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Opioid Overdose Prevention Strategies in MA Sarah Ruiz, MSW Bureau of Substance Abuse Services MA Department of Public Health October 30, 2014.

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Presentation on theme: "Opioid Overdose Prevention Strategies in MA Sarah Ruiz, MSW Bureau of Substance Abuse Services MA Department of Public Health October 30, 2014."— Presentation transcript:

1 Opioid Overdose Prevention Strategies in MA Sarah Ruiz, MSW Bureau of Substance Abuse Services MA Department of Public Health October 30, 2014

2 March 27, 2014 Governor Deval Patrick declares opioid use a Public Health Emergency in MA This action provided emergency powers to the DPH Commissioner. The Public Health Council passed orders that: Universally permit first responders to carry and administer naloxone Facilitate access to naloxone through standing orders at pharmacies Accelerate enrollment in the PMP Governor also ordered that an Opioid Task Force be formed to make recommendations about policy and resource development in the areas of prevention, intervention, treatment and recovery support s/feature-story/end-opioid- abuse-in-mass.html

3 Opioid Task Force Recommendations BSAS is implementing a total of 15 recommendations which requires 11 procurements for new services such as : Acute Treatment Services Clinical Stabilization Services Residential Treatment Services Recovery High School Assessment Centers (pilots) Central Navigation System

4 New Funding included in FY15 GAA for BSAS : Substance Abuse Services $2,000,000 added to this line item to support & strengthen public access to substance abuse services in the commonwealth, including the following: $500,000 for a voluntary training and accreditation program for alcohol and drug free housing : Naloxone Pilot Expansion New line item for $1,000,000 for naloxone purchase, and administration and training for first-responder and bystander naloxone distribution programs Not less than 10 first-responder pilot communities and 7 bystander distribution communities : Substance Abuse Treatment Trust Fund $10,000,000 new line item to increase the number of clients receiving substance abuse treatment through BSAS utilizing a range of treatment settings

5 Naloxone ( Narcan® ) Treatment of choice for the reversal of an opioid overdose by emergency responders for decades (Paramedics, Emergency Department Physicians) Displaces opioids from the brain receptors and restores consciousness and breathing = pure opioid antagonist Extremely safe with no potential for abuse - not psychoactive Acts within 2 to 8 minutes, lasts 30 to 90 minutes Overdose may return, naloxone may be repeated

6 Dr. Jake Fishman In March 1961, Dr. Fishman and Dr. Mozes Lewenstein applied for one of the first patents for naloxone In 1971, the Food and Drug Administration approved using naloxone to treat overdoses Naloxone was FDA approved in 1971

7 Intranasal Administration Naloxone may be given by needle into a vein (IV) or muscle (IM) or it may be sprayed up the nose (intranasal or IN). In Massachusetts we are distributing intranasal naloxone Avoids the risk of secondary needle exposure and eliminates concerns with disposal Kit requires assembly but is easy to administer

8 Naloxone and Mucosal Atomization Device (MAD)

9 DPH Pilot Program Components Approved staff enroll people in the program and distribute naloxone –http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone- info.pdfhttp://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone- info.pdf Curriculum delivers education on OD prevention, recognition, and response –http://www.mass.gov/eohhs/docs/dph/substance-abuse/core- competencies-for-naloxone-pilot-participants.pdfhttp://www.mass.gov/eohhs/docs/dph/substance-abuse/core- competencies-for-naloxone-pilot-participants.pdf Referral to treatment available Kits include instructions and 2 doses Data collected on everyone who receives a kit and returns for a refill

10 DPH Overdose Education & Naloxone Distribution Program Sites AIDS Action Committee AIDS Project Worcester AIDS Support Group of Cape Cod Brockton Area Multi-Services Inc. (BAMSI) Boston Public Health Commission Greater Lawrence Family Health Center Learn to Cope Center for Human Development Lowell House/ Lowell Community Health Center Manet Community Health Center MAPS/ Health Innovations North Suffolk Mental Health Seven Hills Behavioral Health Tapestry Health Center for Social Innovation Learn to Cope Site Coming Soon

11 Parents Support Groups “Learn to Cope” Currently has 13 meetings weekly throughout the state Parents are trained and approved to distribute naloxone at their meetings Also “Parents Supporting Parents” on Cape Cod

12 Learn to Cope Current Weekly Meeting Locations: BrocktonQuincy Cambridge Salem GardnerTewksbury GloucesterWorcester HolyokeYarmouth LowellComing Soon: New BedfordTaunton, Pittsfield & NorwellFramingham

13 Massachusetts - Passed in August 2012: “An Act Relative to Sentencing and Improving Law Enforcement Tools” Law allowing broader prescribing of naloxone Patient Protection: A person acting in good faith may receive a naloxone prescription, possess naloxone and administer naloxone to an individual appearing to experience an opiate-related overdose. Prescriber Protection: Naloxone or other opioid antagonist may lawfully be prescribed and dispensed to a person at risk of experiencing an opiate-related overdose or a family member, friend or other person in a position to assist a person at risk of experiencing an opiate-related overdose. For purposes of this chapter and chapter 112, any such prescription shall be regarded as being issued for a legitimate medical purpose in the usual course of professional practice.

14 Pharmacy Access Many pharmacies in MA are now stocking intra-nasal naloxone to fill prescriptions –Walgreens, CVS, Eaton Pharmacies in Community Health Centers, MGH MA Board of Pharmacy recently released guidance on Pharmacy Standing Orders for dispensing naloxone acy/dispensing-of-naloxone-by-standing-order-.html acy/dispensing-of-naloxone-by-standing-order-.html

15 Prescribe naloxone Prescribetoprevent.org

16 Each auto-injector contains only 1 dose Inject into muscle or skin of the outer thigh Can be injected through clothing if needed Device injects intramuscularly or subcutaneously, delivers the naloxone, and retracts the needle fully into its housing Needle not visible before, during, or after Auto-injector Naloxone

17 Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency The Trainer does not contain a needle or medicine It can be reused to practice your injection The red safety guard can be removed and replaced on the Trainer Auto-injector Naloxone

18 First Responder Pilot DPH provided the medical direction and naloxone, approved training & monitored overdose reports All Police Officers or Fire Fighters in 6 participating departments were trained with DPH approved curriculum Annual refresher incorporated into annual required first responder training A one page data collection form is completed each time the naloxone is used

19 EMT & First Responder Regulations (2014) DPH Drug Control Program and EMS regulations & clinical protocols now incorporate both EMT (required) and First Responder (optional) administration of naloxone. Training rolling out in collaboration between public health, law enforcement, fire, and EMS Resources and Technical Assistance: narcan-technical-assistance narcan-technical-assistance

20 Helpful overdose weblinks…. For prescribers and pharmacists Prescribetoprevent.org Family support Learn2cope.org Grasphelp.org News + research on overdose prevention Overdosepreventionalliance.org International overdose prevention efforts Naloxoneinfo.org Opioid overdose prevention education Stopoverdose.org Legal interventions naloxone-10-4.pdfwww.networkforphl.org/_asset/qz5pvn/network- naloxone-10-4.pdf Project manual harmreduction.org/issues/overdose-prevention/ 2013 National Drug Control Strategy national-drug-control-strategy national-drug-control-strategy ASAM 2010 Policy Statement statements/1naloxone-1-10.pdf statements/1naloxone-1-10.pdf SAMHSA toolkit store.samhsa.gov/product/Opioid-Overdose- Prevention-Toolkit/SMA store.samhsa.gov/product/Opioid-Overdose- Prevention-Toolkit/SMA SAMHSA Letter to prescribers SAMHSA_fentanyl_508.pdf SAMHSA_fentanyl_508.pdf

21 Contact Information Sarah Ruiz, MSW MA Dept. of Public Health Bureau of Substance Abuse Services


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