1. Police and Naloxone “The Indianapolis Experience” Daniel O’Donnell, M.D. Medical Director IEMS/IFD Assistant Clinical Professor IUSOM Dept. of Emergency Medicine

2. Let me start by telling you a secret “Now I will tell you how we got here”

3. What are we going to cover Describe the Indianapolis experienceDescribe the Indianapolis experience How we startedHow we started What were the key steps along the wayWhat were the key steps along the way Present the science/evidence that has come out of this experiencePresent the science/evidence that has come out of this experience TrainingTraining Patient outcomesPatient outcomes Give you necessary evidence to support your own programsGive you necessary evidence to support your own programs Goal: Give you the information you need to development your own successful programGoal: Give you the information you need to development your own successful program

4. What is naloxone?

5. How did this all begin? IMPD Southwest District Spring 2013IMPD Southwest District Spring 2013 A “Motley Crew”A “Motley Crew” Police (all divisions)Police (all divisions) EMSEMS Mental health/addiction centersMental health/addiction centers SchoolsSchools Criminal JusticeCriminal Justice One Mission: How can we combat the rising crime that is associated with the opiate epidemicOne Mission: How can we combat the rising crime that is associated with the opiate epidemic CRIME

6. We knew this was a problem

7. Things took a turn All parties realized that we “ cannot arrest our way out of this problem ”All parties realized that we “ cannot arrest our way out of this problem ” Had to take a fundamental approachHad to take a fundamental approach Education in the schoolsEducation in the schools Programs that go beyond current drug education/awarenessPrograms that go beyond current drug education/awareness Not your average “Don’t do drugs talk”Not your average “Don’t do drugs talk” Look at ways to decrease the number of fatalitiesLook at ways to decrease the number of fatalities Police naloxone?Police naloxone?

8. Brief history of police and naloxone Not necessarily a brand new conceptNot necessarily a brand new concept A growing number of police agencies had been successfully delivering intranasal naloxoneA growing number of police agencies had been successfully delivering intranasal naloxone Quincy, MAQuincy, MA Nassau County, NYNassau County, NY Boston, MABoston, MA All had reported a fair amount of successAll had reported a fair amount of success

9. Why we thought it was important Individual OD Bystanders recognize something is wrong Activate 911 Public Safety Response

10. The proposal was born We had the support within the districtWe had the support within the district Had to go to the City County BuildingHad to go to the City County Building Emphasize the growing epidemicEmphasize the growing epidemic Stress the safety of officer delivered naloxoneStress the safety of officer delivered naloxone Highlight the new laws regarding naloxoneHighlight the new laws regarding naloxone HB 227HB 227 Devise a way to make it economically “feasible”Devise a way to make it economically “feasible” After 20 minutes  All in for our pilot projectAfter 20 minutes  All in for our pilot project

11. The procedure All district officers trained:All district officers trained: Recognition of opioid ODRecognition of opioid OD Administration of Naloxone intranasallyAdministration of Naloxone intranasally If deemed an opioid overdose  2mg Intranasal naloxoneIf deemed an opioid overdose  2mg Intranasal naloxone Brief report completedBrief report completed 100% patients transported100% patients transported If refusal  Immediate DetentionIf refusal  Immediate Detention Concern for self harmConcern for self harm

12. The SW District pilot project Goal: Train 150 officers how to deliver a medication they may have only heard ofGoal: Train 150 officers how to deliver a medication they may have only heard of Many were not “excited” about this opportunityMany were not “excited” about this opportunity Potential perceived barriersPotential perceived barriers Viewed as “enabling”Viewed as “enabling” Goes beyond the scope of what a police officer was trained to doGoes beyond the scope of what a police officer was trained to do Will they even be receptive to the trainingWill they even be receptive to the training

13. The training Had to be quickHad to be quick Stress the importance of the problemStress the importance of the problem Answer the question “Why police”Answer the question “Why police” Chain of survivalChain of survival Time is lost in an overdoseTime is lost in an overdose Dispel potential mythsDispel potential myths Combativeness (< 3% documented)Combativeness (< 3% documented) Legal questionsLegal questions

14. attitudes What would they think about the training program?What would they think about the training program? Would they reject?Would they reject? Would it be effective?Would it be effective? Is it even seen as a problem?Is it even seen as a problem?

15. The study Performed a prospective investigation of officer attitudes towards naloxone trainingPerformed a prospective investigation of officer attitudes towards naloxone training 117 subjects117 subjects Asked to complete a standardized evaluationAsked to complete a standardized evaluation Experience with opiate overdosesExperience with opiate overdoses Perceived difficulty of naloxone trainingPerceived difficulty of naloxone training Perceived importance of naloxone trainingPerceived importance of naloxone training

16. What did we find

17. What else They were seeing it as well They were seeing it as well 93.2% on an overdose in 1 year 93.2% on an overdose in 1 year 49.6% last month 49.6% last month Training was not difficult Training was not difficult Officers should be trained Officers should be trained Experience mattered Experience mattered More overdose cases = higher competency More overdose cases = higher competency

18. conclusions Overwhelmingly positive attitudes towards naloxone training Overwhelmingly positive attitudes towards naloxone training Consistent with literature showing that police are receptive to harm reduction interventions Consistent with literature showing that police are receptive to harm reduction interventions Prior experience with opioid overdoses increased confidence Prior experience with opioid overdoses increased confidence

19. The beginning Training was complete in 10 daysTraining was complete in 10 days Officers began using immediatelyOfficers began using immediately Fire department asking about police naloxoneFire department asking about police naloxone “Racing to the scene”“Racing to the scene” 100% feedback to the officers100% feedback to the officers Time to go department wideTime to go department wide

20. continuation Began training each district within IMPDBegan training each district within IMPD Same modelSame model TrainingTraining 100% medical director review100% medical director review 100% feedback to officers100% feedback to officers Data collectionData collection

21. Data collected Basic demographicsBasic demographics Indications for administrationIndications for administration Breathing statusBreathing status Level of consciousnessLevel of consciousness Difficulty with administrationDifficulty with administration Response to administrationResponse to administration Need for Immediate DetentionNeed for Immediate Detention

23. The evidence Reviewed all police naloxone administrations from April 2014-August 2015Reviewed all police naloxone administrations from April 2014-August 2015 Reviewed all required officer administration formsReviewed all required officer administration forms Examined EMS runs and hospital outcomesExamined EMS runs and hospital outcomes N = 121 officer administrationsN = 121 officer administrations

24. Administration by time of year

25. demographics

26. Indicators and response

27. EMS and hospital outcomes Continuing to gather dataContinuing to gather data Roughly 30% receive additional naloxone by EMSRoughly 30% receive additional naloxone by EMS Almost 95% survive to the EDAlmost 95% survive to the ED 90% ultimately discharged from the ED90% ultimately discharged from the ED

28. What does this mean? Police are appropriately recognizing opiate overdoses on the streetPolice are appropriately recognizing opiate overdoses on the street Once recognized, police are safely and effectively administering naloxoneOnce recognized, police are safely and effectively administering naloxone Incidence of combativeness or need for scene escalation are rareIncidence of combativeness or need for scene escalation are rare Patients who receive naloxone from police have similar outcomes when compared to those who receive from EMSPatients who receive naloxone from police have similar outcomes when compared to those who receive from EMS

29. Where do we go from here? More data is needed to analyze impact on patient careMore data is needed to analyze impact on patient care Improved outcomes when compared to EMS?Improved outcomes when compared to EMS? Examine impact on overall mortalityExamine impact on overall mortality

30. Where we need this now Rural communitiesRural communities EMS resources are spread outEMS resources are spread out Includes ALS and BLSIncludes ALS and BLS Volunteer servicesVolunteer services Often times police are first on scene for an extended period of timeOften times police are first on scene for an extended period of time As overdose time increases  increase potential for deathAs overdose time increases  increase potential for death This issue is not just an urban problemThis issue is not just an urban problem

31. What do you do now? Multidisciplinary approach to combatting overdose deaths seams to be workingMultidisciplinary approach to combatting overdose deaths seams to be working Now that lives are being saved  Time to look into treatmentNow that lives are being saved  Time to look into treatment “Outside the box” treatment?“Outside the box” treatment? Home naloxone prescriptionsHome naloxone prescriptions Naloxone Rx from Emergency Dept.Naloxone Rx from Emergency Dept. Alternative treatment opportunitiesAlternative treatment opportunities

32. conclusions This is one stepThis is one step Would not have been possible if not for support from a MULTIDISCIPLNARY teamWould not have been possible if not for support from a MULTIDISCIPLNARY team Officers are receptive to naloxone trainingOfficers are receptive to naloxone training Officers can be trained to correctly identify opiate overdoses and actOfficers can be trained to correctly identify opiate overdoses and act Officer naloxone administration appears safe and effectiveOfficer naloxone administration appears safe and effective

33. Thank you! Questions?