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

2. Universally permit first responders to carry and administer naloxone
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

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. Naloxone was FDA approved in 1971
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

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
Curriculum delivers education on OD prevention, recognition, and response
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
Coming Soon
Learn to Cope
AIDS Action Committee
AIDS Project Worcester
Lowell House/ Lowell Community Health Center
AIDS Support Group of Cape Cod
Manet Community Health Center
Brockton Area Multi-Services Inc.  (BAMSI)
MAPS/ Health Innovations
Boston Public Health Commission
North Suffolk Mental Health
Greater Lawrence Family Health Center
Seven Hills Behavioral Health
Learn to Cope
Tapestry Health
Center for Human Development
Center for Social Innovation

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: Brockton Quincy
Cambridge Salem
Gardner Tewksbury
Gloucester Worcester
Holyoke Yarmouth
Lowell Coming Soon:
New Bedford Taunton, Pittsfield &
Norwell Framingham

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

15. Prescribe naloxone
Prescribetoprevent.org

16. Auto-injector Naloxone
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
Key Point: Benefits of intranasal naloxone

17. Auto-injector Naloxone
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
Key Point: Benefits of intranasal naloxone

18. First Responder Pilot 2010-2014
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:

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
Project manual
harmreduction.org/issues/overdose-prevention/
2013 National Drug Control Strategy
ASAM 2010 Policy Statement
SAMHSA toolkit
store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA
SAMHSA Letter to prescribers

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