1. An overdose Reduction PlaN
Prevention Point Philadelphia

2. Our Mission PPP is a non-profit, public health
organization committed to protecting the
health and welfare of drug users and sex
workers. PPP works to reduce the harm
associated with substance use and sex
Industry work by offering a safe and humane
alternative to the war on drugs.
Our Mission

3. Penn's National Clinician Scholars Program 2016-2018 Cohort
[ ] add back in background and agenda slides

4. Background: Opiate Epidemic in Philadelphia
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5. Background: Naloxone
Naloxone (aka narcan): prescription medication that blocks effects of opioids and can reverse overdose
Available intranasal or injectable form
Free w/ Medicaid but can cost in the $1,000s out of pocket
Shelf-life is months
Goal: distribute naloxone to users, caregivers, family members, first responders to reverse overdose in the community
Intranasal and injectable forms

6. Provider training in naloxone prescribing is effective.
Four Key Lessons
Public and community-based organizations should be integrated into opiate reduction efforts.
People who use drugs (PWUD) want to use naloxone, but face barriers to access.
Pharmacies don’t know about the standing order and if they do, they misunderstand.
Provider training in naloxone prescribing is effective.
Pharmacies don’t know about the standing order and if they do, they misunderstand.
People who use drugs (PWUD) want to use naloxone, but face barriers to access. 1 2
Public and community-based organizations should be integrated into opiate reduction efforts.
Provider training in naloxone prescribing is effective. 3 4

7. Lesson #1
Pharmacies don’t know about the standing order and if they do, they misunderstand.

8. Pennsylvania Standing Order
October 2015, PA Surgeon General Rachel Levine signed PA standing order
“Non-patient specific” prescribing
Third-party prescribing
Standing order is voluntary & pharmacists are not required to have naloxone in stock

9. Pharmacy Awareness of Standing Order by Zip Code
Lesson #1: Pharmacists
Pharmacy Awareness of Standing Order by Zip Code
Total answering question = 85 pharmacies
6 did not know
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35 Yes (41%)
44 had not heard (51%)

10. Is a prescription needed to dispense Naloxone?
Lesson #1: Pharmacists
Is a prescription needed to dispense Naloxone?
n = 61
Don’t Know
26%
Yes
53% No
21%

11. 1 of 8 Lesson #1: Pharmacists
Pharmacies had naloxone in stock AND will dispense without a prescription.
[ ] explain why in the highest OD area, there are so few pharmacies that are aware of the standing order

12. Lesson #1: Pharmacists
Pharmacies don’t know about the standing order and if they do, they misunderstand.
Deliver a naloxone toolkit to pharmacies in targeted zip codes before expanding city-wide
Implement widespread pharmacy teaching by partnering with pharmacy professional associations, city/state health commissions, and pharmacist champions, with options for continuing education credits
Create a serial data collection protocol to monitor uptake of standing order amongst pharmacies in high-risk areas
[ ] add in pharmacy association
[ ] PA physician general
[ ] Philadelphia Health Commissioner
[ ] Pharmacy Association
[ ] pharmacy-based credits

13. Lesson #2
People who use drugs (PWUD) want to use naloxone, but face barriers to access.
There’s low but increasing awareness of overdose risk, cost and pharmacy access
Pwud need: 1) naloxone 2) safe site etc

14. Lesson #2: People Who Use Drugs
People who use drugs want to use naloxone, but face barriers to access
Educate users that Medicaid recipients can obtain Naloxone from pharmacies for free
Develop strategies for Medicaid recipients to store/replicate insurance cards and IDs in order to receive free Narcan from pharmacies
Increase insurance enrollment among people who use drugs
Support existing drop-in harm reduction services to ensure secure, safe environments for drug users
[ ] add in pharmacy association
[ ] PA physician general
[ ] Philadelphia Health Commissioner
[ ] Pharmacy Association
[ ] pharmacy-based credits

15. Lesson #3
Public and community-based organizations (CBOs) should be integrated into opiate reduction efforts.

16. Lesson #3: Public & CBOs
General public has little knowledge of overdose deaths
Mass media campaigns and neighborhood-based solutions are needed
Model CBO Opioid Overdose Prevention Programs
Baltimore Crisis Response - Mobile Crisis Team
New York State Opioid Overdose Prevention Program Registry

17. Lesson #3: Public & CBOs
Public and community-based organizations should be integrated into opiate reduction efforts.
Secure immediate and long-term, sustainable funding to purchase naloxone
Apply lessons from mass media public health campaigns (i.e. HIV), targeting not just users, but also pain patients, caregivers, families, and the general public
Identify CBOs that are willing to distribute naloxone and coordinate with existing opiate reduction organizations
[ ] add in pharmacy association
[ ] PA physician general
[ ] Philadelphia Health Commissioner
[ ] Pharmacy Association
[ ] pharmacy-based credits

18. Provider training in naloxone prescribing is effective.
Lesson #4
Provider training in naloxone prescribing is effective.

19. Lesson #4: Providers
Coffin et. al, Ann Intern Med, 2016 Aug 16;165(4):245-52

20. Lesson #4: Providers
“If you have someone on chronic opioids, it is useful to co-prescribe naloxone.”
--Stakeholder

21. Provider training in naloxone prescribing is effective.
Lesson #4: Providers
Provider training in naloxone prescribing is effective.
Develop mandatory, multi-modal training models on co-prescribing and PDMP to all providers, including nurses, physicians, and trainees
Implement mandatory training on opiate reversal and increase access to naloxone for first responders
Collect and monitor prescribing patterns by advocating for EHR and PDMP interoperability
[ ] add in pharmacy association
[ ] PA physician general
[ ] Philadelphia Health Commissioner
[ ] Pharmacy Association
[ ] pharmacy-based credits

22. This is a multifaceted issue - framing is important!
Tying It All Together
This is a multifaceted issue - framing is important!

23. Provider training in naloxone prescribing is effective.
Tying It All Together
Pharmacies don’t know about the standing order and if they do, they misunderstand.
People who use drugs (PWUD) want to use naloxone, but face barriers to access. 1
PEOPLE WHO USE DRUGS 2
PHARMACIES
Public and community-based organizations should be integrated into opiate reduction efforts.
Provider training in naloxone prescribing is effective. 3 4
PUBLIC
PROVIDER

24. 4-P Strategy for Opioid Overdose Reduction
PEOPLE WHO USE DRUGS
PHARMACIES
PUBLIC
PROVIDER

25. Questions Jose A. Benitez Executive Director
Prevention Point Philadelphia
Questions