State Agencies Approval PA
|
|
- Sabina May
- 5 years ago
- Views:
Transcription
1 State Agencies Approval PA Version 1.0 1
2 ACPE Information The Illinois Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The online training is approved for 1.75 hours (0.175 CEUs) of continuing pharmacy education credit. UAN: H04-P Contact Hours: 1.75 Hours Initial Release Date: Planned Expiration Date: March 11, 2019 Target Audience: Pharmacists in all practice settings Continuing Pharmacy Education Requirements This activity is structured to meet knowledge-based educational needs and acquire factual knowledge. Information in knowledge-type activities is based on evidence as accepted in the literature by the health care professions. Continuing pharmacy education (CPE) credit will be earned based on participation in the activity. Participation is required before obtaining CPE credit. Participants must complete an activity evaluation and posttest (if applicable) with a passing score of 70 percent or greater. This activity is accredited through ACPE for pharmacist continuing pharmacy education credit. If all requirements are met, participants will receive continuing pharmacy education credit in the following manner. Partial credit will not be awarded. Please allow 60 days for processing. Pharmacists CPE Monitor, a national, collaborative effort by ACPE and the National Association of Boards of Pharmacy (NABP) to provide an electronic system for pharmacists and technicians to track their completed CPE credits, went into effect on January 1, IPhA, as an ACPE-accredited provider, is required to report pharmacist CPE credit using this tracking system. Pharmacist participants must provide their NABP e- Profile Identification Number and date of birth (in MMDD format) when they register for a CPE activity or complete activity evaluations. It will be the responsibility of the pharmacist to provide the correct information (e-profile Identification Number and Date of birth in MMDD Format). If this information is not provided, NABP and ACPE prohibit IPhA from issuing CPE Credit. Online access to their inventory of completed credits will allow pharmacists to easily monitor their compliance with CPE requirements and print statements of credit. Therefore, IPhA will not provide individual printed statements of credit to pharmacists. For additional information on CPE Monitor, including e-profile set-up and its impact on pharmacists and pharmacy technicians, go to Faculty Kelly Gable, PharmD, BCPP Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville kgable@siue.edu Chris Herndon, PharmD, BCPS Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville cherndo@siue.edu Jessica Kerr, PharmD, CDE Assistant Chair and Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville jekerr@siue.edu Garth Reynolds, BSPharm, RPh Executive Director Illinois Pharmacists Association greynolds@ipha.org Version 1.0 2
3 Disclosures/Conflicts of Interest The Speakers of this continuing education program, do not have financial relationships or conflicts of interests. The content of this webinar may include information regarding the use of products that may be inconsistent with, or outside the approved labeling for, these products in the United States. Pharmacists should note that the use of these products outside current approved labeling is considered experimental and are advised to consult the prescribing information for these products Learning Objectives 1. Describe the opioid abuse and overdose epidemic on a state and national level. 2. Review unique pharmacological properties of commonly prescribed opioids and heroin. 3. Discuss the neurobiology of addiction and opioid use disorder. 4. Understand risk factors, signs of an opioid overdose, and the role of opioid antagonist therapy. 5. Describe the role of pharmacy personnel in opioid overdose management. 6. Evaluate key elements of patient and caregiver education on opioid overdose management. 7. Discuss standardized procedures, naloxone standing order sets, and clinical documentation. Version 1.0 3
4 Opioid Abuse and the Overdose Epidemic Kelly Gable, PharmD, BCPP Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville Alarming Statistics - An Epidemic The CDC has officially declared prescription drug abuse in the US an epidemic 1 in 20 people report using prescription opioids for non-medical reasons In 2010, enough opioid pain relievers were sold to medicate every adult in the US with 5 mg of hydrocodone every 4 hours for 1 month In 2014, ~1.9 million people had an opioid use disorder related to prescription pain relievers and ~586,000 had an opioid use disorder related to heroin use Only 16% of Americans believe that the US is making progress in its efforts to reduce prescription drug abuse Version 1.0 4
5 Version 1.0 5
6 Overdose Deaths Each day, ~46 people in the United States die from overdose of prescription pain medications >47,000 Americans died of a drug overdose in 2014, an increase of 7% from 2013 >50% were related to pharmaceuticals (~70% involved opioid analgesics and 30% involved benzodiazepines) The increase was driven largely by deaths from heroin + prescription opioids Women who lost their lives opioid overdoses rose 415% between 1999 and 2010 Heroin Use Rising Version 1.0 6
7 Heroin Abuse Risk Factors Male gender, aged years Non-Hispanic white race/ethnicity Residence in a large urban area <$20,000 annual household income with no health insurance or Medicaid Past-year abuse or dependence on alcohol, marijuana, cocaine, or opioid pain relievers National Survey on Drug Use and Health (NSDUH), CDC Vital Signs, July Opioid Abuse - Illinois 12 th lowest drug overdose mortality rate in the US, with 10 per 100,000 drug overdose fatalities Drug overdose deaths increased by 49% since 1999 ~8 people die from prescription drug overdoses/week in Illinois (81% involve opioid pain relievers) Hydrocodone was the most available opioid to nonprescribed users for nonmedical use in 2013 In 2012, there were 15,350 primary heroin treatment admissions in Chicago Heroin purity at the street level remains between 10 and 20%- cut with quetiapine, diphenhydramine, fentanyl Illinois Department of Human Services. Prescription Drug Abuse: Strategies to Stop the Epidemic. Version 1.0 7
8 Top Abused Prescription Drugs in America Clinical Pharmacology of Opioids Chris Herndon, PharmD, BCPS Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville Morphine Version 1.0 8
9 Opioid Receptors μ mu (MOR) κ kappa (KOR) δ delta (DOR) N/OFQ (Noceptin) Commercially Available Opioids Pure MOR (mu) agonists morphine, methadone, codeine, hydrocodone, fentanyl, oxycodone, oxymorphone, levorphanol, hydromorphone, heroin, dihydrocodeine, sufentanil, alfentanil, remifentanyl Partial MOR (mu) agonist buprenorphine Mixed agonist-antagonists nalbuphine, butorphanol, pentazocine Centrally acting MOR agonists tramadol, tapentadol Nonselective antagonists naloxone, naltrexone Peripherally acting MOR opioid antagonists alvimopan, methylnaltrexone, naloxegol MOR = mu-opioid receptor Version 1.0 9
10 What is High Dose for Opioids? Canadian Guidelines 200mg/day OME American Pain Society Guideline 200mg/day OME Washington State Work Comp 120mg/day OME OME = Oral Morphine Equivalent Prescription Opioids and Illicit Heroin Quantitative questionnaire using street outreach, venue-recruitment, and needle-exchange advertisement (n = 123) Median age 29 yrs (75% male, 53% white, 28% hispanic, 19% black or other) 39.8% reported problematic prescription opioid use prior to first heroin use Heroin rapidly metabolized to morphine in CNS Version
11 Relative Equianalgesia Drug IV (mg) Oral (mg) Morphine Buprenorphine (SL) Codeine Fentanyl 0.1 Hydrocodone 30 Hydromorphone Meperidine Oxycodone Oxymorphone 1 10 IV = intravenous; mg = milligram; SL = sublingual Let s Get Some Practice. CH is a 42 year old male who is currently using opioid and non-opioid analgesics for severe low back pain (failed back surgery syndrome). His current regimen includes: CR morphine 60mg by mouth every 8 hours IR oxycodone 15mg by mouth every 4 to 6 hours as needed Pregabalin 50mg by mouth every 12 hours What is CH s total daily Oral Morphine Equivalent (OME)? CR = controlled-release; IR = immediate-release Version
12 Calculate 24 hour Oral Morphine Equivalent (OME) CR morphine 60mg Q8h = 180mg OME IR oxycodone 15mg Q4-6h (actually take Q4h) = 90mg of oxycodone Ratio is 2:3 (90mg/2)(3) = 135mg OME Total OME is 315mg daily Drug IV (mg) Oral (mg) Morphine Buprenorphine (SL) Codeine Fentanyl 0.1 Hydrocodone 30 Hydromorphone Meperidine Oxycodone Oxymorphone 1 10 CR = controlled-release; IR = immediate-release; SL = sublingual Distinct Opioid Concerns Fentanyl Incredibly potent and lipophilic Abusers may cheek cut patches and accidentally swallow Continued delivery may prolong exposure and require repeated dosing of reversal Buprenorphine Significantly higher MOR binding affinity More difficult to antagonize with reversal agent requiring higher doses for longer Methadone Highly variable terminal half-life May require repeated doses of reversal antagonist Heroin Patients recently abstaining cannot tolerate previously high doses used Often cut with acetyl fentanyl increasing potency and respiratory depressant risk Version
13 The Neurobiology of Addiction Kelly Gable, PharmD, BCPP Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville Why Do People Use Substances? Version
14 Substance Use Disorders Complex biological health conditions involving the brain Encompass many different drug classes: Caffeine Alcohol Cannabis Hallucinogens Inhalants Sedative-hypnotics / anxiolytics Stimulants Nicotine Opioids Neurochemical Imbalance: Addiction Receptor DOPAMINE OPIOID SEROTONIN Roles Mood Attention Psychosis Reward Pleasure Analgesia Euphoria Sedation Dysphoria Respiratory depression Appetite Mood Sleep Drug Effects Opioids, Nicotine, Alcohol, Stimulants increase dopamine release Reinforcing effects of endogenous opiates Stimulants inhibit removal of serotonin synapses Alcohol depletes Version
15 Drugs of Abuse Targeting of the Brain s Pleasure Center Risk / Protective Factors for Addiction Risk Factors Aggressive behavior in childhood Poor parental supervision Poor social skills Drug experimentation Availability of drugs at school Community poverty Protective Factors Good impulse-control Parental support Positive relationships Academic competence School anti-drug policies Neighborhood pride Version
16 Substance Use Disorders Substance Use Disorders: Relapse and Recover Version
17 Substance Use Disorders: Barriers to Treatment Only 1 in 10 Americans with a substance use disorder actively receive treatment. Stigmas that prevent treatment: Treatment doesn t work They have an addictive personality People with addiction are bad, crazy, can t be helped, don t want to be helped Treatment outcomes are improved if the substance use disorder / psychiatric disorder are addressed collaboratively with other medical conditions. 1. Traditional 12 step programs Substance Use Disorders Recovery Options 2. Inpatient / outpatient programs 3. Harm reduction and behavioral therapy 4. Pharmacotherapy: treatment of withdrawal syndromes, anti-craving medication (naltrexone), buprenorphine, methadone maintenance 5. Screening, Brief Intervention, and Referral to Treatment (SBIRT): evidenced-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and drugs Version
18 Opioid Use Disorders: Risk Factors for Abuse and Overdose Kelly Gable, PharmD, BCPP Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville Warning Signs of Abuse Jason is a 25 year-old patient who you see routinely at the pharmacy. He is receiving treatment for chronic low back pain and panic disorder. He is prescribed the following regimen from his psychiatrist: Alprazolam (Xanax) 0.5 mg twice daily Oxycodone 10mg every 6 hours prn pain Paroxetine (Paxil) 10 mg daily Jason shows up 2 weeks early for his refills reporting that he lost the rest of his medication and really needs his Xanax. Version
19 Warning Signs of Abuse 1. Frequently running out of medication 2. Reporting lost or stolen prescriptions 3. Presenting with prescriptions from multiple prescribers 4. Filling prescriptions at multiple pharmacies 5. Urine drug screen negative 6. Reports allergies to all other drugs but. 7. Frequently demonstrating signs and symptoms of intoxication Opioid-Related Disorders Opioid Use Disorder Opioid Intoxication Opioid Withdrawal Version
20 Opioid Use Disorder, Withdrawal, or Intoxication Stacy is a 34 year-old female presenting to the emergency department for treatment of an infected abscess on her arm. She experiences chronic back pain from a car accident 2 years ago. In an effort to gain better control of her pain, she started using heroin 3 months ago, on top of her routine treatment with oxycodone, cyclobenzaprine, and alprazolam. After testing positive for heroin use, she was released from treatment by her PCP. She now uses heroin daily. Opioid Use Disorder Problematic pattern of opioid use leading to clinically significant impairment within a 1 year period, consisting of 2 of the following: 1. Taken in larger amounts over longer period then intended 2. Unsuccessful efforts to stop or decrease use 3. Excessive time spent obtaining opioid, using, or recovering from use 4. Craving to use 5. Use results in failure to fulfill work, school, home obligations 6. Use continues despite negative consequences 7. Opioid use becomes more important than social, work, or recreational activities 8. Continued use despite risky situations 9. Persistent use despite knowledge of physical or psychological problems 10.Tolerance has developed (need more opioid to achieve desired effects) 11.Withdrawal occurs when opioid is stopped Version
21 Prescription Opioid Abuse Almost all prescription drugs involved in overdoses come from prescriptions originally (not pharmacy theft) Frequently diverted to people using them without prescriptions Most prescriptions come from primary care physicians, internal medicine physicians, and dentists; not specialists Roughly 20% of prescribers prescribe 80% of all prescription opioids Prescription Opioid Abuse Risk Factors Those who abuse prescription opioids (vs heroin): 1. Are more likely to have complaints of pain 2. Are more likely to be in psychiatric treatment 3. Have greater social stability 4. Are less likely to use other illicit substances Version
22 Opioid Use Disorder, Withdrawal, Intoxication? Shane is a 53 year-old male diagnosed with prostate cancer with bone metastasis. On top of his chemotherapy treatment, he receives treatment for bone pain with oxycodone controlled-release (OxyContin) 80 mg daily and oxycodone 10 mg q 4 hours for break-through pain. Last month his wife phoned 911 because she found Shane unresponsive on the couch. Opioid Intoxication vs. Withdrawal Euphoria Dysphoria Apathy Motor Retardation Sedation Slurred speech Attention impairment Pinpoint pupils Respiratory depression Opioid Intoxication Opioid Withdrawal* Lacrimation Rhinorrhea Dilated pupils Goosebumps Sweating, fever Diarrhea Yawning Insomnia Muscle aching *Duration of withdrawal = 7 to 14 days Version
23 Opioid Overdose Reduced sensitivity to changes in O2 and CO2 outside of normal ranges Decreased tidal volume and respiratory frequency Respiratory failure and death due to hypoventilation Signs and symptoms: 1. Pinpoint pupils 2. Not arousable with sternal rub 3. Breathing less then 8 per minute 4. Choking, gurgling, snoring sounds 5. Blue/gray lips and fingertips Who is at Risk for Overdose? 1. Taking multiple controlled substance prescriptions from multiple providers doctor shopping 2. Taking high daily dosages of prescription opioids and/or misuse multiple abuse-prone prescription drugs 3. People with chronic medical conditions (HIV, cardiovascular disease, respiratory diseases, mental illnesses) 4. Changes in opioid purity 5. Previous history of overdose 6. Lower socioeconomic status and those living in rural areas 7. Recent discharge from incarceration or substance use facility Version
24 Risky Situations Pam is a 50 year-old female patient diagnosed with Crohn s Disease, fibromyalgia, generalized anxiety disorder, PTSD, chronic back pain, and sleep apnea She receives treatment from her primary care physician, rheumatologist, and psychiatrist. She struggles with ongoing pain and frequently over takes her pain medication. She is prescribed: Olanzapine (Zyprexa), lorazepam (Ativan), amitriptyline (Elavil), oxycodone (OxyContin), trazodone (Desyrel), zolpidem (Ambien), tramadol (Ultram), duloxetine (Cymbalta), quetiapine (Seroquel), diazepam (Valium), hydrocodone / acetaminophen (Vicoden), prednisone PTSD = Post Traumatic Stress Disorder Dangerous Combinations Multiple CNS Depressants: Opioids Benzodiazepines- alprazolam, diazepam, clonazepam, chlordiazepoxide Barbiturates Z-hypnotics- zolpidem, zaleplon, eszopiclone Muscle relaxants- cyclobenzaprine, nabumetone, carisoprodol Alcohol Sedating antipsychotics: quetiapine Version
25 Opioid Overdose and Naloxone Rescue Therapy Kelly Gable, PharmD, BCPP Associate Professor, Department of Pharmacy Practice Southern Illinois University Edwardsville Image taken from hpubchem.ncbi.nlm.nih.gov. Accessed Feb 14, 2016 Naloxone Rescue Therapy Naloxone (Narcan): a competitive antagonist at all opioid receptor sites Reverses analgesic, dysphoric, and other pharmacologic effects of opioids 1 mg can reverse the effect of ~25mg heroin Naloxone is NOT naltrexone (a long-acting opioid antagonist) Naloxone is NOT effective in reversing an overdose with benzodiazepines, barbiturates, or stimulants Is it safe to use? FDA-approved and used by EMS to reverse opioid overdose for > 40 years Has minimal interaction in the body without the presence of opioids Rapid opioid reversal causes: hypertension, tachycardia, sweating, recurring pain, agitation, other withdrawal symptoms Version
26 s that Work Rhode Island All Walgreens and CVS pharmacies supply and dispense IM and IN naloxone through a collaborative practice agreement Project Lazarus A public health model based on the premises that drug overdose deaths are preventable and that all communities are ultimately responsible for their own health. Facilitated overdose prevention in Wilkes in collaboration with Health Department, law enforcement, schools, clinicians, hospitals, and faith community. Over 3 years: overdose deaths 42%; drug-related hospital visits 15%; the number of prescriptions for controlled substances stabilized IM = intramuscular; IN = intranasal Why at the Pharmacy? 1. Many patients at risk for an overdose do not visit routine providers. 2. There is a shortage of physicians/providers prescribing naloxone. 3. Patients may not report opioid misuse due to fear of loss of access to pain management. 4. It ensures easier access to a life saving treatment. 5. An opioid overdose can happen within minutes to hours. 6. Naloxone is rapid-acting, safe, and effective at reversing opioid overdose. 7. Bystanders are easily trainable to recognize and respond to an overdose. 8. Risk of liability is no higher than with other prescription medications. *The practice of harm reduction follows a patient-centered philosophy of care with the primary goal focusing on a reduction of harm, rather than complete cessation of opioid use. When a patient is offered naloxone rescue therapy, it allows the healthcare provider to further discuss opioid use, safety concerns, and overdose risk. Version
27 Who Should Get Naloxone? 1. Prescribed long-term opioid therapy; doses > 50 mg of morphine equivalent/day 2. Prescribed rotating opioid medication regimens 3. Prescribed methadone 4. Taking an opioid plus other CNS depressants (benzodiazepines, alcohol) 5. Prescribed or taking an opioid with co-occurring renal/hepatic dysfunction, cardiovascular disease, respiratory disorders (sleep apnea), mental illness, or HIV/AIDS 6. Using heroin 7. Recently discharged from a substance abuse treatment facility or from an acute medical center following opioid intoxication or poisoning 8. Recently released from jail and history of opioid abuse Naloxone Dispensing Steps Patient requests overdose prevention product Perform real-time claim submissions to determine coverage; patients can pay cash if uninsured Initiate education with caregiver present Filling an opioid prescription Check prescription monitoring program database and review current medications prescribed Discuss any potential overdose risk with current medications Educate on opioid overdose and naloxone rescue therapy Version
28 Prescription Monitoring s Teaching Patients, Friends, Family, Caregivers Education specific to prescription opioid use: 1. Use prescription opioids only as directed by a health care provider 2. Ensure that all prescribers and pharmacists know of all medications you are taking 3. Don t mix opioids with alcohol or other sedating drugs 4. Store your medication in a safe and secure place and dispose of unused medication 5. Know that not taking your opioids for a period of time and change your tolerance and you may need a lower dose when you restart 6. Ensure that your friends and family know how to respond to an overdose and administer naloxone Version
29 Teaching Patients, Friends, Family, Caregivers Requirements during naloxone training session: 1. Review the signs of opioid intoxication, overdose, and withdrawal 2. Ensure understanding of naloxone purpose 3. Review insurance coverage and personal preference for IM or IN delivery system 4. Discuss the contents of the naloxone kit 5. Demonstrate naloxone administration (IM or IN) and verify understanding of method 6. Re-enforce importance of calling Provide informational brochure 8. Document/record required patient information Throughout your session, try to avoid stigmatizing terminology- addict, user, abuse Teaching Patients, Friends, Family, Caregivers Version
30 Identify the Overdose STEP 1: Identify if someone is experiencing an overdose -- No response upon yelling their name or vigorously rubbing chest with knuckles -- Blue lips or fingertips -- Slow breathing (< 8 breaths/minute) -- Limp body or choking/gurgling/snoring noise STEP 2: Call 911 for help STEP 3: If breathing is shallow or non-existent, perform mouth-to-mouth rescue breathing Perform Rescue Breathing Place the person on their back. Tilt their chin up to open the airway. Check to see if there is anything obstructing the airway. Place your mouth over the person s mouth to make a seal. Give 2 slow breaths. The person s chest should rise. Breathe again. Give one breath every 5 second. Version
31 Administer Naloxone and Stay Until Help Arrives! 1. Administer naloxone via IM or IN delivery system 2. Place the person in the recovery position. A. On their side with their top leg and arm crossed over their body 3. Stay with the person- do not leave someone alone after giving naloxone A. The effect of naloxone wears off in 30 to 90 minutes and patients can go back into overdose if a long-acting opioid was taken (methadone, oxycodone) B. Patients may want to take more opioids upon reversal due to feeling opioid withdrawal symptoms C. Some patients may become agitated or combative during withdrawal IM = intramuscular; IN = intranasal Naloxone Product Information Version
32 Administration of Naloxone IM 1. Single Dose or Multi-dose vials of naloxone are available 2. Use a inch 25 gauge needle and 3mL syringe Do not draw up naloxone into syringe until ready to administer Remove cap from naloxone vial and uncover needle Insert needle through rubber plug with vial upside down; pull back on plunger and draw up 1 ml Inject 1mL at 90 degree angle into muscle, can be deltoid or outer thigh IM injection may be administered through clothing if needed 3. Prompt reversal of opioid agonist should occur within 3 to 5 minutes (hypotension and sedative effects) 4. A second dose may be administered if there is no response in 3 to 5 minutes IM = intramuscular Administration of Naloxone IM Auto-Injector 1. Pull auto-injector out of case from white end 2. Follow automated voice prompts 3. Remove red cap 4. Place black end against patients outer thigh, hold firmly for 5 seconds IM = intramuscular Version
33 Administration of Naloxone Intrasal (IN) 1. Remove yellow caps at both ends of syringe and red cap from naloxone 2. Attach to Luer lock syringe and twist naloxone into barrel of syringe 3. Place nasal applicator into one nostril of patient, administer half of medication with a short, vigorous push 4. Repeat for other nostril Contraindications to IN delivery nasal septal abnormalities nasal trauma epistaxis cocaine induced septal damage recent use of topical decongestants IN = intranasal Resources for Further Education Overdose prevention education and naloxone rescue therapy: Prescribe to Prevent: SAMHSA Opioid Overdose Prevention Toolkit Project Lazarus: Centers for Disease Control and Prevention (CDC): Harm Reduction Coalition: College of Psychiatric and Neurologic Pharmacists (CPNP): Opioid prescribing education: SAMHSA and NIDA: Substance use treatment locator: or call HELP Version
34 Rationale and Method for Implementation Jessica L. Kerr, PharmD, CDE Associate Professor Assistant Chair Department of Pharmacy Practice Southern Illinois University Edwardsville School of Pharmacy Garth Reynolds, RPh Executive Director Illinois Pharmacists Association Springfield, Illinois Overview Key elements of Public Act The approved Naloxone Standardized Procedures Clinical documentation and record keeping Version
35 Illinois Naloxone Standardized Procedures PA amended the Illinois Pharmacy Practice Act by adding Section 19.1(b) Section 19.1(b) Dispensing naloxone antidote Notwithstanding any general or special law to the contrary, a licensed pharmacist may dispense and opioid antagonist in accordance with written, standardized procedures or protocols developed by the Department with the Department of Public Health and the Department of Human Services if procedures or protocols are filed at the pharmacy before implementation and are available to the Department upon request. the Department = Illinois Department of Financial and Professional Regulations Illinois Naloxone Standardized Procedures Definitions per Public Act Opioid antagonist means a drug that binds to opioid receptors and blocks or inhibits the effect of opioids acting on those receptors, including, but not limited to naloxone hydrochloride or any other similarly acting and equally safe drug approved by the U.S. Food and Drug Administration for the treatment of drug overdose. the Department = Illinois Department of Financial and Professional Regulations Version
36 Illinois Naloxone Standardized Procedures Definitions per Public Act Changes in the Alcoholism and other Drug Abuse and Dependency Act Health Care Professional means a physician licensed to practice medicine in all its branches, a physician assistant who has been delegated prescriptive authority by his or her supervising physician, an advanced practice registered nurse who has written collaborative agreement with a collaborating physician that authorizes prescriptive authority, or an advanced practice nurse or physician assistant who practices in a hospital, hospital affiliate, or ambulatory surgical treatment center and possesses appropriate clinical privileges in accordance with the Nurse Practice Act or a pharmacist licensed to practice pharmacy under the Pharmacy Practice Act. Illinois Naloxone Standardized Procedures Definitions per Public Act Changes in the Alcoholism and other Drug Abuse and Dependency Act Patient information included information provided to the patient on drug overdose prevention and recognition; how to perform rescue breathing and resuscitation; opioid antagonist dosage and administration; the importance of calling 911; care for the overdose victim after administration of the overdose antagonist; an other issues as necessary. Version
37 Illinois Naloxone Standardized Procedures A health care professional who, acting in good faith, directly or by standing order, prescribes or dispenses an opioid antagonist to: a patient who, in the judgment of the health care professional, is capable of administering the drug in an emergency A person who is NOT at risk of opioid overdose but who, in the judgement of the health care professional, may be in a position to assist another individual during an opioid-related drug overdose AND who has received basic instruction on how to administer an opioid antagonist Illinois Naloxone Standardized Procedures A health care professional SHALL NOT, as a result of his or her acts or omissions, be subject to: Any disciplinary or other adverse action under the Illinois Pharmacy Practice Act Any criminal liability, except for willful and wanton misconduct. Any civil liability, except for willful and wanton misconduct. Version
38 Illinois Naloxone Standardized Procedure Several amendments in other Acts Alcoholism and Other Drug Abuse and Dependency Act Illinois Criminal Justice Information Act Illinois Police Training Act Illinois Fire Protection Training Act School Code Emergency Medical Services (EMS) Systems Act Hospital Licensing Act Safe Pharmaceutical Disposal Act Environmental Protection Act Illinois Controlled Substance Act Others Other Changes of PA Provides guidance for drug overdose response policy Law Enforcement Officers, Fireman and EMS On-hand opioid antagonist Training Version
39 Other Changes of PA School Code amendment Administration of opioid antagonist School personnel or nurse on-hand carry May allow for school to obtain opioid antagonist through the standing order of Standardized Procedures. School must immediately active the EMS system and notify guardian and emergency contact and within 24 hours notify the health care professional who provided the prescription Within 3 days after administration the school must report to the Board Annual Training and proof of CPR and AE certification is required Other Changes of PA Safe Pharmaceutical Disposal Act amended to include: Coverage for opioid antagonist Includes medication product, administration devices and pharmacy administration frees Refills must be included for expired or utilized medication Version
40 Other Changes of PA Director of the Division of Alcoholism and Substance Abuse shall publish annual reports on drug overdose trends statewide that reviews State death rates Report shall also provide: Trends in drug overdose death rates Trends in emergency room utilization Trends in utilization of prehospital and emergency services and the cost impact of emergency services utilization Suggested improvements in data collection Descriptions of efforts undertaken to educate the public about unused medications Description of other interventions to achieve outcome Naloxone Standardized Procedures The Naloxone Standardized Procedures are divided into the following sections: Background Continuing Education Standardized Procedures Pharmacist Standardized Procedure to Dispense Naloxone Standardized Procedures for Naloxone Distribution for Overdose Prevention (December 2015) Counseling Protocol for Naloxone Standardized Procedures Version
41 Background Review that PA was passed in September 2015 expanding access to opioid antagonists (including Naloxone). Establishes the Standardized Procedures and required training for pharmacists. Naloxone to the following patient (or patient s agent) group that would benefit: Individual at risk of overdose Family member, friend, or other person in a position to assist a person at risk of overdose Trained First Responder Trained School Nurse PA establishes that Department of Financial and Professional Regulation in accordance with the Department of Human Services and the Department of Public Health may approve the standardized procedures for pharmacists. Continuing Pharmacy Education Eligible pharmacists must have completed: A Certificate Training in Opioid Overdose Prevention; Be CPR certified, in accordance with 68 IAC (a) (4) The pharmacist shall maintain a current Basic Life Support Certification for Healthcare Providers issued by the American Heart Association, the American Red Cross, the American Safety and Health Institute, or an equivalent as determined by the Division. Training shall consist: Opioid overdose prevention; Reducing the risk of prescription opioid abuse; Safe use of opioids for the management of chronic pain; Use of screening tools to detect opioid abuse or dependency and management of difficult patients; Preventing diversion of prescribed opioid medications; Naloxone administration techniques; Knowledge of Protocol for Naloxone Standing Order for Opioid Antagonist Initiative. Version
42 Standardized Procedures Once pharmacists have completed the certified Naloxone Antagonist Training (such as this course) and wish to participate in the Illinois Naloxone Antagonist Overdose Prevention : The pharmacy may request a copy of the Standardized Procedures for Naloxone Opioid Overdose by contacting the Illinois Prescription Monitoring (ILPMP) at their website ilpmp.org. The Standardized Procedures covers dispensing and possession of Naloxone Kits. Kits include: Naloxone HCl, IM syringe, injection supplies, nasal atomizers, or commercial Naloxone auto-injectors. The Standardized Procedures authorizes the pharmacist to maintain supplies for Naloxone Kits to dispense according to the Protocol for the identified individuals. IM = intramuscular Pharmacist Standardized Procedure to Dispense Naloxone The Protocol allows the Pharmacist to dispense one Naloxone Kit to an identified individual. Individual is approved to receive Naloxone by meeting the criteria outlined in the standardized procedures. 1. Individual is a person at risk of experiencing an opiate-related overdose or a family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose. 2. Individual has received counseling by a pharmacist trained in the use of Naloxone regarding the recognizing and responding to suspected opioid overdose. Family member, friend, or other person in a position to assist a person at risk of overdose Trained First Responder Trained School Nurse Version
43 Pharmacist Standardized Procedure to Dispense Naloxone Counseling is required to cover the proper use of the dosage forms listed below: Intramuscular Naloxone Kits contain the following, at a minimum: Two (2) single-use 1 ml vials Naloxone Hydrochloride (0.4mg/ml) Two (2) intramuscular needle syringes Overdose prevention information pamphlet with step by step instructions for use. Intranasal Naloxone Kits containing, at a minimum: Two 2 ml Luer-Jet Luerlock syringes prefilled with Naloxone Hydrochloride (2mg/2ml) Two mucosal atomization devices Overdose prevention information pamphlet with step by step instructions for use. Auto-injector Kits Containing the following: Naloxone HCL 0.4 mg/ml pre-packaged kits (Evzio, NDC ) Containing 2 autoinjectors with audio instructions and 1 training device and step by step instructions for administration of Naloxone by autoinjector. Standardized Procedures for Naloxone Distribution for Overdose Prevention - December 2015 The Pharmacist shall review the Directions for Use : 1. Evaluate the individual for signs and symptoms of potential Opioid or Heroin Overdose. 2. If individual is not breathing, start rescue breathing using a disposable rescue breathing device. 3. Administer Naloxone as follows (of the select dispensed dosage form). 4. Call 911 as soon as possible for a person suspected of an opioid overdose with respiratory depression or unresponsiveness. 5. Continue rescue breathing and monitor respiration and responsiveness of the Naloxone recipient until emergency help arrives. Version
44 Standardized Procedures for Naloxone Distribution for Overdose Prevention - December 2015 The Pharmacist shall cover how to administer Naloxone as follows (of the select dispensed dosage form): Intramuscular Naloxone: Uncap the Naloxone vial and uncap the muscle needlesyringe. Insert the muscle needle through the rubber membrane on the Naloxone vial, turn the vial upside down, draw up 1 ml of Naloxone liquid, and withdraw the needle. Insert the needle into the muscle of the upper arm or thigh of the victim, through clothing if needed, and push on the plunger to inject the Naloxone. Repeat the injection if there is no response after three minutes. Intranasal Naloxone: Pop off two colored caps from the delivery syringe and one from the Naloxone vial. Screw the Naloxone vial gently into the delivery syringe. Screw the mucosal atomizer device onto the top of the syringe. Spray half (1 ml) of Naloxone in one nostril and the other half (1 ml) in the other. Repeat if there is no response after three minutes. Auto-injector Naloxone: Pull auto-injector from outer case pull off red safety guard. Place the black end of the auto-injector against the outer thigh, through clothing if needed, press firmly and hold in place for 5 seconds. Repeat if there is no response after three minutes. Counseling Protocol for Naloxone Standardized Procedures The Pharmacist shall cover the following areas in counseling the individual on the use of Naloxone. Indications and Usage; Assessment; Provider Actions; Follow Up Requirements; Contraindications; Precautions; Adverse Reactions. Version
45 Counseling Protocol for Naloxone Standardized Procedures Indications and Usage: Naloxone is indicated for the complete or partial reversal of opioid overdose induced by natural or synthetic opioids and exhibited by respiratory depression or unresponsiveness. Counseling Protocol for Naloxone Standardized Procedures Assessment: Subjective Findings Individual is at risk of experiencing an opiate-related overdose or is in a position to assist a family member, friend, or other person at risk of experiencing an opiate-related overdose. Individual reports no known sensitivity or allergy of the intended recipient to Naloxone Hydrochloride. Objective Findings In the pharmacist s judgement, the client is oriented to person, place, and time and able to understand and learn the essential components of overdose response and Naloxone administration. Version
46 Counseling Protocol for Naloxone Standardized Procedures Provider Actions: Screen individual for contraindications / precautions to dispensing Naloxone. If a contraindication / precaution exists, refer individual to medical provider for evaluation. Provide Opioid overdose training information which covers at least the following: 1. Risk factors for opioid overdose and possible prevention actions; 2. Recognition of opioid overdose; 3. Calling 911; 4. Rescue breathing, using a disposable rescue breathing device. 5. Administration of Naloxone as described within the Standardized Procedures. Upon the successful counseling session, the pharmacist will dispense the Naloxone kit and explain contents to individual. The pharmacy is to report dispensed kits to the ILPMP with daily reporting of dispensed controlled substances. As part of the mandatory counseling function, the pharmacist shall provide information and /or referral for substance abuse or behavioral health treatment options. Counseling Protocol for Naloxone Standardized Procedures Follow Up Requirements: The pharmacist shall instruct individual/parent/guardian to call medical provider if questions, concerns, or problems arise. The pharmacist shall, instruct individual/parent/guardian to return for refill as needed, subject to use and expiration of Naloxone (approx. 18 months). The pharmacist shall encourage opioid user or other concerned individual to communicate with primary care provider regarding overdose, use of Naloxone, and availability of behavioral health services. Version
47 Counseling Protocol for Naloxone Standardized Procedures Contraindications: Patient is known to be hypersensitive to Naloxone Hydrochloride. Counseling Protocol for Naloxone Standardized Procedures Precautions: Pre-existing cardiac disease or seizure disorder Person is suspected to be physically dependent on opioids including newborns of mothers with narcotic dependence. (Reversal of narcotic effect will precipitate acute abstinence syndrome). Use in Pregnancy: 1. Teratogenic Effects: Pregnancy category C, no adequate or well-controlled studies in pregnant women. 2. Non-teratogenic Effects: Pregnant women known or suspected to have opioid dependence often have associated fetal dependence. Naloxone crosses the placenta and may precipitate fetal withdrawal symptoms as well. Nursing Mothers: Caution should be exercised when administering to nursing women due to transmission in human milk. Risk and benefits must be evaluated. Geriatric Use: Choose lower range dose taking precautions for potential decreased hepatic, renal and cardiac function, as well as, concomitant disease and other pharmacotherapies. Version
48 Counseling Protocol for Naloxone Standardized Procedures Adverse Reactions: Adverse reactions are related to reversing dependency and precipitating withdrawal and includes fever, hypertension, tachycardia, agitation, restlessness, diarrhea, nausea/vomiting, myalgia, diaphoresis, abdominal cramping, yawning, sneezing. 1. These symptoms may appear within minutes of Naloxone administration and subside in approximately 2 hours. 2. The severity and duration of the withdrawal syndrome is related to the dose of Naloxone and the degree of opioid dependence. Adverse effects beyond opioid withdrawal are rare. Clinical Documentation and Recordkeeping All records shall be kept for at least five (5) years as according to the Pharmacy Practice Act ILCS 85. This shall include: Prescription Records (including from a pharmacy workflow management system); Any corresponding clinical and/or patient documentation completed. Naloxone dispensing records shall be transmitted to the Illinois Prescription Monitoring within one (1) business day as required according to the authority given the ILPMP 720 ILCS 570/316, 570/318. Version
49 Claiming of CPE Credits The participant must complete the following: All components of the Illinois State Opioid Antagonist Training ; Successfully complete the post-test examination (70% passing score required); Complete the Training evaluation. The participant s information and CPE credit will be electronically submitted to the NABP CPE monitor by the Illinois Pharmacists Association. The participant s record of completion of the Illinois State Opioid Antagonist Training will be electronically submitted to the Illinois Prescription Monitoring by the Illinois Pharmacists Association. Any questions: Concerning the completion of the Training, please contact the Illinois Pharmacists Association at 217/ or via at kimc@ipha.org. Concerning your record of completion or access to the Standardized Procedures, please contact the Illinois Prescription Monitoring at 217/ , 217/ , or 217/ or via at ilpmp.org contact page. Recourses to Further Education Public Act Illinois Controlled Substance Act Illinois Prescription Monitoring (ILPMP) Opioid Treatment Directory - SAMHSA Version
50 State Agencies Approval PA Version
Naloxone 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 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 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 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 informationOpioid 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 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 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 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 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 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 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: 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 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 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 informationCommunity Pharmacy Naloxone Distribution: Updates from the Field
Community Pharmacy Naloxone Distribution: Updates from the Field Garth K. Reynolds, BSPharm, RPh Executive Director Illinois Pharmacists Association Marty Michel, BSPharm, RPh, MBA, CDE Owner Key Drugs
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 informationDrug Overdose Prevention Program (DOPP)
Drug Overdose Prevention Program (DOPP) GUIDELINES FOR IMPLEMENTATION [Type a quote from the documen T or the s ummary of an interesting p oint. You can position the text box anywhere in the document.
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 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 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 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 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 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 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 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 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 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 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 informationNaloxone in Schools. Training for School Staff
Naloxone in Schools Training for School Staff Objectives Learn the signs and symptoms of opioid drug overdose Have the skills to administer naloxone Review the use of naloxone protocol in responding to
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 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 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 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 informationPharmacist Directed Opioid Antagonist Dispensing
Pharmacist Directed Opioid Antagonist Dispensing MARK BOESEN, PHARM.D., J.D. CHAIRMAN AND CEO GENRX PHARMACY C0-CHAIRMAN ARIZONA PHARMACY ASSN. LEGISLATIVE COMMITTEE DECEMBER 15, 2016 Opioid Substance
More informationPharmacy Law Disclosure Statement. Objectives 6/11/2016. I have no conflicts of interest to disclose related to this presentation.
Pharmacy Law 2016 Ronda H. Lacey, J.D., M.S. Pharm Disclosure Statement I have no conflicts of interest to disclose related to this presentation. Objectives At the conclusion of this continuing education
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 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 Overdose: Risks, Clinical Features, Treatment, and Reduction of Negative Consequences
Opioid Overdose: Risks, Clinical Features, Treatment, and Reduction of Negative Consequences Joji Suzuki, MD Assistant Professor of Psychiatry Harvard Medical School Director, Division of Addiction Psychiatry
More informationCOMBATING THE OPIATE CRISIS IN OHIO THROUGH COMPREHENSIVE RESPONSE 2018 HOUSING OHIO CONFERENCE APRIL 9 TH, Objectives: Key Terms
COMBATING THE OPIATE CRISIS IN OHIO THROUGH COMPREHENSIVE RESPONSE 2018 HOUSING OHIO CONFERENCE APRIL 9 TH, 2018 2 Objectives: qreview names of different types of opioids qidentify the signs and symptoms
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 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 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 informationOverdose Response Training
Overdose Response Training Dave Morgan, RPh Safe Prescribing Consultant, Norfolk District Attorney s Office Daniel Muse, MD Brockton Hospital Sgt. Brian Holmes & Sgt. Donna McNamara Stoughton Police Department
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 informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationTranscript for Overdose Responder Training: Adapted from NJ Department of Human Services/Division of Mental Health and Addiction Services
Transcript for Overdose Responder Training: Adapted from NJ Department of Human Services/Division of Mental Health and Addiction Services #1 TITLE SLIDE #2 INTRODUCTION AND PURPOSE Welcome to Overdose
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 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 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 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 informationStrategies to Manage The Opioid Crisis
Strategies to Manage The Opioid Crisis Matt Feehery, LCDC Senior Vice President & CEO PaRC (Prevention & Recovery Center) Behavioral Health Services February 1, 2018 A Pill for Your Pain But my doctor
More informationNaloxone. Medical Uses. Opiate overdose. From Wikipedia, the free encyclopedia. Naloxone
Naloxone From Wikipedia, the free encyclopedia Naloxone Naloxone, sold under the brandname Narcan among others, is a medication used to reverse the effects of opioids, especially in overdose. [2] Naloxone
More informationSAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES AGENCY. Administration of Naloxone for Opiate Overdose
SAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES AGENCY Administration of Naloxone for Opiate Overdose Disclaimer: Authorization - EMT Optional Skills Only authorized Emergency Medical Technicians (EMT) who
More informationApril 26, New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) New Mexico Board of Pharmacy Prescription Monitoring Program (PMP)
New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) New Mexico Nurse Practitioner Council New Mexico Board of Pharmacy Prescription Monitoring Program (PMP) Peter Ryba, PharmD PMP Director
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 informationBe it enacted by the People of the State of Illinois,
AN ACT concerning education. Be it enacted by the People of the State of Illinois, represented in the General Assembly: Section 5. The School Code is amended by changing Section 22-30 as follows: (105
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 informationHow to Prevent an Opioid Overdose
How to Prevent an Opioid Overdose MEDICAL CARE PROVIDERS: Providers can help reduce the likelihood of an opioid overdose by identifying patients who are at increased risk of opioid-induced respiratory
More informationPotential Solutions to Epidemic Substance Abuse in US and Europe
Potential Solutions to Epidemic Substance Abuse in US and Europe Richard C. Dart, MD, PhD Director, Rocky Mountain Poison and Drug Center, Denver Health 1 Professor, University of Colorado School of Medicine
More information9/5/2011. Outline. 1. Past and Current Trends re: RX Abuse 2. Diversion Methods 3. Regulatory Reporting Requirements 4. Q/A
Prescription Drug Abuse Crises Outline 1. Past and Current Trends re: RX Abuse 2. Diversion Methods 3. Regulatory Reporting Requirements 4. Q/A 1 1970s 1980s 2 The 1990s OXYCODONE Oxycodone/APAP OxyContin
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 informationOpioid Management of Chronic (Non- Cancer) Pain
Optima Health Opioid Management of Chronic (Non- Cancer) Pain Guideline History Original Approve Date 5/08 Review/Revise Dates 11/09, 9/11, 9/13, 09/15, 9/17 Next Review Date 9/19 These Guidelines are
More informationWR Fentanyl Symposium. Opioids, Overdose, and Fentanyls
Opioids, Overdose, and Fentanyls Outline: What are opioids? Why are we experiencing and opioid crisis? Potency, purity, and product How do opioids cause overdose and overdose deaths? What is naloxone and
More informationNaloxone Opioid Overdose Reversal Collaborative Drug Therapy Agreement
Naloxone Opioid Overdose Reversal Collaborative Drug Therapy Agreement As a licensed health care provider authorized to prescribe medication in the State of Washington, I delegate prescriptive authority
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 informationClinical Policy: Opioid Analgesics Reference Number: OH.PHAR.PPA.13 Effective Date: 10/2017 Last Review Date: 6/2018 Line of Business: Medicaid
Clinical Policy: Reference Number: OH.PHAR.PPA.13 Effective Date: 10/2017 Last Review Date: 6/2018 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationSUBJECT: Opioid Overdose and Intranasal Naloxone Training for Law Enforcement: Train the Trainer Session: Queens County October 17, 2014
ANDREW M. CUOMO GOVERNOR STATE OF NEW YORK DIVISION OF CRIMINAL JUSTICE SERVICES Alfred E. Smith Office Building 80 South Swan Street Albany, New York 12210 http://criminaljustice.ny.gov MICHAEL C. GREEN
More informationNEW MEXICO DEPARTMENT OF HEALTH Administrative Manual ADMINISTRATION
Chapter NEW MEXICO DEPARTMENT OF HEALTH Administrative Manual ADMINISTRATION EFFECTIVE: Policy REVISED: 4/13/9 draft NALOXONE DISTRIBUTION POLICY I. PURPOSE: This New Mexico Department of Health (NMDOH)
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 informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
More informationOpioids - Fentanyl - Naloxone. Public Health Nurse
Opioids - Fentanyl - Naloxone Public Health Nurse What are Opioids? Opioids are a family of drugs that treat pain and can cause sleepiness. Prescription (legal) Opioids fall into 3 main categories: 1.
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 informationSubstitution Therapy for Opioid Use Disorder The Role of Suboxone
Substitution Therapy for Opioid Use Disorder The Role of Suboxone Methadone/Buprenorphine 101 Workshop, December 10, 2016 Leslie Lappalainen, MD, CCFP, dip ABAM Prepared by Mandy Manak, MD, ABAM, CCSAM
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 informationDISPENSING OR SELLING NALOXONE. Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug.
DISPENSING OR SELLING NALOXONE Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug. UPDATED ON: April 21, 2017 Purpose The intent of this document is to provide
More informationThe Solution. A multi-faceted approach to overdose prevention is required. A comprehensive array of efforts are underway in Oklahoma, including:
Saves Lives The Solution A multi-faceted approach to overdose prevention is required. A comprehensive array of efforts are underway in Oklahoma, including: PREVENTION & EDUCATION MONITORING & DIVERSION
More informationPOWER TO HELP REVERSE AN OPIOID OVERDOSE
POWER TO HELP REVERSE AN OPIOID OVERDOSE FDA APPROVED Concentrated 4 mg dose Needle-free; no assembly required Designed for ease-of-use in the community setting Requires no specialized training* Not a
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 informationFentanyl Fact and Fiction: The Rise of America s Narcotic Crisis. Dan
Fentanyl Fact and Fiction: The Rise of America s Narcotic Crisis Dan Batsie daniel.batsie@vermont.gov @danbatsie "Opium Throughout History". PBS Frontline. Retrieved 22 October 2006 Jim Edwards for Business
More informationOpioid Use and Other Trends
Opioid Use and Other Trends National Overview Across the nation communities are struggling with a devastating increase in the number of people misusing opioid drugs, leading many to identify the current
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 informationSierra Sacramento Valley EMS Agency
Sierra Sacramento Valley EMS Agency BLS IN NALOXONE ADMINISTRATION OPTIONAL SKILL (UPDATED 06/2017) Acknowledgement: Siskiyou County SO - source of some slide content In order for PSFA, EMR or EMT personnel
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2009 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More information2004-L SEPTEMBER
BULLETIN INTELLIGENCE Buprenorphine: Potential for Abuse Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E NDIC Within the past 2 years buprenorphine a Schedule III
More informationOpioid Abuse in Iowa Rx to Heroin. Iowa Governor s Office of Drug Control Policy January 2016
1 Opioid Abuse in Iowa Rx to Heroin Iowa Governor s Office of Drug Control Policy January 2016 Why Is This Important? 2 3 National Rx Painkiller Trends CDC, 2013 4 National Rx-Heroin Trends NIH, 2015 5
More informationKurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States
More informationSUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program
SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets Risk Evaluation and Mitigation Strategy (REMS) Program Office-Based Buprenorphine Therapy for Opioid Dependence: Important Information for Prescribers
More informationOpioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine
Natural derivatives of opium poppy - Opium - Morphine - Codeine Opioid Agonists Semi synthetics: Derived from chemicals in opium -Diacetylmorphine Heroin - Hydromorphone Synthetics - Oxycodone Propoxyphene
More informationPRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE
PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE September 20, 2013 Association of State and Territorial Health Officials Annual Meeting R. Gil Kerlikowske Director of National Drug Control Policy National
More information(Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines)
Buprenorphine Initiation and Maintenance in Pregnancy (Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines) Assessment The diagnosis of OUD should be confirmed by DSM-5
More informationProposed Revision to Med (i)
Proposed Revision to Med 501.02 (i) I. Purpose This rule has been adopted to enable the Board to best protect public health and safety while providing a framework for licensees to effectively treat and
More informationPREVENTING OPIATE OVERDOSES IN SCHOOLS. Head 2 Toe 2017 April 20, 2017 Winona Stoltzfus BSN, MD, School Health Officer and Acting RHO SE Region
PREVENTING OPIATE OVERDOSES IN SCHOOLS Head 2 Toe 2017 April 20, 2017 Winona Stoltzfus BSN, MD, School Health Officer and Acting RHO SE Region WHY IS THIS EVEN A QUESTION FOR SCHOOLS? In 2014, 467,000
More informationBROCKTON AREA S OPIOID OVERDOSE PREVENTION TRAINING
BROCKTON AREA S OPIOID OVERDOSE PREVENTION TRAINING Mayor Carpenter s Office In collaboration with High Point Treatment Center Supported by the Massachusetts Opioid Abuse Prevention Collaborative Grant:
More informationSubstance Misuse and Abuse
CHAPTER 18 Substance Misuse and Abuse Lesson Objectives 1. Explain actions that can be taken to help prevent youth from abusing drugs and other substances. 2. Describe specific steps for preventing someone
More informationPATIENT GROUP DIRECTION (PGD)
PATIENT GROUP DIRECTION (PGD) SUPPLY OF NALOXONE HYDROCHLORIDE INJECTION BY REGISTERED NURSES TO CLIENTS BEING RELEASED FROM HMP FORD Version Number: 01HMP Patient Group Direction originally drawn up by:
More information????? PL CE LIVE Special Edition: Overdose Prevention with Naloxone Opportunities for Pharmacists. Objectives. Questions We ll Answer Today
Objectives PL CE LIVE Special Edition: Overdose Prevention with Naloxone Opportunities for Pharmacists May 5, 2015 Describe the impact of naloxone in preventing opioid overdoses and deaths. Identify three
More informationADMINISTRATIVE REQUIREMENT MANUAL EFFECTIVE DATE
PURPOSE: I. To establish the minimum requirements for a first responder training course in first aid, which all first responders must take, in order to meet the requirements of M.G.L. c. 111, 201 and 105
More informationOpioid Replacement Therapy
Opioid Replacement Therapy Matthew A. Felgus, MD mafelgus@wisc.edu 6333 Odana Rd, Suite 3, Madison, WI 53719 (608) 257-1581 Board Certified in Addiction Medicine Board Certified in Psychiatry matthewfelgusmd.com
More informationJournal Club: Naloxone Programs in the Community and Their Success to Decrease Overdoses from Opioids
Journal Club: Naloxone Programs in the Community and Their Success to Decrease Overdoses from Opioids Emily Junck, MD Hayes Wong, MD Paul Freeman, MD Special Guest: Caleb Banta-Green, PhD, MPH, MSW Special
More information