Presentation on theme: "From Underground to State-Funded: The History of Overdose Prevention/Naloxone Distribution in Massachusetts First state funded programs began toward the."— Presentation transcript:
1From Underground to State-Funded: The History of Overdose Prevention/Naloxone Distribution in MassachusettsFirst state funded programs began toward the end of 2007 in Boston, Cambridge, New Bedford/Fall River, Quincy, Lynn/Gloucester, Brockton, Provincetown/Hyannis, and Springfield/Northampton. In 2010 the State expanded into four additional communities; Lowell, Lawrence, Holyoke, and Worcester. The selected communities reflect cities with the highest rate of fatal and non-fatal overdose.Adam Butler, Jon Zibell,Kathy Day, Monique Tula and Gary Langis
2PurposeTo describe in timeline format the history of Overdose Prevention in MassachusettsTo describe how OD Prevention went from an underground effort to a comprehensive, state- sanctioned & funded program that includes naloxone distributionTo describe the various initiatives that have been developed and integrated into other services over time.To share successes, challenges, key opportunities and identify ways for different types of organizations (underground, CBO, state) to all play a part in developing a successful program and initiatives .
3National and Regional Drug Threat United StatesNew England38.8%37.6%36.5%33.2%15.5%11%8.5%9.3%3.9%1.9%Strategic Findings• The availability of Mexican heroin isincreasing, albeit slightly, in eastern heroinmarkets traditionally supplied by SouthAmerican heroin.• Mexican DTOs increasingly are transportingand distributing South American heroinin eastern U.S. drug markets, on behalf ofColombian DTOs.• Continued declines in heroin production inSouth America could result in increasedavailability of Mexican and Asian heroin ineastern U.S. heroin markets.HeroinCocaineMethamphetamineMarijuanaPharmaceuticalsHeroinCocaineMethamphetamineMarijuanaPharmaceuticalsSource: National Drug Threat Assessment, 2007
4Opioid-related Health Problems 2007, rates per 100,000 by Town Identifying areas of high opiate use and potential of overdose. The darker blues are also where the state has sited Naloxone programsRates suppressed for towns with less than 5 casesSource: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
5Opioid-Related Poisoning Deaths 1990-2008 Explaining the rise in incidents of fatal overdose over the past decade and contributing factors i.e. availability of prescription drugs.Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
6Active players: Underground Community-Based Organization 2000Active players:UndergroundCommunity-Based OrganizationDiscussing how the underground distribution of Naloxone began in MA and how community based organizations would get the word out to their participants that it was happening.
7Community-Based Organization 2001Active players:UndergroundCommunity-Based OrganizationCambridge Cares receives funding for overdose prevention, underground distribution continues on the North Shore, Springfield, Boston, and Cambridge.
8Community-Based Organization 2002Active players:UndergroundCommunity-Based OrganizationCCAA begins to work more formerly with underground distributors providing space where their participants could be trained by NEPA staff and a peer educator, underground continues in other areas.
9Community-Based Organization 2003Active players:UndergroundCommunity-Based OrganizationCCAA and other programs attempt to have Naloxone distribution introduced as legislation with little luck of finding a legislative sponsor
10Community-Based Organization 2004Active players:UndergroundCommunity-Based OrganizationCCAA asks for Board of Director support for Naloxone distribution. Distribution remains underground. NEPA (underground) is collecting limited data, demographics, and information on reversals. First overdose vigil held in Cambridge.
112005 Active players: Underground Community City Naloxone distribution is discontinued at CCAA after meeting between Board members and NEPA personnel due to legalities and liability concerns but Board members recognize and support further discussion with BPHC officials. CAB holds its first overdose vigil, 200 persons attend, CAB creates NOMAD (NOT One More Anonymous Death) website. Fatal overdose occurs on Boston Common, numerous media negative attention is placed on Boston and Cambridge programs, AHOPE is shutdown for several days because of safety concerns. PACT program begins to distribute Naloxone under medical directors license. Boston Mayor calls for meeting of BPHC/AHOPE, CAB, and PACT to explore strategies. Distribution remains underground. Advocates begin working on legislation similar to the New Mexico legislation that led to narcan distribution but could not identify a legislator with the courage or will to take on the cause.
132005 – Boston Herald front page photo No Response = DeathBoston Herald Photographer captures this photo of man in process of dying from fatal heroin overdose. Would this of got the same response if it was someone having a heart attack?2005 – Boston Herald front page photo
152006 Active players: Underground Community City BPHC holds Public hearings on Naloxone distribution. BPHC and CAB staff visit SKOOP sites in New York, BPHC administrators visit sites in Baltimore, New York, and Chicago. BPHC implements Naloxone distribution. BPHC launches OD 800 line. Pharmacy Access bill passes and implemented in MA. Underground continues in North of Boston communities.
162007 Active players: Underground Community City State Former BPHC commissioner John Auerback is appointed as MDPH Commissioner. BPHC releases its six month report on Naloxone distribution program, project becomes part of regular programming in the BPHC. Naloxone protocol and distribution begins in Cambridge modeled after the BPHC program. State announces Naloxone pilot project, 5 sites are announced and program staff are trained. Underground is very limited at this time due to underground volunteers disbanding and pilot projects be up and running.
17Massachusetts Department of Public Health funded Naloxone Programs GloucesterLynnBostonCambridgeProvincetownQuincyBrocktonSpringfieldNorthamptonFall RiverFirst state funded programs began toward the end of 2007 in Boston, Cambridge, New Bedford/Fall River, Quincy, Lynn/Gloucester, Brockton, Provincetown/Hyannis, and Springfield/Northampton.HyannisNew Bedford2007
18Media in 2007Programs expanded to 7 programs covering 12 sites
192008 Active players: Underground Community City State Underground is not really happening at this time. All pilot sites training and distributing Naloxone. CAB implements Naloxone training at both Danvers and Boston detoxes. ODP and Naloxone become part of all BPHC methadone treatment facilities. 15 communities receive MassCall2 funding from MDPH through a SAMHSA SPF-SIG to address fatal and non-fatal opioid overdose.
20Media in 2008There were 637 overdose deaths reported in both 2006 and 2007
21MassCall215 Municipalities received funding through MDPH to build capacity to address fatal overdoseCommunities were chosen due to high OD ratesAll identified barrier of calling 911 as variableMost communities work closely with state funded naloxone programsEngaged law-enforcement, treatment providers, harm reduction personnel, and community membersOnly Massachusetts identified fatal overdose as a priority in their SAMHSA SPF-SIG as most states identified underage drinking. Communities used SPF Assessment (3 months), Capacity Building, Planning, Implementation, and Evaluation.
22Good Samaritan Legislation Two GS bills were introduced in MA in 2008Several groups advocated and lobbied legislatorsBoth bills failed during this legislative sessionBut we came close, some last minute behind the door dealings help to defeat bills
232009 Active players: Underground Community City State Revere Fire Dept and Quincy Police personnel are trained to carry and administer Naloxone as part of the State Pilot Program.
24More Work to DoState report says deaths from opioid-related overdoses declined in 2008By Vicki-Ann DowningEnterprise Staff WriterPosted Dec 19, 06:00 AMBROCKTON —“The overdose rate for the South Shore in 2009 was high and it was steady throughout the year,” said Dubois. “As a whole, 2010 was lower in the amount of fatal overdoses compared to 2009, but still too high.”That the governor’s report contained any information at all about deaths from drug overdoses – in addiction to cancer, heart disease, Alzheimer’s disease and diabetes – shows it “is still something that the Commonwealth deems to be a critical issue,” said Dubois.The report, based on statistics from the state Department of Public Health, showed 594 deaths from opioid-related overdoses in 2008, compared to 637 in both 2006 and 2007.The number of overdose deaths began to climb beginning in 1996, when there were 178, according to the state…State overdose deaths put at 594, first drop in 4 years
252010 Active players: Underground Community City State Underground is limited to one community as four new state programs begin
26Massachusetts Department of Public Health funded Naloxone Programs LawrenceLowellGloucesterLynnBostonProvincetownCambridgeQuincyHolyokeWorcesterBrocktonSpringfieldNorthamptonFall RiverIn 2010 the State expanded into four additional communities; Lowell, Lawrence, Holyoke, and Worcester. The selected communities reflect cities with the highest rate of fatal and non-fatal overdose.HyannisNew Bedford2010
27Good Samaritan Legislation Good Samaritan Coalition formedThree GS bills introduced, another with a provision to address GSGarner community supportParent support groupsTreatment and Recovery Community supportCommunity forums conductedStudents for Sensible Drug PolicyMomentum grows for another Good Samaritan push and growing support from many quarters
282011 Active players: Community City State Learn To Cope members are trained as MDPH approved Naloxone trainers. Gloucester Police and Fire Dept personnel are trained to administer Naloxone as part of the State Pilot Program.
29Screening Brief Intervention, Referral to Treatment (SBIRT) Eight Hospitals funded by MDPH for SBIRTHarm reduction strategies have been incorporatedMotivational Interviewing (MI)HPA’s provided with training to train and enroll participants into state naloxone programHPA’s are enrolling patients who present at hospitals with opioid or overdose isssues.
30Learn To CopeSupport group for family members and loved ones of opioid usersFive groups in eastern MA14 members are approved MDPH Naloxone trainersTraining of peers take place at their meeting’sParents have used Naloxone to reverse OD’s.
312012 Active players: Community City State Good Samaritan legislation is passed, overdose vigils and remembrances take place in several communities,
32ChallengesSlow paceNeeded legal backing and buy-in from “authorities” before could become legitimizedGetting over ego stuffStaff buy-in to risks of distributing naloxone pre-pilot yearsNegative press/mediaLimited research made it difficult for public health people to buy inChallenges that faced all who took part in this initative will be discussed.
33Looking Forward Expanding into more ER’s (SBIRT) Expanding first responder involvementPersons in Recovery and Treatment become partnersODP being incorporated into standards of care for short-term drug treatmentResearch possibilities that contributes to the case being made for OTC sale of NarcanFDA approval of nasal Narcan useODP being incorporated into the DOCEducation on Good Samaritan lawsPossibilities for the future will be explored and discussed.
34SuccessesCollaborative process between underground and funded programsPhilosophy shift in State (BSAS)Acceptance of harm reduction philosophy by treatment programs, parents of users, etc.Buy in from many stakeholders to legitimize naloxone distributionGood Samaritan Law passedLives savedPossibilities for the future will be explored and discussed. Good Samaritan bill included Naloxone language protecting individuals and physicians who prescribe naloxone.
35More Successes 2006-2012 Enrollments 15,000+ individuals 300 per month 1500+ reported reversals30 per monthRFD has more than 70 OD reversalsPossabilities for the future will be explored and discussed.