1. Intranasal Naloxone to Reverse Opioid Overdose in the Pre-hospital Setting
Daliah Heller, PhD, MPH
Assistant Commissioner
Bureau of Alcohol & Drug Use Prevention, Care & Treatment

2. The context of drug overdose: An opportunity for prevention
Overdoses are rarely instantaneous
Death usually happens over one to three hours
Recovery from opioid overdose treated with naloxone is nearly universal if administered correctly
Minimal risk of adverse effects
Naloxone lacks abuse potential
More than 50% of overdoses are witnessed*
Educate ‘civilians’ and prescribe naloxone to administer when witnessing an overdose
Fear of arrest deters calling 911
Other half of ODs occur alone – need to educate for prevention, also
Program evaluations confirm that drug users learn and do administer naloxone to successfully reverse overdose
Health of the homeless report showed us that overdose was a leading cause of excess death among NYC homeless.
*Source: Darke & Hall, 2003

3. Opioid Overdose Prevention Programs in NYS law
Effective April 1, 2006 in New York State, registered programs can provide overdose reversal training and prescribe naloxone to ‘civilians.’
Programs submit a brief application to NYS DOH AIDS Institute
Programs maintain confidential training logs of ‘trained overdose responders’
Programs submit information on reported overdose reversals (responder remains anonymous)

5. Opioid Overdose Prevention Programs
Educate people to respond to overdose
Train people individually or in groups
Prescribe and dispense naloxone to ‘trained overdose responders’
Injectable or intranasal naloxone formulation is offered
Target people who use drugs, people in their social networks, family members and friends, as well as staff of shelters, housing programs, drug treatment programs, and other locations where overdoses might occur

6. A typical overdose prevention and reversal training…
Describes risks for opioid overdose
Describes symptoms of an opioid overdose
Teaches how to respond to an opioid overdose (call 911 is the first response!)
Prescribes naloxone to the ‘trained responder’
Can take 10 minutes or up to one hour
Provided to individuals or groups

7. Trained overdose responders are offered intranasal or intramuscular naloxone
Intranasal naloxone (IN): 2mg/2mL

8. Intranasal naloxone

9. Intramuscular naloxone
Intramuscular naloxone (IM): 0.4mg/1mL

10. The Overdose Rescue Kit also includes
Rescue breathing mask
Latex gloves
Alcohol pad

12. As of October 1, 2009
50 registered Opioid Overdose Prevention Programs in New York State
44 registered programs in New York City
Programs include:
Homeless shelters and outreach programs
Syringe exchange / harm reduction programs
HIV/AIDS services
Drug treatment programs
NYC DOHMH

13. Initial program success in NYC
> 4,000 kits (2x naloxone doses) distributed
> 300 reversals reported by trained overdose responders