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The Opioid Epidemic and Naloxone CTSMA 57th Annual Conference

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Presentation on theme: "The Opioid Epidemic and Naloxone CTSMA 57th Annual Conference"— Presentation transcript:

1 The Opioid Epidemic and Naloxone CTSMA 57th Annual Conference
Ann Linskey, Pharm D, RPh March 25, 2017 ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

2 ©2017 Walgreen Co. All rights reserved
©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

3 Connecticut Overdose Deaths
States with statistically significant increases in drug overdose death rates from 2014 to 2015 included Connecticut, Florida, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Washington, and West Virginia Connecticut had a 25.6% increase in drug overdose deaths from 2014 to 2015 ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

4 The Epidemic The majority of overdose deaths (more than 6 out of 10) involve an opioid Since 1999, the number of overdose deaths involving opioids quadrupled 91 Americans die every day from an opioid overdose From more than 500,000 people died Overdoses from prescription opioids are a major factor in the 15 year increase ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

5 Opioid Receptors Mu(OP3) Kappa(OP2) Delta(OP1) Analgesia Sedation
Euphoria Respiratory depression Constipation Physical Dependence Kappa(OP2) Mild Analgesia Sedation Disorientation) Delta(OP1) Mild analgesia ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

6 Overdose Opioid receptors are found in the brain, including in the respiratory center in the medulla ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

7 Overdose Opioid Overdoses Cause
Reduced sensitivity to changes in O2 and CO2 outside of normal ranges Changes in tidal volume and respiratory frequency Opioid Overdoses Cause White JM, Irvine RJ. Mechanism of fatal opioid overdose. Addiction Jul;94(7): ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

8 An acute condition due to excess intake of opioids
Overdose An acute condition due to excess intake of opioids Overdose death usually occurs over 1 to 3 hours ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

9 Acute respiratory failure
Overdose Opioids death is caused by: Acute respiratory failure Hypoventilation Increased CO2 Decreased Oxygen ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

10 Naloxone An ANTIDOTE for OPIOID overdose
Naloxone is an opioid receptor antagonist at mu, kappa, and delta receptors Works at the opioid receptor to displace opioid agonists Shows little to no agonist activity Shows little to no pharmacological effect, even at high doses, in patients who have not received opioids ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

11 Naloxone is an antidote for opioids only:
Fentanyl Morphine Buprenorphine Hydrocodone Hydromorphone Codeine Oxymorphone Methadone Oxycodone Heroin ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

12 Pharmacology Reverses toxic & clinical effects of opioid overdose
Reverses respiratory depression, hypotension & sedation Restores breathing Reverses analgesia Patients can enter withdrawal after naloxone administration ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

13 Onset and Duration of Action
Naloxone takes effect in 3 to 5 minutes If patient is not responding in this time, a second dose may need to be administered Naloxone wears off in minutes Patients can go back into overdose if long acting opioids were taken. More naloxone may be necessary Patients should avoid taking more opioids after naloxone administration so they do not go back into overdose after naloxone wears off Patients may want to take more opioids because they may feel withdrawal symptoms ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

14 Side Effects The most common adverse event is opioid withdrawal symptoms IM & IN Naloxone do not result in withdrawal reaction More severe adverse events are considerably less common and even when severe, less dangerous than an untreated opioid overdose ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

15 Available Dosage Forms
Intranasal Form (IN) Brand Name Narcan spray Also as 2mg/2ml prefilled syringes -Compatible with mucosal automation device for nasal delivery Intramuscular (IM) Available as 0.4mg/ml solution for injection in 1ml and 10ml vials Auto-injector (Evzio) Intravenous (IV) Standard antidote used by EMS for diagnosing and treating opioid ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

16 Nasal Administration (Narcan Nasal Spray)
©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

17 Nasal administration (generic injection with atomizer)
Pros Acceptable to non-users No needle stick risk No disposal concerns Same onset as IM Cons Non FDA approved Assembly required Subject to breakage ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

18 ©2017 Walgreen Co. All rights reserved
©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

19 Why use Naloxone? Not scheduled or controlled Cannot be used
Effective, inexpensive and easy to administer Fewer barriers to access No euphoria from Naloxone No effects if opioids are not present Success in take home programs facilitated by community outreach ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

20 Access to Naloxone Certifications Law Prescribing
There is no special certification needed to prescribe Certifications CT law allows for anyone to be prescribed Naloxone Can be prescribed to a family member or a friend of an at risk person Law As of 10/1/15 pharmacist trained and certified by DCP or their approved employer can PRESCRIBE Naloxone Prescribing ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

21 Liability Who is responsible?
Generally associated with fewer risks than other commonly used injectable rescue medications such as epinephrine for anaphylactic shock and glucagon for hypoglycemia. Not aware of any case in which a provider of naloxone has been subjected to a malpractice case or professional discipline. An Act Providing Immunity to a person who administers an opioid antagonist to another person experiencing an opioid-related drug overdose”, also known as Public Act became effective on 10/1/14. Provides protection from civil liability and criminal prosecution to anyone administering naloxone ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

22 Does availability of Naloxone lead to increased drug use?
There is no data to support this claim Drug Users can only enter treatment if they are alive Data from a recently published study shows that for the period of , the adoption of Naloxone laws was associated with a 9 to 11 % reduction in opioid related deaths Rees, et al, The Effects of Naloxone Access and Good Samaritan Laws on Opioid-Related Deaths, National Bureaus of Economic Research, February 2017 ©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

23 Thank you for all that you do!
©2017 Walgreen Co. All rights reserved. Confidential and proprietary information.

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