The Role of Prevention in Addressing Opioid Overdose

Transcription

1 CAPT TRAINING October 10, 2017 The Role of Prevention in Addressing Opioid Overdose Trainers: Erin Haas, MPH, CAPT Associate Hayden D. Center, Jr., Ph.D., L.P.C, CAPT Associate

2 Technical Information This training was developed under the Substance Abuse and Mental Health Services Administration s Center for the Application of Prevention Technologies task order. Reference #HHSS I/HHSS T. The views expressed in this training do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services. 2

3 Trainers Erin Haas CAPT Associate SAMHSA s CAPT Hayden Center CAPT Associate SAMHSA s CAPT 3

4 Welcome and Introductions Please share: Your name Your role One thing you hope to get out of today s training 4

5 Group Guidelines Take turns speaking Participate fully Be open and respectful ELMO (enough, let s move on) Save , etc., for breaks Return promptly from breaks 5

6 Roadmap for Today s Training Defining the Problem Focus Populations Factors that Place Individuals at Risk Prevention Strategies Common Challenges 6

7 Defining the Problem Terminology and National Data on the Opioid Crisis 7

8 How is preventing opioid misuse and overdose different from other prevention work you ve done in the past? 8

9 Definitions Prescription Opioids Non-medical Use Misuse Non-Medical Use Opioids Used Illicitly Handout: Glossary of Commonly-Used Terms Associated with Preventing Opioid Misuse and Overdose 9

10 How Opioids Work 1 Opioids attach to receptors found in the brain (and other organs) and reduce pain. Source: 10

11 Health Effects of Opioids 1 Health effects include drowsiness, confusion, slowed breath, and euphoria. Individuals who use opioids for extended periods will develop a tolerance over time. 11

12 Opioid Overdose 2,3 An overdose is bodily harm that occurs when a person takes more of a substance than his/her body can process or a dangerous combination of substances. Overdoses can be fatal or nonfatal. 12

13 What does the opioid crisis look like in your community? 13

14 Overdose Rates on the Rise 4,5 >15.2 Age-Adjusted Death Rate from Drug Poisoning per 100, CDC/NCHS National Vital Statistics System 14

15 Overdose Deaths Involving Opioids, by Type of Opioid ( ) 6,7 National Center for Health Statistics (NCHS), Multiple Cause of Death (2016) 14,000 12,000 10,000 8,000 Heroin Natural and Semi-synthetic Opioids Synthetic opioids (e.g., fentanyl) 6,000 4,000 Methadone 2,

16 2015 IMS Health, National Prescription Audit Prescriptions Filled 8 16

17 Sources of Misused Prescription Drugs 9 Rx from 1 doctor: 34% Rx from 2+ doctors: 1.7% From a Health Care Provider: 36.4% Rx stolen:.7% From a drug dealer or stranger: 4.9% From a relative or friend: 53.7% Some other way: 4.9% Source of Rx Drugs Among People Aged 12 or Older Taken: 3.8% Bought: 9.4% Given free: 40.5% 2015 National Survey on Drug Use and Health 17

18 Opioid Crisis: Related Trends 10,11,12,13,14 Lack of education about opioid use disorders Increased availability of heroin Widespread prescribing of opioids Opioid Crisis Increased hopelessness and depression associated with economic decline 18

19 Roadmap for Today s Training Defining the Problem Focus Populations Factors that Place Individuals at Risk Prevention Strategies Common Challenges 19

20 Focus Populations Who Is the Target of Your Opioid Overdose Prevention Efforts? 20

21 The Institute of Medicine (IOM) Continuum of Care Model 21

22 Opportunities for Prevention Interventions Universal Prevention Selective Prevention Indicated Prevention 22

23 Target Populations for Opioid Overdose Prevention Universal Selective Indicated 23

24 Is It Universal, Selective, or Indicated? Example: Providing information to all people who use opioids on strategies for reducing overdose risk (for example, to avoid alcohol while using prescriptions) 24

25 Is it Universal, Selective, or Indicated? Example: Educating people who have previously overdosed on strategies to reduce their overdose risks (for example, by using naloxone) 25

26 Is it Universal, Selective, or Indicated? Example: Reaching out to people who currently misuse opioids to reinforce safe-use messages 26

27 Road Map for Today s Training Defining the Problem Focus Populations Factors that Place Individuals at Risk Prevention Strategies Common Challenges 27

28 Factors that Place Individuals at Risk 28

29 Components of Prevention Planning Problems and Related Behaviors Risk and Protective Factors Interventions 29

30 What are some risk or protective factors that you have addressed in previous prevention work? 30

31 Areas of Overlap 15,16 Non-medical use of prescription drugs Opioid overdose Heroin use 31

32 Factors Associated with Opioid Overdose Opioid Use and Misuse Ability to Process Opioids Opioid Knowledge and Perceptions Non-Fatal Overdose Chronic Pain and Mental Health Opioid Access and Supply 32

33 Opioid Use and Misuse: Related Factors 20,21,22 Illicit use of any opioids o o o Non-medical use of prescription opioids Use of heroin and other non-prescription opioids Illicit use of opioids in combination with other controlled substances (similar to medical use) Using opioids alone (increases risk of fatal overdose) 33

34 Opioid Use and Misuse: Related Factors 17,18,19 Medical use of prescription opioids o Nature of the prescription (e.g., high dosage, longacting, long-term) o Concurrent prescriptions (e.g., multiple opioids or opioids and benzodiazepines) 34

35 Ability to Process Opioids: Related Factors 23,24,25 Opioid dependence and opioid use disorder Change in tolerance o Increase in tolerance with opioid use o Decrease in tolerance with time away from use (due to hospitalization, treatment, incarceration) Compromised physical health 35

36 Chronic Pain and Mental Health: Related Factors 20,23,26,27 Chronic pain Mental health disorders 36

37 Chronic Pain and Mental Health: Related Factors 20,28 Adverse life experiences/ periods of severe stress o Witnessed a family member overdose o Financial struggles, including unemployment o Homelessness 37

38 Opioid Access and Supply: Related Factors 17,19 Opioid prescribing practices o Increases in number of opioid prescriptions o Increases in dosage and/or duration (includes days supply/number of pills prescribed) 38

39 Opioid Access and Supply: Related Factors 19,29 Diversion of prescription opioids o Friends or relatives o Healthcare providers (doctor shopping, pharmacy hopping, pill mills) o Drug dealers Availability of other/non-prescription opioids 39

40 Opioid Knowledge and Perceptions: Related Factors 30,31 Lack of awareness/understanding of overdose risks Low perception of harm associated with opioids (specifically prescription opioids) 40

41 Non-fatal Overdose: Related Factors 32 Experiencing a nonfatal overdose in the past increases an individual s risk of fatal overdose in the future. 41

42 How are these factors similar to or different from those you ve addressed in the past? Handout: Factors Associated with Opioid-Related Fatal and Non-fatal Overdose 42

43 Road Map for Today s Training Defining the Problem Focus Populations Factors that Place Individuals at Risk Prevention Strategies Common Challenges 43

44 Strategies for Preventing Opioid Overdose and Death 44

45 Components of Prevention Planning Problems and Related Behaviors Risk and Protective Factors Interventions 45

46 Categorization of Strategies Strategies to Prevent Overdose Strategies to Prevent Overdose Death 46

47 Categorization of Strategies Strategies to Prevent Overdose Strategies to Prevent Overdose Death Education Prescription drug disposal programs Prescription Drug Monitoring Programs Prescribing and dispensing regulations Law enforcement actions Treatment and follow-up services Naloxone access and promotion strategies Help-seeking promotion strategies Supervised injection facilities 47

48 A Note About Evidence Compared to other strategies, there is less evidence for opioid overdose prevention strategies. However, less evidence does not mean ineffective. Practitioners should rely on their experience working with other substances to inform opioid overdose prevention efforts. Evaluation is key to building the evidence base. 48

49 Education Strategies Strategies to Prevent Overdose People Who Use Opioids Illicitly Target Audiences for Education Strategies Healthcare Professionals People Who Use Prescription Opioids Medically Community Members 49

50 For People Who Use Opioids Illicitly Education topics include: Strategies to Prevent Overdose Personal characteristics or behaviors that increase overdose risk Changes in the local drug supply that increase overdose risk (e.g., types, purity, or negative effects of available drugs) Available risk reduction, treatment, and support services 50

51 For Healthcare Providers Strategies to Prevent Overdose Education topics include: Benefits and risks of prescription opioids Best practices for prescribing/dispensing Alternatives to opioids How to talk to patients about risks How to recognize an individual who is at risk Referrals to treatment and support services 51

52 For People Who Use Rx Opioids Medically Education topics include: Strategies to Reduce Strategies to Prevent Opioid Misuse or Overdose Overdose Risks of prescription opioids and non-opioid alternatives How to safely use prescriptions Proper medication storage and disposal How to recognize the signs of an opioid use disorder Available treatment and support 52

53 For Community Members Strategies to Prevent Overdose Universal prevention programs Communication campaigns, including: o o Information dissemination campaigns Social marketing campaigns 53

54 Prescription Drug Disposal Programs Strategies to Prevent Overdose Encourage community members to voluntarily and safely dispose of their unwanted, expired, and/or unused medications. Strategies include: o Dropbox programs o Take-back programs o Mail-back programs 54

55 Prescription Drug Monitoring Programs Strategies to Prevent Overdose Statewide electronic data systems that collect, analyze, and make available data on controlled prescription medications, including opioids. Can be used to: o Target prevention efforts (e.g., identify hot spots ) o Change prescriber behavior (e.g., through prescriber report cards) 55

56 Prescribing and Dispensing Regulations Strategies to Prevent Overdose Designed to: Limit the number, quantity, and duration of prescriptions Restrict the circumstances under which prescriptions can be issued or refilled Establish requirements for monitoring patients who are using prescription medications 56

57 Law Enforcement Actions Strategies to Prevent Overdose Use PDMP data to identify providers and patients engaged in troublesome behavior Implement tip and reward programs Take criminal action against those who possess, sell, or use illicit substances Connect people with treatment and support services 57

58 Door Knock Program Law enforcement and outreach workers in several Massachusetts communities follow up with individuals who have experienced an opioid overdose and their families to provide education and connect them to support systems. 58

59 Treatment and Follow- Up Services Strategies to Prevent Overdose Medication-assisted treatment, particularly buprenorphine, can prevent opioid overdose Follow-up services or after-care keep individuals engaged in the recovery process 59

60 Participant Questions 60

61 Categorization of Strategies Strategies to Prevent Overdose Strategies to Prevent Overdose Death Education Prescription drug disposal programs Prescription Drug Monitoring Programs Prescribing and dispensing regulations Law enforcement actions Treatment and follow-up services Naloxone access and promotion strategies Help-seeking promotion strategies Supervised injection facilities 61

62 What Is Naloxone? Source: 62

63 Characteristics of Early Naloxone Distribution Programs 33 Subsisted on little or nonexistent funding Sometimes operated without local approval Community- and social networkbased Designed and delivered by active drug users New programs supported by informal resource-sharing and technical assistance from existing programs 63 Photo source:

64 Naloxone Access and Promotion Strategies Strategies to Prevent Overdose Death Expand naloxone access to those most likely to be on the scene of an overdose emergency Promote the use of naloxone among people who use drugs, professional groups, social service agencies, and the broader public 64

65 Who Needs Access? Strategies to Prevent Overdose Death Professional First Responders Lay First Responders 65

66 Types of Naloxone Access Strategies to Prevent Overdose Death Traditional prescriptions Third-party prescriptions Collaborative practice agreements Standing orders Protocol orders 66

67 Naloxone Education Strategies to Prevent Overdose Death Prescribers and Dispensers Broader Community Potential First Responders 67

68 For Potential First Responders In 2016, the New York City Health Department led a citywide overdose prevention campaign focused on educating potential lay first responders about naloxone. 68

69 For Prescribers 34 In 2015, the San Francisco Department of Public Health reached out to prescribers, in one-onone meetings, to promote the coprescribing of naloxone and opioids for individuals at risk for opioid overdose. 69

70 For the Community International Overdose Day (held every year on August 31) creates materials geared towards the general public to increase awareness of the overdose problem (and naloxone s role) and reduce stigma. 70

71 Help-Seeking Promotion Strategies Strategies to Prevent Overdose Death Strategies to encourage helpseeking in the event of an opioid overdose include: 911 Good Samaritan Laws and Policies 911 Good Samaritan Education 71

72 911 Good Samaritan Education At the county needle exchange in Seattle, the Center for Opioid Safety Education (COSE) distributes wallet cards that describe the state s 911 Good Samaritan law (what it does and does not cover) pdf 72

73 Supervised Injection Sites 35 Strategies to Prevent Overdose Death Legally sanctioned settings where people can obtain and use sterile equipment to inject opioids (obtained elsewhere) under the supervision of trained medical staff. 73

74 Implementing a Comprehensive Approach Strategies to Prevent Opioid Misuse or Overdose Strategies to Prevent Overdose Death 74

75 Case Study: Sometown, USA & Anyville, USA Handout: Case Study: Opioid Overdose Prevention Strategies 75

76 Road Map for Today s Training Defining the Problem Focus Populations Factors that Place Individuals at Risk Prevention Strategies Common Challenges 76

77 Common Challenges to Preventing Opioid Overdose and Death 77

78 What are some challenges you ve experienced (or anticipate) doing this work? 78

79 Challenge #1: Engaging New Partners Opioid overdose prevention requires collaboration with a diverse range of sectors for example, primary care, professional first responders). Many of these may be new partners for prevention practitioners and not easy to engage. 79

80 Challenge #2: Stigma Stigma experienced by people who use drugs may prevent them from seeking help for a substance use disorder. It may also prevent potential partners from supporting overdose prevention efforts. 80

81 Challenge #3: Limitations of Naloxone Naloxone can prevent death from opioid overdose, but it will not reduce underlying substance use problems. 81

82 How might your group overcome this challenge? Challenge #1: Engaging new partners Challenge #2: Stigma Challenge #3: Limitations of naloxone 82

83 Reflecting on the Day 83

84 Evaluation Please take the time to fill out the evaluation form. Your feedback is very important to us! 84

85 85

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