Project Coordinator Overdose Prevention Project, Prevention Point Pittsburgh Alice Bell, LCSW

Prophylactic Prescription of Naloxone to Prevent Fatal Opioid Overdose July 2012 Overdose Prevention Project Prevention Point Pittsburgh Alice Bell, Project Coordinator

Each year in Allegheny County, more people die of accidental drug overdose than die in traffic accidents and homicides, combined. Of 261 overdose deaths in 2011, 261 involved one or more substance that would respond to naloxone. Data released from CDC for 2009, indicates drug overdose is now the number one cause of injury death, exceeding motor vehicle accidents, and killing at least 37,485 people in U.S. Data released from CDC for 2009, indicates drug overdose is now the number one cause of injury death, exceeding motor vehicle accidents, and killing at least 37,485 people in U.S. Roughly half of these deaths involve opioids; almost 40% opioid analgesics and almost 10% heroin.

4 Motor vehicle traffic, poisoning, and drug poisoning death rates: U.S., Source: NCHS Data Brief, December, 2011, updated with 2009 mortality data

Allegheny County Trends in Accidental Drug Overdose Deaths * * Data is from Allegheny County Medical Examiners Annual Reports and includes all overdose deaths where these drugs were present at time of death, not necessarily cause of death.

Overdose Deaths from Opioids are preventable We have the antidote, safe, highly effective, naloxone. We have the antidote, safe, highly effective, naloxone. Paramedics use naloxone (Narcan) to immediately reverse the effects of opiate overdose. Paramedics use naloxone (Narcan) to immediately reverse the effects of opiate overdose.

 Failure to recognize symptoms of overdose.  Don’t know what to do results in delayed or ineffectual response.  Fear of stigma associated with drug use.  Fear of Police Involvement. So, Why Are People Dying?

Prescription Monitoring Programs: Prescription Monitoring Programs: Reduce Diversion, not demonstrated to reduce overdose. Reduce Diversion, not demonstrated to reduce overdose. Concern about increase in heroin use. Concern about increase in heroin use. Methadone and Suboxone treatment: Very effective Methadone and Suboxone treatment: Very effective Abstinence-based drug treatment: Abstinence-based drug treatment: Risk of overdose increases when relapse occurs. Risk of overdose increases when relapse occurs. Community Based Education: Risk Factors, Identification of Symptoms, Effective Response, including Rescue Breathing, Calling 911 and Naloxone Administration Community Based Education: Risk Factors, Identification of Symptoms, Effective Response, including Rescue Breathing, Calling 911 and Naloxone Administration Naloxone Prescription Programs Naloxone Prescription Programs Physician Prescribing when prescribing opioids for pain Physician Prescribing when prescribing opioids for pain Strategies for Reducing Overdose Deaths

Implemented in Pittsburgh July 2005 at Syringe Exchange Implemented in Pittsburgh July 2005 at Syringe Exchange Medication is Prescribed by Volunteer Physicians Medication is Prescribed by Volunteer Physicians Over 800 individuals have received Naloxone Over 800 individuals have received Naloxone Over 650 successful peer overdose rescues. Over 650 successful peer overdose rescues. Updated Data 6/15/12 Bennett, A.S., Bell, A., Tomedi, L., Hulsey, E.G., Kral, A.H. (2011); Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania. Journal of Urban Health, 88 (6): Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, PennsylvaniaCharacteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania Overdose Prevention/Naloxone Prescription Program: Prevention Point Pittsburgh

Number (#)2007*2010† States w/ OENDs916 Programs42155 People enrolled20,95053,339 Reported OD reversals2,64210,194 * Knox, 2008 † Wheeler, E. NOPE Working Group - Harm Reduction Coalition PMMWR, Centers for Disease Control, February 17, 2012, Volume 61, No. 6ngeles, Massachusetts, Mendocino County, CA, New Haven, New Mexico, New York City, Oakland, Pittsburgh, Rhode Island, San Francisco, Wilkes County, NC and more OD Education and Naloxone Distribution (OEND) Programs in U.S.

11 Project Lazarus - North Carolina In response to some of the highest drug overdose death rates in the country, Project Lazarus developed a community-based overdose prevention program with routine physician prescription of naloxone when opioids were prescribed for pain. Overdose death rate dropped from 46.6 per 100,000 in 2009 to 29.0 per 100,000 in Unpublished data indicates rate of death has continued to drop to 7 deaths per 100,000 is ( rates based on provisional data from OCME via Wilkes Co. Health Department.) Pain Med.Pain Med Jun;12 Suppl 2:S77-85

Project Lazarus: Naloxone Rescue Substance Abuse Treatment Prescribe naloxone Pain Diagnosis Opioid prescription Identify high risk patient Prescribe naloxone 2.3.

Womack Army Medical Center, Ft. Bragg, NC: Operation OpioidSAFE MAJ Anthony Dragovich MD Medical Director, Pain Medicine Ft. Bragg, NC Operation OpioidSAFE is a novel provider, patient and community education program with the added advantage of lay person diagnosis and reversal of opioid overdose by naloxone.

Model for Integrating Overdose Prevention and Treatment Into Standard Practice at Primary Health Centers and HIV Treatment Programs in Pittsburgh, PA /2012 Cristina Elgin, PharmD Candidate Positive Health Clinic – AGH Positive Health Clinic – AGH PACT - UPMC PACT - UPMC Metro Family Practice- Metro Family Practice- Birmingham Free Clinic Birmingham Free Clinic

DVD Opioid Medication Safety: The Role of Naloxone by Prevention Point PittsburghPrevention Point Pittsburgh PrescribetoPrevent.org

If you take medicine for pain, YOU may be at risk for accidental overdose! Do you take opioid medicine for pain like morphine, methadone, Oxycontin, Percocet, Vicodin, fentanyl, or Opana? Do you use other opioids like heroin? Using any opioids puts you at risk. Your risk is greater if you take other medications or have other medical conditions. Opioid overdose is PREVENTABLE and REVERSIBLE Naloxone (Narcan) is a medication that STOPS overdose! You can get naloxone here at ### Family Health Center. Ask a staff member or call ##-###-#### to learn more! Ask a staff member or call ##-###-#### to learn more! Multiple medications Multiple medical conditions + Opioid pain medication INCREASED RISK OF OVERDOSE ASK ABOUT NARCAN

Physician/Pharmacy Collaboration for Naloxone Prescription in Pittsburgh Positive Health Clinic- February 2012 Positive Health Clinic- February 2012 UPMC – PACT-March 2012 UPMC – PACT-March 2012 Center for Pharmacy Services-2011 Center for Pharmacy Services-2011 Metro Family Practice-June 2012 Metro Family Practice-June 2012 Birmingham Free Clinic-July 2012 Birmingham Free Clinic-July 2012 Mercy Family Health Center-July 2012 Mercy Family Health Center-July 2012

American Medical Association Endorses Community Based Naloxone Programs “The AMA today adopted policy to support further implementation of community-based programs that offer naloxone and other opioid overdose prevention services. The policy also encourages education of health care workers and opioid users about the use of naloxone in preventing opioid overdose fatalities.” – Health News Digest June 19, 2012