opioid overdose prevention strategies in ma sarah ruiz, msw bureau of substance abuse services ma...
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Opioid Overdose Prevention Strategies in MA
Sarah Ruiz, MSWBureau of Substance Abuse Services
MA Department of Public Health
October 30, 2014
March 27, 2014Governor Deval Patrick declares opioid use a Public Health Emergency in MA
This action provided emergency powers to the DPH Commissioner. The Public Health Council passed orders that:• Universally permit first responders to carry
and administer naloxone• Facilitate access to naloxone through standing
orders at pharmacies• Accelerate enrollment in the PMP
Governor also ordered that an
Opioid Task Force be formed to make recommendations about policy and resource development in the areas of prevention, intervention, treatment and recovery support
http://www.mass.gov/eohhs/feature-story/end-opioid-abuse-in-mass.html
Opioid Task Force Recommendations
• BSAS is implementing a total of 15 recommendations which requires 11 procurements for new services such as:
• Acute Treatment Services• Clinical Stabilization Services• Residential Treatment Services• Recovery High School• Assessment Centers (pilots)• Central Navigation System
New Funding included in FY15 GAA for BSAS
4512-0200: Substance Abuse Services• $2,000,000 added to this line item to support & strengthen public access
to substance abuse services in the commonwealth, including the following:
• $500,000 for a voluntary training and accreditation program for alcohol and drug free housing
4512-0204: Naloxone Pilot Expansion• New line item for $1,000,000 for naloxone purchase, and administration
and training for first-responder and bystander naloxone distribution programs
• Not less than 10 first-responder pilot communities and 7 bystander distribution communities
4512-0210: Substance Abuse Treatment Trust Fund• $10,000,000 new line item to increase the number of clients receiving
substance abuse treatment through BSAS utilizing a range of treatment settings
Naloxone (Narcan®)
• Treatment of choice for the reversal of an opioid overdose by emergency responders for decades (Paramedics, Emergency Department Physicians)
• Displaces opioids from the brain receptors and restores consciousness and breathing = pure opioid antagonist
• Extremely safe with no potential for abuse - not psychoactive
• Acts within 2 to 8 minutes, lasts 30 to 90 minutes• Overdose may return, naloxone may be repeated
Dr. Jake Fishman 1930-2013
• In March 1961, Dr. Fishman and Dr. Mozes Lewenstein applied for one of the first patents for naloxone
• In 1971, the Food and Drug Administration approved using naloxone to treat overdoses
Naloxone was FDA approved in 1971
Intranasal Administration
• Naloxone may be given by needle into a vein (IV) or muscle (IM) or it may be sprayed up the nose (intranasal or IN).
• In Massachusetts we are distributing intranasal naloxone
• Avoids the risk of secondary needle exposure and eliminates concerns with disposal
• Kit requires assembly but is easy to administer
Naloxone and Mucosal Atomization Device (MAD)
DPH Pilot Program Components
• Approved staff enroll people in the program and distribute naloxone– http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone-info.
• Curriculum delivers education on OD prevention, recognition, and response – http://www.mass.gov/eohhs/docs/dph/substance-abuse/core-compete
ncies-for-naloxone-pilot-participants.pdf
• Referral to treatment available• Kits include instructions and 2 doses• Data collected on everyone who receives
a kit and returns for a refill
DPH Overdose Education & Naloxone Distribution Program Sites
• AIDS Action Committee• AIDS Project Worcester • AIDS Support Group of Cape Cod• Brockton Area Multi-Services Inc. (BAMSI) • Boston Public Health Commission• Greater Lawrence Family Health Center• Learn to Cope• Center for Human Development
• Lowell House/ Lowell Community Health Center• Manet Community Health Center• MAPS/ Health Innovations• North Suffolk Mental Health• Seven Hills Behavioral Health• Tapestry Health• Center for Social Innovation
Learn to Cope
Site
Coming Soon
Parents Support Groups
“Learn to Cope” www.learn2cope.org• Currently has 13 meetings weekly
throughout the state• Parents are trained and approved to
distribute naloxone at their meetings
Also “Parents Supporting Parents” on Cape Cod
Learn to Cope
Current Weekly Meeting Locations:Brockton Quincy
Cambridge Salem
Gardner Tewksbury
Gloucester Worcester
Holyoke Yarmouth
Lowell Coming Soon:
New Bedford Taunton, Pittsfield &
Norwell Framingham
Massachusetts - Passed in August 2012:“An Act Relative to Sentencing and Improving
Law Enforcement Tools”Law allowing broader prescribing of naloxone
Patient Protection: • A person acting in good faith may receive a naloxone prescription, possess naloxone and administer naloxone to an individual appearing to experience an opiate-related overdose.
Prescriber Protection:• Naloxone or other opioid antagonist may lawfully be prescribed and dispensed to a person at risk of experiencing an opiate-related overdose or a family member, friend or other person in a position to assist a person at risk of experiencing an opiate-related overdose. For purposes of this chapter and chapter 112, any such prescription shall be regarded as being issued for a legitimate medical purpose in the usual course of professional practice.
Pharmacy Access
• Many pharmacies in MA are now stocking intra-nasal naloxone to fill prescriptions– Walgreens, CVS, Eaton Pharmacies in
Community Health Centers, MGH• MA Board of Pharmacy recently released
guidance on Pharmacy Standing Orders for dispensing naloxone http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/pharmacy/dispensing-of-naloxone-by-standing-order-.html
Prescribe naloxone
Prescribetoprevent.org
• Each auto-injector contains only 1 dose • Inject into muscle or skin of the outer
thigh• Can be injected through clothing if
needed• Device injects intramuscularly or
subcutaneously, delivers the naloxone, and retracts the needle fully into its housing
• Needle not visible before, during, or after
Auto-injector Naloxone
• Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency
• The Trainer does not contain a needle or medicine• It can be reused to practice your injection• The red safety guard can be removed and replaced on the
Trainer
Auto-injector Naloxone
First Responder Pilot2010-2014
• DPH provided the medical direction and naloxone, approved training & monitored overdose reports
• All Police Officers or Fire Fighters in 6 participating departments were trained with DPH approved curriculum
• Annual refresher incorporated into annual required first responder training
• A one page data collection form is completed each time the naloxone is used
EMT & First Responder Regulations (2014)
DPH Drug Control Program and EMS regulations & clinical protocols now incorporate both EMT (required) and First Responder (optional) administration of naloxone.• Training rolling out in collaboration between
public health, law enforcement, fire, and EMS• Resources and Technical Assistance:
http://masstapp.edc.org/first-responder-naloxone-narcan-technical-assistance
Helpful overdose weblinks….
For prescribers and pharmacists•Prescribetoprevent.org
Family support•Learn2cope.org
•Grasphelp.org
News + research on overdose prevention•Overdosepreventionalliance.org
International overdose prevention efforts•Naloxoneinfo.org
Opioid overdose prevention education•Stopoverdose.org
Legal interventions•www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf
Project manual•harmreduction.org/issues/overdose-prevention/
2013 National Drug Control Strategy•www.whitehouse.gov/ondcp/2013-national-drug-control-strategy
ASAM 2010 Policy Statement•www.asam.org/docs/publicy-policy-statements/1naloxone-1-10.pdf
SAMHSA toolkit•store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA13-4742
SAMHSA Letter to prescribers•www.dpt.samhsa.gov/pdf/dearColleague/SAMHSA_fentanyl_508.pdf
Contact Information
Sarah Ruiz, MSW
MA Dept. of Public Health
Bureau of Substance Abuse Services
617-624-5136