Saves Lives Oklahoma’s Plan to Reduce Prescription Drug Abuse and Prevent Overdose

Drug overdose is now the leading cause of injury death in the United States. 1 Opioid analgesics, such as prescription painkillers, account for about 80 percent of those deaths. 1 Overdose rates have increased five-fold since Background

Oklahoma Oklahoma ranked number one nationally for the nonmedical use of painkillers (opioids) for all ages in Oklahoma consumption of painkillers for nonmedical use exceeded the national average by 232%. Prescription painkillers were involved in 9 out of 10 prescription drug-related deaths, with 460 opioid- involved deaths in 2012 alone.

Oklahoma Oklahoma’s ranks 5 th highest in drug overdose deaths nationally. 2

Drug overdose death rates compared to motor vehicle-related death rates, Oklahoma residents, Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database

Mortality Rates by Age Group and Gender, Unintentional Poisoning, Oklahoma, Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database Deaths Involving Prescription Drugs, Illicit Drugs, or Alcohol by Year of Death, Unintentional Poisoning, Oklahoma,

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports) Number of drug overdose deaths involving opioid pain relievers and other drugs, Oklahoma residents,

Substances Involved in Unintentional Poisoning Deaths, Oklahoma, Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database Five most common substances involved in unintentional poisoning deaths, Oklahoma,

Oklahoma Overdose Unintentional Overdose Death,

The Solution A multi-faceted approach to overdose prevention is required. A comprehensive array of efforts are underway in Oklahoma, including: PREVENTION & EDUCATION MONITORING & DIVERSION CONTROL INTERVENTION & TREATMENT

Opioid Prescribing Guidelines Prescriber/Dispenser Training SBIRT Requirements Disposal/Storage Methods Media Campaign Prescription Drug Monitoring Program Overdose Antidote (Naloxone) Program Solutions

Naloxone is a drug used to reverse the effects of opioids. Naloxone is safe and effective. Naloxone has no effect on non-opioid overdoses. In the United States 6, there are: Over 180 naloxone programs Over 50,000 people trained Over 10,000 overdose reversals (lives saved) Narcan ® (naloxone)

Opioids Natural opium morphine codeine Semi-synthetic heroin hydrocodone oxycodone Fully synthetic fentanyl methadone Demerol Opioids are used primarily in medicine for pain relief, treatment of opioid use disorders, and cough relief.

Narcan knocks the opioid off the opiate receptor Only blocks opioid receptors; no opioids = no effect Not harmful if no opioids in system Temporarily takes away the “high,” giving the person the chance to breathe Narcan works in 1 to 3 minutes and lasts 30 to 90 minutes Narcan can neither be abused nor cause overdose Only known contraindication is sensitivity, which is very rare Too much Narcan can cause withdrawal symptoms such as: nausea/vomiting diarrhea chills muscle discomfort disorientation combativeness Narcan ® (naloxone)

How do opioids affect breathing? Opioid Receptors, brain Opioid

How does Narcan affect overdose?

1.Increase capacity of first responders to administer naloxone. 2.Increase capacity of family members of opioid users to administer naloxone. 3.Increase capacity of people at risk for overdose, including patients with opioid analgesic prescriptions and people with substance use disorders, to obtain naloxone. 4.Increase access to naloxone products. 5.Decrease misperceptions of naloxone. Overdose Prevention Objectives

2013 First responders and family members can carry and administer naloxone with Good Samaritan protection House Bill 1782 Standing Orders Public Education Law Enforcement Program Oklahoma Medical Licensure Board approves rule to allow for standing orders for naloxone Naloxone training video and materials published for the public on TakeAsPrescribed.org Naloxone law enforcement pilot program launched in the County of Tulsa

Naloxone can be sold or dispensed by licensed pharmacists to the public House Bill 2666 EMS/EMRA Program Public Sales Emergency Medical Service and Emergency Medical Response Agency training and protocol adoption program launches for basic and intermediate-level personnel Walgreens and Economy Pharmacy launch 34 retail locations where naloxone may be purchased by the public Today

ABLE Commission Absentee Shawnee Tribal Police Bixby Police Department Broken Arrow Police Department Bureau of Narcotics Enid Fire Department Enid Police Department Garfield County Sheriff Glenpool Police Dept Jenks Police Department Moore Police Department Oklahoma Highway Patrol Owasso Police Department Rogers County Sheriff Sand Springs Police Department Skiatook Police Department Tulsa County Sheriff Tulsa Police Department Agency Agreements

1.Stimulate 2.Alert EMS 3.Administer naloxone 4.CPR – Rescue breathing/ventilations 5.Repeat 3 & 4, if necessary 6.Recovery position, if breathing Training Approach

Mucosal Atomization Device (MAD) Prefilled ampule of naloxone Luer-lock syringe

883 law enforcement officers trained 30% of those trained have been present at an overdose scene within the last 12 months 77% of those trained support law enforcement officials being authorized to administer naloxone (56% positive change from pre training) 89% of those trained are willing to administer naloxone (21% positive change from pre training) Pilot Training Results

No physically aggressive or combative reactions reported Positive response within 3 minutes every time on the first administration of naloxone 17 naloxone saves, nearly 2 per month Pilot Administration Results

References 1. Centers for Disease Control and Prevention. Wide-ranging OnLine Data for Epidemiologic Research (WONDER) [online]. (2012) Available from URL: Massachusetts Department of Public Health 2. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. (accessed July 2013). 3. Oklahoma State Department of Health, Injury Prevention Service. Unintentional Poisoning Fatality Surveillance System (abstracted from medical examiner reports). 4. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, Automation of Reports and Consolidated Orders System (ARCOS) Reports, Retail Drug Summary Reports by State, Cumulative Distribution Reports (Report 4). 5. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death, 2010 on CDC WONDER Online Database, released Centers for Disease Control and Prevention. Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010, Morbidity and Mortality Weekly Report. February 17, 2012 / 61(06); The Oklahoma Department of Mental Health and Substance Abuse Services wishes to acknowledge the DuPage County Department of Public Health and the Massachusetts Department of Public Health for permitting use of training content.