Transcript Overdose Prevention

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Overdoses are rarely instant
There are often bystanders
Naloxone is a safe and effective antidote
Many overdoses are preventable with prompt
recognition and treatment
Sporer 2006
Overdose prevention:
 Makes drug user health a priority in diverse
settings
 Endorses idea of drug users as capable and
concerned with their community
 Expands benefits from harm reduction intervention
to other medical populations
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Prevention: understanding the role of:
◦ mixing drugs
◦ reduced tolerance
◦ using alone
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Overdose recognition
Actions
◦ Call emergency services
◦ Rescue breathing- using dummy
◦ Naloxone administration
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Syringe exchange/syringe access sites
Homeless Shelters
Hospitals
◦ Inpatient
◦ Public Clinics
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Drug Treatment
◦ Methadone/Buprenorphine
◦ Detoxification programs
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HIV programs
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Jails/ Prisons and with the formerly incarcerated
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SEPs serve a high risk population
SEPs have trusting relationships with drug users
and have expertise in working with drug users
including peer educators
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Competition with existing programs for staff and
resources Syringe exchange programs funding
and staff is stretched and has a lot of turnover
◦ Peer educators can be excellent trainers
◦ Reinforcement of message often possible
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SEPs usually do not have medical personnel
able to prescribe medications on staff
◦ Sharing paid medical staff, use of volunteer clinicians
14 syringe distribution programs offering
overdose prevention
Over over 2,600 syringe exchange participants,
trained at 14 syringe access sites
 Reports of overdose reversals using naloxone:
over 260
SKOOP 5/08
New York City Department of Health is promoting
naloxone training and distribution in:
 Detoxification units
 Methadone programs
 Buprenorphine programs
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Recently detoxified patients are at high risk of
overdose
Methadone & buprenorphine patients go in and
out of treatment
These patients are in contact with other drug
users
Use of other sedatives associated with death of
opioid maintained patients
Wines 2007, Sporer 2006
May be interpreted as condoning/expecting drug
use
◦ Address it as a community issue- points of contact
Staff may not see drug users as capable of such
an intervention
Staff often invested in abstinence model
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6 programs including detoxification units,
methadone and buprenorphine programs have
registered. All City Hospitals and several more are
preparing to register
1 methadone program has distributed over 200
kits
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Being homeless is associated with risk of OD
In NYC, leading cause of death among homeless
2005-2006 was OD (23%)
Associated factors may be:
◦ Social and economic stress
◦ Lack of safe, familiar place to inject
 Using alone and rushing injection
◦ Less access to opioid maintenance treatment
Driscoll 2001,NYCDOHMH
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Creation of policies and procedures for large
agency with wide diversity in settings
Medical providers not present in all facilities to
dispense naloxone
Needles are not allowed in all shelters
Fear of repercussions/ stigma around disclosing
drug use
NYC plan for homeless shelters:
 One staff member on every shift trained in
overdose response. Initial training of medical
staff completed Training of staff as overdose
responders imminent
 Medical providers will offer training and
intranasal naloxone to all interested clients in
city funded shelters
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1 shelter implemented training of staff
immediately after legislation passed
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42% of cumulative AIDS cases in NYS have
injection drug use or sex with an IDU as a risk
factor
People with advanced disease are at higher risk of
overdose death
In impoverished areas of NYC, OD is leading
cause of non-HIV death in persons with AIDS.
NYSDOH, Wang 2005, Sackoff 2006
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Clients may be reluctant to disclose drug use
◦ May be a bridge to further discussion of drug use
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Serving DU needs may still be “controversial”
Staff lack of experience and knowledge about
harm reduction and drug use issues
Lack of medical personnel on staff for naloxone
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6 programs in NYS have registered
4 have initiated services
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Post incarceration is major risk factor for death
from OD (10)
◦ Study of deaths in first 2 weeks post incarceration among
30,237 released inmates
◦ 129 times greater likelihood of dying of OD vs. other WA
state residents
◦ Bingswaner 2007
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Gaining entrée to system
Inability to give naloxone, must arrange for follow
up after release
Institutional discomfort with the harm reduction
model
Persons on parole are forbidden to access harm
reduction services
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NYC Department of Health:
◦ Plan to include OD prevention education with all intakes
for opioid maintenance or detoxification at the city jail
◦ Some OD training done of NYCDOH counselors working
jail settings
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Outreach :
◦ Harm Reduction Coalition working with 3 service
organizations working with the formerly incarcerated
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Hospitals see patients admitted with drug related
illnesses
Overdose prevention training not only addresses
overdose risk but can build patient-provider
relationship
Program is new with low volume but very
acceptable to medical residents
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Implementation of overdose prevention
programs appears to be more acceptable to
many agencies than provision of syringes
Core elements of the training can be adapted to
many settings
Discussion of overdose prevention can
contribute to patient/provider relationship & lead
to discussions of drug treatment
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Injection Drug Users Health Alliance
New York City Department of Health and Mental
Hygiene
New York State Department of Health