Post on 03-Aug-2020
transcript
Preventing Opioid Overdose
Death: Naloxone Rescue Kits
Our Utah Experience
Jennifer Plumb, MD, MPH
University of Utah Health Care
School of Medicine Department of Pediatrics
Utah Naloxone
Disclosures
• Dr. Plumb has no commercial or financial
relationships nor any conflicts of interest to
disclose
Utah 2013-2014 Overdose Deaths
4th Highest in the U.S.
CDC, 2016
Injury Deaths in Utah
UTDOH, 09/2014
De
ath
Ra
te P
er
10
0,0
00
5
Drug Overdose Death Rate
in the U.S. 2003-2014
National Vital Statistics System
U.S. Overdose Deaths 2014
CDC, 2015
U.S. Opioid and Heroin Deaths
1999 vs. 2014
Common Opiates/Opioids
• Heroin
• Codeine
• Demerol
• Morphine
• Darvocet
• Fentanyl
• Dilaudid
• Methadone
• Opium
• Hydrocodone
• Oxycodone
• Vicodin
• OxyContin
• Tylenol 3
• Tylox
• Levorphanol
• Percocet
• Percodan
Dependence can develop in 7 days
Number of Prescription Pain
Medication Deaths per 100,000 Adults
Utah 2009-2012
Fondario, UTDOH, 2014
Rate of Opioid-related ED Visits per
10,000 Population by Age Group,
Utah 2009-2013
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Less than 1year
1-4 years 5-14 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 85+ years
Cru
de
Rat
es p
er 1
0,0
00
ED
Tre
at a
nd
Rel
ease
En
cou
nte
rs Heroin
Prescription Opioids
UTDOH 2015
Heroin related visits higher for MalesPrescription opioids higher for Females
Number of Unintentional/Undetermined
Opioid Deaths, Utah 2000-2014
0
50
100
150
200
250
300
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014*
Nu
mb
er
of
De
ath
s
Year
Heroin
Rx Opioid Only (no illicit drugs)
UTDOH, 2016
We averaged one opioid-related
death every day in 2014
The Role for Naloxone
NALOXONE, What is It?
• Naloxone (Narcan®) is a non-addictive
prescription medication that helps to block the
effects of opiates on the body
• It has been used by EMS and in EDs routinely
for 45 years, since 1971
• There are no effects on a person if an opiate has
not been used
• ONLY works on opiates
• Works quickly
• Very safe
What Happens in an Opiate Overdose?
The brain has
many, many
receptors for
opioids. Too much
opioid fitting in too
many receptors
slows and stops the
breathing.
Opioid fits exactly in
receptor
Opioid receptor
on brain
Naloxone Reversing an Overdose
Naloxone has a stronger
affinity to the opioid
receptors than the other
opioids or heroin, so it
knocks the heroin off the
receptors for a short time
and lets the person
breathe again.
Opioid
receptor
Naloxone
Opioid/
Heroin
Naloxone Distribution Programs
• U.S. Starting in 1996, first legislation passed 2001
• Morbidity and Mortality Weekly Reports (CDC)
– Between 1996-2014, U.S. programs distributed
152,283 rescue kits with 26,463 reversals reported
– 1 in 6 saving a life
• Has not been shown to increase use or lead to
riskier use
– Actually shown to increase motivation to seek treatment
Who is at Risk of Overdose Death?
• History of substance abuse
• Prescribed high dose opioids
• Current or history of psychiatric illness
• Those with benzodiazepines and opioids in their
possession
• History of mis-using medications
• Taking more than prescribed
• Drinking alcohol with meds
• Past history of overdose, currently in ED for overdose
• Have medical co-morbidities
• Veterans
• After release from prison, treatment, supervised care
Naloxone Rescue Kits
Opiate
Antagonist
(Naloxone)
Act
2014 HB 119, Emergency
Administration of Opiate
Antagonist Act
• It is not unlawful or unprofessional conduct for health professionals to prescribe or dispense an opiate antagonist to:
• A person at increased risk of experiencing an opiate-related drug overdose event; or
• A family member, friend, or other person in a position to assist a person who is at increased risk of experiencing an opiate-related drug overdose (at increased risk of witnessing an overdose); and
• No physician-patient relationship required
• Requires a person who prescribes or dispenses an opiate antagonist to advise a person to seek a medical evaluation after experiencing a drug overdose and taking an opiate antagonist
• Clarifies that the administration of an opiate antagonist is voluntary and that the act does not establish a duty to administer an opiate antagonist
Opiate
Antagonist
Response
Act
Bills
2016 HB 238, Opiate Overdose
Response Act – Overdose
Outreach Providers
• Authorizes “Overdose Outreach Providers” to furnish naloxone without civil/criminal liability:
• Law enforcement
• Fire departments
• EMS providers
• Orgs providing treatment for drug/alcohol use
• Orgs providing services for an individual, or a family of an individual, with a substance use disorder
• Orgs providing substance use/mental health services under contract with a local substance abuse/mental health authority
• Orgs providing services to the homeless
• Local health departments
• Individuals
• Pharmacy Practice Act licensure exemptions
Opiate
Antagonist
Response
Act
Bills
2016 HB 192, Opiate Overdose
Response Act – Pilot Program
• Licensed providers may prescribe an opiate antagonist to:
• An individual who is at increased risk of experiencing an opiate-related drug overdose; and
• A family member, friend, or other person who is in a position to assist at-risk individuals, including:
– Law enforcement
– Health department
– Orgs that provide drug/alcohol treatment
– Orgs that serve the homeless
– Orgs that provide opiate antagonist training
– Schools
• An org defined by DOH rule as being in a position to assist at-risk individuals
Opiate
Antagonist
Response
Act
Bills
2016 HB 240, Opiate Overdose
Response Act – Standing
Orders
• Authorizes the use of a standing prescription
drug order issued by a physician to dispense
an opioid antagonist in accordance with a
protocol
• Allows for a “behind the counter” model for
naloxone access
• No prescription required if a standing order
agreement is in place
First Year Successes Utah Naloxone
• 126 Reversals reported (as of 9/1/16)– Over 2,800 free kits distributed
– Parents, spouses, friends, law enforcement, strangers
• 12 law enforcement entities trained and equipped– Reversals reported within 24 hours in 2 agencies
– 14 reversals in the 1st 4 months
• Trainings provided statewide in over 60 settings
• Statewide awareness campaign and billboards