Overdose Prevention

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Overview

Substance misuse and overdose are an increasing community health concern across the city of Denver. The DDPHE Community & Behavioral Health division is home to the Substance Misuse Program, which aims to prevent substance misuse, improve treatment access and retention, and reduce harm associated with drug use.

Explore the information below to learn more and see what resources are available to the community.

Fatal and non-fatal overdoses are preventable. Harm reduction strategies to prevent overdoses vary a bit by the specific type of drug, but generally include using less, testing your drugs, using a less risky method of administration, and not using alone. For opioids, there is a medication that can be used to reverse the effects of an overdose.

The video below describes how to identify and respond to an opioid overdose using naloxone. Additional information regarding opioids and overdose prevention can be found further down on this page. 

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What is an opioid?

diagram depicting how opioids work
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Opioids are pain relievers, including opioid analgesics (prescription painkillers), heroin, and fentanyl. Examples include: methadone, oxycodone, hydrocodone (Vicodin), and morphine.

Fentanyl is a highly potent, fast-acting opioid.

Opioids work by binding with opioid receptors in the brain to:

  • Relieve pain
  • Relieve withdrawal
  • Produce feelings of mental and/or physical comfort
  • Cause side effects such as constipation, drowsiness, and respiratory depression

Opioids are NOT:

  • Stimulants such as cocaine, crack, or methamphetamines
  • Benzodiazepines such as valium, Xanax, klonopin
  • Alcohol
  • Muscle relaxers

Note that some non-opioids, such as cocaine, have been found to contain fentanyl (an opioid) in Denver. Therefore, DDPHE encourages anyone who uses illicit substances and/or may be in the position to respond to an overdose to carry naloxone, regardless if they intend to use an opioid.

More information on fentanyl in Denver

What does an opioid overdose look like?

OverdoseDescription_Graphic.png
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Opioid overdoses happen when a person takes too many opioids or a combination of opioids and other drugs that lead to respiratory depression, or slowed breathing.

If a person is not breathing enough, oxygen levels in the blood decrease.  The lack of oxygen eventually inhibits the function of other vital organs including the heart and the brain.  This can lead to unconsciousness, coma, and ultimately death.

This process is rarely instantaneous; respiratory depression can last over the course of minutes to several hours after the drug was used until a person stops breathing completely. This means there is usually time to intervene between when an overdose starts and the person’s death.

The window to respond to an overdose may be shorter with fentanyl.

It is also important to note that COVID-19 can impact someone’s respiratory function and we are unsure how COVID-19 impacts someone’s risk to overdose. 

What is Naloxone?

NaloxoneDescription_Graphic.png  
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Naloxone is a medication that reverses opioid overdoses by blocking opioid receptors, which prevents opioids from binding to them. It will have no impact if an overdose is not opioid related.

Naloxone is available in the form of a nasal spray, as well as an intramuscular injectable form. DDPHE distributes the intranasal spray naloxone under the brand name Narcan.

There are no negative side effects of using Naloxone and no potential for misuse or dependence. However, naloxone may put a person dependent on opioids into withdrawal, which can be a very painful and uncomfortable experience.

Where to get Naloxone

Use the form below to request Naloxone from DDPHE. DDPHE is only able to fulfill requests from residents of the City and County of Denver. 

If you live outside of Denver, several pharmacies also distribute Naloxone. Visit stoptheclockcolorado.org to explore an interactive map of locations where Naloxone can be obtained.

Click here to view form.

Risk Factors for an Overdose

Changes in Tolerance:

  • Tolerance is how your body adapts to regular use of a drug over time.
  • If someone has not used the drug for a long period of time their tolerance will decrease, meaning that the next time they use the drug they will be highly impacted and at an increased risk of overdose.
  • Individuals who have abstained from drug use for any reason—possibly due to isolation and inconsistent access to drugs, being incarcerated, detox, or rehab that require abstaining from drug use—are at increased risk of an overdose. 

Mixing Drugs:

  • Research shows that most drug overdoses involve poly-drug use, the use of multiple drugs.
  • Central nervous system (CNS) depressants such as alcohol, benzodiazepines, and opioids can increase someone’s risk of experiencing an overdose when mixed. 

Drug Quality:

  • The strength and purity of drugs purchased off the street and online are unknown.
  • Unpredictable changes in drug quality, purity and strength may occur.

Previous Non-Fatal Overdose:

  • Research shows that once someone has experienced a non-fatal overdose, they are at higher risk to experience another overdose in the future.

Using Alone:

  • While using a substance alone is a not a risk factor for an overdose itself, it puts the person at a higher risk for a fatal overdose because there is no one there to respond if they lose consciousness, to call 911, to administer naloxone, or to help in any way. 
  • As social distancing is promoted due to COVID-19, there may be increases the circumstances where people are using alone.

How to Reduce Risk

Changes in Tolerance Be careful if you take a break or miss doses, use les, go slow
Mixing Drugs Go slow/do a slow shot, make an overdose plan, have a phone on hand to call 911
Drug Quality Assess for risk, carry naloxone
Previous Non-Fatal Overdose Use with someone else, take turns; it's important to have someone to help
Using Alone For those who are ready, medication assisted treatment (MAT) with methadone or buprenorphine

Use of any opioids can put someone at risk!

Community Resources for People who use Substances

Syringe Access Programs

Syringe access programs (SAPs) are evidence-based interventions shown to reduce the transmission of HIV and hepatitis C (HCV) and do not increase drug use or crime. They meet people where they are to provide an array of services in a safe, anonymous setting.

SAPs have many benefits including:

  • creating opportunities to engage people who use substances and linking them to services,
  • they are shown to be safe, effective, and cost-saving, and
  • they are associated with a 50 percent reduction in HIV and HCV incidence.

Participants of SAPs are:

  • more likely to safely dispose of needles,
  • more likely to reduce or stop injecting, and
  • five times more likely to access treatment for substance use.

Recent increases in fatal and non-fatal overdoses, and changing drug supply, have identified an additional need to promote the use of these programs to provide overdose education and naloxone to individuals who use substances but do not inject.

Programs provide a variety of services including:

  • Access to sterile syringes and syringe disposal.
  • Injection supplies such as cottons, cookers, waters, tourniquets, sharp containers and more.
  • Overdose prevention education, including access to naloxone.
  • Referrals to substance use treatment and resources for people who want to reduce or eliminate drug use in their life.
  • Linkage to care and referrals to HIV and hepatitis C care.
  • Harm reduction counseling and substance use education.
  • Fentanyl Testing Strips.
  • Wound care education.
  • Other harm reduction supplies to reduce the impacts of drug use.

Currently, there are three syringe access programs in Denver.

  1. Access Point: A program of Colorado Health Network and provides services 3 days a week at 6260 East Colfax.
  2. The Harm Reduction Action Center: Focuses specifically on providing services to people who inject drugs.  They operate 5 days a week at 112 E. 8th Ave. and provide mobile services via street outreach 3 days a week.
  3. Lifepoint: A program of Vivent Health that provides mobile syringe access services throughout Denver.

For People Who Use Alone

Because many individuals use substances when alone, there are resources available to ensure someone can respond to a potential overdose. Visit: neverusealone.com to receive anonymous support from a volunteer when you use your substances.

Wellness Winnie

What is Wellness Winnie?

  • Wellness Winnie is a “fun size” RV, with scheduled travel route through Denver for the purpose of providing integrated behavioral health and support services.
  • Wellness Winnie exists to empower all people in Denver to live their healthiest life and to increase equitable access to resources, helping the community to thrive.
  • Wellness Winnie is staffed with mental health counselors and peer navigators. Through shared experiences, peer navigators are skilled to support recovery and mental well-being.

What does Wellness Winnie currently provide?

  • Peer support and navigation
  • Informal classes and presentations
  • Sharps disposal
  • Behavioral health screening and assessment
  • Active referral to services such as: medical, legal, and social services
  • Distribution of items such as: socks, gloves, toiletries, etc.
  • Rehydration and cooling from the heat
  • Warming from the cold
  • Narcan distribution and overdose education

For more information about Wellness Winnie or to locate a stop near you, please visit our Wellness Winnie webpage.

Drug Checking Resources

Other harm reduction strategies include testing your substances for the presence of fentanyl prior to use.

Because drugs purchased on the street can contain fentanyl and other unknown substances, it is important to test drugs before using them.

DanceSafe is an organization that promotes health and safety within the electronic music community. They provide a number of resources. They also offer fentanyl test strips for purchase.