An overdose Reduction PlaN Prevention Point Philadelphia

Our Mission PPP is a non-profit, public health organization committed to protecting the health and welfare of drug users and sex workers. PPP works to reduce the harm associated with substance use and sex Industry work by offering a safe and humane alternative to the war on drugs. Our Mission

Penn's National Clinician Scholars Program 2016-2018 Cohort [ ] add back in background and agenda slides

Background: Opiate Epidemic in Philadelphia Revise this slide

Background: Naloxone Naloxone (aka narcan): prescription medication that blocks effects of opioids and can reverse overdose Available intranasal or injectable form Free w/ Medicaid but can cost in the $1,000s out of pocket Shelf-life is 18-24 months Goal: distribute naloxone to users, caregivers, family members, first responders to reverse overdose in the community Intranasal and injectable forms

Provider training in naloxone prescribing is effective. Four Key Lessons Public and community-based organizations should be integrated into opiate reduction efforts. People who use drugs (PWUD) want to use naloxone, but face barriers to access. Pharmacies don’t know about the standing order and if they do, they misunderstand. Provider training in naloxone prescribing is effective. Pharmacies don’t know about the standing order and if they do, they misunderstand. People who use drugs (PWUD) want to use naloxone, but face barriers to access. 1 2 Public and community-based organizations should be integrated into opiate reduction efforts. Provider training in naloxone prescribing is effective. 3 4

Lesson #1 Pharmacies don’t know about the standing order and if they do, they misunderstand.

Pennsylvania Standing Order October 2015, PA Surgeon General Rachel Levine signed PA standing order “Non-patient specific” prescribing Third-party prescribing Standing order is voluntary & pharmacists are not required to have naloxone in stock

Pharmacy Awareness of Standing Order by Zip Code Lesson #1: Pharmacists Pharmacy Awareness of Standing Order by Zip Code Total answering question = 85 pharmacies 6 did not know [ ] change back to bar chart slide 35 Yes (41%) 44 had not heard (51%)

Is a prescription needed to dispense Naloxone? Lesson #1: Pharmacists Is a prescription needed to dispense Naloxone? n = 61 Don’t Know 26% Yes 53% No 21%

1 of 8 Lesson #1: Pharmacists Pharmacies had naloxone in stock AND will dispense without a prescription. [ ] explain why in the highest OD area, there are so few pharmacies that are aware of the standing order

Lesson #1: Pharmacists Pharmacies don’t know about the standing order and if they do, they misunderstand. Deliver a naloxone toolkit to pharmacies in targeted zip codes before expanding city-wide Implement widespread pharmacy teaching by partnering with pharmacy professional associations, city/state health commissions, and pharmacist champions, with options for continuing education credits Create a serial data collection protocol to monitor uptake of standing order amongst pharmacies in high-risk areas [ ] add in pharmacy association [ ] PA physician general [ ] Philadelphia Health Commissioner [ ] Pharmacy Association [ ] pharmacy-based credits

Lesson #2 People who use drugs (PWUD) want to use naloxone, but face barriers to access. There’s low but increasing awareness of overdose risk, cost and pharmacy access Pwud need: 1) naloxone 2) safe site etc

Lesson #2: People Who Use Drugs People who use drugs want to use naloxone, but face barriers to access Educate users that Medicaid recipients can obtain Naloxone from pharmacies for free Develop strategies for Medicaid recipients to store/replicate insurance cards and IDs in order to receive free Narcan from pharmacies Increase insurance enrollment among people who use drugs Support existing drop-in harm reduction services to ensure secure, safe environments for drug users [ ] add in pharmacy association [ ] PA physician general [ ] Philadelphia Health Commissioner [ ] Pharmacy Association [ ] pharmacy-based credits

Lesson #3 Public and community-based organizations (CBOs) should be integrated into opiate reduction efforts.

Lesson #3: Public & CBOs General public has little knowledge of overdose deaths Mass media campaigns and neighborhood-based solutions are needed Model CBO Opioid Overdose Prevention Programs Baltimore Crisis Response - Mobile Crisis Team New York State Opioid Overdose Prevention Program Registry

Lesson #3: Public & CBOs Public and community-based organizations should be integrated into opiate reduction efforts. Secure immediate and long-term, sustainable funding to purchase naloxone Apply lessons from mass media public health campaigns (i.e. HIV), targeting not just users, but also pain patients, caregivers, families, and the general public Identify CBOs that are willing to distribute naloxone and coordinate with existing opiate reduction organizations [ ] add in pharmacy association [ ] PA physician general [ ] Philadelphia Health Commissioner [ ] Pharmacy Association [ ] pharmacy-based credits

Provider training in naloxone prescribing is effective. Lesson #4 Provider training in naloxone prescribing is effective.

Lesson #4: Providers Coffin et. al, Ann Intern Med, 2016 Aug 16;165(4):245-52

Lesson #4: Providers “If you have someone on chronic opioids, it is useful to co-prescribe naloxone.” --Stakeholder

Provider training in naloxone prescribing is effective. Lesson #4: Providers Provider training in naloxone prescribing is effective. Develop mandatory, multi-modal training models on co-prescribing and PDMP to all providers, including nurses, physicians, and trainees Implement mandatory training on opiate reversal and increase access to naloxone for first responders Collect and monitor prescribing patterns by advocating for EHR and PDMP interoperability [ ] add in pharmacy association [ ] PA physician general [ ] Philadelphia Health Commissioner [ ] Pharmacy Association [ ] pharmacy-based credits

This is a multifaceted issue - framing is important! Tying It All Together This is a multifaceted issue - framing is important!

Provider training in naloxone prescribing is effective. Tying It All Together Pharmacies don’t know about the standing order and if they do, they misunderstand. People who use drugs (PWUD) want to use naloxone, but face barriers to access. 1 PEOPLE WHO USE DRUGS 2 PHARMACIES Public and community-based organizations should be integrated into opiate reduction efforts. Provider training in naloxone prescribing is effective. 3 4 PUBLIC PROVIDER

4-P Strategy for Opioid Overdose Reduction PEOPLE WHO USE DRUGS PHARMACIES PUBLIC PROVIDER

Questions Jose A. Benitez Executive Director Prevention Point Philadelphia 215-461-1710 jose@ppponline.org Questions