PRE-HOSPITAL ADMINISTRATION OVERDOSE PREVENTION PRE-HOSPITAL ADMINISTRATION OF NALOXONE RENEE YANDEL PAT MOORE HIV ALLIANCE D.I.N.T.

Amnesty in overdose reporting Senate Bill 839 of the 2015 Oregon Legislative Session. A person who calls EMS or Police to report an OD, along with the actual patient, may not be arrested or prosecuted for the following crimes if the evidence was obtained pursuant to the emergency response: Frequenting a Drug House, Possession of Controlled Substance, Unlawful Possession of Hydrocodone, Methadone, Oxy, Heroin, Marijuana, Cocaine, Meth, Rx, or Paraphernalia w/ intent to sell. Pre-existing arrest warrants will NOT be served upon the reporting party or patient if the warrant was issued for any of the crimes listed above, or for a violation of Parole or Probation pursuant to such an offense

Douglas county overdose rates: 33 deaths in 30 months (2012 to 2014): 24 of the 33 (73%) by Opiates, including synthetic opioids. 75% of Opiate deaths involved Rx; the other six were by Heroin. Two-thirds of ALL fatal ODs were via Rx; nine via illicit drugs. Meanwhile, Heroin arrests in Douglas County topped 200 for the first time ever, in the calendar year 2015. Naloxone has been issued to select, trained LE officers in DINT, the county jail, and Winston Police Department.

Oregon Senate Bill 384 You can use naloxone on someone else. You will not be liable if something bad happens (mostly). A variety of organizations can train individuals and give them naloxone. You can also take a “training certificate” to a pharmacy. Pharmacists can train/prescribe. New House Bill 4124 Social service agencies: trained staff use, not just by individual named employee. New House Bill 4124 SECTION 4. In accordance with rules adopted by the State Board of Pharmacy under ORS 689.205, a pharmacist may prescribe unit-of-use packages of naloxone, and the necessary medical supplies to administer the naloxone, to a person who meets the requirements of ORS 689.681 (4). SECTION 6. (1) For purposes of this section, “social services agency” includes, but is not limited to, homeless shelters and crisis centers. (2) An employee of a social services agency may administer to an individual a unit-of-use package of naloxone that was not distributed to the employee if: (a) The employee conducts or has successfully completed opiate overdose training under ORS 689.681; (b) The unit-of-use package of naloxone was distributed to another employee of the social services agency who conducts or has completed the opiate overdose training under ORS 689.681; and (c) The individual appears to be experiencing an opiate overdose as defined in ORS 689.681. (3) Fo

What is naloxone ? Opioid antagonist-temporarily stops effects of opioids Cannot be used to get high, not addictive No effect if the person has not taken Opioid Effective even if Opioid taken w alcohol or other drugs No risk if the person has not taken Opioid or not overdosing Research shows: Overdoses are usually witnessed (McGregor, Addiction 1998) Death takes a while (Sporer, Ann Intern Med 1999) 911 and EMS not routinely accessed (Coffin, Ann Emerg Med, 2009) Naloxone is very safe and effective More rapid reversal with naloxone improves outcomes (Gonzva, Am J Emerg Med 2013) Cost-effective (Coffin, Ann Intern Med 2013) This is a picture of a naloxone vial that we give out at needle exchange. This is the injectable form.

What is naloxone? Administered via injection or nasal Injection Dose 1mL vial, kits contain 2 Onset of action 3-15 mins Duration of action: 30- 45 mins

Nasal naloxone Here’s what a fully assembled nasal naloxone device looks like.

Auto-injector Evzio is an auto-injector product that was approved by the FDA in 2014, a year after the Oregon naloxone law passed and protocols were implemented. Compared to injectable and nasal naloxone, Evzio is quite expensive (quotes at $300-700 per device). We will not cover Evzio during our training today. It comes with audio instructions that walk you through how to use it. It is apparently fairly simple to use. Another example of an auto-injector product used in emergency situations are certain types of epi-pens. 8

Narcan Spray

Naloxone Training OAR 333-055-0100 through 333-055-0110 Training must meet OHA criteria Training must be “approved” by a licensed physician or Nurse Practitioner Retraining every 3 years OHA Training Video: https://www.youtube.com/watch?v=wsN0ijLnK2k&feature=youtube

CDC Report 2015 Opioid Overdose Prevention Programs Providing Naloxone to Laypersons 82.8% of the reported reversals were done by people who use drugs and 9.6% by family and friends of a user. Service providers came in at 0.2%. “An opioid overdose is a life-threatening medical emergency. If laypeople have naloxone, they can start the process of reviving the person before paramedics or law enforcement come through the door.” Dr. Stephen Jones, researcher and author of the report

HIV Alliance Naloxone Distribution December 2015-OR DOJ Settles with Insys January 2016- Lines for Life (LFL) receives funds from settlement to prevent Opioid abuse and misuse April 2015-HIV Alliance receives funding through LFL July 2016- HIVA launches Naloxone project in Lane Co. January 2017-HIVA launches Naloxone project in Douglas Co. February 2017- HIVA partners with Max’s Mission to host a community training and distributes 22 doses to family/friends

HIVA kit Naloxone Syringes Face shield Alcohol wipes Sharps container Info & Instructions MCHD naloxone kit. MCHD started naloxone training on May 29, 2014 at their NE site. In July, added the East County site. In Aug, added the Tues night shift at the 82nd site. In Sept, added the Fri night shift at the 82nd site – our busiest shift every week.

NEX survey Have you ever witnessed a drug overdose ? 83% reported YES Have you ever overdosed? 53% reported YES Have you overdosed in the last yr? 20% reported YES What type of insurance do you have? OHP 63% None 27% Medicare 5% VA 3% Private 2%

Syringes Exchanged 2013-2016 (Douglas County)

Contact Information Renee Yandel HIV Alliance Executive Director 541.342.5088 x 113 ryandel@hivalliance.org Lieutenant Pat Moore, Commander Douglas Interagency Narcotics Team 541.440.4474 pmoore@cityof roseburg.org