with our partners at the health department to provide venues staff and security with life saving training, as well as patrons, life saving training on how to use naloxone and for venues to get free overdose rescue kits by mail. We know that the stigma of substance use in nightlife can be particularly challenging and concerning and may hold you back from wanting to have Narcan behind your bars, but the fentanyl crisis is an issue. We cannot ignore and that we know is not exclusive to nightlife. Substances may be present in a variety of work settings and gathering places, not just nightlife venues, but we really do know that venues are places where people can look out for and protect each other. And we see you venues and promoters as partners, really in helping to prevent to combat this crisis. So this is about bringing life saving harm reduction tools and resources to all of you in the nightlife community. So every venue and promoter is strongly encouraged to have at least a few doses of Narcan on hand in case of a suspected overdose, both in the front of house and back of house like kitchen areas. It's much like having a CPR or first aid kit or free NYC condoms. So harm reduction tools can help you to be prepared. So you will learn how to become a certified opioid overdose responder, and how you can receive the overdose rescue kits by mail. Before I introduce my colleague to conduct the training, just a few quick housekeeping notes. I'm going to use the Q&A feature in the zoom to let us know your questions throughout the meeting. And during and after the presentation there will be opportunities for those questions to be answered. Also this meeting is being recorded and live stream to Facebook. You can see the names of video screens or names will be presented or shown. So your anonymity is protected. And a recording will be available to share with your staff and other colleagues who would like to view the training at a later time, just having a Narcan kit behind the bar is not enough. Your staff really needs to know how to use it. So now without, oh, let's see. You can also visit nyc.gov slash Narcan behind every bar to find out information on other scheduled trainings by the health department that are not necessarily nightlife specific, but you can also visit nyc.gov slash Narcan and your staff can see those trainings for your staff as well. So without further ado, this training will be conducted by my colleague at the health department, Alex Clark is an overdose prevention trainer in the department's bureau of alcohol and drug use prevention care and treatment. Thanks so much to all of you and to Alex, take it away. Thank you. Hello, everyone. Thank you so much for having me. I'm so glad and grateful for the office of nightlife for helping to spread the word about this life saving medication so we're really grateful for all of you who have logged on today. I'm not sure if I can see things that people are putting in the chat, but can anyone see my screen. Yes. Great. Looking good. Love that. And we will monitor the Q&A for you as well so just feel free to stick with the presentation and we'll help with the Q&A. Awesome. That's great. Yeah, so as Ariel said, my name is Alex and I'm the overdose prevention training coordinator in the overdose education and naloxone distribution unit at the New York City Department of Health, so much mouthful. Yeah, I work to spread information about naloxone and overdose prevention more broadly throughout the city. My pronouns are she or hers and I'm really excited to get to share this information with y'all today so thank you for taking time out of your day to show up for this. So Ariel went over some housekeeping agreements. Thank you all for that. I just also want to say, if we get disconnected for any reason, I'll log back on really quickly. And what's other housekeeping agreement. If I think of it, I'll let you know. But I also just want to acknowledge that, you know, the content in today's course can be heavy and so we really want to encourage everyone to take care of themselves during today's training get up get a drink of water. So what is on the agenda for today's training and first we're going to do a brief background about how overdose is affecting New Yorkers, then we're going to develop an understanding of opioid overdose. So what is on the agenda for today's training and first we're going to do a brief background about how overdose is affecting New Yorkers, then we're going to develop an understanding of opioid overdose and naloxone. We're going to go over the steps for responding to an opioid overdose and we're going to discuss naloxone access. So let's get into the training. So some key terms so that we're all on level playing field as we start this training. The first term is opioids. So opioids are playing pain relievers. These include opioid analgesics which are prescription painkillers and they also include substances like heroin and fentanyl. So a lot of y'all have heard of fentanyl. What fentanyl is, is a highly potent fast acting opioid. So it does the same things in the body or similar things in the body as heroin or prescription painkillers like oxy cotton but it just acts much more quickly and is incredibly potent. Finally, our last key term is naloxone. So naloxone is a safe medication that can reverse the effects of opioids and prevent fatal overdose. So some key things to know about naloxone will go in more depth later in the training. But when in doubt administer naloxone rate if you see the signs of an opioid overdose which will go over in depth, you can feel comfortable administering naloxone because there are no negative effects to administer naloxone. So that's really important. The other thing is I'm sure y'all have heard this campaign that Ariel just mentioned, right? Narcan behind every bar. So Narcan is the brand name for naloxone. So Narcan is ping pong to naloxone's table tennis. It's just the, you know, the trademark formulation of this medication. So I'm going to use them interchangeably throughout the training. They mean essentially the same thing. All right, so how are overdoses affecting New Yorkers? So we're going to go into some data. And, and before I, you know, go to the data slides I just really want to again acknowledge that while when talking about data can feel really abstract. These are New Yorkers that we have lost to unintentional drug poisoning deaths or fatal overdoses. And so, yeah, I may be speaking about it abstractly, but it is, you know, it's heavy. So this is a figure that shows overdose deaths in New York City from 2000 to 2021. And what we know is that both the number and the rate of overdose deaths in New York City increased between 2020 and 2021. So the rate of overdose death between 2019 and 2021 increased by 80%. And it increased by 25% between 2020 and 2021. So we're seeing, you know, a very drastic rise in the number and rate and the total number of overdose deaths in New York City in 2021 was 2668 deaths. So for me, that's hard to conceptualize what that means. But what it means is that during 2021, someone died of a drug overdose in New York City every three hours. So yeah, incredibly frequent. So this figure shows. I can't barely see the title of the slide but I hope that y'all can I have my little zoom bar up there but this shows the. It's clearly a map of the five boroughs of New York City if you're from New York City or live here you're very familiar with this map. And it shows no go back the rates of overdose death by neighborhood of residents. So if we look at the little legend here on the left of the screen, we can see different squares with increasingly dark blue colors. So the darker the color of blue the higher the rate of overdose fatalities. The key is that the overdose fatalities, the five neighborhoods with the highest rates of overdose death are outlined in red. And we're seeing that four of those neighborhoods are in the South Bronx, and one of those neighborhoods is in Manhattan in East Harlem so this is a citywide crisis rate it's happening all throughout New York City the only area of New York City that is not colored in is unfortunately is Central Park and that's because that is no one's official neighborhood of residents although we do know that folks live there. Yeah, it's a citywide crisis is impacting everyone but it is having a disproportionate impact in, you know, communities that have been where we have seen systemic divestment so right so communities where there has been divestment in housing infrastructure in. You know, in jobs in education. We're also seeing disproportionate rates of overdose fatalities. So this figure is a little public health 101 primer. Whenever we hear about some sort of public health crisis in the news, we often get either a rate or a number on the last slide I was talking about rate. We're talking about a number of people per 100,000 people in the population. So one way to think about this rate is if we look at Staten Island which has the second highest rate of overdose fatalities. One of the reasons it has the second highest rate but the smallest number is because the population in Staten Island is really small right smaller than Brooklyn Manhattan or Queens. So when we think about, you know, who is being impacted by a crisis it's important to ask oh they're giving us the rate but what does that mean in terms of number and, and on the last slide you know we saw that five the highest, four of the highest neighborhoods. Four of the neighborhoods the highest rates of overdose fatalities are in the Bronx, but that doesn't mean that this crisis isn't impacting folks in Brooklyn so when we look at the number of overdose deaths we see that Brooklyn have the highest number of overdose deaths. So this is all to say that you know this crisis is impacting us all. So what substances were involved in these overdose fatalities in 2021. Well what we know is that fentanyl for the fifth year in a row was the substance involved in the highest number of overdose fatalities fentanyl was involved in 80% of overdose fatalities. It was involved in 84% cocaine, and this includes crack cocaine and powder cocaine was involved in 47% of overdose fatalities heroin was involved in 37% benzodiazepines which are central nervous system depressants like Xanopin or Xanax were involved in 17%. Xilazine was involved in 16%, although all 16% of xilazine overdose fatalities included fentanyl which is just really important to note prescription opioids were involved in 15% and methadone was involved in 13% of overdose deaths in 2021. So these numbers don't add up to 100% because people whether knowingly or unknowingly may be ingesting multiple substances at a time. And what we know is that when people ingest multiple central nervous system depressants, which is multiple substances that suppress someone's drive to breathe which we'll talk about more later, they are at higher risk for overdose fatality for overdose period and then potentially overdose fatality. Great. So as I said fentanyl for the fifth year in a row is the most common substance involved in drug overdose deaths, 80% of drug overdose deaths involved fentanyl in 2021. So fentanyl is being found increasingly in the New York City drug supply. And we talk about fentanyl we're talking about non pharmaceutical fentanyl right fentanyl is used clinically, all the time and surgery for prescriptions for pain given in the form of patches or lollipops. That's not what we're talking about. We're talking about fentanyl that's being illicitly produced and then mixed in with substances prior to purchase. This fentanyl is 50 to 100 times more powerful than morphine and 30 to 50 times more powerful than heroin and again we give a range because it's not being produced in a in a pharmaceutical setting it's not pharmaceutical fentanyl. So we don't exactly know there are lots of different types of fentanyl. So fentanyl has been found in New York City's heroin, cocaine, crack, counterfeit pills, ketamine, methamphetamine and other drugs that are bought on the street. So when we talk about counterfeit pills we're talking about non pharmaceutical pills that might be pressed to look like a conopin or Xanax but if they're from a non pharmaceutical force source they could be counterfeit. We know that fentanyl is almost entirely replacing existing supplies of heroin so people who might think they're doing heroin might have been using fentanyl for a long time. And the last thing I want to say about this is that what we know is that people who are novel or naive opioid users who might not know they're using opioids might now be at risk for opioid overdose, especially people who use cocaine are now at increased risk for opioid overdose. And the last thing I want to say about fentanyl is that there is no risk of overdose for touching fentanyl and this is really important for the purposes of our training, because we just want to let y'all know that as responders, you are not at risk of overdosing by responding to an overdose right responding to an overdose is a safe thing to do, obviously use your best judgment. But yeah, no risk of overdose from touching fentanyl and responding. Okay, any questions, I see two questions, can someone start a lawsuit for giving them Narcan without their consent yeah this is a really great question. This is Miguel is I'm not a lawyer, but there is liability protection for responders in New York State if they're acting in good faith right if they are attempting to respond in good faith. There is liability protections. Is there a card that's in the kit that provides that sort of language or liability protection. Yeah, thank you Ariel I'll definitely talk about this more later. Yeah, of course, but I think definitely down to mention it now. When you're trained if you choose to receive a kit, you will get in your kit a blue card which I will talk about more later that gives is your permission to carry around the lock if you've been trained, and you are, you know, you've been trained to respond. Thank you for, for pointing that out. Then, what is Zilazine yeah thank you so much for asking that so Zilazine is white horse tranquilizer that we're finding increasingly in the New York City drug supply. It's based in with a lot of fentanyl prior to purchase. It's, it's a central nervous system depressant. So, people are potentially at increased risk for overdose. Yeah, I will touch on Zilazine again when we talk about responding because it potentially does impact what people might seem like after responding but that's what Zilazine is it's also referred to as trunk. It's a street name for it. Yeah. Awesome. Thank you for those questions. Alright so understanding opioid overdose. So how do opioids work. So this is a little. It's just in the training with a friend who is like, this is what all our brains look all our bodies look like and it was just funny to me. So there are an image of opioids sitting on opioid receptors in the brain and when someone ingest opioids. They can experience a handful of effects opioids can relieve pain they can relieve withdrawal they can produce feelings of happiness and comfort you know these are some of the desired effects, but they can also cause some side effects such as constipation nausea drowsiness drowsiness. It's also referred to as nodding right if you hear that someone is nodding because they're drowsy and respiratory depression and for the purposes of our training we're really concerned about respiratory depression. So the process of overdose can happen over the course of minutes to hours and when someone consumes a quantity or strength of opioids. What happens is that amount of opioids. They're sitting on the opioid receptors in the brain and it gradually slows someone's natural drive to breathe so we all breathe all day every day without thinking about it. Oh my God I thought I was going to cough. But when opioids are sitting on the opioid receptors in our brain this natural process slows down. So when breathing slows the amount of oxygen that's being circulated to major organs such as the heart and the brain decreases and eventually stops functioning. And this can lead to unconsciousness coma or fatal overdose. So it's rare that someone dies immediately from an overdose. And when people survive it's because someone was there to respond into administer naloxone so again super grateful for y'all for thinking about how you can potentially intervene on this process. So what are some risk factors for overdose. So some common risk factors that we know are one changes in tolerance so as a person uses a substance over time, the way their body responds to that substance changes so you know my example is when I first started drinking coffee I would have one cup and I would be vibrating all day from the caffeine the drug and the coffee. And now I need to drink coffee all day every day to achieve the same desired effect. That is true for opioids as well right when you first start consuming opioids your body is having one type of reaction but over time it gets used to that amount of opioids and you need more opioids to achieve the same desired effect. If you stop using opioids for any reason if you're incarcerated or you can't access supply or you went to an abstinence only treatment program, your tolerance will decrease and if you start using opioids at the same amount that you were your potentially at risk for opioid overdose. So the next one is mixing drugs. So as I said previously consuming multiple ingesting multiple central nervous system depressants right because it might not necessarily be intentional puts you at risk for overdose and also like, you know, consuming alcohol and then other substances puts you at risk for overdose. Yeah, drug quality so when you're purchasing substances off the street, you don't always know what's in them right and so that could potentially put someone at risk for opioid overdose. If some other things are being mixed in with the substances prior to purchase. We know that previous non fatal overdose, a previous non fatal overdose makes someone two times as likely to potentially experience another opioid overdose who I didn't mean for those to show up yet those are a secret, not really. So this just sort of highlights how challenging it is to make changes to patterns of use and. Yeah, so we just want to flag that and then also using alone here's a little misleading because it's not a risk factor for overdose, but it is a risk factor for fatal overdose so when you're using alone there's potentially no one there to respond. But we just want to highlight that use of any opioids can put someone at risk. So we at the Department of Health, you know, acknowledge that substance use happens right like this is a real thing we're not trying to deny reality. But these are some risk production strategies that people can take if and when they're possible to potentially mitigate some of the harms that come from using substances. So, you know, if you take a break from using for any reason, whether your choice or not, you can be careful when you begin using again. And these are strategies that you can use in your personal life you can share with pals or friends or family members loved ones. They're just, you know, good universal strategies for preventing opioid overdose. You know, you can do a slow shot or a test shot to see what how your body is responding to the substances. You can make an overdose plan if you Google overdose plans that will have lots of different questions about how to potentially prevent overdose, and have a phone on hand to call 911 this is more for if you're responding to a loved one. You can buy from people you trust and ask about changes in product quality with others who buy from similar folks right. You can use with someone and take turns so they could use and then you could use or you could use and they could use so that someone's there to respond where you could use and never use alone hotline. And then, you know, if and when ready. It's really hard to make changes to patterns of substance use and everyone ready medication for opioid use disorder such as buprenorphine or methadone are really helpful for people who are, you know, have opioid use disorder. So as I mentioned in the last slide making changes to substance use is super challenging. And I believe it's made even more challenging by how our society, you know, treats people who use drugs like there is so much stigma against substance use, and, and the words we use and how we talk about substance use really matters. And I think about, you know, especially as people who are potentially going to be responding to an overdose like how we think about engaging with those folks when we're responding and afterwards and it really does matter and these words on the left are potentially stigmatizing language that I'm sure we've all used right because we live in a culture that holds a lot of stigma against folks who use drugs. But these words convey a lot of judgment and potentially don't open the door for a conversation about changing patterns of use if that's what the person wants right, or just open the door to connection and and acknowledging someone else's humanity right. And so the words on the right are some more compassionate person centered language that we can use when we talk about substance use. Yeah, I think some of my faves are, you know, steering clear of using the word clean and talking about currently abstaining or making changes, rather than saying addict saying person who uses or injects drugs right so just really kind of isn't of the language we use. Alright, so I'm going to pause again for any questions. There are currently no questions in the chat but I'll give it a second. Right, I'm going to assume there are no questions because I'm being incredibly clear. But if you do have questions, please put them in the chat. So understanding the lock zone. So as I mentioned previously, no lock zones only function is to reverse opioid overdose. It has zero effect if opioids are not present. There's like one little caveat here that we're going to dive into it's not that it's a negative effect it's just something we want to be mindful of the lock zone comes in a nasal spray or an intramuscular injection and in this training we're going to be talking about Narcan nasal spray. So, there are no no negative effects of the lock zone. And as I said the caveat is that it may put an opioid dependent person withdrawal and this is really important right because if we think about we want to respond by car causing as little harm as possible. So we really want to be super mindful when responding to an overdose as mindful as we can be given that we're potentially responding to a crisis right. There is no potential for misuse or dependence I was just chatting with a colleague who was talking about people in a program she worked at who really tried to misuse no lock zone and they were like, Yeah, it's not possible. There are previously responders in New York State have liability protections when responding to an opioid overdose. So we talked about how opioids work. Now let's talk about how to lock zone works to someone ingest some opioids they're sitting on the opioid receptors in the brain. And if that person is experiencing an opioid overdose, you're going to give them the naloxone and the lock zone is going to come into the body and bump the opioids off the opioid receptors in the brain. So this process usually takes two to eight minutes to restore the person's breathing, which is one of the things we're really concerned about in an opioid overdose is that this person is not breathing. The oxygen is not getting to their major organs and naloxone lasts in the body for 30 to 90 minutes. So after the 30 to 90 minute period, any opioids that are remaining in the body will be attached to the opioid receptors. But in that, you know, 30 to 90 minute window, there will be the person will not have any opioids sitting on the opioid receptors in their brain. So now we're going to talk about responding to an opioid overdose. So before you can respond to an opioid overdose, you need to identify if an opioid overdose is even occurring right and this is a really crucial step. So people. So the signs of opioid overdose are that the person will have slow or stopped breathing, they will be unconscious or unresponsive. This is a huge one right if someone is unconscious or unresponsive. This is a huge flag that they may be having an opioid overdose, blue, gray, white, lips or nails, they'll be snoring or gurgling sounds, which means that person is gasping for air. And they may have muscle stiffness or rigidity, which is. We see this a lot with fentanyl it's called wooden chest syndrome. If someone who you believe is experiencing an opioid overdose. What you want to do first is check for responsiveness. So you can do this in two ways first we recommend shouting at the person if you know their name. You can say their name, say you're going to call 911. If you're in a nightlife establishment, you know, you're probably going to want to be very loud because I'm sure there will be a lot of other things going on right. You really want to shout at the person to see if they're responsive if they are aware of what's going on. The second thing we really don't necessarily need to be aware they just their eyes need to be open and they need to be, you know, breathing. The second piece is that you can do a sternal rub so if they're not responsive to you shouting, what you can do is take your fist, and you can all do this from wherever you are and grind your knuckles into the person's sternum or the person's breastbone, applying pressure up and down and I'm doing it right now and it's uncomfortable it's uncomfortable in any way, but that could potentially cause a person to become responsive, because it's just uncomfortable, and we always want to shout and perform the sternal rub before administering naloxone because someone might be high, but not yet So this is a really important distinction and we've seen a lot of reports in the news recently about people using naloxone on someone who is awake conscious talking that person is not experiencing an overdose right, it might be high. But they have not met the criteria for overdose and it's important to try to keep them alert and monitor them closely because overdose is potentially still possible to keep naloxone nearby to stay with them and ensure that they're not alone again because overdose is still possible. And when in doubt about the medical event someone is experiencing you can call 911 for medical help. So if someone is not responsive to the sternal rub, you can call 911 for medical help. And how we advise folks to do this is to give the dispatcher the address and the specific location, tell them what you see, because I'm not a medical professional I'm not going to say I'm with someone who's overdosing I'll say I'm with someone who is not breathing turning blue or gray and is unconscious or non responsive. Yeah, so tell them what I see. And again we encourage folks to call 911 for a handful of reasons. One is that this may not be an overdose. They might just be having some sort of other medical event that has caused them to go unconscious or unresponsive. There could be potential medical complications from overdosing and more doses of naloxone might be needed. So we'll talk about the fact that the kit comes with two doses but more doses might be needed. In the United States, there is a 911 Good Samaritan law which offers some protection to overdose victims, and those who call 911 from prosecution for drugs up to a to felony offenses, alcohol for underage drinkers cannabis of any amount paraphernalia offenses and sharing of drugs. And the person who calls and the person who is overdosing have some protections. It does not provide explicit legal protections for probation or parole violations violations for open warrants, or issues related to immigration or child welfare. And we also just want to, you know, I just want to acknowledge that, you know, calling 911 is not everyone's favorite thing to do, and different people have different relationships with calling 911 and with the police, because in New York City, if you call 911 it's possible that NYPD will show up. So really encourage everyone to make an overdose response plan that is individualized and works for them. And there are a handful of reasons why someone might not want to call 911 they might have had previous experience reversing an overdose without medical help. Oh, Lord, I wish I would stop doing that. Without medical intervention, like I said previously and like Ariel said there is stigma attached to drug use. They might fear for their personal safety, the potential for the impact on other legal matters, and in New York City the NYPD overdose response squads which can show up on the scene and investigate, return to investigate after the fact and could potentially have implications for other legal matters. All right, so it is that moment it's time to administer naloxone. So what you're going to do is we'll first rate we've identified that this person is unconscious or unresponsive. And then we're going to administer the Narcan so every kit comes with two doses of Narcan nasal spray was a little bit of glare they look like this and these little blister packs. And the person will either be you know sitting up or laying down to what you want to do is tilt their head back. And then you want to take your blister pack and peel back the blister pack to access the naloxone. Then you want to take your two piece fingers and put it around the Narcan and put my thumb on the side so that I don't accidentally push down on the plunger and then I want to place the device inside of the person's nostril. My fingers are touching the bottom of the person's nostril. And then I want to push down on the plunger, which will release all of the medication at once. So, again, peel place and press. And then I want to wait for two minutes. And we're going to talk about some things you can do during those two minutes while you wait. But yeah, it's very important to wait two minutes to administer the second dose because we want to give as little naloxone as possible to potentially not precipitate withdrawal. So we want to get the person breathing again without potentially, you know, going the person more naloxone than is necessary. So again, if it's been two minutes. I just want to acknowledge that two minutes when your someone is unconscious is a really long time to wait. I know certain trainers who literally set a timer and ask everyone to be silent for two minutes right. I went I first started meditating two minutes was forever so two minutes is a long time. So again, we really want to give someone as little naloxone as possible to reverse their overdose. And then if the person is still not awake when I administer the second dose in the second nostril so one dose one nostril second dose second nostril. And again you're going to peel over the blister pack place the naloxone inside the person's nose and press down on the plunger to release all of the medication at once. I'm excited to see a question. Please show the device again in full screen no graphics your picture is so small it's hard to see. Yeah, thank you so much I will do that at the end. So that everyone can see the naloxone I don't want to unshare and then reshare my screen. That's just me but um, yeah I will make sure to do that at the end before we get off this room so you can all see the device. And I think we're going to show a picture of it up close and but yeah thanks for asking that. Okay, so if the person becomes responsive. They might be confused or afraid. So it's important to explain to them. Hey, you overdose I administer naloxone. You know, it's important to be compassionate with this person right this is really scary and especially in a nightlife establishment, you know, to like wake up from an overdose, where you might not know what's going on, you're potentially surrounded by tons of people and potentially EMS right like this is really scary so this is a moment to foster connection and be really compassionate presence and the person if they're opioid dependent might be in withdrawal so you want to reassure them that the naloxone wears off to in 30 to 90 minutes and emphasize that using more drugs during this 30 to 90 minute period is unlikely to reduce their withdrawal but may put them at increased risk for another overdose. After the naloxone wears off so whatever opioids are hanging around in that person's body, once the naloxone wears off will reattach to the opioid receptors. This is why it's important that someone stays with this person for at least three hours, and you can discuss with the person if you haven't called 911 the benefits of receiving follow up medical care. But this is a place where you can give this, the person overdosing some agency back right and ask them if they would like to call 911 if they would like to go to the hospital, etc, etc. So previously that we could talk about that some things to do in those two minutes. That was excruciatingly long two minutes and the first is and I'm joking about it being excruciating. The first is provide rescue breathing so every kit comes with a face shield and I can also show this again. When I have stopped sharing my slides. The face shield looks like this. The message looks like that. The mask looks like this, and it has some writing. So what you want to do is tilt the person's head back again to open up their airway and lay the face shield down over the person's face and pinch their nose, and the face shield has a one way air filter. You want to give two normal sized breaths and see if their chest begins to rise. If their chest doesn't begin to rise and try to reposition their head to open up their airway, and then you want to give one breath every five seconds. If your CPR trained, you can do CPR. I'm not CPR trained. So if I was responding to an overdose I would provide rescue breathing. The second rate like the thing that we're concerned about is that the person is not not getting oxygen to their major organs. So this is a major way to provide some support for that person. The other way to provide support is to put someone in the recovery positions recovery position is shown here. This is a supported position that can potentially helps to prevent someone from choking or aspirating on their own vomit. One hand out to the side so that their mouth is running downhill. Then you want an arm out to the side and a leg out to the side which prevents the person from rolling over onto their stomach or onto their back. So you want someone to put someone in the recovery position if you have to leave them alone for any reason. If you're not actively providing rescue breathing, or if you're not actively administering naloxone so this is a really great supportive position to put someone in. Are there any known side effects to giving someone to someone getting the naloxone who is not overdosing. Say whatever they're experiencing with some sort of different sort of medical event. Yeah, thank you so much for asking that. There are no known negative side effects to administering naloxone to someone who is not experiencing an opioid overdose. Right so if someone is unconscious or unresponsive and having a different medical event. The Narcan is essentially like spraying water up the person's nose like it's not going to do anything. Okay, so thank you for that question. It's a really great question. And the second question is, is Narcan only effective on opioid overdoses. Yes, not because what naloxone does what Narcan does is it sits on the opioid receptors in the brain bumping naloxone bumping opioids off right. It's an effect on opioid overdoses. If someone is, you know, overamping, which means they've consumed a lot of a of a stimulant and consumed a lot of cocaine or methamphetamine naloxone is not going to have any impact. And this is a really great point so naloxone is not going to have any impact on the other substances and someone's system. If someone is going to administer naloxone and someone has xylosine in their system, they might still be really grubby and super out of it because they have consumed another substance but as long as they're breathing right the naloxone has taken effect on the opioids in their system. Same goes for you know cocaine or any other stimulants or operas like the person might come out of their naloxone come out of their opioid overdose but still be experiencing the effects of cocaine. All right, so some things to consider. So overdose response elements so here are all the elements that are involved in overdose response. One is to monitor the person to assess if they're experiencing an overdose to communicate with folks around you to call 911 and create a response area right if someone's experiencing an overdose in a nightlife situation, maybe you want to close off the area in some way administering naloxone right as we just went over and that's a really important step in responding to an overdose to engage with the person experiencing the overdose, experiencing the emergency afterwards and during so if you can communicate with them during they're not actually overdosing and afterwards right communicating with them and talking with them about what they have experienced engaging with EMS and NYPD and some follow up and reporting so we'll talk about how to follow up and report if you use the naloxone in your establishment. So, after today's training y'all are welcome to get kits for your personal use but we are you know encouraging nightlife establishments to get kits for communal use at your bar or nightlife venue. You can you know assess your nightlife venue and think about how many kids do I actually need for this space right a lot of nightlife venues in New York City are small and tight and cramped and so you know it's like okay maybe I need one or two. Depending on the side of your size of your space, and then you can also request from us this communal kits poster, which will help staff who maybe haven't attended this training know about where the kit is stored so it says find the naloxone kit stored here, and it goes over the steps to responding to an overdose on the steps for identifying an overdose and the steps for responding to an overdose on this poster so you can keep it conveniently located and accessible for staff. And then the other thing to consider is whether you want to stock fentanyl test strips at your bar. These are a great resource for folks who are using substances and might not want to use fentanyl some people do want to use fentanyl. Because that's their substance of choice, but some people don't want to be using fentanyl and so having fentanyl test strips on hand. can help people to identify whether they're fentanyl in their substances, we have a lot of resources around fentanyl test strips their fentanyl test strip training. So I'm going to send out these slides at the end of this training for y'all. That was my other piece of housekeeping was that I will circulate the slides to y'all so you can reference them. But we'll have all these resources related to fentanyl test strips on there. Okay, two questions. I'm going to go over how we can access the kit and then I will deal with these questions because some of them are going to be answered during during this next part so naloxone access. So you can request a kit by going to next distro dot org backslash nyc naloxone. If you all could put the link in the chat right now that would be really excellent so we're going to drop a link in the chat. You can go there fill out a form and get naloxone delivered to you for personal use or to or to your nightlife establishment, you can also scan this QR code. And you can order naloxone through the form there. If you need naloxone so that naloxone will arrive to you within 10 business days if you need naloxone access sooner. You can visit nyc.gov backslash naloxone that link is also being put in the chat and find some naloxone within your community at community based organizations or pharmacies, etc, etc. There are lots of good resources on there. So what is in an overdose rescue kit. Oh, my goodness yeah this image is pretty small too so I will definitely make sure to go off sharing screen so you can see the blister packs but if you can overdose rescue kit it's going to look like this. This is a little blue kit and it's going to come with the face shield to non latex gloves to doses of Narcan nasal spray educational materials Narcan instructional sheet and the blue certificate of completion. So once you receive your kit, you're going to want to take out the blue card and add your name and the date and this can just be the date you receive your kit and your name. And keep the blue card in your kit because this is your permission to carry naloxone to use naloxone. And we also suggest that once you get your kit you review the instructional insert in the kits on the response steps so this training is great and it's good to have a refresher. So on the back of the blue card is if you get the kit from us is our email address naloxone at health.nyc.gov. If you use the naloxone in your establishment we encourage you to submit an anonymous report as soon as possible by emailing that email address. We can help you walk through how to submit a report, and then we also encourage you to get a refill of the naloxone after you use it. We encourage you to get a refill if you use one or more doses of naloxone if your kit is lost damaged or stolen, or if the naloxone is expired so I saw a question in the q amp a expired naloxone. So I believe that naloxone lasts for three years. The time from when it's produced to when the expiration date is you'll see the expiration date on the back of the blister pack here. It's also on the back of the blister pack here. But we really encourage folks to know is that expired naloxone is better than no naloxone so if you find yourself, you know, five years from now, accessing the kit because someone's experiencing an overdose and all you have is expired naloxone, give them the expired naloxone and then we really encourage folks to call 911. So summary steps. Naloxone is a safe medication that can reverse the effects of opioid overdose. I want you all to look for signs of opioid overdose. Specifically the person is unconscious or not responsive. We want you to check for responsiveness by shouting and doing a sternal rub. Give naloxone. You can provide support in these three ways, getting medical help, doing rescue breathing and putting the person in the recovery position. And finally, if you use naloxone we really encourage everyone to report it and refill your kit for future use. Oh, and then finally, we have some additional training. So this is the last of our trainings with the Office of Nightlife. As I said, we're really grateful to y'all for helping to get the word out about this. We have upcoming training so we host three trainings a month. So if you have staff members who are interested in attending if you have pals who you know want to attend. Here are the dates for upcoming trainings and they can also be found at the nyc.gov backslash naloxone link that was posted in the chat. All right, and now I'm going to answer some questions. So first things first, I'm going to stop sharing my screen. Hopefully I'll be my image will be larger now. So this is what the blister packs look like. I don't know why I showed them both are exactly the same. Yeah, so I hope that was easier to see. And then this is what the blue card looks like. You put your name here and the date here. And this is your certificate of completion for this training. I'm going to look at some other questions. So regarding what happens if someone becomes conscious following the application of Narcan. If this is happening in my restaurant, I know from a former owner considering and guest facing perspective they will not want the person to remain on the premises for three hours. Nor for me to be with them for three hours in this scenario isn't the most responsible to call 911 regardless of the person's interest. If they haven't indicated. There is anyone specific to come and get them. Yeah, yeah, I mean I think I hear the concern right and I think this is really important to think about we at the Department of Health really want to emphasize the agency dignity and humanity of folks who are using substances. And that this is, you know, paramount in our work, and to creating the world that we would like to live in. And so yeah I hear that there are some competing concerns here and ultimately you're the one who's responding so you're going to have to do what is best for you but we really just do encourage folks to give to give dignity to the person who has just experienced this medical event. And that's your question I get that it's a sticky situation. What's the shelf life expiration date on a kit to have to replace them every year. Yeah, so if it gets expired in three years you go and look and see it expired we encourage you to replace it. Do we get a certificate for doing the training unfortunately no there are no certificates for doing the training, I will send a follow up email confirming your attendance so for whatever reason you need to prove that you were at this training that can serve as proof that you were here. But no the this is a certificate of completion if you get a kit but just for doing the training now. Please show open the device and close out of the package and two packages the two doses not two doses per device. Okay. So the first part of your question is that this is a dose, and this is a dose, one dose per one device. That's a great question I'm sorry that that was not clear. And then the second thing is you wanted to see me take the device out of the blister pack so yeah it's just like any other sort of little peely back moment right you're just going to feel black this little metal thing like you're accessing any other you know like Benadryl, or any other medication and a little thing, take the device out. I put my two piece fingers around the nozzle, my thumb on the side, and then I'm going to push down on the plunger when it's inside the person's nostril to make sure they're getting all the medication. I'm glad that was what you needed. Great. Are there any other questions. Alrighty. Well, Alex, thank you so much for such a thorough and human presentation on this really important. Training for the nightlife community to feel comfortable with knowing how to use this and to really feel I think hopefully confident that they can do it. I just want to, you know, remind and encourage everyone to make sure that there are kids that are maybe in the front of the house as well as back of the house to make sure that not only patrons but also staff are also considered like kitchen staff and so forth. You know, I just want to thank everyone again for coming and taking time out of your day. We really do see clubs and bars and nightlife as places where people can look out for each other and actually save lives. So feel free to contact our office if you have any other further questions at nightlifeatmedia.nyc.gov. Follow us on social media nyc.no nyc nightlife gov at nyc nightlife gov and have a great week. Stay safe, stay healthy, stay happy, and we will be in touch with you all very soon. Reach out anytime. Thank you again Alex and thank you everyone for attending. Bye. Thank you all so much.