Steve Alsum. The Grand Rapids Red Project. (616)

Transcription

1 Steve Alsum The Grand Rapids Red Project (616)

2 Red Project Basics Overdose Epidemiology Naloxone Distribution Overview Locally And In Michigan Innovative National Models A How To

3 A 501c3 non-profit founded in 1998 Mission: Improve Health, Reduce Risk, Prevent HIV We utilize a Harm Reduction philosophy The space in between prevention & treatment Meeting people where they are at Providing a range of options Client centered Low threshold approach Pre-recovery supports Health Issues: HIV, Hepatitis C, and Overdose

4 Deaths / 100,000 Living Kent County Mortality Rates Narcotic Overdose Viral Hepatitis 3 2 HIV/AIDS related Year

5 Deaths/ 100,000 living Michigan Mortality Rates Narcotic Overdose Viral Hepatitis HIV/AIDS related Year

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7 We are in the midst of a national epidemic 38,000 deaths annually Michigan is now one of 16 states in which drug related causes now kill more people than automobile accidents Kent County has not been spared. OD Deaths are highly preventable!

8 Most immediate health concern of the people we serve Kills more people in Kent County each year than HIV and HCV combined Kills more people than are in infected with HIV each year Leading cause of accidental death of ALL people aged 0-65 From 1994 to 2012 fatalities increased sixfold from about 15 deaths to 97 Where is the public health outcry?

9 Overdose Fatalities Kent County Overdose Fatalities by Drug of First Mention Total Total Opioid ODs 40 Narcotic Analgesic 20 Heroin/Morphine Methadone Year

10 In most of this presentation I use data from Kent County, because we have relatively good data Kent County is representative of MI, MI is of the US Data issues arise in Medical Examiner coding of deaths For an excellent statewide report on OD see: A Profile of Drug Overdose Deaths Using the Michigan Automated Prescription System _ ,00.html

11 Total Deaths Mean age: 41 years Kent County Overdose Fatalities <25 25 to to to 54 >54 Age Group

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14 Naloxone HCl is an unscheduled prescription medication both federally and in the state of MI. Naloxone is a medication used solely for the prevention and reversal of opiate overdoses. Naloxone is pretty much a pure antidote for opiates. It will have little or no effect on people without opiates in their system. Naloxone is so safe and effective that often when someone presents unresponsive medical personnel will administer Naloxone without knowing whether or not an overdose has occurred. Naloxone was FDA approved in 1971 for first responders to use to respond to overdose situations

15 Red Project Program Data October 2008 January 2014 Over 650 individuals trained Our average client has witnessed 5.87 overdoses, of which only 1.98 have resulted in a 911 call Since 2000 many programs have shown that lay-people (people who use opioids, their families & friends) can be trained in safely and effectively responding to opioid overdoses with naloxone hydrochloride

16 CDC MMWR, June 18, 2015 Nationally there were 136 local overdose prevention programs that distribute Naloxone From Trained 152,283 people 26,463 reported reversals Multiple Models For Successful Programming Syringe Access/Harm Reduction-Chicago Recovery Alliance, etc Point of Prescription/Medical Model-Project Lazarus State Health Department- Massachusetts, etc The Take Away: Finding ways to put tools in hands to save lives

17 In October 2008, Red Project chooses to address this issue Naloxone HCl, and first responders Prevention, Risk Reduction & SCARE ME

18 Mixing Multi-Drug Use Alcohol Consumption Tolerance/Period of Abstinence Quality Unregulated drugs Unfamiliar medications Using alone Decreased Health Decreased Breathing Function Prior History of Overdose

19 Stimulation Call for Help Airways Rescue Breathing Evaluation Muscular Injection Evaluate/Support

20 Naloxone Hydrochloride 4 IM Syringes Training DVD & Instructions Rescue breathing barrier, alcohol pads, gauze, rubber gloves Information on our program all in a recognizable bag

21 Clean Works Program- October 2008 Cherry St Health Methadone Clinic Network 180 and SUD Treatment SA Turning Point, Arbor Circle IOP, Our Hope, Jellema House, Freedom House, Cherry St Health Methadone Clinic, Degage Open Door Women s Shelter, Network 180 Access Center, etc Results (as of 8/31/2015) 1,934 individuals trained which has led to 258+ reported reversals The Future Increased local collaboration/partnerships Technical assistance and program support in out-state

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23 The legal status of community based overdose prevention with naloxone in MI Funding overdose prevention and intervention efforts Other successful models to address overdose fatality Institutional and national supporters

24 Naloxone is an unscheduled prescription medication both nationally and in Michigan PA signed into law October 2014 Allow prescription to anyone Allows prescription to an organization Allow administration to anyone Eliminates potential criminal and civil liability, and professional disciplinary action, for prescribers and end-users Naloxone is one of the easiest/safest medications to prescribe, we need to make it easier to obtain Still no Good Samaritan legislation

25 SAMSHA has released guidance on utilizing block grant funds to support OD prevention efforts with naloxone Staffing Naloxone rescue kits In Kent County, Network 180 uses liquor tax dollars to fund OD prevention efforts at Red Project Staffing Naloxone rescue kits

26 Project Lazarus Prescribe to Prevent Collaborative Practice Agreements Equipping Law Enforcement

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28 Community Engagement 2008: Wilkes County, NC has 6 th highest OD mortality rate in nation Fatality is caused primarily by prescription opioids Work with doctors to train individuals receiving opioid prescriptions in how to respond to overdose with Naloxone OD deaths down 69% between 2009 and 2011 Less than 1% change in how many residents had a prescription for an opioid pain reliever in Wilkes County In % of OD fatality victims had a prescription from a Wilkes County prescriber, in 2011 this decreased to 0%

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30 The prevention of drug overdoses is consistent with the Board's statutory mission to protect the people of North Carolina. The Board therefore encourages its licensees to cooperate with programs like Project Lazarus in their efforts to make naloxone available to persons at risk of suffering opioid drug overdose.

31 A comprehensive resource for organizations and doctors looking to integrate take-home Naloxone into their service delivery Sections specific to providers of: Pain Management Emergency Medicine Substance Use Disorder Website includes resources related to: Research, Medical, Legal, Training, Billing, Program Locator, etc

32 Received emergency medical care involving opioid intoxication or poisoning Suspected history of substance abuse or nonmedical opioid use Prescribed methadone or buprenorphine Higher-dose (>50 mg morphine equivalent/day) opioid prescription

33 Receiving any opioid prescription for pain plus: Rotated from one opioid to another because of possible incomplete cross tolerance Smoking, COPD, emphysema, asthma, sleep apnea, respiratory infection, or other respiratory illness or potential obstruction. Renal dysfunction, hepatic disease, cardiac illness, HIV/AIDS Known or suspected concurrent alcohol use Concurrent benzodiazepine or other sedative prescription Concurrent antidepressant prescription Patients who may have difficulty accessing emergency medical services (distance, remoteness) Voluntary request from patient or caregiver

34 Anyone currently using opioids Individuals using opioids as prescribed Individuals abusing prescription opioids Individuals using or abusing other opioids Anyone with a history of opioid abuse Relapse can be a part of recovery, and in relapse there is extreme danger of overdose If an individual is allergic to bee-stings they have an epi-pen: We need to look at naloxone rescue kits in the same way

35 CA and RI recently passed new legislation that allows a pharmacist to issue a naloxone rescue kit without the patient seeing a doctor New legislation is unnecessary in Michiganwe already do this with other medications Think flu shots and vaccinations Benefits Rural communities Seeing a doctor could be a barrier Stigma

36 Law enforcement, as first responders, often witness overdose Nationally, this has been a successful strategy PA 462 (SB 1049) of 2014 allows equipping law enforcement in Michigan Local Models: Benzie County, Macomb Barriers- no Good Sam, calling 911 Benefits Law enforcement buy-in after a reversal A positive role within the community First responders

37 American Medical Association, American Public Health Association, American Society of Addiction Medicine, Office of National Drug Control Policy, Us Conference of Mayors, National Coalition Against Prescription Drug Abuse, United Nations Office on Drugs and Crime, National Alliance of State and Territorial AIDS Directors, Substance Abuse and Mental Health Services Administration

38 Impeding [the IDU] population from obtaining or using sterile syringes amounts to prescribing death as a punishment for illicit drug use. Source: Human Rights Watch, Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation, April 2004, Vol. 16, No. 5, p.3

39 Doing Your Research Options and Opportunities Selecting a Model Core Components Medical Director Training Naloxone

40 What does overdose look like in your area? Prescription opioids/heroin Data Sources Medical Examiner Reports Hospital/ER admissions Emergency Medical Services MDHHS CDC Wonder Mortality Database What does your community look like? Who will you target? PWUD, Family Members, Providers, etc

41 Your Provider Network/Potential Partners SUD Providers Medical Providers Pharmacies First Responders Community Based Organizations Do you have a potential funder? Community based funding Local foundations Substance use dollars Billing insurance

42 Community Based Integrated Into Treatment Pharmacy Collaborative Practice Agreement First Responders Point of Prescription

43 Naloxone can be prescribed like any other medication- the issue is physician awareness PA 311 of 2014 allows prescription to: Third parties, ie family members, friends, etc An organization that: Acts at the direction of a prescriber Stores the naloxone properly Dispenses the naloxone under a valid prescription to a patient Performs requirements without charge or compensation PA 462 of Law Enforcement No matter what model: a physician must be involved at some point in the process

44 Why are we here? To train community health responders What is an overdose? Why do people die of overdoses? What do people overdose on? Opioids, and the role of naloxone Overdose risk/prevention Mixing, tolerance, quality, using alone, etc Recognizing an overdose The line Responding to an overdose S.C.A.R.E. M.E. courtesy of CRA Naloxone kit assembly/storage/legality

45 Naloxone Rescue Kit Options Intramuscular ($40-50) Intranasal ($105) Auto-injector ($650) Stocking and assembling the kit Will you do this yourself? Or work with a pharmacy? Paying for the kit Some options are more affordable than others Work with your insurance companies- this is cost effective no longer cost effective at a cost of $4,480/kit- Coffin et al. AIM 2013; 158: 1-9.

46 Trauma Empowerment Enhancing the therapeutic relationship

47 Massachusetts provides overdose education and naloxone distribution on a statewide level, supported through their health department Walley et al. BMJ 2013; 346: f174. found that: 0 kits per 100,000 people resulted in a 0% change kits/100,000 people resulted in a 27% reduction in community overdose mortality rates >100 kits/100,000 resulted in a 46% reduction Decreasing overdose mortality is dependent on increasing naloxone kit distribution

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49 The Chicago Recovery Alliance and Dan Bigg Network 180 Our Physicians Dr Vernon Proctor Dr Sandra Dettmann Dr Cara Poland Our Staff Our Clients They do the real work

50 Centers for Disease Control Kent County Medical Examiner Red Project Internal Data Physicians Desk Reference The Chicago Recovery Alliance MDHHS Project Lazarus Prescribe to Prevent Coffin et al Walley et al