Opportunities for Opioid Safety and Community-Based Overdose Management

Transcription

1 Opportunities for Opioid Safety and Community-Based Overdose Management DANTE COLLINS ERICA C. ERNST MAYA DOE-SIMKINS SEPTEMBER 13, 2013

2 Overview Prevalence & data Overdose prevention Making an overdose plan Recognizing & responding to an overdose Experiences talking with drug users Additional organizational strategies

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4 Some vocabulary Narcan = naloxone hydrochloride naloxone is NOT naltrexone (Vivitrol, Revia ) Suboxone = buprenorphine + naloxone naloxone -> discourage people from injecting Subutex = buprenorphine

5 Prevalence & data

6 NCHS, 2012

7 Mortality, overdose & homeless people Homeless people overall mortality rate 25 to 44-9x 45 to x Deaths from (comparable demographic) Homeless men- 16x higher Homeless women- 24x Baggett et al. JAMA Intern Med 2013

8 Macro strategies to address overdose Prescription monitoring programs (Paulozzi et al. Pain Medicine 2011) Prescription drug take back events (Gray et al. AIM 2012) Abuse deterrent formulations (Cicero et al. NEJM 2012) Safe opioid prescribing education (Albert et al. Pain Medicine 2011) Expansion of opioid agonist treatment (Clausen et al. Addiction 2009) Supervised injection facilities (Marshall et al. Lancet 2011) Take home naloxone (OEND) (Walley et al. BMJ 2013)

9 Tailoring the content We want to make sure we touch on questions & thoughts you have- what would you like to make sure we discuss today?

10 Preventing an overdose

11 Increased Risk Of Overdosing Mixing drugs Variation in strength and content of street drugs (purity) Tolerance changes (coming out of jail/tx) Using alone Physical health (liver function, weight loss, smoking, etc.) Transient living new dealers/new product Thinking you know everything Switching from sniffing/swallowing to injection

12 How Can You Lower Your Personal Risk Of Overdose? Stop using Engage in treatment Know your tolerance If relapse, start low and go slow Avoid mixing substances Use when others are around Train your network to call for help, rescue breathe, and administer naloxone Encourage your network to get a naloxone rescue kit Keep a kit where you use Tailor this plan to the client s situation

13 Sample Prevention Messages I want to remind you that (BECAUSE OF) your tolerance is very low, you are at high risk for an overdose Do you have an overdose plan? Do you and your friends know about naloxone? I don t want anything to happen to you If you relapse please do not do it alone People, places & things have a way of reappearing- it is my responsibility to make sure you have access to the skills & information to survive, no matter what happens

14 Strategies for preventing overdose Always use with someone else Always get your drugs from the same person Taste or use a smaller amount if a new provider Taste or use a smaller amount if you have been clean for a period (voluntary, hospitalization, incarceration) Don t mix with other drugs or ETOH Keep an overdose kit wherever you use Have an overdose plan

15 Making an overdose plan CHALLENGES PERSONAL PROCESS

16 OD plans affect: Individuals People around individuals v=_a_1qrohxw8u1frpjowtkw# action=share v=_a_1qrohxw8

17 Recognizing really high vs overdose Really high Pupils pinned Nodding, but arousable Responds to sternal rub Speech is slurred Sleepy, intoxicated, but breathing 8 or more times per minute Overdose Pupils pinned Not arousable No response to sternal rub Breathing slow or stopped Less than 8 times per minute May hear choking sounds or a gurgling/snoring noise Blue lips, blue fingertips >> Stimulate and observe >> Rescue breathe + give naloxone

18 Responding to an overdose

19 How do opioids affect breathing? Opioid Receptors, brain Opioid

20 If an overdose happens 1. Call 911 (you don t have to say that it is an OD) 2. Rescue breathing 3. Give naloxone 4. Keep breathing for the person?another dose of naloxone? (3-5 min) Rescue position

21 Rescue Position

22 How does naloxone affect overdose?

23 Experiences talking with fellow drug users

24 Some people are very interested in hearing more about overdose prevention Some people are not

25 More organizational strategies

26 Materials Referrals More ways to address overdose Ask clients/stakeholders what they want 911 Good Samaritan Make public space for overdose & join in

27 Message: Alive is more important than abstinent! Program restroom

28 PUD take care of each other: Drug using status of responders Enrollments Nondrug Users 31% Nondrug Users 13% Overdose rescues Drug Users* 69% Drug Users* 87% *Active + in treatment + in recovery Walley, BMJ, 2013

29 More ways to address overdose Address OD in counseling Mental health SUD Tx Upon entry Discharge planning Relapse prevention Screen for overdose risk Organize Rx disposal event Develop an organizational overdose policy Support dialogue & activism

30 Public displays; collective grief; tangible activism Lobbying for 911 Good Sam in MOquilt- 400

31 Public displays; collective grief; tangible activism Quilt detail

32 Public displays; collective grief; tangible activism International Overdose Awareness Day, Schaumberg

33 Public displays; collective grief; tangible activism Terri preparing for vigil

34 Public displays; collective grief; tangible activism OD vigil, Yarmouth

35 Public displays; collective grief; tangible activism Overdose Awareness Day, Gloucester

36 Public displays; collective grief; tangible activism 911 Good Samarian advocacy, NY

37 Ongoing remembrance; Increased awareness

38 Ongoing remembrance; Increased awareness

39 Ongoing remembrance; Increased awareness

40 Ongoing remembrance; Increased awareness

41 Ongoing remembrance; Increased awareness

42 Take home points Addressing overdose: Life affirming Enhances provider-patient relationship Response to fatalism Activates and soothes community members Creates community Sample policies? me:

43 MAYA DOE-SIMKINS ERICA C. ERNST DANTE COLLINS (773)

44 Overdose Education and Naloxone Distribution Program Reach 2010 States w/ OENDs 15 Programs 188 People enrolled 53,032 OD rescues 10,171 Wheeler E et al. Morb Mortal Wkly Rep 2012

45 Evaluations of OEND programs Feasibility Walley et al. JSAT 2013; 44:241-7 (Methadone and detox programs) Bennett et al. J Urban Health. 2011: 88; Enteen et al. J Urban Health 2010:87: Doe-Simkins et al. Am J Public Health 2009: 99: Piper et al. Subst Use Misuse 2008: 43; Increased knowledge and skills Wagner et al. Int J Drug Policy 2010: 21: Tobin et al. Int J Drug Policy 2009: 20; Green et al. Addiction 2008: 103; No increase in use, increase in drug treatment Seal et al. J Urban Health 2005:82: Wagner et al. Int J Drug Policy 2010: 21: Reduction in overdose in communities Maxwell et al. J Addict Dis 2006:25; Evans et al. Am J Epidemiol 2012; 174: Walley et al. BMJ 2013; 346: f174 Cost effective Coffin & Sullivan Ann Internal Med 2013; 158: 1-9

46 Reduction in community OD death rate Naloxone coverage per 100K Opioid overdose death rate 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 27% reduction 46% reduction No coverage ppl 100+ ppl Funding: CDC National Center for Injury Prevention and Control 1R21CE Walley, BMJ 2013