Transcript The Grand Rapids Red Project and The POD Program

Steve Alsum
The Grand Rapids Red Project
[email protected] (616) 456-9063
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Introduction
Overdose Epi
Naloxone Distribution: Core Components
Distribution Models
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Community Based
Law Enforcement
Pharmacy
Co-Prescription
Naloxone Distribution: Michigan
What’s Next?
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A 501c3 non-profit founded in 1998
Mission: Improve Health, Reduce Risk, Prevent
HIV
We utilize a Harm Reduction philosophy
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The space in between prevention & treatment
Meeting people where they are at
Providing a range of options
Client centered
Low threshold approach
Pre-recovery supports
Health Issues: HIV, Hepatitis C, and Overdose
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Overdose Prevention
Rapid HIV/Hepatitis C Testing
Risk Reduction Counseling
Syringe Access
HIV Linkage To Care & Case Management
Recovery Coaching/Access To Treatment
Support Groups
Red Project provides comprehensive
programming along the continuum of care
Michigan Mortality Rates
6
Deaths/ 100,000 living
5
4
Narcotic Overdose
3
Viral Hepatitis
HIV/AIDS related
2
1
0
1999
2001
2003
2005
Year
2007
2009
2011
Kent County Overdose Fatalities
by Drug of First Mention
Overdose Fatalities
100
80
Total
60
Total Opioid ODs
Heroin/Morphine
40
20
Methadone
Narcotic Analgesic
0
1994
1998
2002
2006
Year
2010
2014
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Naloxone can be prescribed like any other
medication- the issue is physician awareness
PA 311 of 2014 allows prescription to:
◦ Third parties, ie family members, friends, etc
◦ An organization that:
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Acts at the direction of a prescriber
Stores the naloxone properly
Dispenses the naloxone under a valid prescription to a patient
Performs requirements without charge or compensation
PA 462 of 2014- Law Enforcement
No matter what model: a physician must be
involved at some point in the process
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Why are we here?
◦ To train community health responders
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What is an overdose?
◦ Why do people die of overdoses?
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What do people overdose on?
◦ Opioids, and the role of naloxone
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Overdose risk/prevention
◦ Mixing, tolerance, quality, using alone, etc…
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Recognizing an overdose
◦ The line…
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Responding to an overdose
◦ S.C.A.R.E. M.E. and the 3 A’s
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Naloxone kit assembly/storage/legality
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Naloxone Rescue Kit Options
◦ Intramuscular ($40-75)
◦ Intranasal ($75-105)
◦ Auto-injector ($650-3,000)
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Stocking and assembling the kit
◦ Will you do this yourself?
◦ Or work with a pharmacy?
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Paying for the kit…
◦ Some options are more affordable than others
◦ Work with your insurance companies- this is cost effective
 no longer cost effective at a cost of $4,480/kit- Coffin et al.
AIM 2013; 158: 1-9.
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Piloted by Chicago Recovery Alliance, Harm
Reduction Coalition’s DOPE Project,
Massachusetts programs
Typically provided in conjunction with other
harm reduction/SUD services:
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Syringe access
Methadone maintenance
Detox
Recovery housing
Family Groups
Reach very high risk individuals and their
social networks
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CDC MMWR, June 18, 2015
Nationally there were 136 local overdose
prevention programs that distribute Naloxone
◦ From 1996-2014
 Trained 152,283 people
 26,463 reported reversals
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Multiple Models For Successful Programming
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The Take Away:
◦ Syringe Access/Harm Reduction-Chicago Recovery
Alliance, etc
◦ Point of Prescription/Medical Model-Project Lazarus
◦ State Health Department- Massachusetts, etc
◦ Finding ways to put tools in hands to save lives…
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Rationale
◦ Law enforcement are first responders
◦ Better serve the public/improve relations
◦ Prevent unnecessary death/potential PTSD
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Successfully Modeled In:
◦ MA, IN, NC, NY, RI, VT, CT, etc…
◦ http://www.nchrc.org/law-enforcement/us-lawenforcement-who-carry-naloxone/
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Most successful when people feel comfortable
calling 911
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Almost over the counter
◦ Through a CPA, pharmacists can issue a naloxone
rescue kit, without a preexisting prescription for a
patient
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CVS and Walgreens have taken the lead,
nationally
◦ Plans to expand to most states
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Is new legislation necessary in Michigan- we
already do this with other medications?
◦ Think flu shots and vaccinations
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Benefits…
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www.prescribetoprevent.org
A comprehensive online resource to encourage naloxone
prescribing
Inclusion Criteria for a Naloxone Rescue Kit
Received emergency medical care involving opioid
intoxication or poisoning
Suspected history of substance abuse or
nonmedical opioid use
Prescribed methadone or buprenorphine
Higher-dose (>50 mg morphine equivalent/day)
opioid prescription
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Receiving any opioid prescription for pain plus:
Rotated from one opioid to another because of possible
incomplete cross tolerance
Smoking, COPD, emphysema, asthma, sleep apnea,
respiratory infection, or other respiratory illness or
potential obstruction.
Renal dysfunction, hepatic disease, cardiac illness,
HIV/AIDS
Known or suspected concurrent alcohol use
Concurrent benzodiazepine or other sedative prescription
Concurrent antidepressant prescription
Patients who may have difficulty accessing
emergency medical services (distance, remoteness)
Voluntary request from patient or caregiver
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Community Engagement
2008: Wilkes County, NC has 6th highest OD
mortality rate in nation
Fatality is caused primarily by prescription opioids
Work with doctors to train individuals receiving
opioid prescriptions in how to respond to overdose
with Naloxone
OD deaths down 69% between 2009 and 2011
◦ Less than 1% change in how many residents had a
prescription for an opioid pain reliever in Wilkes County
◦ In 2008 82% of OD fatality victims had a prescription from a
Wilkes County prescriber, in 2011 this decreased to 0%
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“The prevention of drug overdoses is
consistent with the Board's statutory mission
to protect the people of North Carolina. The
Board therefore encourages its licensees to
cooperate with programs like Project Lazarus
in their efforts to make naloxone available to
persons at risk of suffering opioid drug
overdose.”
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Clean Works Program- October 2008
Cherry St Health Methadone Clinic- 2012
Network 180 and SUD Treatment- 2013
◦ SA Turning Point, Arbor Circle IOP, Our Hope, Jellema
House, Freedom House, Cherry St Health Methadone Clinic,
Degage Open Door Women’s Shelter, Network 180 Access
Center, etc
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Results (as of 6/30/2016)
◦ 3,150 individuals trained which has led to 345+ reported
reversals
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The Future
◦ Increased collaboration/partnerships
◦ Multiple points of distribution
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Direct Client Service Delivery
◦ Allegan, Ottawa, Muskegon, lake, Mason, and
Oceana counties
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Technical Assistance/Program Start-Up
◦ Region 10 PIHP- 4 County Region Flint to Port
Huron
◦ SWMBH- Kalamazoo and 8 Counties in SW MI
◦ Lansing and Montcalm Counties
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Law Enforcement Training
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Local Task Force Creation
◦ This epidemic is bigger than what the capacity of a
few scattered not-for-profits can handle- it
requires a community response
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Local Law Enforcement Training
Integration into the medical community- coprescription along with opioids
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Naloxone is an unscheduled prescription
medication both nationally and in Michigan
PA 311 – 314 signed into law October 2014
Allow prescription to anyone
Allows prescription to an organization
Allow administration to anyone
Eliminates potential criminal and civil liability, and
professional disciplinary action, for prescribers and
end-users
◦ Naloxone is one of the easiest/safest medications
to prescribe, we need to make it easier to obtain
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Still no Good Samaritan legislation
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Governor Snyder’s office has endorsed this,
and it will be the standard for LE agencies to
be equipped
Currently carrying kits (and trained through
Red Project):
◦ Hastings PD, Barry Sheriff, Nashville PD, Barrein Sheriff, Berrein Springs-Oronoko PD,
Buchanan PD, Coloma PD, Bridgmen PD, Pokagon Tribal PD, Three Oaks PD, Grand
beach PD, New Buffalo PD, Niles PD, Michiana PD, Coldwater PD, Branch Sheriff,
Bronson PD, Union City PD, Albion PD, Calhoun Sheriff, Battle Creek PD, Marshall PD,
Dowgiac PD, Ontwa Township PD, Cass Sheriff, Cassopolis PD, Kalamazoo Sheriff,
MSP- Specialty Teams, MSP-Wayland, MSP Post 54, MSP 5th District HQ, MSp-Niles,
MSP-Paw Paw, St Joe Sheriff, Three Rivers PD, Centreville PD, Decatur PD, Van Buren
Sheriff, Bangor PD, Hartford PD, Covert PD, Oceana Sheriff, Lake Sheriff, Mason
Sheriff, Baldwin PD, Hart PD, Ludington PD, Benzie
County Sheriff*,
Macomb County Sheriff*, etc…
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*not trained through Red Project
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PA 462 makes it legal for law enforcement
officers and agencies to purchase, possess,
dispense, and administer naloxone
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Removes potential civil and criminal liability
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To carry, and administer, officers must:
◦ Receive training
◦ Believe someone is experiencing an opioid related
overdose
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Pharmacy Access
◦ Spartan/Nash Stores (Duthler’s, D&W, Family Fare)have a CPA operating at three stores in the GR area
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Medical Community/Co-Prescription
◦ The epidemic is primarily among prescription
opioid users in Michigan
◦ We need statewide leadership in this area
◦ To be addressed:
 Physician awareness/education
 Billing
 Stocking Naloxone Rescue Kits
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Clear and direct leadership from the state
◦ We are at least 10 years into this epidemic…
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Legislative change
◦ Broad Good Samaritan protections
◦ Clear Standing Orders
◦ Other access points
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Full Integration Into Various System Points
◦ Law Enforcement/Criminal Justice
◦ Medical community, co-prescription and pharmacy
access
◦ Substance use, and addressing the trauma
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Massachusetts provides overdose education
and naloxone distribution on a statewide
level, supported through their health
department
Walley et al. BMJ 2013; 346: f174. found that:
◦ 0 kits per 100,000 people resulted in a 0% change
◦ 1-100 kits/100,000 people resulted in a 27%
reduction in community overdose mortality rates
◦ >100 kits/100,000 resulted in a 46% reduction
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Decreasing overdose mortality is dependent
on increasing naloxone kit distribution
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Anyone currently using opioids
◦ Individuals using opioids as prescribed
◦ Individuals abusing prescription opioids
◦ Individuals using or abusing other opioids
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Anyone with a history of opioid abuse
◦ Relapse can be a part of recovery, and in relapse
there is extreme danger of overdose
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If an individual is allergic to bee-stings they
have an epi-pen: We need to look at naloxone
rescue kits in the same way…
Just because you own
one of these…
Does not mean you will
start one of these…
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The Chicago Recovery Alliance and Dan Bigg
Network 180/CMH of Ottawa County/Health
West/SWMBH/Region 10 PIHP
Our Physicians
◦ Dr Vernon Proctor
◦ Dr Sandra Dettmann
◦ Dr Cara Poland
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Our Staff
Our Clients
◦ They do the real work
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CDC: Injury Prevention and Control
MDHHS
Kent County Medical Examiner
MAPS
Physicians Desk Reference
CDC MMWR, June 18, 2015-Community-Based
Opioid Overdose Prevention Programs Providing
Naloxone – United States, 2010
The Grand Rapids Red Project
Walley et al. BMJ 2013; 346: f174.
North Carolina Harm Reduction Coalition
Coffin et al. AIM 2013; 158: 1-9.