Opioid Overdose Response Plan Procedure

Naloxone - Naloxone is an “opioid antagonist” medication used to reverse the effects of an opioid overdose. The effects of naloxone last only 30-60 minutes and after it wears off the individual might resume overdosing. Naloxone is only used to treat opioid overdoses and does NOT reverse the effects of other substances such as alcohol, benzodiazepines, or stimulants (cocaine, methamphetamine, etc.). Naloxone does not cause or induce any clinical side effects to a person that does not have opioids in their system.

For someone who is physically dependent on opioids, naloxone can cause post-naloxone administration withdrawal symptoms. These symptoms are temporary, and may include fever, anxiety and irritability, rapid heart rate, sweating, nausea, vomiting, and tremors (Centers for Disease Control and Prevention, National Institutes of Health).

Opioid - Opioids are a class of drugs that bind to opioid receptors. They are used to treat

moderate to severe pain. They include illicitly manufactured drugs such as heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescriptions, such as oxycodone, hydrocodone, codeine, morphine, and many others.

Statewide Standing Order to Dispense Naloxone:
People may take this standing order to a pharmacy to get naloxone instead of going to a health care provider to get a prescription. Organizations may also use this standing order to get naloxone.

• Statewide Standing Order to Dispense Naloxone
• Statewide Standing Order to Dispense Naloxone FAQ

Washington Good Samaritan Law

Washington's Good Samaritan Law provides some protection when calling 9-1-1 to save a life — even if drugs are at the scene. (RCW 69.50.315).

1. A person acting in good faith who seeks medical assistance for someone experiencing a drug-related overdose shall not be charged or prosecuted for possession of a controlled substance pursuant to RCW 69.50.4013, or penalized under RCW 69.50.4014, if the evidence for the charge of possession of a controlled substance was obtained as a result of the person seeking medical assistance.
2. A person who experiences a drug-related overdose and is in need of medical assistance shall not be charged or prosecuted for possession of a controlled substance pursuant to RCW 69.50.4013, or penalized under RCW 69.50.4014, if the evidence for the charge of possession of a controlled substance was obtained as a result of the overdose and the need for medical assistance.
3. The protection in this section from prosecution for possession crimes under RCW 69.50.4013 shall not be grounds for suppression of evidence in other criminal charges.

Washington Department of Health
Roles/Responsibilities:

1. Provide or facilitate subject-matter expertise on overdose prevention.
2. Provide or facilitate technical assistance in the development and implementation
3. of overdose response protocols and relevant overdose rescue supply maintenance.
4. As funding allows, and as part of the Overdose Education and Naloxone Distribution (OEND) program, provide Olympic College with free naloxone for distribution to community members.
5. As capacity allows, and as part of the OEND, provide free overdose recognition and response trainings, and technical assistance to Olympic College.

Olympic College Safety and Security
Roles/Responsibilities:

1. Collaborate on community-wide overdose prevention efforts.
2. Ensure that all security officers understand the Naloxone administration procedure.
3. Respond in case of a drug-related emergency on campus.
4. Equip security officers with doses of naloxone.
5. Provide training to the campus community on responding to an opioid overdose.
6. Provide storage for resupply of overdose response kits
7. Resupply overdose response kits as necessary

Bremerton Campus Residence Hall
Roles/Responsibilities:

1. The Residence Hall Manager will train all Resident Hall Assistants on opioid overdose response prior to each academic year.
2. Offer opioid overdose response training via online and video modalities to Resident Assistants.
3. Resident Hall Manager and/or Resident Assistants will perform weekly box site checks.
4. Inform The Director of Well-Being and Health Promotion if opioid overdose boxes fall into disrepair.
5. Inform the Director of Safety and Security if any items in the box need to be replaced.
6. Immediately following known administration of naloxone, ensure that 9-1-1 has been contacted.
7. Inform Campus Safety and Security immediately 360-475-7800 of any naloxone deployment in response to an overdose that happens in a residence hall.
8. Distribute communications to all residents about the availability of opioid overdose response boxes in the residence halls.

Olympic College Office of Well-Being and Health Promotion
Roles/Responsibilities:

1. Inform campus community of opioid overdose response implementation.
2. Liaise as necessary between on and off campus partners to facilitate opioid overdose training, overdose response box implementation, and community training at Olympic College.
3. Secure safe and accessible training venues for students and/or staff, with adequate equipment to host.
4. Request additional doses of naloxone and supplies as needed from the Washington State Department of Health and Welfare.
5. Collaborate on community-wide overdose prevention efforts.
6. Send quarterly communication to all students and staff about overdose response plan and response kit locations.
7. Complete and annual review of the Olympic College Overdose Response Plan

Olympic College Communications Department

1. Develop opioid overdose response educational website.
2. Share information about the Overdose Response Plan on social media platforms.

Olympic College Social Sciences and Humanities Division

1. Ensure that Olympic College adheres to our commitments as members of the Washington Department of Health Overdose Education and Naloxone Distribution (OEND) program
2. Support the application and potential implementation of State of Washington Collegiate Recovery Support Initiative (SWCRI)
3. Support the planning and programming for Olympic College’s Recovery Rangers program.
4. Collaborate on community-wide overdose prevention efforts.

Olympic College Poulsbo Campus

1. Maintain and regularly inspect overdose rescue supplies to ensure contents are in working condition.
2. Distribute communications about the availability of opioid overdose response measures on campus
3. Request additional doses of naloxone and supplies as needed
4. Secure safe and accessible training venues as necessary for students and/or staff, with adequate equipment to host.
5. Immediately following known administration of naloxone, ensure that 9-1-1 has been contacted.
6. Inform Campus Safety and Security immediately 360-475-7800 of any naloxone deployment in response to an overdose that happens in a residence hall.

Olympic College Shelton Campus

1. Maintain and regularly inspect overdose rescue supplies to ensure contents are in working condition.
2. Distribute communications about the availability of opioid overdose response measures on campus
3. Request additional doses of naloxone and supplies as needed
4. Secure safe and accessible training venues as necessary for students and/or staff, with adequate equipment to host.
5. Immediately following known administration of naloxone, ensure that 9-1-1 has been contacted.
6. Inform Campus Safety and Security immediately 360-475-7800 of any naloxone deployment in response to an overdose that happens in a residence hall.

All information related to the Olympic College Opioid Overdose Response Plan will be available via a response plan web page and made available on the Office of Well-Being and Health Promotion and Campus Safety and Security web pages.

Information on the Opioid Overdose Response Plan will be included in the faculty handbook within the Safety and Security section.

Information on the Opioid Overdose Response Plan will be included in the student catalogue.

The Office of Well-Being and Health Promotion will send quarterly notifications to all students and staff about the opioid overdose response plan and response kit locations.

Campus Communication will share information about the opioid overdose response plan on social media platforms.

The Office of Well-Being and Health Promotion and Campus Safety and Security will partner with student leadership groups such as Student Government of Olympic College, Recovery Rangers, and student clubs to develop and distribution informational flyers on campus.

If the overdose occurs in the residence hall, after administration of naloxone, Residence Hall Staff will follow Olympic College protocols.

The responding Residential Hall staff member will do the following:

• Ensure that both 9-1-1 and the Department of Public Safety at 208-426-6911 have been notified.
• Notify the Associate Vice President for Student Success and Engagement
• Notify the Director of Campus Safety
• Notify the Director of Well-Being and Health Promotion.

In the event of an overdose and subsequent use of an opioid overdose response box elsewhere on campus, the Director of Well-Being and Health Promotion will reach out to the student to provide support services. In accordance with similar post-emergency follow up, a letter will be mailed to the home address listed on file for students that experience an opioid overdose on campus.

If the individual impacted is an Olympic College staff or faculty member, follow-up will occur from Human Resources once they are notified.

Assessment Plan

• An annual review led by the Office of Well-Being and Health Promotion will be conducted each spring.
• Campus Safety and Security will partner on review
• The Review will consist of an evaluation of process, outcome, and impact measures.
• Reporting will be included in the biennial Drug and Alcohol Abuse Prevention Program report

Process Evaluation: To be conducted in between the Fall 2024 and Spring 2025 semesters

The Director of Well-Being and Health Promotion will meet with all project partners to discuss the following questions:

• Is the program being implemented as intended?
• Does anything need to be adjusted for next semester? Next year?
• How many doses of naloxone have we distributed so far?
• How many individuals have we trained so far?
• Does any change need to be made in our communication between campus and community partners?

Impact Evaluation: To be conducted at the end of the Spring 2025 semester

• Determine which locations use the most doses of naloxone during the implementation period
• Determine which locations are most frequently associated with emergency response
• Analyze pre and post-data from all the trainings to see if there were changes in knowledge, skills, and attitudes around overdose response
• Poll students to assess awareness of the program

Methodology of evaluation:

• Measure the number of trainings
• Collect data from pre- and post-surveys at trainings
• Record number of doses distributed

Naloxone will be located in mounted cabinets also referred to as opioid overdose response kit boxes. These boxes will be kept out of direct sunlight and at room temperature. (Naloxone can be damaged if exposed to extreme heat or cold temperatures.)

Additional Naloxone for resupply will be stored with the Office of Well-Being and Health Promotion.

Security officers shall be responsible for their provided Narcan kit and must be able to account for it at all times, including ensuring that they are in possession of the naloxone kit at the beginning of each shift.

Due to extreme weather sensitivity, the naloxone kit will not be left in vehicles beyond the duration of the officer’s shift.

These wall-mounted boxes contain the following:

• Face shield for administering rescue breaths
• Overdose information flier
• Gloves
• 6 boxes of Narcan nasal spray; each box contains 2 doses
• Fentanyl test strips

Packaged Narcan Boxes 
Each Narcan box contains 2 doses of Narcan nasal spray

Fentanyl Test Strips
Each Response Kit will contain fentanyl test strips. Fentanyl test strips (FTS) are small strips of paper that can detect the presence of fentanyl in different kinds of drugs and drug forms (pills, powder, and injectables).

You can find more information about fentanyl test strips on the CDC website.

Funding for Supplies
Olympic College is a Washington Department of Health Overdose Education and Naloxone Distribution (OEND) program participant. The Washington DOH will provide Naloxone free of charge while they have supplies.

Olympic College has been awarded funds as part of the State of Washington Collegiate Recovery Support Initiative (SWCRSI) grant. The grant pays for Fentanyl test strips.

Bremerton Campus 

Poulsbo Campus

Shelton Campus

The shelf life of naloxone is approximately 24-36 months. Prior to distributing naloxone to boxes, Campus Security and the Office of Well-Being and Health Promotion will verify that the doses are viable within 24-36 months of manufacturing.

In all campus locations, boxes will be checked monthly by campus safety and records maintained by Campus Security, Residence Hall, and the Office of Well-Being and Health Promotion.

Campus Safety and Security are responsible for the following:

1. Checking overdose response kits monthly to ensure that each box contains all initial items as outlined above (4 boxes of Narcan, fentanyl step strips, 1 face shield, gloves, wipes, information flier).
2. Ensuring the doses are current and not expired.
3. Ensure the boxes have not been tampered with and are still secured to the wall.
4. Request replacement of any doses or other supplies that are damaged, unusable, expired, missing, or have been used.
5. Building coordinators will request supplies via email to the Director of Well-Being and Health Promotion.

Replacement doses may be obtained for free from the Washington Department of Health as part of Olympic College’s participation in the Overdose Education and Naloxone Distribution (OEND) program

If naloxone or fentanyl test strips are not available for distribution, Campus Environmental Health and Safety funds will be used to purchase. Additional doses of intranasal naloxone will be stored and secured at Campus Safety and Security offices in a locked storage closet.

A log will be kept by the Director of Well-Being and Health Promotion for tracking available supply and dates of doses used as well as the impending expiration dates of currently circulated doses.

Boxes will be monitored monthly by the Building Coordinators, Residence Hall, Campus Safety and Security, and the Office of Well-Being and Health Promotion to determine if doses have been utilized and will follow the procedure for documentation and replacement detailed above.

Overdose response boxes will be checked by building coordinators on a weekly basis. If it has been determined that the doses or the box has been tampered with, the box site checker or community member will call Public Safety immediately and report the incident. Broken seals on the box of naloxone or on the rescue breath package are both signs of tampering. If students have been found tampering with the opioid overdose response box without intent to respond to an emergency, they may be referred to disciplinary action with the Director of Community Standards. A student taking a dose to use in case of a future emergency is not considered tampering. Students can take doses from the box in the case of a current or future emergency.

Each opioid overdose response box will have signage that trains the potential responder on how to respond in the event of an overdose. The signage will detail the appropriate steps for responding to an overdose. In addition, there will be a QR code that links to a training video as well as instructions for deploying the medication on the medication boxes themselves.

Campus Security and the Office of Well-Being and Health Promotion will host free quarterly 30-minute training on overdose education and response that will be open to any member of the Olympic College Community.

Washington Department of Health training slides are available here.

A free, 30 minute online training is available through SAFE Project here.

A brief training video on Naloxone administration is also available here.

Residence Hall staff will be trained by Campus Safety and Security and Residence Hall Manager before classes start each fall.

Campus Security and the Office of Well-Being and Health Promotion will host free quarterly 30-minute training on overdose education and response that will be open to any member of the Olympic College Community.

Washington Department of Health training slides are available here.

Online training provided by Vector Solutions will be accessible to all Olympic College staff and faculty. The Washington State Department of Health is in the process of developing a video training that will be made available in the fall of 2024.

A free, 30 minute online training is available through SAFE Project here.

A brief training video on Naloxone administration is also available here.

Responding to an Opioid Overdose:

1. Assess for overdose
   • Extreme sleepiness, difficulty to arouse
   • Loss of consciousness
   • Limp body
   • Unresponsive to touch or sound
   • Slow, shallow, or no breathing
   • Choking or gurgling sounds
   • Pale, blue, or cold skin, lips, or fingernails
   • Slow heartbeat and low blood pressure
      
2. Call 9-1-1 to report observable symptoms and plan to administer naloxone
   • Control the scene to inform others you are calling 9-1-1. Use bystanders to keep doors open or move environmental barriers that may impede paramedics from arriving to the scene.
   • Provide precise details to the dispatcher, including address and location inside facility.
   • Contact the Department of Public Safety at (208) 426-6911 after your call with 9-1-1 dispatch ends.
   • Retrieve ‘Opioid Overdose Response Kit’ supplies including CPR Rescue Mask, and naloxone. Administer naloxone nasal spray (instructions are located on the box; each device is a single dose).
   • If the patient does not respond within 2-3 minutes, provide a second dose of intranasal naloxone by administering it in the other nostril.
   • If the patient responds to naloxone but relapses back into abnormal or insufficient breathing before emergency assistance arrives, give another dose.
   • Use pulse oximeter to relay pulse and oxygen saturation to dispatcher.
      
3. Conduct rescue breaths
   • If possible, place the individual on their back. If there is any possibility of neck or head injury, refer to dispatcher instructions.
   • Check for breathing
     • Chest rising and falling
     • Placing the back of your hand over their mouth to feel for air
     • Listen for normal breathing
     • Check that nothing is blocking their airway
   • If the individual has low, slow, or disrupted breathing, conduct rescue breaths while naloxone comes into effect.
   • Place one hand on the individual’s forehead to tilt the head back while simultaneously using your other hand to lift the chin. This “Head Tilt Chin Lift” method will open the airway.
   • If using a shield, position the valve on the center of the patient’s mouth, before pinching the nostrils closed.
   • Have one hand cover the bottom of the mask while keeping the chin lifted. Use your other hand to cover the tip of the mask to create a tight seal.
   • Conduct two (2) rescue breaths, one (1) second apart.
   • Check that the individual’s chest rises and falls with each breath. If it does not, reposition the mask, open the airway again, and repeat rescue breaths.
   • Continue to conduct two (2) rescue breaths, 1 (one) second apart, every five (5) seconds for two (2) minutes or until they start to breathe on their own.
   • If the individual does not respond within 2 (two) to 3 (three) minutes, give a second dose of intranasal naloxone by administering in the other nostril.
   • If the individual responds to naloxone but relapses back into abnormal or insufficient breathing before emergency assistance arrives, give another dose.
      
4. Place them in the recovery position
   • When the individual has started to breathe normally on their own, you will place them in the recovery position.
   • Kneeling beside them, place the arm closest to you at a right angle to their body with the palm facing up.
   • Take the other person’s arm, and fold it so the back of their hand rests on the cheek closest to you, and hold it in place.
   • Use your free hand to bend the person’s knee, so it is propped up with their foot flat on the floor.
   • Carefully roll the person onto their side by pulling on the bent knee, while pulling that person towards you.
   • Their bent arm should be supporting the head, and their extended arm will stop you from rolling them too far.
   • Make sure their bent leg is at a right angle and keep that person propped up on their side.
   • Open their airway by gently tilting their head back and lifting their chin.
   • This position will help keep the airway clear and open, ensuring vomit or fluid will be expelled away from the body.
5. Stay with the patient until emergency medical personnel arrive
   • Naloxone wears off after 30-60 minutes and an individual may resume overdosing. It is imperative that the patient receives medical attention as soon as possible.
   • As they regain consciousness, individuals may experience confusion, anxiety, and irritability. Naloxone may cause acute opioid withdrawal in individuals that are opioid dependent. This is temporary and will reduce in severity as naloxone wears off. It is important that individuals do not use substances to relieve withdrawal symptoms.
      
6. Important tips:
   • Do not test the nasal spray before using it
   • Each device will spray 1 time only
   • Narcan can be used in either nostril, nowhere else
   • 1 nasal spray is equivalent to 1 dose of medicine