Naloxone in North Carolina Robert Childs, MPH Harm Reduction and Drug Policy Consultant

911 Good Sam/Naloxone Legislation in North Carolina 2013 911 Good Samaritan Law, Community Naloxone Access 2015 Good Samaritan Protections for People on Parole, Probation, Pretrial Release & Pharmacy Standing Orders Funding for naloxone 2017 Stop Act: Provision allowing for expanded naloxone access and changed mechanism to expand syringe exchange funding Naloxone Funding

Naloxone Non-addictive prescription medication reverses opiate overdose Distribution is associated with up to a 50% drop in OD fatalities Administer via intramuscular injection or nasal spray Cannot be abused nor cause overdose Restores breathing and consciousness Onset: One to three minutes Duration: 30 to 90 minutes

Recognizing an Opioid Overdose Signs Unresponsiveness to loud noises or sharp pain Blue skin/lips/fingernails Shallow breathing Strange, gurgling, or snoring-like noises

Responding to an Opioid Overdose Attempt to make verbal contact Perform a sternum rub to determine the level of responsiveness. Prepare the naloxone Confirm correct medication, expiration date, and dosage Administer the Naloxone Follow your protocol for requesting EMS

Responding to an Opioid Overdose Recovery Position Once the victim is breathing again, place them in recovery position due to risk of vomiting. Monitor the patient for medication effects, which may include opiate withdrawal symptoms and/or agitation. This should include the patient’s assessment of his/her response to the treatment and reassessment of vital signs. Notify person an overdose reversal medication was used on them and that they may feel pain/withdrawal symptoms and that it is NORMAL!! On their side, mouth facing down, with the leg propped up over to the side and arm underneath their head

Recap Blue color Sluggish breathing Not responding Sternum Rub/Mustache Rub Call 911! Administer narcan Recovery position If trained to do chest compressions, you can do chest compressions

Myths Intentional Overdosing Narcan Parties People reversed are combative

Emergency Department Opioid Overdose Visits & EMS Naloxone Administrations, 2011-2017† Emergency Department (ED) visits for opioid overdoses are increasing. Heroin overdose ED visits significantly increased since 2011 (shown in blue above). The use of naloxone by Emergency Medical Services (EMS) has also increased dramatically during this time. Technical Notes: Note that naloxone administration alone does not necessarily equate to an opioid overdose as EMS may administer naloxone when an individual is suffering from a different condition with similar signs and symptoms to an opioid overdose. Additionally, the coding transition of ICD-9-CM to ICD-10-CM occurred in October 2015, making it difficult to assess trends before and after the transition. However, this metric still serves as an indication of the number of opioid overdoses seen by EMS. Some ED visits are coded as substance abuse rather than overdose, therefore, the counts represented above are likely an undercount of overdoses. Important Note: Due to an on-going transition to a new EMS data system, beginning in 2017 Q4 there is an under-counting of EMS naloxone administrations. This is a statewide transition currently being worked on, and data will be backfilled as agencies complete the transition