phigclinical skills workshop

Clinical Skills Workshop: Overdose Prevention and Response —Administering Naloxone to Save LivesPOPULATION HEALTH INTEREST GROUPSEPTEMBER 8, 2016

Conflict of Interest Disclaimer

No financial disclosures. Adapt Pharma provided one trainer of its nasal spray (no

medicine) for demonstration. Kaleo provided Evzio autoinjectable trainers (no medicine) for

demonstration.

How bad is it?

National Overdose DeathsNumber of Deaths from Prescription Drugs

20012002

20032004

20052006

20072008

20092010

20112012

20132014

0

5,000

10,000

15,000

20,000

25,000

30,000 Total Female Male

Source: National Center for Health Statistics, CDC Wonder

National Overdose DeathsNumber of Deaths from Prescription Opioid Pain Relievers

20012002

20032004

20052006

20072008

20092010

20112012

20132014

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000 Total Female Male

Source: National Center for Health Statistics, CDC Wonder

National Overdose DeathsNumber of Deaths from Heroin

20012002

20032004

20052006

20072008

20092010

20112012

20132014

0

2,000

4,000

6,000

8,000

10,000

12,000 Total Female Male

Whom are we talking about?

Break for video #1

It’s more than “use as directed”An adverse reaction can occur if:

Co-morbidities: lungs, liver, kidneys, etc. Co-pharmacy: e.g. sedative Genetic susceptibility Drinking alcohol User error Period of abstinence Switching opioids Family member may help themselves

When to write a script

If patient is prescribed an opioid medication. If patient is using opioids of any kind. After a period of abstinence (any kind, including incarceration or

drug treatment). If pt. has experienced an overdose or adverse reaction. If pt. has witnessed an overdose or adverse reaction. If pt. asks for it. If pt. has a household member who might benefit from it.

Break for video #2

Enabling? No!Safe? Yes!• Been around since 1961• Communities have been

distributing since 1996• No compensatory behavior

since it causes withdrawal.• No potential for abuse.• People use it.• Leads to treatment for

substance use disorder.• Decrease in deaths much

greater than amount supplied, indicating decrease in risky behavior as result of the educational process that is part of providing rx.

Si se puede! 150K laypersons trained. 26K OD reversed . 80% of reversals were

performed by drug users In North Carolina, their

three-year-old program has had 4,000 reversals.

FDA working on making it OTC.

FDA changing labels on all opiates and benzos.

Rx, OTC, Standing Order

To script or not to script

There may not be a standing order in your state. Standing order may only be for certain pharmacies. Pharmacist may not be aware of standing order. Patient may not know to ask for it. Patient may not remember to ask for it. Easier to pick up all rx at once. Less worry about payment and billing issues. There is no downside to writing a script.

Your new best friend:www.prescribetoprevent.orgOne-stop shopping for patients, advocates, prescribers, pharmacists: videos, online CME, research, legal info, billing, Rx pads, and things you never thought you might need.

Where do we go from here? Train your classmates: this is an easy brown-bag lunch session.

Show video(s) Give demo Tell people where to get it for themselves

Make this a national AMSA Project, educating medical students, college students, incarcerated populations, drug treatment programs, faith communities, etc.

Thank you!

Mary Beth Levin, MPHAssociate ProfessorDepartment of Family MedicineGeorgetown University School of Medicinelevinmb@gmail.com

Other resources:Harm Reduction Coalition: www.harmreduction.orgNorth Carolina Harm Reduction Coalition: www.nchrc.org Chicago Recovery Alliance: www.anypoisitivechange.org