Kû Aloha Ola Mau
A place of healing and recovery

Emergency Information

• WHAT TO DO IF YOU'VE MISSED YOUR METHADONE DOSE
• EMERGENCY CONTACT NUMBERS
• INTOXICATION AND OVERDOSE SIGNS AND SYMPTOMS

WHAT TO DO IF YOU'VE MISSED YOUR METHADONE DOSE

Kû Aloha is open six days a week for dosing. The hours are Monday through Friday 5:30 am to 11:30 am with office hours until 3:00 p.m. and Saturdays from 6:30 am to 11:00 am in Honolulu. In Hilo it is Monday through Friday 5:30 am to 10:30 am with office hours until 1:30 p.m. and Saturday 7:30am to 10:00 am. The clinic is closed on SUNDAYS and most Holidays. Talk with each specific clinic for updated list of Holidays.

If you miss your dose today, you may come in the next day to drink your next day's dose. Methadone stays in your system for up to 48 hours so even if you miss a day, you will still have the effect of the last dose in your system. That is why emergency rooms will not give you methadone if you miss a dose.

Missing doses is not uncommon, especially for new haumana on the program. We have had people come in and actually forget to get their dose that day.

If you are concerned, following these simple steps may help you get through the day:

1. It has probably been a while since you've taken the time to pamper yourself. When the afternoon rolls around, go ahead and do those nice things for yourself that you have been putting off for a long time. Perhaps having your partner give you a massage, or laying on the beach and soaking up some sun, sitting under a tree with your favorite book or watching a good movie. Anything that helps you de-stress and focus on something positive will help.
2. Call a friend and talk to someone. Sometimes it helps to talk about other subjects which are supportive to your recovery.
3. Plan to come in the next morning to dose.
4. Or, you can just focus on other activities.

What you should NOT do is take other medications or drink to "make up" for your missed dose. You do not need it. Make an emergency plan with your counselor for what to do in case you should miss your dose in the future. Anything can happen and if you are prepared, it will help a lot!

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EMERGENCY CONTACT NUMBERS

Here are some emergency numbers to call if you suspect someone, or yourself is in need of immediate attention and yet, not enough to call 911.

Medical Director: Dr. George Rourke	(808) 252-1608 (located in Hilo)
	(808) 961-6822 office
Suicide and Crisis Center	(808) 521-4555

When to call?

If you suspect overdose, call 911 (see INTOXICATION AND OVERDOSE SIGNS AND SYMPTOMS)

If you are hospitalized, ask the hospital to call Dr. Vivian Ishimaru-Tseng in Honolulu or Dr. George Rourke in Hilo during off-hours and the clinic during business hours.

If you feel very depressed and the office is closed, do not hesitate to call the Suicide and Crisis Center. If you feel so low that you want to end it all or feel you need to hurt someone else, let the Crisis Center know how you feel, where you are and your phone number. They will keep information confidential. If they feel you are a danger to yourself or others, they can send someone out to help you.

Call your sponsor when you need support, at any time. You can call your counselor at Hui Ho`omaikai during the weekdays as well, or call the program physician. He/she can contact your counselor if there is an emergency.

If you are a family member and you suspect your loved one has taken unauthorized drugs or has been drinking heavily and may be overdosing, call 911.

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PURPOSE OF THIS SECTION
We hope that this information will help you identify if someone is using drugs or alcohol self-destructively and needs professional help. The sooner you can identify a problem, the better. Don’t wait 20 years to get help, or get someone you love, help. The longer the wait, the more difficult the recovery process and the greater the losses

INTOXICATION AND OVERDOSE SIGNS AND SYMPTOMS

The following information comes from 20 years of “hands on” knowledge of what we have seen and experienced in running a treatment center. It is written in lay terms and hope it will be helpful for friends, or family members to use. Nothing is written here that has not been “seen” or felt by staff members and staff who have used drugs and are now in recovery. It is not from a book, or a medical practitioner. It is from the day to day experiences of staff, conversations with thousands of people who are/were addicted and are now in recovery and following those who have lost their lives to drug overdoses. Therefore, there may be signs and symptoms which are not mentioned, but relevant. It is always good to contact a physician knowledgeable about drug use, or to request an assessment from a certified substance abuse counselor or program to confirm what you suspect.

In ALL CASES, if you even suspect overdose, call 911. You do not want to make a mistake which will cost someone’s life. Do not call a program for further information; you do not have time to waste, CALL 911 first.

In addition, these signs and symptoms may not be apparent in everyone and the intensity or frequency of each symptom may vary by individual, how much the person has taken, how “pure” the drug is, whether the drug was mixed with other drugs, solutions, or alcohol and the person’s general tolerance.

Some medical conditions may also mimic the effects of intoxication, overdose, or withdrawal too. If you notice these symptoms in a friend or significant other or family member, do not rule out drug/alcohol use OR a possible physical condition. Have them see their general practice physician who can rule out any dangerous medical problems.

CAUTION: Methadone is a powerful medication and even small amounts can be fatal to children. Please keep the medication away from children. If ingested accidentally, take the child immediately to the emergency room. Inform them that the child has ingested methadone.

Alcohol

Intoxication and overdose:

1. History of alcohol use
2. Smell of alcohol
3. Slurred speech
4. Lack of coordination
5. Aggressive or overly emotional behavior
6. Belligerent
7. Drowsiness
8. Staggering
9. Blood shot eyes
10. Foaming at the corners of the mouth
11. Tremors (hands shaking)
12. Violent behavior
13. Suicidal thoughts
14. Unable to awaken

Some of these may also mimic diabetic shock or coma so be careful to not confuse the conditions!

Withdrawal:

Nausea, vomiting, weakness, sweating, anxiety, elevated blood pressure, depressed mood, irritability, headache, insomnia, convulsions, blood shot eyes, suicidal thoughts, hallucinations or delusions anywhere from 12 to 24 hours after stopping use.

Benzodiazepine, anti-depressants, opiates, barbiturates, sedatives, or opiates in combination with alcohol

Sedation and Overdose:

1. History
2. Slurred speech
3. Appearing in a "nod" (drifting in a sleep mode)
4. Eyes appearing sleepy (drowsiness)
5. Lack of coordination
6. Memory problem
7. Foaming at the corners of the mouth
8. Blood shot eyes
9. Belligerent/aggressive behavior
10. Quick temper (quarrelsome nature)
11. Suicidal thoughts
12. When you approach the person who is sitting, they appear sleepy or sleeping. Ask them if they are okay. Observe the comeback speech if it is slurred or their eyelids appear droopy.
13. Your gut feeling is that there are inconsistencies in their normal behavior and you know something is wrong.
14. If their pulse is rapid and they are difficult to keep awake and breathing slowly, call 911 immediately. You do not need to check for all these signs and symptoms. This one is enough to call.
15. Constipation (opiates like heroin)
16. Irregular or missing periods (opiates like heroin)

Withdrawal signs:

Nausea or vomiting, muscle aches, runny eyes (tearing), runny nose, dilation of pupils, chicken skin, sweating, convulsions, nervousness, shakes, anxiety, insomnia, high blood pressure, unable to sit still, blood shot eyes, suicidal thoughts, diarrhea. The person may appear to have a cold or the flu for opiate use. It is not recommended that the person abruptly discontinue benzodiazepine or barbiturate use. Withdrawal must be medically supervised to avoid possible convulsion and/or death.

Amphetamines, Methamphetamines, cocaine (ice, crack, speed, uppers, etc.)

Intoxication and Overdose:

1. History of use
2. Tired and drained appearance
3. Blood shot eyes
4. Erratic, flighty (unpredictable, indecisive, irregular)
5. Impatient (annoyed, edgy, irritated)
6. Depressed (sad, unhappy, miserable, dejected, gloomy) conversations
7. Hyperactive (agitated, manic, overexcited, unable to sit still)
8. dramatic loss of weight
9. Suicidal thoughts
10. High blood pressure
11. Hard time breathing
12. Chest pains
13. Convulsions

Withdrawal signs:

Feeling tired, moody, agitated, depressed, angry; experiencing unpleasant dreams, insomnia, nervousness, anger, aggressive behavior, chest pains; and having suicidal thoughts.

GETTING HELP

It is not uncommon for people to take different types of drugs at a time. There are also different methods to use the same or different drugs. Paraphernalia of any kind is a good indication of drug use. Therefore even if the signs and symptoms of different classes of drugs may be difficult to figure out, remember that the most important thing is for a friend or loved one to figure out that there is a “problem” and begin the process of getting help. If you are a friend or loved one, the help can begin with you. You can open the door by seeking assistance, information and/or support for yourself.