1. SB 57 PROJECT DAWN LORAIN COUNTY PILOT NARCAN PRESENTATION

2. Lorain County overdose deaths nearly tripled in one year  2011: 22  2012: 60 Lorain Narcan Task Force convened in 2012 by Lorain County’s Coroner, Dr. Stephen Evans ADAS of Lorain County, University Hospitals LCGHD, ECHD, Law Enforcement, Lorain County Prosecutor's Office, representatives from substance abuse treatment, family support Project DAWN (Deaths Avoided With Naloxone) which originated in Scioto County – used as technical assistance Aligning with other similar programs- name changed to Project Dawn of Lorain County in 2012 HISTORY

3. Naloxone- drug used along with emergency medical treatment to reverse life-threatening effects of opiate (narcotic) overdose. “Narcan” is a brand name Nasal naloxone administered into the nose used for this pilot WHAT IS NALOXONE? NARCAN?

4. SENATE BILL 57 Led by Lorain’s Police Chief, Cel Rivera and Lorain County Coroner, Dr. Stephen Evans, Senator Gayle Manning introduced a bill proposing Lorain County become a pilot for first responders to carry and administer nasal naloxone (Senate Bill 57) – based off Quincy Mass plan.

5. Bill passed unanimously and was signed into law by Governor Kasich on July 11, 2013 to become effective October 11, 2013

6. SB 57 A bill to establish a pilot project in Lorain County from August 1, 2013 to July 31, 2014, pursuant to which qualified emergency responders in that County may obtain and administer naloxone to revive a person suffering from an apparent opioid related overdose.

7. PROJECT DAWN OF LORAIN COUNTY Monthly meetings to coordinate efforts of the pilot Training presentation and video developed for law enforcement fire fighters, and EMS Dr. Stephen Evans, Coroner, Lorain County Mike Gidich, Detective, Lorain Police Department Natalie Karn, RN, Lorain County General Health District Training to (582 personnel) consisted of information on Opioids Risks and Signs of Overdose Naloxone instruction and administration Data collection/reporting procedures

8. PROJECT DAWN OF LORAIN COUNTY – COMMUNITY COLLABORATION Local Hospital Systems University Hospitals Elyria Medical Center and Mercy Regional Medical Center provided the Naloxone medication for the pilot Police, Fire, and EMS Received training, administered Naloxone medication, collected data Local Public Health Lorain County General Health District and Elyria City Health District provided coordination, training, and promotion Alcohol and Drug Addiction Alcohol and Drug Addiction Services Board of Lorain County provided coordination and leadership, and served as the data hub

9. TIMING IS EVERYTHING..

10. PROJECT DAWN OF LORAIN COUNTY RESULTS

16. Overdose rate continued to rise to 67 deaths, rate of increase slowed 2011: 22 2012: 60 2013: 67 69 total administrations of nasal naloxone 63 total known reversals 48 Police reversals 15 Fire reversals

18. PROJECT DAWN OF LORAIN COUNTY: SHARING PILOT ACROSS OHIO AND THE U.S. Press conference held on October 4

19. PROJECT DAWN OF LORAIN COUNTY: IN THE NEWS

20. PROJECT DAWN AROUND THE NATION Detective Michael Gidich (Lorain PD) has shared the training resources around Ohio to law enforcement and 20 resource kits have also been shared outside Ohio around the Nation LPD has drafted and shared policies The Pilot project’s report has been shared with the Substance Abuse and Mental Health Services Administration and the Office of National Drug Control Policy (Whitehouse)

21. EXCERPT FROM LORAIN’S POLICE CHIEF:

23. SUMMARY Project DAWN of Lorain County convened to address the opioid epidemic and prevent overdose deaths Senate Bill 57 proposed pilot program in Lorain County for first responders to use nasal naloxone to reverse life threatening effects of opioid overdoses Training and medication provided to local police departments, fire departments, and EMS squads through cross-sector community collaboration in Lorain County 69 total administrations of nasal naloxone during the pilot year (Oct 2013-Oct 2014) 63 lives saved

24. Amherst Police Department Avon Police Department Avon Lake Police Department Carlisle Fire Department Elyria Fire Department Elyria Police Department Elyria Township Fire Department Grafton Village EMS Department PARTICIPATING FIRST RESPONDERS

25. LaGrange EMS Department Lorain Police Department Lorain County Metroparks Lorain County Sheriff’s Department North Ridgeville Police Department Oberlin Police Department Sheffield Lake Fire Department Sheffield Lake Police Department PARTICIPATING FIRST RESPONDERS

26. Sheffield Township Fire Department Sheffield Village Police Department Vermilion Police Department Wellington Police Department PARTICIPATING FIRST RESPONDERS

27. Alcohol and Drug Addiction Services Board of Lorain County Communities That Care of Lorain County Elyria Health Department Greater Victory Christian Ministries Lorain County Alcohol and Drug Abuse Services PROJECT DAWN PARTNERS

28. Lorain County General Health District Lorain County Coroner’s Office Lorain County Drug Task Force Lorain County Prosecutor’s Office Mercy Regional Medical Center Nord Center PROJECT DAWN PARTNERS

29. SOLACE of Lorain County University Hospitals/Elyria Medical Center Senator Gayle Manning Ohio Department of Health Ohio Mental Health and Addiction Services PROJECT DAWN PARTNERS

30. Clinics/kits for Substance Abuse Treatment Clients (LCADA & Nord Center) - continues Clinic at Greater Victory Christian Ministries Monthly Walk-in Clinics at Elyria Health Department (in partnership with the Lorain County General Health District) - continues OTHER PROJECT DAWN INITIATIVES STARTED DURING PILOT

31. SUPPORT Thank you to SOLACE of Lorain County and Lorain County’s Recovery Coaches for participating at the clinics. First responders have “how to access substance abuse services” brochures in their possession

32. Faith and the fight to save lives: Church addresses heroin epidemic http://fox8.com/2014/11/09/faith-and- the-fight-to-save-lives-church- addresses-heroin-epidemic/ 50+ kits were distributed http://fox8.com/2014/11/09/faith-and- the-fight-to-save-lives-church- addresses-heroin- epidemic/#ooid=pmdDltcTqR2Dkf FwqoWNkuF0314NXwyW LORAIN, OH -- A Lorain County church is mixing faith and fellowship with a fight to save the lives of those battling heroin addictions. Sunday service at the Greater Victory Christian Ministries Church in Lorain was filled with prayer and song. The message this day was to break the chain of despair that comes with heroin addiction.Greater Victory Christian Ministries Church "This is about saving lives. It is not about judging folks," Pastor Tim Williams said. Church members listened to the word and to a training video on Narcan, a nasal spray that can help reverse the effects of a heroin overdose. GREATER VICTORY SUNDAY SERVICE/CLINIC

34. PROJECT DAWN OF LORAIN COUNTY- WHAT’S NEXT? Project DAWN of Lorain County will continue to address the opioid epidemic and overdose deaths and work with first responders. Data collection continues ADAS Website – fillable form E-OPOTA (Ohio Police Officer Training Academy) PROJECT DAWN meetings are held quarterly

35. H.B. 170 130TH GENERAL ASSEMBLY EMERGENCY BILL ACT SUMMARY Naloxone access Permits a physician or other health care professional who is authorized to prescribe drugs to personally furnish or issue a prescription for naloxone to a friend, family member, or other individual in a position to provide assistance to an individual at risk of experiencing an opioid-related overdose. Grants a health care professional who in good faith furnishes or issues a prescription for naloxone immunity from criminal or civil liability or professional disciplinary action for the actions or omissions of the individual to whom the drug is furnished or prescription is issued. Requires the health care professional to instruct the individual to whom the drug is furnished or prescription issued to summon emergency services immediately before or immediately after administering naloxone. Grants immunity from criminal liability to a family member, friend, or other individual (except for certain licensed emergency responders) who administers naloxone obtained pursuant to the act, if the individual summons emergency services. Grants immunity from administrative action and criminal prosecution to a peace officer acting in good faith who administers naloxone if it is obtained from the law enforcement agency that employs the officer and the agency is licensed as a terminal distributor of dangerous drugs. Requires wholesale and terminal distributors of dangerous drugs to prioritize the sale, distribution, and delivery of naloxone to hospitals, children's hospitals, emergency medical service organizations, and urgent care centers.

37. HB 367 Requires the Governor’s Cabinet Opiate Action Team to make recommendations for instruction in prescription opioid abuse prevention and submit those recommendations to the Department of Education by July 1, 2015. the Department would then be required to publish the recommendations online. Requires the health curriculum of each school district to include instruction on the dangers of prescription opioid abuse. Language form the Bill: (5) Health education, which shall include instruction in: (f) prescription opioid abuse prevention, with an emphasis on the prescription drug epidemic and the connection between prescription opioid abuse and addiction to other drugs, such as heroin.

38. SUBSTITUTE HOUSE BILL 4 Substitute House Bill 4 allows physicians to issue protocols for pharmacists and family members to administer the life-saving treatment. The legislation also authorizes local departments of health to sell naloxone at wholesale prices to local law enforcement agencies and provides protections for individuals that distribute the medication in accordance with established physician protocols. “This legislation is about providing hope for loved ones who desperately want to see their family member get help,” said Senator Gayle Manning. “This bill is about fewer final ‘I love you’s’ and ‘goodbyes’ that haunt the memory of too many children of those struggling with addiction.”

39. GOVERNOR’S CABINET OPIATE ACTION TEAM

40. Am J Emerg Med.Am J Emerg Med. 2015 Sep;33(9):1201-4. doi: 10.1016/j.ajem.2015.05.022. Epub 2015 May 29. Intranasal naloxone administration by police first responders is associated with decreased opioid overdose deaths. Rando J Rando J 1, Broering D 2, Olson JE 3, Marco C 4, Evans SB 5.Broering DOlson JEMarco CEvans SB Author information Abstract OBJECTIVE: This study sought to answer the question, "Can police officers administer intranasal naloxone to drug overdose victims to decrease the opioid overdose death rate?" METHODS: This prospective interventional study was conducted in Lorain County, OH, from January 2011 to October 2014. Starting October 2013, trained police officers administered naloxone to suspected opioid overdose victims through a police officer naloxone prescription program (NPP). Those found by the county coroner to be positive for opioids at the time of death and those who received naloxone from police officers were included in this study. The rate of change in the total number of opioid-related deaths in Lorain County per quarter year, before and after initiation of the NPP, and the trend in the survival rate of overdose victims who were given naloxone were analyzed by linear regression. Significance was established a priori at P <.05. RESULTS: Data from 247 individuals were eligible for study inclusion. Opioid overdose deaths increased significantly before initiation of the police officer NPP with average deaths per quarter of 5.5 for 2011, 15.3 for 2012, and 16.3 for the first 9 months of 2013. After initiation of the police officer NPP, the number of opioid overdose deaths decreased each quarter with an overall average of 13.4. Of the 67 participants who received naloxone by police officers, 52 (77.6%) survived, and 8 (11.9%) were lost to follow-up. CONCLUSIONS: Intranasal naloxone administration by police first responders is associated with decreased deaths in opioid overdose victims. Copyright © 2015 Elsevier Inc. All rights reserved. PMID: 26095132 [PubMed - in process]

41. Ohio State Board of Pharmacy Naloxone Resources Pharmacist Dispensing of Naloxone Section 4729.44 of the Ohio Revised Code and rule 4729-5-39 of the Ohio Administrative Code authorizes a pharmacist or pharmacy intern under the direct supervision of a pharmacist to dispense naloxone without a prescription in accordance with a physician-approved protocol. The State of Ohio Board of Pharmacy has developed the following resources to assist with the implementation of this law. Patient Counseling Brochure - Spanish Patient Counseling Brochure Naloxone Notification Form Sample Naloxone Dispensing Protocol for Pharmacies Ohio Administrative Code Rule 4729-5-39 – Dispensing of Naloxone Guidance Document - Dispensing of Naloxone without a Prescription Ohio Pharmacies Dispensing Naloxone Pursuant to a Protocol. Prescriber Resources Joint Regulatory Statement 2014 - Prescription of Naloxone to High-Risk Guidance Document - Personally Furnishing Naloxone Pursuant to a Protocol Law Enforcement Resources Law Enforcement Naloxone Guidance Document “Guidance Document “ Law Enforcement Agencies Seeking to Obtain Naloxone Hydrochloride (Narcan)”Law Enforcement Naloxone Guidance Document http://pharmacy.ohio.gov/Documents/Pubs/Naloxone/LawEnforcement/Law%20Enforcement%20Naloxone%20Guidance%20Document.pdf Additional Resources (GCOAT) Opiate Action Team Naloxone CEU for Pharmacists Ohio Department of Health - Project DAWN (Deaths Avoided with Naloxone)

42. http://pharmacy.ohio.gov/Documents/Pubs/Naloxone/Prescriber/Joint%20Regulatory%20Statement %202014%20-%20Prescription%20of%20Naloxone%20to%20High-Risk.pdf

43. Ohio Attorney General DeWine Announces Agreement with Naloxone Manufacturer 3/4/2015 (COLUMBUS, Ohio) -- Ohio Attorney General Mike DeWine announced today that Ohio has reached an agreement with naloxone manufacturer Amphastar Pharmaceuticals, Inc. regarding rebates for public entities that purchase Amphastar naloxone within the next year. As part of the agreement, Amphastar has agreed to provide a $6 rebate for each Amphastar naloxone syringe purchased by non-federal public entities in Ohio between March 2, 2015, and March 1, 2016. "It is my goal each and every day to protect Ohioans, and this agreement will not only save money, but it will also save lives," said Ohio Attorney General DeWine. "Because we were able to secure these rebates, law enforcement and other agencies can use the money they save to buy more doses of naloxone. The more doses that are available, the more lives that can be saved." The agreement is in response to a letter sent by Attorney General DeWine to Amphastar last month after the company dramatically increased its price for the life-saving drug. When given to a person overdosing on heroin or a prescription opioid, naloxone can limit or stop the overdose by reversing the effects of the opioid on the brain. Public entities that qualify for the rebates include, but are not limited to, law enforcement agencies, the Ohio Department of Mental Health and Addiction Services, Project DAWN (Deaths Avoided with Naloxone) community programs, and county and local governments. a letter sent by Attorney General DeWine to Amphastar last month

44. LORAIN COUNTY OVERDOSE DEATH RATES 22 in 2011 60 in 2012 67 in 2013 65 in 2014 At least 60 in 2015

46. POST PILOT DATA FOR FIRST RESPONDERS

47. HERE’S WHY..

48. WHAT’S NEXT FOR PROJECT DAWN The Lorain County Health Improvement Plan (CHIP) includes the goal to, “Reduce overdose deaths from opiates/heroin by 25% within 3 years (approximately 17 fewer deaths) by December 31, 2017.” This will be coordinated through the Alcohol and Drug Addiction Services Board of Lorain County Strategies: Reducing the availability of opiates, including heroin Providing support to addicts and family members – including treatment and relapse prevention Prevention and Education to: Addicts, family members, recovery community, schools/students, pharmacies, medical personnel, faith based and general community Advocacy, Legislation, Regulation

49. QUESTIONS? Elaine Georgas, Executive Director, Alcohol and Drug Addiction Services Board of Lorain County www.lorainadas.org Georgas@loraindas.org 440.282.9920