These notes are based on an overdose training session that I ran for a day
centre for homeless drug users, and on discussions with trainers who have
conducted od awareness courses for drug users. They are a bit rough and ready,
but are posted in the hope they might be useful to people planning similar
sessions.
Introduction
Overdose response training is a potentially life-saving intervention that should be
offered to injecting drug users and their families and friends.
Sessions should be run by an experienced drug worker and a qualified first-aid
trainer (usually a paramedic as this builds useful links with the ambulance
service).
Other than in in-patient and residential settings and where the session is part of
an education programme it is good practice to pay people for their time in
attending. Payment should be in cash and the recommended sum is £10–£20. If
you think this might be a problem, please click here.
This is a plan for a 1–2 hour overdose response training session for drug users.
The variation in how long the course will take is because this will vary according
to how many attend, how well you know the clients, the environment the course
is taking place in and the number of questions/amount of discussion.
Recommended audience is about 8 participants, maximum is usually 12
(although in residential groups, or groups that know each other well, it could be
up to 16).
The following notes are written for trainers, and detail things to cover, and the
sorts of things I say when running the course. Any experienced trainer, with
experience of working with drug users, and a thorough understanding of the
issues and who has read the od campaign briefing paper carefully should be able
to run the course.
Course Plan
Open the session
welcome the participants.
give the background to the session:
national increase in od deaths from less than 100 1990, 3000+ in
1999.
local experience numbers of overdose deaths
investigations into what’s going on have shown that most
overdoses are witnessed
this course is part of a national programme of od prevention
workshops that aim to give drug users the information they need to
respond to od situations.
‘ground rules’
Session will run for no longer than 2 hours;
happy to have discussions and answer questions as we go along;
but it will be easier if we just talk one at a time;
and bear in mind that I may have to cut discussion down at times just so
we can get through everything;
hope that’s ok with everyone.
also cover fire exits, toilets and smoking
Introduce yourself.
Introduce first-aid trainer.
Get the group to introduce themselves with their name and then ask for some
additional information to get people talking. What you ask the group for will
depend on the number of people there and how well you know them, and how
well they know each other.
Additional information should help get the session going, and discuss the subject.
Suggestions are:
Smaller groups, groups that know each other/the trainer something like:
tell us briefly if you’ve seen an overdose where someone was saved
(not process the stories now, move on if taking too long - max 1-2 mins.
per person)
would be appropriate.
For larger groups, groups that don’t know each other/the trainer something
simpler like
how many times you’ve seen someone really od, go blue?
might be more appropriate.
GoingOver video
The GoingOver video may be more useful in settings where the participants
know each other well, and the trainer should consider whether the more
upsetting scenes in the video will focus the group or upset people who might then
decide to leave.
If you’re not going to use it, go straight to the flip chart exercise.
If the video is used, introduce it carefully, explain that the voices are of 4 real
drug users telling stories of their overdose experiences, with a dancer
demonstrating the recovery position in between. The people you see on screen
are actors, but the voices are real.
It is important to let people know that it can be upsetting, but that we’re showing it
because it reminds us of why we’re here, and the footage of the dancer putting
himself in the recovery position is a really helpful way of remembering what to do.
But give participants permission, if it is too much, to feel free to get a coffee, and
come back in a couple of minutes when we get down to talking about what
causes od and how to respond.
Key messages
on the flipchart write up and say that the key messages from the video/from the
session are:
Dial 999
Put people in the recovery position
and we’re going to talk about first aid in a minute, but first I want to talk about
what people actually do…
1st exercise:
Can you give me a list - to write up on the board - of the things people actually do
when they see someone overdose.
before you end, make sure the list includes:
 walk people around
 inflict pain (long list of ways helps)
 bath/cold water
 inject salt
 run away
Discuss once you’ve got the whole list. Key points:
Deal with inflict pain first
explain od is pharmacological process (in some ways like a general
anaesthetic if you’ve had an od there is nothing anyone can do to wake
you up - in surgery they cut you open!)
if they come round during pain infliction, it is because the body is
metabolising the drugs.
stimulus can only rouse people from semi-consiousness and it can only be
used to assess consciousness only explain that this should be done by
pinching ear
shouting
gentle slap to the cheeks
walk people around
as above + speeds up absorption of any drugs/alcohol taken orally
bath/cold water
as above + risk of hypothermia, increasing core blood levels and risk of
drowining
inject salt
as above + risk of viral transmission.
run away
risk of death. Most overdoses happen more than 3 hours after the heroin
use!
First-aid
OK, practical bit.
First-aider to demonstrate
1. recovery position.
2. assessment of need for CPR
3. CPR
If possible get everyone to put someone in the recovery position, and be put in
the recovery position. Also everyone to have a go on the little annie resus doing
mouth-to-mouth and CPR.
finish off.
OK, to finish off, I just wanted to go over the main risks for overdose deaths…
these are:
mixing drugs, particularly alcohol and opiates, benzos and opiates.
injecting.
being a longer term user (most od’s are people in late 20’s and early 30’s)
idea to change the way people react.
stuff in these packs is to help you do that with everyone you know.
highlight the tear off cards.
give out packs
Thanks, and close with
Certificate of attendance
A certificate of attendance saying something like ‘this certificate confirms that
…………………… has attended an overdose awareness and first aid training
session at…………………… on………………..” signed………………… project
manager.” Will add to the status and positive feelings that participants have
about the course.
Evaluation form (it is good practice to pay people to attend these sessions, and
payment is normally handed over in return for a completed evaluation form at the
end of the session)
Handouts:
Od campaign booklet
Od recovery position pad (to be given with encouragement to take it away and
practice the recovery position with everyone who is given a card, ask people to
try and use up the whole pad)
Plus, if appropriate, the Od detox and you leaflet and/or the od methadone
storage cards.