The San Francisco Department of Public Health held a free workshop Wednesday night on recognizing overdoses and administering Narcan, a medicine that reverses potentially fatal opioid overdoses.
The event, held at Manny’s, was one of several efforts in recent years by the public health department to train San Francisco residents on Narcan use.
Some 49 percent of overdose deaths in San Francisco occur in the Tenderloin, SOMA and the Mission, according to Eileen Loughran, director of DPH’s Office of Overdose Prevention.
This is how to recognize an overdose, administer Narcan, and attempt resuscitation while awaiting professional medical support, according to the city’s training:
Recognizing an overdose
An overdose begins with shallow or no breathing, develops into brain swelling and, eventually, leads to a heart attack.
When someone is experiencing an overdose, the victim’s symptoms might include the following:
- Losing consciousness
- Having shallow or no breathing
- Discolored lips, fingernails or skin from lack of oxygen — turning blue or purple for lighter skin tones, and grayish for darker skin tones.
When you suspect someone of overdosing, the first thing to do is to call them loudly and, if they don’t respond, shout, “I’m going to Narcan you!”
If they are just asleep, they will wake up: “Because nobody wants to be Narcanned if they don’t have to be Narcanned,” said Emily Valadao, one of the presenters.
If they don’t respond, the next thing is to administer some pain, such as rubbing your knuckles up and down the center of their chest; make it hurt, Valadao said. “Some people actually get bruised from it,” said Valadao, demonstrating rubbing across her sternum.
If they still don’t respond to the pain, the next step is to “Narcan” them.
Mapping Strips and Narcan at Mission Bars
Give Narcan and call 911
Have the person lie on the ground facing up, and open their mouth to check that the airway is unblocked. Remove the foil from the individually-packaged Narcan and insert the tip of the nozzle into one nostril. Then press the plunger in the middle with your thumb to administer the medicine. Once pressed, that Narcan is used up, and the plunger doesn’t come back down.
Set a timer for two to three minutes for the Narcan to do its job before giving the second dose; more doses all at once do not speed up the process.
Call 911 immediately, and then start rescue breathing.
If two or more people are helping out, one may call 911 as soon as possible. If you are on your own, it’s important to administer the first dose of Narcan right away, and then call.
Rescue breathing, or mouth-to-mouth resuscitation
Rescue breathing requires you first to tilt the victim’s head back to open the airway and pinch the nose. Then seal your mouth onto their mouth, give two quick breaths and turn your head to see their chest rise. Then give one breath every five seconds.
You may add a thin layer between your mouth and the victim’s mouth as a protective barrier. In her demonstration, Loughran used her thin sweater.
As your timer sounds two to three minutes after the first dose, you may pause the rescue breathing to administer the second dose of Narcan. Repeat the procedures until paramedics arrive.
Loughran acknowledged that some people may not feel comfortable doing rescue breathing, especially with the potential risk of contracting Covid-19. But that doesn’t mean they can’t help. “You can still go through all the other steps and administer the Naloxone and call 911,” said Loughran.
Narcan safety
Naloxone — the generic name for Narcan — is safe and has no side effects, according to Loughran. “I could Narcan myself now, because I have no opioids in my system, [and] it would do nothing.”
People who overdose will start to feel “withdrawal” from “the high,” she said of the medicine’s effect.
California law protects individuals who are trained in administering Naloxone against legal liabilities when they are helping in good faith, even if the person being attended to is not a victim of an opioid overdose.
A total of 16 people attended the workshop. Katrin Tomanek, who has lived in the Mission for nine years, said she attended because, “I live in the Mission, people pass out and I want to learn what I can do to help.”
Another woman in the audience said she carries Narcan in her bag so that she can offer help when it’s needed. “Overdose is not exclusive on the street,” she said, “it could also be your friends at a party.”
Having training in overdose recognition and rescue procedures helps reduce such deaths, because “more people have the knowledge and the skills to address overdose,” said Loughran.
Narcan can be obtained for free from Community Behavioral Health Services Pharmacy at 1380 Howard Street, 9 a.m. to 6 p.m. Monday to Friday, and 9 a.m. to 4 p.m. Saturday and Sunday.
It’s also available through a “standing order” at pharmacies such as CVS and Walgreens without a prescription. But there could be a cost, depending on the insurance. It is not yet available over-the-counter.
Many bars and some organizations in the Mission also have Narcan available.
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