Transcript Presentation: NeilCapretto, DO, FASM

Prescribing Naloxone and Overdose
Prevention Within an Addiction
Treatment Program
Neil A. Capretto, D.O., F.A.S.A.M.
Medical Director
Conflict of Interest Statement:
Dr. Capretto has no fiduciary or other conflicts of
interest to disclose
www.gatewayrehab.org
Number of Overdoses by Year
Allegheny County
Year
Number of Overdose Fatalities
1980-1990
Average of 58 per year
1998
2001
2005
2006
2012
2014
104
180
223
252
288
306
Drug Overdose Deaths Increasing in Allegheny County …
Roberta Lojak holds a
high school
graduation picture of
her daughter Ashley
Elder, who died of a
heroin overdose in
October 2001. Lojak
is standing in a
garden she planted in
her daughter's
memory.
September 27, 2004, Pittsburgh
Post-Gazette
.
Time, June 2015
33-year Study Finds Lifelong, Lethal
Consequences of Heroin Addiction
• Heroin addiction exacts a terrible toll. For many addicts
the condition lasts a lifetime – a lifetime shortened by
health and social consequences of addiction.
• NIDA-supported researchers at the University of California,
Los Angeles (UCLA), examined the patterns and
consequences of heroin addiction over 33 years in nearly
600 heroin-addicted criminal offenders and found that their
lives were characterized by repeated cycles of drug abuse
and abstinence, along with increased risk of crime or
incarceration, health problems, and death.
33-year Study … continued
• The death rate among the members of the group is 50 to
100 times the rate among the general population of men
in the same age range.
• “The high mortality rate is evidence of the severe
consequences of heroin use,” Dr. Hser says “Even among
surviving members of the group, severe consequences
such as high levels of health problems, criminal
behavior, incarceration, and public assistance were
associated with long term heroin use.”
Naloxone
Opioid Overdose Reversal ACT 139
•
In recent years, there has been a significant increase in deaths resulting
from heroin and prescription opioids. This epidemic has spread across
Pennsylvania as currently one in four families struggle with a substance
abuse problem. Coroners’ reports since 2009 have shown there have
been more than 3,000 deaths due to overdose.
•
The enactment of ACT 139 provides first responders, friends and
families access to an opioid overdose reversal medicine that will save
lives and hopefully lead an individual toward the substance abuse
treatment they need.
•
Allows first responders (law enforcement, fire fighters, EMS) or other
organizations acting at the direction of a health care professional
authorized to prescribe naloxone, to administer the drug to individuals
experiencing an opioid overdose.
Colorado Clinicians Hesitate to Prescribe
Naloxone as OD Antidote, Study Says
• Doctors expressed concerns that patients might be
offended or engage in riskier opioid use
http://www.denverpost.co
m/news/ci_28280924/col
orado-clinicians-hesitateto-prescribe-naloxone-asod-antidote-study-says
Clinicians Fear Offending Patients When
Discussing Opioid Overdose Risk, Study
Finds
http://www.forbes.com/sit
es/cjarlotta/2015/06/10/cli
nicians-fear-offendingpatients-when-discussingopioid-overdose-riskstudy-finds/
Gateway Rehab and the Kenneth S.
Ramsey, PhD. Research & Training
Institute Naloxone Research Project
www.gatewayrehab.org
Gateway Rehab is a private, not-for-profit organization that
is a positive force and leader in the prevention, treatment,
education and research of substance misuse and addiction.
•
•
Our Mission: To help all affected by addictive diseases to be healthy in mind,
body and spirit.
Our Vision: To be a preeminent national resource for effective addiction
treatment, prevention, education and research.
Naloxone: Increasing Access, Saving
Lives Research Project
• Original funding provided by the Pennsylvania Commission on
Crime and Delinquency: $114K
• Additional funding provided by Staunton Farms Foundation $50K
– To include outpatient locations
Naloxone: Increasing Access, Saving
Lives Research Project
•
•
•
As much as we want our patients to “get it” the first time, to leave rehab and
abstain from drug use for the rest of their lives, we know, for a significant
number of our patients, that isn’t realistic. And that is especially so for those
with opiate dependence.
One of the most dangerous periods for overdose risk is immediately following
discharge from a treatment program. Because the person’s physical tolerance
for heroin or other opiate medications has decreased significantly during
treatment, going back and using the same amount of the drug as their last dose
can be deadly.
Of course we want them NOT to use, but we know that some will. We need to
educate our patients and their families about the risks of relapse, including
overdose, AND give them the tools to protect themselves and/or reverse
overdose.
The 5 Ws
WHY - Primary Goals
1) To provide overdose prevention education to all
inpatients and their family members/concerned other
person
2) To enroll patients and family members in a research
study where intranasal (IN) naloxone will be distributed
at no cost
3) To conduct in-person follow-up data collection on
naloxone use and other clinical variables
WHY - Secondary Goals
1) To increase family involvement in a patient’s postdischarge care by strengthening the family’s connection
to Gateway
2) To “fast track” – when appropriate – patients back into
treatment if a treatment need is identified at follow-up
3) To train staff in overdose prevention education and build
a sustainable naloxone initiative by this project’s
conclusion
4) To promote Gateway Rehab as a leader in overdose
prevention via innovative research
WHO
• OD prevention education – all inpatient adults
and visitors during family program
• 150 patient + family member dyads = 300 total
subjects
• Prevention Point Pittsburgh will provide initial
educational sessions
• An expanded program was offered to outpatients
starting July 2015
WHO
• Research staff will be responsible for all duties
related to study participation
• Research staff will eventually provide OD
prevention education throughout study
enrollment period until n=150 dyads inpatients
plus an expanded arm for outpatients
WHEN
• Initial OD prevention education session and
research enrollment occurred April 15
• Subsequent education and enrollment sessions
were scheduled throughout April, May and June
• Follow-up began mid-May
• Follow-up visits will happen monthly for six months
WHERE
• Research enrollment will occur at Center
Township Main Campus in Aliquippa
• Follow-up visits will occur at any Gateway
Rehab location of the patient’s choice
WHAT
• 15-20 minute educational videos
– How to recognize an overdose
– How to assemble IN naloxone
• 10 minute “live” IN naloxone assembly demo
with Q&A
WHAT
• Research staff will ask for interested
patients/family members
– Study specifics will be discussed
– Consent forms will be reviewed and signed
– Baseline data will be collected
• ALL family program participants will be given a
naloxone resource list of locations where the
medication can be obtained
WHAT
• At discharge, nursing will give naloxone kit to
family member or patient (if family is not
available)
– Kits include naloxone, nasal adapter, personal
protective equipment, instructional brochure,
Gateway Rehab contact info
WHAT
• Research staff will schedule first follow-up
appointment; goal = schedule prior to inpatient
discharge
• Follow-up appointment will take approximately
one hour; includes patient and family member
– Data collection
– UDS (pt. only)
– $10 gift card payment
WHAT
• If the patient experienced a lapse/relapse and is
open to re-connecting with treatment,
procedures have been developed to connect
him or her with an evaluator or clinical specialist
during the follow-up session
• If naloxone was used, a replacement dose will
be provided at no cost
www.gatewayrehab.org
Take-home Naloxone Opioid
1.
2.
3.
4.
5.
6.
This standing order authorizes Registered Pharmacist(s) at HOMETOWN APOTHECARY
DRUGS INC. NEW BRIGHTON, PA to maintain supplies of naloxone rescue kits for the
purpose of dispensing 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.
This standing order authorizes Registered Pharmacist(s) at HOMETOWN APOTHECARY
DRUGS INC. NEW BRIGHTON, PA to dispense naloxone rescue kits to a person at risk of
experiencing an opiate-related overdose of a family member, friend or other person in a
position to assist a person at risk of experiencing an opiate related overdose.
The Pharmacist Manager of Record must file a copy of the signed standing order with the
Pennsylvania Board of Registration in Pharmacy and must maintain a copy of this signed
standing order and the “Naloxone Pamphlet” on file and readily retrievable at the pharmacy
location.
The pharmacy that assembles naloxone rescue kits will label kits as “Naloxone Rescue Kit”
and note the expiration date based on the expiration date of the included Naloxone
Hydrochloride Unit.
The Registerd Pharmacist dispensing naloxone rescue kits must be familiar with the
“Naloxone Pamphlet”
The Registered Pharmacist dispensing naloxone rescue kits should be familiar with the use
of naloxone rescue kits.
NOTE: INDIVIDUALS SHOULD BECOME FAMILIEAR WITH ASSEMBLY AND
ADMINISTRATION OF NALOXONE PRIOR TO THE NEED TO USE IT.
Learning Curve
Stages of Change for…
1. Patients
2. Family and Friends
3. Addiction Treatment Professionals
4. Addiction Treatment Programs
5. Other Mental Health/Medical Professionals and
Organizations
6. 12-Step Community
Obstacles
Getting Naloxone to Patients,
Family and Friends
1. Provide overdose kit on site
2. Provide a prescription of naloxone
3. Direct to a pharmacy with a standing order for
naloxone
Potential Benefits of Increasing
Availability of Naloxone
1. Saves lives
2. Confront and reduce stigma
3. Improve community relations for police and first
responders
4. Improve availability and effectiveness of
treatment
Addiction Batters Thriving Families …
Addiction is a
BIO-PSYCHO-SOCIALSPIRITUAL DISEASE
Good treatment
addresses all
four aspects
Contact Information
NEIL A. CAPRETTO, D.O., F.A.S.A.M.
MEDICAL DIRECTOR
GATEWAY REHABILITATION CENTER
100 MOFFETT RUN ROAD
ALIQUIPPA, PA 15001
1-800-472-1177, x1119
[email protected]
www.gatewayrehab.org