Transcript Intranasal and intramuscular naloxone program in New York City

Intranasal Naloxone to
Reverse Opioid Overdose in
the Pre-hospital Setting
Daliah Heller, PhD, MPH
Assistant Commissioner
Bureau of Alcohol & Drug Use Prevention, Care & Treatment
The context of drug overdose:
An opportunity for prevention
• Overdoses are rarely instantaneous
– Death usually happens over one to three hours
• Recovery from opioid overdose treated with
naloxone is nearly universal if administered
correctly
– Minimal risk of adverse effects
– Naloxone lacks abuse potential
• More than 50% of overdoses are witnessed*
– Educate ‘civilians’ and prescribe naloxone to administer when
witnessing an overdose
*Source: Darke & Hall, 2003
Opioid Overdose Prevention
Programs in NYS law
Effective April 1, 2006 in New York State, registered
programs can provide overdose reversal training
and prescribe naloxone to ‘civilians.’
– Programs submit a brief application to NYS DOH AIDS
Institute
– Programs maintain confidential training logs of ‘trained
overdose responders’
– Programs submit information on reported overdose
reversals (responder remains anonymous)
Opioid Overdose Prevention Programs
• Educate people to respond to overdose
– Train people individually or in groups
• Prescribe and dispense naloxone to ‘trained overdose
responders’
– Injectable or intranasal naloxone formulation is
offered
• Target people who use drugs, people in their social
networks, family members and friends, as well as staff of
shelters, housing programs, drug treatment programs,
and other locations where overdoses might occur
A typical overdose
prevention and reversal training…
• Describes risks for opioid overdose
• Describes symptoms of an opioid overdose
• Teaches how to respond to an opioid
overdose (call 911 is the first response!)
• Prescribes naloxone to the ‘trained responder’
• Can take 10 minutes or up to one hour
• Provided to individuals or groups
Trained overdose responders
are offered intranasal or
intramuscular naloxone
Intranasal naloxone
(IN): 2mg/2mL
Intranasal naloxone
Intramuscular naloxone
Intramuscular naloxone
(IM): 0.4mg/1mL
The Overdose Rescue Kit
also includes
– Rescue breathing mask
– Latex gloves
– Alcohol pad
As of October 1, 2009
• 50 registered Opioid Overdose Prevention
Programs in New York State
– 44 registered programs in New York City
• Programs include:
–
–
–
–
–
Homeless shelters and outreach programs
Syringe exchange / harm reduction programs
HIV/AIDS services
Drug treatment programs
NYC DOHMH
Initial program success in
NYC
• > 4,000 kits (2x
naloxone doses)
distributed
• > 300 reversals
reported by trained
overdose responders