Opioids & Fentanyl - How to Recognize an Overdose and Save a Life | Amudim

Obi has become a crisis across the world, certainly the United States and within our communities as well. We spent many, many years pretending that nothing affects us and that, you know, we're this Jewish community and therefore, you know, we don't have any of these issues. The reality is is that drugs doesn't discriminate. Drugs doesn't really care and anybody's susceptible to getting caught up in it. And opiates is a huge problem in America and people die. So we didn't really discuss I I mean if you want to go through some of the stat statistics you know more people particularly that younger ages die from um overdoses than motor vehicle accidents than homicides motor vehicle accidents and suicides combined. It's the leading cause of death of premature death among New York City residents etc etc etc. It's not great and it affects us. Um just try to jump through that. Do we know what opiates are? Cover ahead. So, what are opiates? Opiates are painkillers. They're pain relievers. They block the pain. And this isn't just limited to, you know, your your street drugs, not limited to heroin. But opiates could include, you know, prescription pain medicines as well, which we'll get into. So, you know, people getting from their doctors think that it's all okay and it's totally fine and just following my doctor's orders. That's, you know, the best one. I'm just doing as as my doctor prescribed. And really it's essentially chemically the same thing and you get hooked on that the same way. So you may start off not looking to be, you know, do drugs. Someone went for a toothache and they're getting prescribed opiates. It's the same thing and it's the same risk. Essentially causes feelings of euphoria, a detachment. It numbs that pain and that'll work whether it's physical pain or emotional pain. It's a numbing effect where you just sort of chill. It typically will stay in your system up to six hours. And what it essentially does is it relaxes you. It cause person to calm the breathing to slow but eventually with enough breath the breathing slows till the breathing stops and that's what we call an overdose. Right? Body still needs oxygen. Some of the generic opiates, right? We know heroin obviously but oxycodone, hydrocodone, morphine, codin, fentinyl, these are all regopids, many of them prescribed. So you go to a dentist and he prescribed I had a a guy like a very straight lace guy. He's telling him about he went to his dentist to get to have his teeth done, whatever it is. He was prescribed and he's following on the bottle, you know, every 3 hours or every four hours, whatever it is. And he's taking really the pain was gone already, but you know, he's by the book and he's taking till his wife like stopped like what's going on, man? like after a couple of days he was just loopy. He just wasn't himself. But he didn't realize cuz he's following you know doctor's orders. But it's a regular pain medicine that's given and it's essentially the same thing as getting heroin on the street. Interestingly some of the methadone which are actually used to detox which is a whole separate discussion also contains opiates in it. Um fentinyl is particularly important to know about. Fentinyl is a is a synthetic opiate and that's been really a huge problem in New York but really across America because it's made in labs and then it's cut into a lot of other drugs. So you know we have people who only smoke pot cuz pot's all natural. It's fine and I never do anything else. I'll never do anything else. And I mean I have one guy like that you know he'll never do anything. It's all natural. And we buried him from a opiate overdose. I had another guy who end up going to rehab and when they test him coming because it was only smoking pot I guess it was just way out of hand and had crazy amounts of opiate in his system but he had never done opiates but everything is cut into it and the weird thing is that dealers don't mind as dangerous as fentinyl is yeah I actually have a slide of that fentinyl is much more potent it's like 100 times more potent than than heroin than street heroin and can be fatal in very small doses And they'll cut this into other drugs that would otherwise be innocuous. And actually what it's sort of counterintuitive, but makes sense when you think about it. When you have a dealer that sells a cells and they have an overdose, it actually increases sales because to the population buying, that means they got good stuff. And if they actually come and get more. So you would say like how why would they use this? Why would they cut it in? But it makes it good. It makes it addictive and keeps people coming back or there's other people coming back. But fentinyl has been a big problem. And fentanyl, just be aware of it, it has been cut into many other drugs. So you may think if you don't know your supplier, which you shouldn't do any drugs, drugs are bad. But if you don't know where you're getting it from, it's not always as clean as you imagine. And that can be a huge problem. >> Effectively, just >> there's no way to know. >> There's testing. They have test kits now that you could, you know, you I might have one with men. I don't think so, but I just sent it down. >> But they do have fentanyl test kits. But >> then how does it test? Like you blow into it like >> you're testing the drug. >> You take a little bit of what it is. >> You crush it. You put in the water. You take the pressure. You put it in the dogs about it, >> right? But there's no way to tell what a person >> what take anything. You should test it essentially. >> No. After a person takes something, there's no way to tell. >> I mean, we have urine tests and blood tests. >> Not instant like >> I you can guess, you know, you can observe people and see. >> Also, different different things will give you different reactions, different ways to way make you act different ways. So if you kind of know what the general things are, you can kind of connect it for yourself. Kind of >> you could take an educated guess if you know what symptoms you're looking for. But really the best way to know is ask them or ask their friends who they're with. Like if you come and somebody's overdosed or reacting or or you know listen to the people who are there. I had a kid just tell me this. He was with a friend. They an acid or something, but they were tripping and someone called Cella because he was on whatever. They call it Cella and Cella comes in and he tries to stop them to try to listen, this guy's tripping. Here's what he's on. Here's what he took. And of course, you know, cuz they just kind of pushed him to the side. They want to deal, but coming in there with somebody who's hallucinating and going through not a pleasant trip, they may have agitated more, but listen to people are there. Be aware of what it is. I mean, the best thing, you know, the best test is don't use drugs. >> Are most overdoses coming from like uh stuff that's laced or people purposefully taking what they wanted to take and overdosing? >> Are most of this coming from You're not saying that people looking to overdose. You're saying they were taking something that they knew what it was. If they were taking, let's say, an opioid, is it more likely that they're going to overdose when they're taking the actual thing or if they're laced or which one's more common to overdose on? >> I actually want to get into a second. >> Okay. >> See why >> you had a question? >> Yeah. The the thing you just said about someone having to call, was that what was he taking? >> What were they on at the time? >> Yeah. Was it just weed? >> No, no, no. They were they were tripping. It was lucenics. Although I've had people who have to be who adjust weed also >> people it it does happen. One of the issues that I have with weed, and that's not what this is really about, is is because everyone could point to somebody and say, "Hey, look, he does it and she does it and they're totally fine and they're functional and whatever, which the truth is you don't really know that because >> I deal with their kids or their spouse or whatever that's going on." And there all sorts of other things going on. But even let's say everyone loves to point to that guy and say, "Well, you know, he has his company and he gets up to work and he's all all great." But what about the 100 people that are not successful? Everyone assumes that I'm going to be that guy. I'm going to imagine that's okay. This illusion of safety and it and it's not true particularly at younger ages for multi I mean this is again this is about marijuana so I'm sorry but particularly at younger ages because a it can cause severe psychotic issues. It's more rare generally, you know, most people handle it, but there are definitely I I've dealt with quite a few who never recovered like just smoking pot, not lace. They smoked with other people who were fine and never recovered. Like one was full-blown schizophrenia. They like, would that have happened anyways? It's it's hard to know. This certainly was the catalyst that caused it. That's not everybody. And there's all sorts of social and emotional and developmental issues that develop as a result of not coping with life and not dealing with things. But that's an aside. But no, they were dealing with the psychedelics. Probably we also, but that wasn't the primary. Anyways, back to opiates. So opiates are painkillers. Essentially, we have opiate receptors in our brain. Again, very basic, simple. Um what the opiates do is they fill those receptors and give up the give us and thereby blocking the sense of pain which again our body needs right which is what the issue really is right because what we say you know the overdose is slows breathing breathing stops right and that is what leads the overdose right that's brain death etc and regular death because typically when we stop breathing that's really uncomfortable and our brain tells us hey that's a problem. When I don't feel that, I don't see it's a problem. Right? So, opiates feel these receptors in our brain. >> You're saying that there's no warnings. >> Pain is a message that our body's telling us that there's something wrong, >> right? You step on glass and you're bleeding out. You want to know that, right? You stop breathing and that's uncomfortable. And the truth is emotional pain is no different. It's a scream that, hey, there's something here that we should deal with. Sometimes it's overwhelming. We want to just numb it. But there's a cost at that. Yeah. It also happens extremely fast. Like extremely fast. The person goes from being okay and then instantly they're not okay. Like it's not like >> with >> Well, it depends how much you're taking. Everybody thinks Darc can't mess again. Like >> Exactly. And then the next thing you know like you like think the person is dead and then you're not. So it's better not to risk it thinking like oh but like this time I was good like next time you might not be. >> That that is definitely true. also you know what exactly you're taking and the method of of of taking it also plays a big role but anyways receptors in our brain and it fills with receptors and that's what blocks the pain and therefore we don't get those messages. So what puts people at a greater risk of overdose? So change in intolerance essentially when we start using we build up a tolerance for it and what gets you high the first time right is not necessarily the same thing that you'll need that second time that second goaround right you need much more to create that same high as we talk about the chasing the high um so when a person stops using then their tolerance goes back now that doesn't matter why they stop using it doesn't matter if they went clean or they went to jail or if they went to rehab or whatever host of reasons, but their tolerance goes down. And this is really a huge one. And I think this is where most of our overdoses are. And it's actually really sad because that's where we see a lot of overdoses is when people do go clean. They go to rehab, they get their life fig, they're doing well and then they have a bad day and you know it doesn't mean that's anything major but they have that bad day and they go back and all the addicts know this. So they always will cut back but they don't necessarily remember that how little it took that first time to get high and you know now I'm doing a bag and then I just needed you know I did one pill and now I'm taking 12 pills. It's like okay so they cut back and they only take six. That's still a huge amount for somebody who hasn't been using in 6 months. And it's really it's really rough because the family has gone through so much and they've gone through so much and they come so far and they're finally, you know, at that point where they're doing well and they they're clean and doing well and it's a little bump and then those off. That's really where I would say we see most of our overdoses. So, they're intentionally using it, but they're not necessarily as aware about what the right levels for them are. mixing drugs. When it comes to drug use, 1 plus 1 does not equal two. 1 plus 1 is like 14. So that means you know you know that you could take, you know, one head and you could drink a beer and you could handle all those things, but when you combine them, it's very different, right? You start popping, you know, just going to get the bad, right? Opiates together with alcohol and you're like, I've always handled my two beers. Not a big deal. And now you're doing it together with it. That also increases the chance of the overdose variation and strength and content of drugs. That's sharing drugs, right? So I don't have what I usually take. I'm allowed. So I go to my buddy. So he goes, "Oh yeah, sure. Take the same thing." But I'm not really aware. It's a different dealer. It's a different pill, right? So that contributes to the overdoses. Previous experience of a non-fatal overdose. So if somebody's overdosed but it wasn't fatal, they are significantly more likely if they're to have another overdose for that to be fatal because >> we'll get into that in a minute using alone. So contrary to what people believe, most overdoses like true overdoses aren't that needle in the arm don't happen instantly. Again, you lose yourself very quickly where you think you're in control and then you're not. But the actual overdose typically is only about 15% of the overdose that happen that like instant. Most overdoses happen over the course of 2 to 3 hours. >> That's why. >> So an actual overdose meaning to to you we know he could be out for a while till it becomes fatal. But that really means using alone really increases the risk of a fatal overdose. If you're using with people, if other people are around, people see it. People are there to intervene. Particularly, you know, talk about Narcan, which we'll get into, but it can truly save a life. And if people are there and they know what they're saying, they know what to do, and they have Narcan, they could really save a person's life. And when you're alone, it doesn't have that. And my favorite, use of any opioids greatly increases your risk of a fatal overdose. You're far less likely to overdose when you don't do drugs. >> Yeah. >> With the timing where you say where it would take a few hours where they're out before they're having a fatal overdose that entire time. Is there a way to know that they took too much or that they're going to be over like dying? >> So, yeah, we'll get into it. As a bystander, >> right? That's what we're going to talk about is how do you see the signs and what can you do about it? I suppose for the person themselves because that's part of the problem here is that they right that the overdose is them essentially passing out. They're super calm and nothing matters. Every breathing is slow and just but you know then they're not really conscious to deal with it. >> And once someone's passing out then it could be quick to to to fatal >> or or does it who knows? typically >> there's so many variables. >> Yeah. I I once they have enough in their system and they're typically taking over the course of time then the body is slowing >> because I feel like there's also like this concept like okay they're going to sleep it off >> and then right so how do you know right >> some people are still sleeping it off >> right >> but if it's taking like a few hours is it that they're continuously using few hours and then they're overdosing or that >> no so I'm with you if somebody is using used and hasn't been using your body is metabolizing it and it is being worked out of your system over a course of time. >> That's not a great idea because you don't know how much they actually took and but but that's again why what we're going to look for in terms of the the the signs that you're looking for the symptoms that are of concern if they're just kind of out cold and that's what we're going to you know talk about and they're you know every time you hit them they they murmur they mumble. Okay. Again, it's risky, especially because you're like, "Okay, they're good. They've been like that." You monitor them for the first hour and a half, two hours, and they're good. So, you go chill in the other room, and then they get up and hop to their desk and take some more and go back to sleep, and you find them in the morning. And that's not great. Essentially, opioid, sorry, the overdose physiology. So, what does it do? The opioids repress the urge to breathe, right? you don't feel that it's necessary just the burden just takes so much effort eventually breathing slows breathing stops which leads to the heart stops stops and ultimate death it generally happens over the course of 1 to 3 hours so again the those needle in the arm is 15% of them that's what our movie show that's what it is you know they inject and they're instantly dead typically it happens over the course of one to three hours >> I didn't mean instantly like within 15 minutes no I meant like instantly like maybe like one day they're good and the next day one day >> in terms of you developing the addiction >> meaning I meant it more like in a long terms situation like one you never know like what day is going to be the last >> yeah although I'm more concerned when they come out of rehab than when they go in because if they manage with what they're managing but but yeah you get one bad batch they could have been using for 10 years and you know um but Again, I most of those happen over the course of 1 to 3 hours, which really does mean that there is more often than not time to intervene if you know what you're looking for. If you have narcan, there there is a time. So, what's Narcan? So, Narcan is a safe effective medication that reverses the effects of an opiate overdose and really almost instantly. That's essentially what it does, right? We talked about the the the receptors in the brain. Essentially, Narcan will knock those receptors off and bind more tightly than the opioid, not allowing the opioid any place to bind. And which means instantly it's gone back. It has no effect if opiates aren't present, which means if somebody is which means two things. It means if somebody is overdosed on something else, Narcan won't work. Right? So if somebody's overdosing on alcohol or cocaine, Narcan won't help. That doesn't mean don't give it. Give it because remember it doesn't hurt, right? It has no effect if if opiates aren't present. There no known addiction, no prescriptive dependence, no known allergies, no side effects. There's no negative really. So if you think that it might be an opiate overdose, it's worth it. But again, it's completely safe. It will instantly almost instantly really reverse the effects of opiate overdose. And it used to be by prescription only, but now they changed that. You could buy it in a in a pharmacy. We give it out for free. Nan, they say usually takes two to two to 3 minutes for it to take effect. In effect, opiates stay into your system for up to 6 hours, whereas Narcan is 60 to 90 minutes. Now the problem is that what happens you know if you if you give somebody narcot you'd love to see them like all appreciative but they're not often so appreciative because you just also may have saved their life you also took away that high or brought back all those feelings and it's not always so great. So often you know their goal at that point is to try to get that high back. The problem is what happens if they take any opiates now >> still in the system. >> Well, what happens is >> they're going to keep taking >> nothing, right? Because you just narcan them. So, they're going to take more opiates, but nothing happens. The problem is the Narcan >> start the 6 hours, >> right? The Narcan wears off after 90 minutes. the opiates that was enough to overdose them the first time is still in their system and that lasts six hours and they just spent the last 90 minutes adding trying to get that high back. Which is why if they're to overdose the second time, that next overdose is very often fatal. Which is why it's super important that if you are ever in that situation where you have to knock on somebody really you want to stay with them and you want to make sure that they're not using it. So again, if you suspect that maybe an opiate overdose, then give it. Again, you don't necessarily know, that doesn't mean you're going to walk over to random, you know, homeless people or sleeping on the subway. They probably won't appreciate you shoving something up their nose. But if you have reason to believe, then you know there there is no downside to it. So opiate overdose. Signs of opiate overdose is essentially like we said, right? It's that slowness of breathing until the breathing stops. What you're looking for is slow or stop breathing. Blue bluish grayish lips or nails, right? That's the restricted blood flow and a general unresponsiveness. And certainly if they're with friends or other people and you could verify that, hey, you know, they're passed out because they were just, you know, doing lines of heroin, then that's probably, you know, a a good thing to go on. But basically what you're looking for is that general unresponsive, which doesn't mean that again you're going with any random person sleeping. The first thing you want to do is try to wake them up. You're talking about a sternum rub, which is like kind of uncomfortable. If it's your friend, you know, kick them around a little bit, try to get them to wake up. But if you're really not getting a response, you know, it's different when you try to wake up a drunk person, right? They they kind of murmur, mumble, you know, what slur their words, but okay, you know that they're there. Here you're getting, you know, you're not really hearing much breathing. It's very very slow breathing and you really can't get much of a response. We'd have to say do call 911. And I would say if you're on your own, right? If you're the only one there, I would call 911 before giving the Narcan because as soon as you give that Narcan really quickly, they're going to wake up and then you're going to have a whole lot to deal with and call 911. Might not be a great idea or may not be so simple. If you're there and there are other people around as well, instruct somebody else. you know, you call 911 and then somebody else get the nar. There is a good Samaritan law because which is essentially is that you call 911 that you're not going to be charged with anything related to this, right? But essentially they would respond to these overdoses and there were tons of people around and nobody called 911 because everyone's afraid that if they call 911, the cops are going to show up and there's drugs all over the place. That's not great. All right. Now, if you have a outstanding warrant in, you know, 17 states, maybe let somebody else give it and you leave, right? It doesn't mean that covers you on everything, right? If you're you're, you know, the FBI is one most wanted. >> Does it cover other people using around them? >> It it covers I don't remember what level, you know, felony a certain level. That means if they show up and you have mounts of cocaine on your table, I can't tell you. They can be like, "Okay, that's cool." You know, carry on. Also, if you're partying, tell everybody else to leave, right? call 911. Everybody else should go home. Whoever's dealing with the overdose should deal with the overdose. Everybody should go. It's not like this blanket like, "Okay, chill. They're going to show up and everyone, you know, you know, the music is still going." >> That's like my least favorite thing ever when people make it into like a spectacle. Just like It's not This isn't like an entertainment on Friday night. It's not. >> Yeah. But really, you send everybody, somebody should call 911 because again, you don't want to leave the person, save their life, only find out that they used again, and that you have. >> You ready? So, basically, you show up, right? Somebody's passed out. >> You have reason to believe, right? You're trying to wake them up. They're not moving, slow breathing, >> right? It might be an op overdose. We believe in the the kit. Each kit has two Narcans in it. There's four milligrams in each one. Each one is a single dose. It's a nasal spray. It's really simple, right? Pull back, peel it open. >> This is the whole thing. There's no cap on it. There's no anything. >> One button. You'll see when she does it that it's knock yourself out. >> So, when I ruffle, she has a big one. >> No. Wait. Do I go more up? Oh, it's always in the nose. >> God dang. >> Did it work? Look at it. >> Ask her. Did it work? >> Yeah, I think it worked. >> I don't know. I never felt it. >> Are you hold up? Hold up. The pace protection. Show. >> I was picturing like an echo pad. >> But that's it. >> Well, you don't have to take that out. That's the point. The point is that once it's done, >> it's one single use, >> right? Once it's done, it's done. It's a single press. >> So, it's a one time. >> Each kit comes with a second. Yeah. >> Nope. Single dose. >> Now, if you give it and they don't respond, the kit does come with the second dose. Use the second dose. >> Even though it might not be >> No, the second dose. She has the first one. >> Okay. Now, if you have to give the second one, >> typically we say do it in the other nostril. >> But that's not like crucial. Like, if you don't remember, just give it. Right. The reason I say put in the second cuz you we don't see what's going on. Maybe there's a blockage. Maybe there's whatever going on, but you want to give it everything goes to the same place. It's just kind of like had your best. But if you don't remember, give them the narcan. So, but this is part of the reason why we're going to call 911 because if your Narcan doesn't work, if they're not coming through or there's something else going on that's not just heroin related, they could respond to that. They can inject the Narcan. They could give different dose. They could give more. They could handle if he wakes up, you know, kicking and breaking things. >> There was like a rock of like cocaine, right? it and then it would have pushed back the cocaine like that could >> well this won't help the cocaine anyways >> exact that's what I'm saying so could it potentially make it more problematic in that sense that you'd be also >> if they're passed out and overdosed at this point >> I guess yeah nothing >> I mean like I don't know if there's more problematic >> not explaining my question >> I had a girl come to me has to do with nan training like a bio girl she saw you know she like didn't fit in everybody else there had friends they were using just and she came cuz she heard about it. She's like, "My brother's using something. I don't know what." And she came, she called me like literally 2 days later that her brother overdosed and she said, "Cuz I was there. I knew exactly what was happening. I knew exactly what to do. I had the Narcan and she saved his life." >> She sent me a message, you know, that he sent her from the emergency room. He called me about a year later. He's been clean. He wanted to come pick up Noran for his friends. It makes a difference if you know what it is. You never know where it'll happen, when it'll happen.