Naloxone: Saving lives in an opioid epidemic
|
|
- Agnes Morgan
- 6 years ago
- Views:
Transcription
1 Naloxone: Saving lives in an opioid epidemic Shannon N. Saldaña, PharmD, MS, BCPP Psychiatry Advanced Clinical Pharmacist Intermountain Primary Children s Hospital Adjunct Assistant Professor of Psychiatry The University of Utah School of Medicine December 2017
2 Conflict of interest disclosure I have no conflicts to disclose.
3 Objectives Explain the role and use of naloxone in opioid overdose Describe Utah legislation on naloxone prescribing and dispensing Identify situations in which to consider co-prescribing naloxone with opioids Outline opioid risk and naloxone talking points for conversations with patients and caregivers
4 Outline Opioid epidemic Risks of opioids: opioid overdose Naloxone rescue kits and how they work Utah legislation on naloxone prescribing and dispensing Opioid prescribing Co-prescribing naloxone Conversations to have with patients Questions, thoughts, discussion
5
6 Opioids
7 Opioids Prescription medications For pain For opioid use disorder Heroin Interact with opioid receptors (body, brain) Control pain signals (analgesia) Produce euphoria Decrease breathing (can lead to death) Generic nameas Hydrocodone Oxycodone Morphine Codeine Fentanyl Hydromorphone Oxymorphone Meperidine Tramadol Buprenorphine Methadone Common brand name Norco, Lortab, Vicodin, Zohydro OxyContin, Percocet, Percodan, Roxicodone MSIR, MS Contin Tylenol #3, Phenergan with codeine Duragesic, Actiq Dilaudid Opana Demerol Ultram, Conzip Subutex, Suboxone, Butrans, Zubsolv Dolophine, Methadose
8 How opioids work Opioid fits exactly in receptor and activates it (turns it on) Opioid activates receptor blocked pain signals, euphoria Brain has many opioid receptors Opioid receptor on brain cell Too much opioid in too many receptors slows and stops the breathing (overdose) Adapted from
9
10 Andy Plumb Penny Cormani Maline Hairup Tennyson Cecchini Ryan Ainsworth Grant Seaver Tony Lewis Opioid overdose Utah loved ones lost
11 Utah drug poisoning deaths, by county, Rate of Drug Poisoning Deaths Per 100,000 Population Web-based Injury Statistics Query and Reporting System, US Census Bureau. 83% involved prescription opioids Utah: 7 th in US
12 Rate per 100,000 population Rate of prescription opioid death in Utah in Male Female * Total Age group Utah Department of Health Violence and Injury Prevention Program graph courtesy of Utah Department of Health. February 14, 2017.
13 Utah prescription opioid overdose and death in 2015 Utah overdose death rate was 12.6 (per 100,000 adults) 566 overdose deaths 347 involved prescription drugs 282 deaths from prescription opioids Top circumstances Top 3 Utah areas Death rate (per 100,000 adults) Carbon/Emery Counties 47.3 Downtown Ogden 31.6 Physical health problem (71%) Substance use problem (68.3%) Current mental health/substance use treatment (60.4%) Southwest Local Health District Beaver, Garfield, Kane, Iron, Washington counties 23.9 Drug use not per a prescription (27.4%) Alcohol dependence/problem (17.1%) History of suicide attempt (13.7%) Utah Department of Health Violence & Injury Prevention Program, Utah Violent Death Reporting System.
14 Naloxone Naloxone rescue kits and how they work Erin Finkbiner Mitch Blain
15 Overdose Education and Naloxone Distribution (OEND) Centers for Disease Control and Prevention (CDC) report in 2012 Reported on OEND programs from programs 53,032 people received naloxone kits and training 10,171 overdose reversals CDC report in 2015 Shows large increase in number of OEND programs Reported on OEND programs from programs 152,283 naloxone kits distributed 26,463 overdose reversals Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons - United States, MMWR 2015:64(23);
16 Opioid overdose Opioid receptor activated (turned on) by opioid Opioid receptor on brain cell Brain has many opioid receptors Too much opioid in too many receptors slows and stops the breathing (overdose) Adapted from
17 Naloxone reversing an overdose Opioid/ Heroin Naloxone Opioid receptor Adapted from Naloxone has a stronger attraction to opioid receptors than other opioids or heroin Naloxone knocks opioid/heroin off the receptors and blocks them for a short time This lets the person breathe again
18 Naloxone can prevent death from opioid overdose Opioid overdose is reversible when Naloxone is given soon after overdose Emergency care is provided Used for decades to reverse opioid overdose Naloxone should be given while waiting for emergency medical services Utah Opiate Overdose Response Act A person who acts in good faith to administer naloxone to someone they believe is experiencing an opioid overdose is not liable for civil damages Administering naloxone is voluntary Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons - United States, MMWR 2015:64(23); Utah HB 119, Utah HB 238, Utah HB 240, 2016.
19 Naloxone Safe prescription medication Not a controlled substance Does not cause euphoria Does not lead to addiction Only function is to block opioid receptors/reverse overdose Will have no effect and will not harm a person who has not overdosed on opioids Can only reverse an opioid overdose Does not reverse other drug overdoses Available to the public in some states since 1996; in Utah since 2014
20 What to know about naloxone Can start working as quickly as 1 minute Effects can last minutes Another dose is needed when effect wears off Can be sprayed in the nose, injected in a muscle, or injected under the skin Same dose for everyone (young, old, pregnant, medical diseases, pets) Goal: unblock enough receptors to restore breathing (not cause withdrawal) Naloxone may trigger withdrawal in people who are opioid-dependent Can feel unpleasant Some people may get agitated or combative and need help to remain calm
21 What to know about naloxone Store naloxone around room temperature (avoid extremes) In an overdose, if there is no alternative, give naloxone even if it has expired or been in extreme temperatures Keep it with you (or with the person at risk) or where it is accessible Do not keep naloxone with the opioids or locked up Tell other people where naloxone is Teach others how and when to use naloxone Naloxone Access: A Practical Guideline for Pharmacists, College of Psychiatric and Neurologic Pharmacists,
22 Opioid withdrawal Goal of naloxone is to unblock enough opioid receptors to restore breathing, not precipitate withdrawal Naloxone may trigger withdrawal in people who are opioid-dependent Can feel unpleasant Some people may get agitated or combative and need help to remain calm Vomiting is also relatively common SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) Rockville, MD, 2016.
23 4 naloxone products Intramuscular (IM) kits Naloxone and IM syringes Intranasal kits Naloxone and nasal atomizers Narcan Nasal Spray Auto-injector (Evzio) Not all pharmacies will have all products
24 Intramuscular naloxone kit 2 single-dose vials of naloxone 0.4 mg/ml 2 intramuscular syringes
25 Intramuscular kit instructions Inject in large muscle (shoulder may be more accessible) Be careful and pinch the thigh if administering to an infant Do not re-cap the needle; put used syringe away from people, if possible in a strong plastic container with a narrow opening Keep at room temperature (avoid extremes) and away from light
26 Intranasal naloxone kit Absorption is through nasal mucosa, the person does not need to inhale 2 pre-filled needless syringes of naloxone 1 mg/ml 2 nasal atomizers (spray cones)
27 Intranasal kit instructions Do not insert naloxone into tube until ready to use (expires in 2 weeks, once inserted) Be careful naloxone glass cartridges can shatter if dropped ½ of the syringe goes in one nostril, and the other ½ goes in the other nostril If nose is blocked, clear it (wipe away vomit) and/or insert tip as far into nose as possible
28 Narcan Nasal Spray Each package has 2 nasal spray devices Each device contains only one spray dose Do not prime the pump Do not reuse after first spray Go give, place the tip of the nozzle in either nostril (until your fingers touch the bottom of the person s nose), then press the plunger If nose is blocked, clear it (wipe away vomit) and/or insert tip as far into nose as possible
29 Auto-injector (Evzio) Naloxone 2-mg auto-injector 2 auto-injectors and 1 trainer per package May pose more risk for opioid withdrawal due to the higher dose of 2 mg Cost ~$5,000+ May give in a muscle or under the skin Electronic voice instruction system Remove from case Pull red guard off Follow instructions
30 Cost Some form of naloxone is covered by most insurances and Medicaid Intranasal and intramuscular kits Costs are usually $ without insurance Intramuscular kits are usually less expensive Naloxone often covered at a generic copay Pharmacies may have a separate charge for syringes or nasal atomizers 4-mg nasal spray without insurance: around $150 2-mg auto-injector without insurance: $4,700-6,100 * Costs/estimates as of Dec 2016-Jan 2017; vary among pharmacies; call pharmacy for current information, due to large price changes over short time periods.
31 Outline Opioid epidemic Risks of opioids: opioid overdose Naloxone rescue kits and how they work Utah legislation on naloxone prescribing and dispensing Opioid prescribing Co-prescribing naloxone Conversations to have with patients Questions, thoughts, discussion
32 Health care provider may prescribe naloxone Without a prescriber-patient relationship Without liability for any civil damages for acts or omissions made as a result of prescribing or dispensing naloxone in good faith To anyone at increased risk of experiencing an opioid overdose To a family member, friend, or other individual in a position to assist someone at risk To an outreach provider for Furnishing to someone else Administering to a person experiencing an overdose Utah Opiate Overdose Response Act, Utah Code
33 Overdose outreach providers Overdose outreach providers are not civilly liable when administering naloxone to someone believed to be experiencing an overdose The definition of overdose outreach provider includes Law enforcement Fire departments Mental health and substance use disorder treatment programs Organizations serving people experiencing homelessness Emergency medical service providers/personnel Local health departments Pharmacists An individual Utah Opiate Overdose Response Act, Utah Code
34 Health care provider who dispenses naloxone Shall provide education that includes written instruction How to recognize an opiate-related drug overdose event How to respond appropriately to an opioid overdose, including how to: Administer naloxone Ensure that an individual to whom [naloxone] has been administered receives, as soon as possible, additional medical care and a medical evaluation
35 Naloxone in Utah pharmacies without a prescription Naloxone is a prescription medication Naloxone does not require a prescriber-patient relationship in Utah Pharmacists may prescribe and dispense naloxone under a protocol with a prescriber: Collaborative Practice Agreement or standing order Do not have to see a medical provider to get a naloxone prescription Can request naloxone at a pharmacy Dispensed as a prescription, with a label, patient name, prescriber name, instructions Some pharmacy protocols do not include all naloxone products Some pharmacies may not participate in a naloxone protocol Utah Pharmacy Practice Act. Utah Code 58-17b-102 Utah Opiate Overdose Response Act, Utah Code
36 Outline Opioid epidemic Risks of opioids: opioid overdose Naloxone rescue kits and how they work Utah legislation on naloxone prescribing and dispensing Opioid prescribing Co-prescribing naloxone Conversations to have with patients Questions, thoughts, discussion
37 Opioid prescribing in Utah % increase in rate of opioids dispensed Each year there were more prescriptions, and higher doses, for females than males 2015: 89 opioid prescriptions per 100 Utahns 2015 Utah population: 2.98 million (all ages) 2.6 million opioid prescriptions filled in Utah in ,000 opioid prescriptions every day Enough for every Utah adult to have a bottle of opioids Opioid prescribing practices in Utah UDOH VIPP
38 Morphine Milligram Equivalents (MMEs) Also called morphine equivalent dose (MED) Convert opioids to a standard value (based on morphine) MME = amount of opioid taken daily x conversion factor If taking multiple opioids, calculate MME for each, then add together
39 CDC Vital Signs, July 2017
40 CDC Vital Signs, July 2017
41 Ages experienced greatest increase (70%) Ages experienced greatest decrease (63%) Violence and Injury Prevention Program. Opioid Prescribing Practices in Utah Salt Lake City, UT: Utah Department of Health
42 Outline Opioid epidemic Risks of opioids: opioid overdose Naloxone rescue kits and how they work Utah legislation on naloxone prescribing and dispensing Opioid prescribing Co-prescribing naloxone Conversations to have with patients Questions, thoughts, discussion
43 Co-prescribing naloxone Some guidelines recommend co-prescribing or offering a prescription for naloxone when patients have risk factors for overdose/overdose death Utah S.B. 258 (2017) required Utah Department of Health to establish guidelines for prescribing naloxone along with a prescription for an opioid Co-prescribing guidelines rule (R ) published for public comment This rule establishes scientifically based guidelines for controlled substance prescribers to co-prescribe an opiate antagonist to a patient Inquiries and comments due by December 15, 2007 at 5:00 PM Utah S.B UTAH STATE BULLETIN November 15, 2017, Vol. 2017, No. 22
44 R Guidelines for the Issuance of a Prescription for an Opiate Antagonist Along with a Prescription for an Opiate 1. Co-prescribing guidelines are applicable when prescribing opioids. 2. Clinicians shall consider offering a co-prescription for an opiate antagonist, such as naloxone, and education on overdose prevention to patients and the patient's household members and/or close contacts, especially when factors that increase risk for opioid overdose are present. These risk factors include: a. history of overdose; b. history of substance use disorder; c. underlying mental health condition that make a patient susceptible to overdose; d. risk for returning to a high dose to which they are no longer tolerant (e.g., patients recently released from prison); e. medical conditions, such as respiratory disease, sleep apnea, or other comorbidities that make a patient susceptible to opioid toxicity, respiratory distress or overdose; f. higher opioid dosages (greater than or equal to 50 MME/day); and g. concurrent benzodiazepine use. 3. Clinicians shall consider offering a co-prescription for an opiate antagonist, such as naloxone, and education on overdose to persons in a position to aid someone who is at risk of overdose. DAR File No NOTICES OF PROPOSED RULES. UTAH STATE BULLETIN November 15, 2017, Vol. 2017, No. 22
45 Common risks for opioid overdose or death High opioid doses Long-acting opioids (also called controlled-release, sustained-release) Rotating opioid regimens Illicit/non-medical opioid or injectable drug use Recent release from treatment or incarceration (lost/decreased tolerance) Veterans Age greater than 65 years Cognitive impairment Children or pets in the home Difficulty accessing emergency medical services (not close to a hospital) Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, MMWR Recomm Rep 2016;65(No. RR-1):1 49. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) Rockville, MD, World Health Organization. Community Management of Opioid Overdose. Geneva, Switzerland, 2014.
46 Factors that increase risk for overdose death Smoking or breathing problems, such as COPD (chronic obstructive pulmonary disease), asthma, sleep apnea, or respiratory illness Kidney disease Liver disease Medical or physical problems History of overdose Drinking alcohol with opioids Taking with other medications Benzodiazepines Sedatives/hypnotics Antidepressants Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, MMWR Recomm Rep 2016;65(No. RR-1):1 49. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) Rockville, MD, World Health Organization. Community Management of Opioid Overdose. Geneva, Switzerland, 2014.
47 Outline Opioid epidemic Risks of opioids: opioid overdose Naloxone rescue kits and how they work Utah legislation on naloxone prescribing and dispensing Opioid prescribing Co-prescribing naloxone Conversations to have with patients Questions, thoughts, discussion
48 Why is it so tough to talk about opioids and naloxone? Conversation takes time Concern that star ratings will go down Pharmacists feel like they are trying to sell patients more medication the pharmaceutical industry got us into the opioid epidemic now companies are going to make money on a drug to reverse overdose Concerned about perceptions Doctor or pharmacist not safely prescribing/dispensing People do unsafe things on purpose or aren t smart or strong enough to be safe Not sure how to tell people they could experience withdrawal, become addicted, or unintentionally die from a medication we are giving them Stigma around drug use and addiction
49 Strategies for success For all medications, explain potential side effects and risks Be honest and get comfortable, patients deserve to know risks Focus on medication safety Opioids are dangerous drugs Not dangerous people (patients, doctors, nurses, pharmacists) Tell patients what to expect from opioids, including risks Mention and briefly explain tolerance, dependence, addiction, overdose Example A risk of this medication is decreased breathing, which can cause sudden death Reversing this process quickly is crucial Naloxone can reverse this effect of the opioid medication
50 Examples A risk of this opioid medication is decreased breathing, which can cause sudden death Reversing this process quickly is crucial Naloxone can reverse this effect of the medication Sometimes, even when people are using the medications as prescribed, something changes, like the person starts taking a new medication, and that could mean that this medication is not as safe anymore Opioids can cause drowsiness and confusion, it is possible that someone could forget if/when they took a dose A tablet could fall on the floor and could be enough to hurt a baby or a pet
51 Examples Even after taking a short time, people may need a higher dose for the same effect, which is called tolerance Physical dependence happens within a week If you take this regularly and then stop, you may feel withdrawal symptoms This does not mean you are addicted Addiction is a risk, especially when taking for longer than 3-7 days This is a chronic brain disease with harmful consequences I have seen people and their families with addiction, and I don t want to see that happen to you or anyone who could access your opioids We didn t tell people about this risk like we should have in the past. Now I tell everyone, to help keep you safe and minimize the risks of opioids.
52 Questions, thoughts, discussion
53 Naloxone: Saving lives in an opioid epidemic Shannon N. Saldaña, PharmD, MS, BCPP Psychiatry Advanced Clinical Pharmacist Intermountain Primary Children s Hospital Adjunct Assistant Professor of Psychiatry The University of Utah School of Medicine December 2017
Opioid Harm Reduction
Opioid Harm Reduction Lucas G. Hill, PharmD Clinical Assistant Professor, The University of Texas at Austin College of Pharmacy Clinical Pharmacist, CommUnityCare FQHCs Director, Operation Naloxone Mark
More informationNaloxone HCI 4 mg/0.1. nostril. Repeat after 3 minutes if minimal or no
THE SOUTH CAROLINA BOARD OF MEDICAL EXAMINERS AND THE SOUTH CAROLINA BOARD OF PHARMACY S JOINT PROTOCOL TO INITIATE DISPENSING OF NALOXONE HCI WITHOUT A PRESCRIPTION This joint protocol authorizes any
More informationWelcome to the Opioid Overdose Prevention Project
Welcome to the Opioid Overdose Prevention Project Narcan Training TODAY S OBJECTIVES Define drug addiction Identify symptoms of addiction Treatment options including support for family members How to recognize
More informationLet s Talk About. Pain Medicines. wisconsin. health literacy. A division of Wisconsin Literacy, Inc.
Let s Talk About Pain Medicines wisconsin health literacy A division of Wisconsin Literacy, Inc. How are prescription opioids different than other pain medicines? People think of opioids as illegal drugs,
More informationNaloxone Standing Order for Opioid Overdose
Naloxone Standing Order for Opioid Overdose By: Christine Trusky, PharmD Candidate 2016, Wilkes University Continuing Education Activity Details: Activity Type: Knowledge-based Target Audience: Pharmacists
More informationOVERDOSE IN UTAH PREVENTION AND RESPONSE. Meghan Balough, MPH Heather Bush, B.S. Suicide Conference October 6, 2017
OVERDOSE IN UTAH PREVENTION AND RESPONSE Meghan Balough, MPH Heather Bush, B.S. Suicide Conference October 6, 2017 Questions How many people have known someone who has experienced an overdose? How many
More informationNALOXONE LEARNING ABOUT NALOXONE COULD SAVE A LIFE
NALOXONE LEARNING ABOUT NALOXONE COULD SAVE A LIFE WHAT IT IS WHAT IT IS NARCAN (naloxone HCl) Nasal Spray is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known
More informationPharmacist Learning Objectives
Opioid Overdose Education and Naloxone Distribution Keith Thornell, Pharm.D. Clinical Pharmacist Co-Occurring Disorders Pain Clinic NM Veterans Affairs Health Care System richard.thornell@va.gov 1 Pharmacist
More informationTake Home Naloxone: Law Update and Considerations for Pharmacy Professionals
Take Home Naloxone: Law Update and Considerations for Pharmacy Professionals Clint Ross, PharmD, BCPP Clinical Pharmacy Specialist Psychiatry Residency Program Director Psychiatric Pharmacy Medical University
More informationNARCAN: THE HISTORY, APPLICATIONS AND FUTURE
NARCAN: THE HISTORY, APPLICATIONS AND FUTURE TABLE OF CONTENTS 3 Intro 4 What is Naloxone? 8 How Naloxone is Administered 12 Where to Find Narcan in California The United States accounts for about five
More informationRevised 16 February, of 7
341 State Street Suite G Madison, WI 53703 ph: (608) 251 4454 f: (608) 251 3853 6333 University Avenue, Middleton WI 53562 ph: (608) 310 5389 f: (608) 285 9603 INTRANASAL OR INTRAMUSCULAR NALOXONE PROTOCOL:
More informationLaw Enforcement Naloxone Training Florida Department of Children and Families. Office of Substance Abuse and Mental Health
Protecting, Leading, Uniting Since 1893 Law Enforcement Naloxone Training Florida Department of Children and Families Office of Substance Abuse and Mental Health 1. Learn how to recognize and respond to
More informationOpiate Overdose Treatment: Naloxone Training Protocol
OREGON STATE PUBLIC HEALTH DIVISION EMS & Trauma Systems Kate Brown, Governor September 22, 2016 For more information, contact David Lehrfeld, MD, Medical Director, EMS & Trauma Systems: (971) 673-0520
More informationOpioid Overdose Education and Naloxone Distribution
Opioid Overdose Education and Naloxone Distribution Emily Stoukides, PharmD PGY-2 Ambulatory Care Pharmacy Resident Nicole Brunet, PharmD, BCPP Clinical Pharmacy Specialist, Mental Health Disclosures Emily
More informationOpioid Overdose Prevention for Law Enforcement and First Responders. Sponsored by the NC Office of EMS
Opioid Overdose Prevention for Law Enforcement and First Responders Sponsored by the NC Office of EMS Overview The goal of this presentation is to help inform the public safety community of North Carolina
More information``Considerations for using opioid drug therapy in workers compensation include patient safety, drug effectiveness and financial impacts
Opioids Effective Case Management Opioids RELEVANCE IN WORKERS COMP Opioids are a diverse group of drugs that represent the strongest pain medications available. They are frequently prescribed for pain
More informationCalvert County Health Department Overdose Education and Naloxone Training
Calvert County Health Department Overdose Education and Naloxone Training Maryland Overdose Response Program January 2015 Behavioral Health Administration Department of Health & Mental Hygiene dhmh.naloxone@maryland.gov
More informationNaloxone Statewide Standing Order. Cheryl A. Viracola, PharmD Pharmacy Programs Manager, Community Care of Wake and Johnston Counties
Naloxone Statewide Standing Order Cheryl A. Viracola, PharmD Pharmacy Programs Manager, Community Care of Wake and Johnston Counties Objectives Review the US & NC trends on opioid overdose Understand key
More informationAnyone Can Become Addicted. Anyone.
Anyone Can Become Addicted. Anyone. PAStop.org Family Toolkit Seeking Drug Abuse Treatment: Know What to Ask Trying to identify the right treatment programs for a loved one can be a difficult process.
More informationCampus Narcan Project OPIOID OVERDOSE FIRST RESPONDER TRAINING
Campus Narcan Project OPIOID OVERDOSE FIRST RESPONDER TRAINING Opioid Epidemic Prescription Opiods Can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side
More informationRole of the Pharmacist: Naloxone Training. Kathleen Besinque, Pharm.D.,MSEd., FASHP, FCPhA Loma Linda University School of Pharmacy
Role of the Pharmacist: Naloxone Training Kathleen Besinque, Pharm.D.,MSEd., FASHP, FCPhA Loma Linda University School of Pharmacy Disclosure Kathleen Besinque Nothing to disclose. Objectives: After attending
More informationNaloxone Standardized Procedures Illinois Departments of DFPR, DPH & DHS Opioid Antagonist Initiative
Naloxone Standardized Procedures Illinois Departments of DFPR, DPH & DHS Opioid Antagonist Initiative Background: In September 2015, Illinois passed a new law, PA99-0480, expanding access to the opioid
More informationNaloxone Information for Community Pharmacies in Georgia: What You Need to Know
Naloxone Information for Community Pharmacies in Georgia: What You Need to Know Your pharmacy may start receiving an increased volume of prescriptions for naloxone (Narcan ) due to legal changes in 2014.
More informationPrescription Opioids
What are prescription opioids? Prescription Opioids Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made
More informationOpioid Safety: Prescribing Guidelines, Quality Measures and Care Coordination Best-Practices
Opioid Safety: Prescribing Guidelines, Quality Measures and Care Coordination Best-Practices August 25, 2017 Presented by Michael Crooks, PharmD. Medication Safety and Care Coordination Task Lead 8/28/2017
More informationNaloxone for Emergency Administration: A 2017 Update On FDA Guidance
Naloxone for Emergency Administration: A 2017 Update On FDA Guidance Nathan A. Painter, PharmD, CDE Associate Clinical Professor University of California San Diego Skaggs School of Pharmacy and Pharmaceutical
More informationNational Council on Patient Information and Education
National Council on Patient Information and Education You are not alone The type of pain that caused your doctor to prescribe a pain medicine for you can make you feel that you are different from everyone
More information3/19/18. Background. School Substance Use Problem: Naloxone and How It Will Be Implemented in Schools. Background
School Substance Use Problem: Naloxone and How It Will Be Implemented in Schools Rodrick J. Marriott, PharmD Director, Drug Control Division Background Background Overdose deaths involving prescription
More informationOpioid Prescription and Illicit Drug Overdoses: On the Rise
Opioid Prescription and Illicit Drug Overdoses: On the Rise Cindy Haynes, MSA-PA, CHES Chronic Pain Program Coordinator Northern Piedmont Community Care Duke Division of Community Health Objectives Define
More information10 mg hydrocodone equals how much oxycodone
Cari untuk: Cari Cari 10 mg hydrocodone equals how much oxycodone Posts about dilaudid 8 vs oxycodone 30 written by buyprescriptionmedication. Can you help me with the conversion of Oxycodone IR (5mg tab)
More informationNaloxone Non-Patient Specific Prescription and Pharmacist Dispensing Protocol, New York City
Section 1: Purpose Naloxone Non-Patient Specific Prescription and Pharmacist Dispensing Protocol, New York City As some of health care s most accessible practitioners, pharmacists are uniquely positioned
More informationTraining of Trainers Maryland Overdose Response Program
Training of Trainers Maryland Overdose Response Program Behavioral Health Administration Maryland Department of Health and Mental Hygiene April 20, 2016 Part I INTRODUCTION 1 Housekeeping Today s schedule
More informationNaloxone and Combating the Opioid Epidemic
Objectives Naloxone and Combating the Opioid Epidemic Jeff Jacobson PharmD Southpointe Pharmacy Discuss the current opioid crisis Define the role of Naloxone in opioid overdose Analyze the barriers to
More informationNaloxone: What You Need to Know About Overdose Reversal In the Midst of an Opioid Epidemic
Naloxone: What You Need to Know About Overdose Reversal In the Midst of an Opioid Epidemic Kyle Troksa, Pharm.D., AE-C PGY1 Resident Community Medical Center March 4th, 2018 Conflicts of Interest No conflicts
More informationMedication Guide. Medication Guide. Lazanda (La-ZAN-da) CII. (fentanyl) nasal spray 100 mcg, 400 mcg
Medication Guide Medication Guide Lazanda (La-ZAN-da) CII (fentanyl) nasal spray 100 mcg, 400 mcg IMPORTANT: Do not use Lazanda unless you are regularly using another opioid pain medicine around-the-clock
More informationNaloxone Opioid Rescue Kits. Aaron Kochar, JD
Naloxone Opioid Rescue Kits Aaron Kochar, JD Common Opioids Codeine Lorcet Demerol Vicodin Oxycontin Hydrocodone Methadone Used as a Medication- Assisted Treatment Liquid methadone (difficult to divert/abuse)
More informationHarm Reduction Coalition DOPE Project Eliza Wheeler 1440 Broadway Suite 902 Oakland, CA
Harm Reduction Coalition DOPE Project Eliza Wheeler 1440 Broadway Suite 902 Oakland, CA 94612 wheeler@harmreduction.org Drug Overdose Deaths in the US: In 2014, there were 47,055 drug overdose deaths in
More informationProtocol For: Personally Furnishing Naloxone. Update Log
Protocol For: Personally Furnishing Naloxone Update Log Updated By: Reason for Update: Date: Approved By: K. Benick RN Original draft 6/7/16 Pam Butler Protocol: Personally Furnishing Naloxone_Morrow County
More informationIS PERCOCET GOOD TATTOO PAIN RELIEVER FOR DOGS
IS PERCOCET GOOD TATTOO PAIN RELIEVER FOR DOGS Is Percocet Good Tattoo Pain Reliever For Dogs Can u mix percocet and suboxone Take suboxone with percocet How much does percocet prescription cost Oxycodone
More informationNALOXONE: HEALTHCARE PROFESSIONALS TRAINING GUIDE FOR ADMINISTRATION AND DISPENSING
NALOXONE: HEALTHCARE PROFESSIONALS TRAINING GUIDE FOR ADMINISTRATION AND DISPENSING Kaitlyn Bernard, PharmD PGY-1 Pharmacy Practice Resident November 18, 2017 Objectives Explain the impact of the opioid
More informationAddressing the Opioid Epidemic Naloxone and its Role in Prevention of Opioid Overdose Death May 24, 2018
Addressing the Opioid Epidemic Naloxone and its Role in Prevention of Opioid Overdose Death May 24, 2018 Five Pillars Today s Speaker Elizabeth Skoy, PharmD Associate Professor of Pharmacy Practice North
More informationMainstreaming naloxone rescue kits from harm reduction programs to pharmacies, police and fire responders
Mainstreaming naloxone rescue kits from harm reduction programs to pharmacies, police and fire responders Alexander Y. Walley, MD, MSc Boston University School of Medicine ThINC Bergen 2015 Conference
More informationSULLIVAN COUNTY Drug Abuse Prevention Task Force
SULLIVAN COUNTY Drug Abuse Prevention Task Force Joseph A. Todora LMSW, Commissioner Sullivan County Division of Health ans Family Servies 17 Community Lane Liberty, NY 12754 MISSION: The mission of the
More informationOpioid Prescribing Guidelines for Patients in the Emergency Department
Opioid Prescribing Guidelines for Patients in the Emergency Department and Immediate Care Centers These guidelines are meant to assist clinicians in treating patients with acute and chronic pain in the
More informationOverdose Prevention, Recognition & Response Education Train-the-Trainer
Overdose Prevention, Recognition & Response Education Train-the-Trainer Bernie Lieving, MSW Overdose Prevention Education Coordinator Santa Fe Prevention Alliance & Office of Substance Abuse Prevention
More informationsome things you should know about opioids before starting a prescription an informational booklet for opioid pain treatment
some things you should know about opioids before starting a prescription an informational booklet for opioid pain treatment This booklet was created to help you learn about opioids. You probably have lots
More informationPL CE LIVE: Overdose Prevention with Naloxone Opportunities for Pharmacists May 2015
PL CE LIVE: Overdose Prevention with Naloxone Opportunities for Pharmacists May 2015 Supplemental Information Background Most people who abuse prescription opioids get them for free from a friend or relative
More informationBree Collaborative AMDG Opioid Prescribing Guidelines Workgroup. Opioid Prescribing Metrics - DRAFT
Bree Collaborative AMDG Opioid Prescribing Guidelines Workgroup Opioid Prescribing Metrics - DRAFT Definitions: Days Supply: The total of all opioid prescriptions dispensed during the calendar quarter
More informationRP PERCOCET STREET VALUE
RP 5 325 PERCOCET STREET VALUE Rp 5 325 Percocet Street Value Max dose of percocet a day Urgent care percocet bothell wa 98012 directions I need a substitute for percocet 10/325 percocet Percocet constipation
More informationOpioids: Public Health Crisis Local Solutions: National Epidemic
Opioids: Public Health Crisis Local Solutions: National Epidemic Nancy McGraw, LCSW, MBA Public Health Director Sullivan County Public Health Services 50 Community Lane Liberty, NY 12754 Luis Alvarez,
More informationNALOXONE AND OVERDOSE PREVENTION EDUCATION PROGRAM OF RHODE ISLAND
NALOXONE AND OVERDOSE PREVENTION EDUCATION PROGRAM OF RHODE ISLAND Law Enforcement and Public Safety!!!!!!! Ariel Engelman NOPE-RI Coordinator 1 Opioids and Overdose in Rhode Island 2 Opioids and Overdose
More information15 mg morphine 10 mg hydrocodone
Cari untuk: Cari Cari 15 mg morphine 10 mg hydrocodone 3-2-2013 Convert From CALCULATED MORPHINE EQUIVALENT BY RESOURCE: Average ( mg ) Range ( mg ) Standard Deviation of Sample ( mg ) Hydrocodone. I usually
More informationPATIENT INFORMATION NARCAN (nar kan) (naloxone hydrochloride) Nasal Spray
PATIENT INFORMATION NARCAN (nar kan) (naloxone hydrochloride) Nasal Spray You and your family members or caregivers should read this Patient Information leaflet before an opioid emergency happens. This
More informationNaloxone Administration Training
Naloxone Administration Training Welcome! Welcome to the online training for naloxone administration The Presenter Dr. Joe Parks, Medical Director, Distinguished Professor, Missouri Institute for Mental
More informationThe Use of Naloxone in Workers Compensation. A Workers Compensation Continuing Education Course
The Use of Naloxone in Workers Compensation A Workers Compensation Continuing Education Course January 19, 2017 This course was previously presented on July 28, 2016. If you attended the course on that
More informationAN OVERVIEW OF THE PRESENTATION AND TREATMENT OF OPIOID OVERDOSE
AN OVERVIEW OF THE PRESENTATION AND TREATMENT OF OPIOID OVERDOSE Jasmine Carpenter, Pharm. D, BCPS, BCPP Clinical Pharmacy Specialist-PACT Mental Health Veterans Affairs Medical Center, Washington DC OBJECTIVES
More informationSlow Release Opioids. Morphine (Zomorph/MST) Oxycodone (Longtec, Oxycontin) Tapentadol (Palexia) For the Treatment of Pain
NHS Greater Glasgow And Clyde Pain Management Service Information for Adult Patients who are Prescribed Slow Release Opioids Morphine (Zomorph/MST) Oxycodone (Longtec, Oxycontin) Tapentadol (Palexia) For
More informationThe Missouri Opioid-Heroin Overdose Prevention and Education (MO-HOPE) Project Mission: to reduce opioid overdose deaths in Missouri through expanded
The Missouri Opioid-Heroin Overdose Prevention and Education (MO-HOPE) Project Mission: to reduce opioid overdose deaths in Missouri through expanded access to naloxone, overdose education, prevention,
More informationTake Home Naloxone elearning Module Script
elearning Module Script Slide 1-3 Review the outline and the plan for the presentation. Slide 4 We do accept the cynicism of this poster. Slide 5 Read from the slide the definition of Harm Reduction Slide
More informationPrescription Drugs MODULE 5 ALLIED TRADES ASSISTANCE PROGRAM. Preventative Education: Substance Use Disorder
Prescription Drugs MODULE 5 ALLIED TRADES ASSISTANCE PROGRAM Preventative Education: Substance Use Disorder Misuse of prescription pain relievers is, after marijuana use, the second most common form of
More informationTO YOUR PHARMACIST TOOLKIT. A Guide to Help Utah Pharmacists Talk to Customers About Prescription Opioids
TALK TO YOUR PHARMACIST TOOLKIT A Guide to Help Utah Pharmacists Talk to Customers About Prescription Opioids Acknowledgements This report was made possible by the following individuals and agencies: Stephanie
More informationBe courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off.
1 2 EMT OPTIONAL SKILL Naloxone Intranasal Cell Phones and Pagers Be courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off. 3 4 5 6 Course Outline Introduction
More informationGeneric Label Name Drug Strength Dosage Form Example Product (s) MME/Unit ACETAMINOPHEN WITH CODEINE
STATE OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF HEALTH CARE FINANCE AND ADMINISTRATION BUREAU OF TENNCARE 3 Great Circle Road NASHVILLE, TENNESSEE 37243 This notice is to advise
More informationProject Narcan: BPD officers equipped with life-saving rescue drug
From: Kelli Williams, Chief Communications Officer City of Bartlesville Date: Oct. 24, 2017 For release: Immediate Project Narcan: BPD officers equipped with life-saving rescue drug By Kelli Williams City
More information2/21/2018. What are Opioids?
Opioid Crisis: South Carolina Responds Carolyn Bogdon, MSN, FNP-BC Coordinator for Emergency Department Medication Assisted Treatment Program Medical University of South Carolina Opioid Crisis: A Mounting
More informationOVERDOSE PREVENTION AND EDUCATION OVERDOSE MANAGEMENT
OVERDOSE PREVENTION AND EDUCATION OVERDOSE MANAGEMENT 1 OBJECTIVES Discuss basics of opioid overdose epidemiology and physiology To share accurate information about overdose prevention and education including
More informationDrug Class Review: Opioid Reversal Agents
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationOPIOIDS. Questions about opioids, and the Answers that may SURPRISE YOU. A booklet for people who may benefit from reducing or stopping their opioid
OPIOIDS Questions about opioids, and the Answers that may SURPRISE YOU A booklet for people who may benefit from reducing or stopping their opioid Generic Name morphine hydromorphone oxycodone tramadol
More informationOPIOIDS. Questions about opioids, and the Answers that may SURPRISE YOU. A booklet for people who may benefit from reducing or stopping their opioid
OPIOIDS Questions about opioids, and the Answers that may SURPRISE YOU A booklet for people who may benefit from reducing or stopping their opioid Generic Name morphine hydromorphone oxycodone tramadol
More informationIMPLEMENTATION OF A SHARED MEDICAL APPOINTMENT FOR OPIOID OVERDOSE EDUCATION AND NALOXONE KIT TRAINING FOR VETERANS Kristin A. Tallman, Pharm.
IMPLEMENTATION OF A SHARED MEDICAL APPOINTMENT FOR OPIOID OVERDOSE EDUCATION AND NALOXONE KIT TRAINING FOR VETERANS Kristin A. Tallman, Pharm.D, BCPS Clinical Pharmacy Specialist Providence Medical Group
More informationThere are no financial or other pertinent conflicts of interest to disclose. Learning Objectives: Key Questions To Ask 10/4/2014
Maintaining Patient Safety When Chronic Opioid Therapy Is Prescribed P. David Pacheco, Ph.C, PA-C, CAAAPM Pain Medication Management Specialist Southwest Interventional Pain Specialists, PC 4700 Jefferson
More informationHow to Save a Life: Naloxone for the Treatment of Opioid Overdose
How to Save a Life: Naloxone for the Treatment of Opioid Overdose Brandon Antinopoulos, PharmD PGY1 Community Practice Resident University of Pittsburgh School of Pharmacy & Pennsylvania Pharmacists Association
More informationMaryland Overdose Response Program CORE CURRICULUM
Maryland Overdose Response Program Educational Training Program CORE CURRICULUM May 31, 2017 Behavioral Health Administration Department of Health & Mental Hygiene dhmh.naloxone@maryland.gov Program Overview
More informationDisclosure. State of Connecticut Naloxone Training Program. Introduction. Objectives. Background. Epidemiology 8/28/2018
State of Connecticut Naloxone Training Program Developed by: Department of Consumer Protection Drug Control Division Connecticut Pharmacists Association Department of Mental Health and Addiction Services
More informationCapital BlueCross Open/Closed Formulary Update (1 st Quarter 2017)
Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017) The Capital BlueCross formulary is a reference list of prescription drugs that contains a wide range of generic and brand drugs that have
More informationOpioids and Heroin in Snohomish County. Marijuana and Opioid Prevention Training May 2018
Opioids and Heroin in Snohomish County Marijuana and Opioid Prevention Training May 2018 OPIOIDS 101 What are Opioids? Opioids 101 Opium Poppy Plant Opiates: A type of pain medication that is naturally
More informationPatient and Family Agreement on Opioids
Patient and Family Agreement on Opioids We care about our patients and are committed to their recovery and wellness. We offer our patients medications and options for various services to keep them from
More informationPennsylvania DEPARTMENT OF HEALTH
Pennsylvania DEPARTMENT OF HEALTH Updated: 01/10/2018 XI. XII. KEY INFORMATION 1. If you believe, someone is experiencing an opioid overdose, call 911! 2. Remain with the person until first responders
More informationNaloxone Intranasal EMT OPTIONAL SKILL. Cell Phones and Pagers. Course Outline 09/2017
EMT OPTIONAL SKILL Naloxone Intranasal Cell Phones and Pagers Be courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off. Course Outline Introduction and Overview
More informationReducing opioid overdose mortality: role of communityadministered
Reducing opioid overdose mortality: role of communityadministered naloxone Vennus Ballen, MD, MPH; Lara Maldjian, MPH New York City Department of Health and Mental Hygiene Clinical Director s Network (CDN)
More informationPrescription Drug Misuse/Abuse in Seniors. April Rovero Founder/Executive Director
Prescription Drug Misuse/Abuse in Seniors April Rovero Founder/Executive Director Deaths per 100,000 Population 30 25 Overdose Demographics Drug Poisoning Death Rates by Age: United States (2010) 20 15
More informationWORRIED ABOUT PAIN AFTER ORAL SURGERY?
WORRIED ABOUT PAIN AFTER ORAL SURGERY? OPIOIDS ARE NOT THE ONLY WAY TO MANAGE PAIN Ask your doctor about opioid-free EXPAREL EXPAREL is indicated for single-dose infiltration in adults to produce postsurgical
More informationOPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN
OPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN ANTOINETTE BROWN, RPH LAUREL RAMER, 2019 PHARMD CANDIDATE 2018 WYOMING CONFERENCE ON AGING LARAMIE, WY OCTOBER 3, 2018 OBJECTIVES 1. Understand the
More informationMEDICATION ASSISTED TREATMENT
MEDICATION ASSISTED TREATMENT MODULE 14 ALLIED TRADES ASSISTANCE PROGRAM PREVENTATIVE EDUCATION: SUBSTANCE USE DISORDER Medication Assisted Treatment Types of Medication Assisted Treatment: Methadone Naltrexone
More informationOpioid Prescribing for Acute Pain
Patient Reference Guide Opioid Prescribing for Acute Pain Care for People 15 Years of Age and Older Quality standards outline what high-quality care looks like. They focus on conditions or topics where
More informationBuprenorphine Patch (Transtec Patch)
NHS Greater Glasgow And Clyde Pain Management Service Information for Adult Patients who are Prescribed Buprenorphine Patch (Transtec Patch) For the Treatment of Pain Contents Page What is a transtec patch?...
More informationA Bill Regular Session, 2015 SENATE BILL 880
Stricken language would be deleted from and underlined language would be added to present law. Act of the Regular Session 0 State of Arkansas 0th General Assembly As Engrossed: S// H// A Bill Regular Session,
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Opioid Analgesics Reference Number: HIM.PA.139 Effective Date: 12.01.17 Last Review Date: 11.17 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the
More informationOpiate Use Disorder and Opiate Overdose
Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5
More informationCONCERNED ABOUT TAKING OPIOIDS AFTER SURGERY?
CONCERNED ABOUT TAKING OPIOIDS AFTER SURGERY? ASK YOUR DOCTOR ABOUT EXPAREL FOR LONG-LASTING, NON-OPIOID PAIN RELIEF. VISIT EXPAREL.com/patient FOR MORE INFORMATION. YOU HAVE A SAY IN HOW YOUR PAIN IS
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 4000-3 Program Opioid Overutilization Cumulative Drug Utilization Review Criteria Medication Includes all salt forms, single and
More informationNew Guidelines for Prescribing Opioids
New Guidelines for Prescribing Opioids Keeping Your Claimants Safe Presented by: Dr. Mitch Freeman, Pharm.D. Chief Clinical Officer, Pharmacy Solutions Agenda The Opioid Challenge Today How We Got Here
More informationDECEMBER 7, 2017 THE OPIOID EPIDEMIC & THE UNIVERSITY S RESPONSE
DECEMBER 7, 2017 THE OPIOID EPIDEMIC & THE UNIVERSITY S RESPONSE Agenda Welcome & Introductions Trending Articles The Opioid Epidemic Key Updates What are Opioids? Chemically similar to heroin, prescribed
More informationUnderstanding and Combating the Heroin Epidemic
Understanding and Combating the Heroin Epidemic Kelly Dunn, Ph.D. Assistant Professor; Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences 1 Talk Outline What is causing the
More informationBraintree Public Schools
Braintree Public Schools Policy and Procedures for School Nurse, Athletic Director and Athletic Trainer Management of Potential Life Threatening Opioid Overdose Program Policy In order to recognize and
More informationPROP PILLS PERCOCET BONANZA
PROP PILLS PERCOCET BONANZA Prop Pills Percocet Bonanza Snort percocet 5 mg Tramadol 100 mg stronger than percocet 10/325 percocet Allergy to percocet vs norco strengthening exercises pdf How to lose weight
More informationNARCAN? YOU CAN!: A LEGISLATIVE & CLINICAL UPDATE ON NALOXONE
NARCAN? YOU CAN!: A LEGISLATIVE & CLINICAL UPDATE ON NALOXONE Stephanie Nichols, PharmD, BCPS, BCPP Associate Professor, Husson University Nicholss@husson.edu Why did you become a pharmacy professional?
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: HIM.PA.139 Effective Date: 12.01.17 Last Review Date: 02.18 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the end of this policy
More information2/20/2017 NALOXONE PRESCRIPTIONS FOR OVERDOSE: OUTSIDE OF MISUSE AND ABUSE DISCLOSURES LEARNING OBJECTIVES
NALOXONE PRESCRIPTIONS FOR OVERDOSE: OUTSIDE OF MISUSE AND ABUSE Brett Badgley Snodgrass FNP-C, CPE, FACPP, FAANP Consultant/Independent Contractor: McNeil Pharmaceuticals, Purdue Pharmaceuticals Speaker's
More information