Transcript Naloxone Presentation – Sara Smith, RN

OPG MEETING
August 17, 2016
130 people die of opioid
overdoses daily
One person every 12 minutes.
-- LA Times 070716 article on naloxone pricing
-- CDC MMWR June 19, 2015
43,982 deaths drug overdose deaths in 2013
(Includes unintentional, intentional, undetermined)
37% overdose deaths due to prescription opioids
19% caused by heroin overdoses
Rx opioids deaths ~ 2 x heroin
deaths
Naloxone
Displaces opioids such as “painkillers” and heroin
from opioid receptors
Restores breathing, lasts 30-90 minutes
Must be used by another person to rescue a
patient or someone who accessed the
medicine, such as a child
Someone else must know where the naloxone is
and how to use it.
Training, 8 min OHA video on internet, HHS DVD
~ Recognize overdose
~ Call 911
~ Start rescue breathing
~ Administer naloxone
~ Continue rescue breathing
~ Administer 2nd dose at 3 minutes if needed.
~ Leave victim in rescue position if you must go
COMMON SENSE
* If your home could catch fire
* If you might get chest pain
* If you might find it hard to breathe
* If you might stop breathing
Know the antidote, be prepared to use it.
Naloxone doesn’t cure addiction,
it keeps people from dying.
The life of an addict is worth saving. Period.
We can’t require they go to treatment as the pricetag for a
naloxone save.
Diabetic arriving in DKA with a known diet of pastries, 2
previous admits. Do we do all we can?
Does the presence of seatbelts encourage people to drive
drunk? If you thought so, would you take them out of your
car?
As of January 1, 2016
Oregon has a Good Samaritan overdose
law!
If someone is overdosing and you seek medical help, neither of
you can be arrested or prosecuted for:
1. Possessing drugs or drug paraphernalia
2. Being in a place where drugs are used
3. Violating probation or parole because of #1 or #2
4. Outstanding warrants related to #1 or #2
PLEASE CALL 911!
The Good Samaritan Law does not protect you from:
1. Crimes that are not listed above
(Including drug dealing, weapons possession, DUI etc.)
1. Outstanding federal warrants, or warrants from other states
besides Oregon
Oregon Law SB839 https://olis.leg.state.or.us/liz/2015R1/Measures/Overview/SB839
It’s a conversation, not just
a prescription.
“I prescribe these medicines to you to improve your life,
but it is possible they could accidentally take it. Because I
care, I am going to prescribe naloxone to you. I do this for
all of my patients taking opioids for chronic pain. I want
you to come back with a loved one for a brief training.
Your insurance will cover it.”
Who is most at risk?
50 MED or higher (general view)
Previous OD (6x more likely OD again)
Co-prescribed benzo (10 x more likely to OD) or other sedatives
On methadone, especially new to it or to dose
Taking an opioid + respiratory condition, renal, hepatic condition
Known to use alcohol
Active SUD, unstable mental health
Released from any abstinence situation (treatment, incarceration)
Rural residence, extended EMS response time
Getting opioids from multiple presribers (check PDMP)
Taking an opioid you didn’t prescribe to them (check UDS)
Jackson & Josephine Counties Naloxone Workgroup
Involved to date
Jackson County Health Dept; Medford Police Dept (13 saves in 18 mo);
Phoenix Police Dept; Allied (700 clients receiving methadone, buprenorphine MAT);
Addictions Recovery Center (medical detox 39 doses, 2 saves in July);
Pharmacists from JCC, AllCare and RRMC ED;
Jim Shames, MD; mother of son lost to heroin OD; Tanya Phillips – syringe exchange;
La Clinica (Birch Grove, “mobile”, West Medford COT patients);
Rogue Community Health; OHSU medical and nursing students;
Josephine County Health Dept.
• Member of Oregon Health Authority naloxone work group
• Support from Multnomah County Health Dept, Outside In, Dr. Paul Coelho, Tri-Counties Opioid Safety Coalition and many more
Local workgroup meets every 4th Thursday from 9 - 10am, second floor of HHS building on Holly Street
or just join the mailing list
“This opioid thing is so overwhelming.
Naloxone is something you can actually
do about it.” community leader in corrections
June 28, 2016 Annals of Internal Medicine
First systematic study of the effectiveness of
co-prescribing naloxone in primary care to people on
chronic opioid therapy for pain.
San Francisco Health Dept clinics: 38% patients on
COT were co-prescribed naloxone.
Patients prescribed naloxone had 47% fewer opioid
related ED visits in the following year than those who
were not prescribed.
The amount of opioids prescribed to patients also
went down.
Those who got naloxone were more likely to be on a
lower dose by the end of the study year.
CDC MMWR June 19, 2015
From 1996 through June 2014, community based
organizations surveyed said they had:
152,283 laypeople trained and 26,463 reported saves
Questions? Want help with your patients or to be involved?
Sara Smith, RN, BSN LA CLINICA 541-618-1330 [email protected]