First Responder Naloxone Grant Webinar October 24th, 2016 Sarah Ruiz, MSW, Naloxone Pilot Program, Massachusetts Department of Public Health Alexander Walley, MD, MSc, Medical Director, MDPH Opioid Overdose Prevention Pilot Program Brittni Reilly, MSW, Naloxone Pilot Program, Massachusetts Department of Public Health

Agenda Changes to OEMS protocols authorizing 4 mg OEND Field Test: Single Step and IM Fentanyl and Risks Post-OD Follow-Up Programs Grant questions Q & A

Formulations and Changes to OEMS Protocols 3

Naloxone formulations Nasal with separate atomizer “Multi-step” NEW: Nasal Spray “Single-Step” Auto-injector Intramuscular Injection

Updated Protocols for First Responders 5

Protocol Changes for Statewide Treatment Protocols, Version 2016.01 # Protocol or Appendix Change Reason 12 2.14 Poisoning/Substance Abuse/Overdose/Toxicology – Adult and Pediatric For First Responder/EMT-Basics and EMT-Intermediates Naloxone dose range is now 2 mg to 4 mg Stronger dosing for more potent opioids. 6

Why did the OEMS protocols change? 7

Bystander Program Field Test of IM and Single-Step 8

Rescue reports – May 27, 2016-October 4, 2016 Post-naloxone withdrawal symptoms

Summary of Bystander Field Test Single-step nasal naloxone reliably reverses opioid overdose Experienced community rescuers prefer single-step over multi-step Withdrawal rates similar to the multi-step naloxone Community naloxone program will likely further expand distribution to more populations and venues While high dose intra-muscular is feasible and acceptable, the rates of precipitated withdrawal are higher Some reports of concern from local first responders Community naloxone program will likely limit this formulation to experienced people who use needle-syringe access programs

Why do we need higher potency naloxone in MA? 11

According to the U.S. Department of Justice, Drug Enforcement Administration’s 2015 Investigative Reporting, while pharmaceutical fentanyl (from transdermal patches or lozenges) is diverted for abuse in the United States at small levels, much of the fentanyl in Massachusetts is due to illicitly-produced fentanyl, not diverted pharmaceutical fentanyl1 . The standard toxicology screen ordered by the Office of the Chief medical Examiner includes a test for the presence of fentanyl. In 2016, the number of fentanyl-related deaths continues to increase. Among the 439 individuals whose deaths were opioid-related in 2016 where a toxicology screen was also available, 289 of them (66%) had a positive screen result for fentanyl. http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/county-level-pmp/opioid-related-overdose-deaths-among-ma-residents-august-2016.pdf 12

Investigative Findings People often die from opioid overdose in their home when they are alone Naloxone was not present on the scene of the deaths People that have survived past overdoses reported being with at least one other person on the scene People that have survived past overdoses reported having naloxone available on the scene DPH was involved in an investigation into the increase in fatal opioid overdoses 13

Community-Based Opportunities Home-based interventions Follow-up at the home of a recent overdose call with the affected individual / family Work with your local prevention and treatment providers Promotion of 911 Good Samaritan Law Emphasize importance of fast response time in the fentanyl era The overdose scene is an opportunity to acknowledge that the affected individuals made the right choice in calling 911 Encourage the affected individuals to always call 911 Encourage bystanders to carry naloxone and call 911 Make sure that if a person has naloxone on them when arrested, it is returned to them in their property DPH was involved in an investigation into the increase in fatal opioid overdoses 14

Post-Overdose Follow-Up Programs in your community What innovative partnerships is your department involved in? We want to hear from you!! 15

First Responder Naloxone Grant Details and Data Collection 16

Second payment vouchers will be issued in November after budget requests are reviewed and approved by DPH Q2 Activity Report will be due in January The Q2 report will provide an opportunity for municipalities to request additional funds if they were unable to do so in October

Data Collection Every time naloxone is administered by your department staff you are required to complete and submit an MDPH First Responder Naloxone Report to DPH. Reports need to be sent via postal mail to DPH on a monthly basis. Reports are then sent to our data processing center for validation and analysis. Questions about this process?

Technical Assistance Online Resources: MassTAPP Page: http://masstapp.edc.org/first-responder-naloxone-narcan-technical-assistance DPH-BSAS Page: http://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/prevention/naloxone-access.html

Go to getnaloxonenow.org for an online module for first responders (EMTs, firefighters, and law enforcement officers) with post-test 20

Thank you!! Questions? 21