Transcript Prophylactic Prescription of Naloxone to Prevent Fatal Opioid

Alice Bell, LCSW
Project Coordinator
Overdose Prevention Project,
Prevention Point Pittsburgh
Prophylactic Prescription of
Naloxone to Prevent Fatal
Opioid Overdose
July 2012
Overdose Prevention Project
Prevention Point Pittsburgh
Alice Bell, Project Coordinator
412-247-3404
[email protected]
Each year in Allegheny County, more people die of
accidental drug overdose than die in traffic accidents
and homicides, combined.
Of 261 overdose deaths in 2011, 261 involved one or
more substance that would respond to naloxone.
Data released from CDC for 2009, indicates drug
overdose is now the number one cause of injury
death, exceeding motor vehicle accidents, and killing
at least 37,485 people in U.S.
Roughly half of these deaths involve opioids; almost
40% opioid analgesics and almost 10% heroin.
Motor vehicle traffic, poisoning, and drug poisoning
death rates: U.S., 1980--2009
Source: NCHS Data Brief, December, 2011, updated with 2009 mortality data
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Allegheny County Trends in Accidental Drug Overdose Deaths
2000-2011*
*Data is from Allegheny County Medical Examiners Annual Reports and includes all overdose
deaths where these drugs were present at time of death, not necessarily cause of death.
Overdose Deaths from Opioids
are preventable

We have the antidote, safe, highly effective,
naloxone.
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Paramedics use naloxone (Narcan) to immediately
reverse the effects of opiate overdose.
So, Why Are People Dying?

Failure to recognize symptoms of overdose.

Don’t know what to do results in delayed or
ineffectual response.

Fear of stigma associated with drug use.
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Fear of Police Involvement.
Strategies for Reducing Overdose Deaths

Prescription Monitoring Programs:
Reduce Diversion, not demonstrated to reduce overdose.
 Concern about increase in heroin use.
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Methadone and Suboxone treatment: Very effective
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Abstinence-based drug treatment:
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Risk of overdose increases when relapse occurs.

Community Based Education: Risk Factors, Identification
of Symptoms, Effective Response, including Rescue
Breathing, Calling 911 and Naloxone Administration

Naloxone Prescription Programs
Overdose Prevention/Naloxone
Prescription Program:
Prevention Point Pittsburgh

Implemented in Pittsburgh July 2005 at Syringe Exchange

Medication is Prescribed by Volunteer Physicians

Over 800 individuals have received Naloxone

Over 650 successful peer overdose rescues.
Updated Data 6/15/12
Bennett, A.S., Bell, A., Tomedi, L., Hulsey, E.G., Kral, A.H. (2011); Characteristics of an Overdose
Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County,
Pennsylvania. Journal of Urban Health, 88 (6):1020-1030.
OD Education and Naloxone Distribution
(OEND) Programs in U.S.
Number (#)
States w/ OENDs
Programs
People enrolled
Reported OD reversals
2007*
2010†
9
16
42
155
20,950
53,339
2,642
10,194
PMMWR, Centers for Disease Control, February 17, 2012, Volume 61, No. 6ngeles,
Massachusetts, Mendocino County, CA, New Haven, New Mexico, New York City,
Oakland, Pittsburgh, Rhode Island, San Francisco, Wilkes County, NC and more
* Knox, 2008 † Wheeler, E. NOPE Working Group - Harm Reduction Coalition. 2010
Project Lazarus - North Carolina
In response to some of the highest drug overdose death rates in the
country, Project Lazarus developed a community-based overdose
prevention program with routine physician prescription of naloxone
when opioids were prescribed for pain.
Overdose death rate dropped from 46.6 per 100,000 in 2009 to 29.0
per 100,000 in 2010.
Unpublished data indicates rate of death has continued to drop to 7
deaths per 100,000 is 2011. (2010-2011 rates based on provisional
data from OCME via Wilkes Co. Health Department.)
Pain Med. 2011 Jun;12 Suppl 2:S77-85
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Project Lazarus: Naloxone Rescue
Pain Diagnosis
Opioid prescription
Identify high risk patient
Prescribe naloxone
2.
Substance Abuse Treatment
Prescribe naloxone
3.
Womack Army Medical
Center, Ft. Bragg, NC:
Operation
OpioidSAFE
Operation OpioidSAFE is a novel provider,
patient and community education program with
MAJ
Anthony
Dragovich
MD
the added advantage of lay person diagnosis and
Medical
Director,
Pain Medicine
reversal
of opioid
overdose
by naloxone.
Ft. Bragg, NC
Model for Integrating Overdose
Prevention and Treatment Into Standard
Practice at Primary Health Centers
and HIV Treatment Programs in
Pittsburgh, PA. -2011/2012
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Positive Health Clinic – AGH
PACT - UPMC
Metro Family PracticeBirmingham Free Clinic
Cristina Elgin, PharmD Candidate
DVD
Opioid Medication Safety:
The Role of Naloxone
by Prevention Point Pittsburgh
PrescribetoPrevent.org
If you take medicine for pain, YOU
may be at risk for accidental
overdose!
ASK
ABOUT
NARCAN
Multiple medications
Multiple medical conditions
+ Opioid pain medication
INCREASED RISK OF
OVERDOSE
Do you take opioid medicine for pain like morphine, methadone, Oxycontin,
Percocet, Vicodin, fentanyl, or Opana?
Do you use other opioids like heroin?
Using any opioids puts you at risk. Your risk is greater if you take other medications
or have other medical conditions.
Opioid overdose is PREVENTABLE and REVERSIBLE
Naloxone (Narcan) is a medication that STOPS overdose!
You can get naloxone here at ### Family Health Center.
Ask a staff member or call ##-###-#### to learn more!
Physician/Pharmacy Collaboration
for Naloxone Prescription in
Pittsburgh
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Positive Health Clinic- February 2012
UPMC – PACT-March 2012
Center for Pharmacy Services-2011
Metro Family Practice-June 2012
Birmingham Free Clinic-July 2012
Mercy Family Health Center-July 2012
American Medical Association
Endorses Community Based Naloxone
Programs
“The AMA today adopted policy to support further
implementation of community-based programs that
offer naloxone and other opioid overdose
prevention services. The policy also encourages
education of health care workers and opioid users
about the use of naloxone in preventing opioid
overdose fatalities.” – Health News Digest June 19, 2012