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What strategies are being implemented for overdose prevention & response?

Posted: 07 Nov, 2016   Recommendations: 3   Replies: 8

What does a “successful” overdose prevention and response program look like? Which strategies have been most successful or unsuccessful? What are some reasons for lack of success in rolling out and implementing these programs and policies? How do we get the treatment to individuals who need it most?

Replies

 

Marie Teichman Replied at 9:38 AM, 7 Nov 2016

In preparation for this week's discussion, I wanted to share some resources that might be of interest. We encourage you to share additional resources on this important topic, as well as any questions you'd like to see our panel address over the course of the week. Looking forward to a great discussion!

All resources for this Expert Panel can be found at ghdonline.org/opioid-epidemic/resources

Attached resources:

Daniel Meloy Respondent Replied at 10:06 AM, 7 Nov 2016

Colerain Township, OH, a community of 60,000 residents and the 14th largest community in the State of Ohio initiated a unique response to the heroin/opioid epidemic. The response plan was facilitated through the creation of a "Community Health Collaborative" group that includes local police, Fire/EMS, and HR personnel. The group also includes the local public health organization, the local school district, area business members, the faith based community, media and people serving in the treatment and recovery business. This group worked to ask questions, listen to answers and then identify the needs of our community. This group facilitated two community meetings; one in early 2015 to learn from a larger scope of community members, the significance of the problem. A second forum was conducted in 2016 to let the community know that the problems raised in 2015 were investigated and steps were initiated to make an impact.

The group also identified a lack of information available to families/addicts about the disease of addiction and reputable treatment resources. The Police and Fire Departments partnered with a local organization, "Community Recovery Project" to distribute "Resource Recovery Packets" at all overdose responses by police and fire. Since August 2014, the Township distributed almost 500 packets to our community. Several patients/families returned to thank the departments and its officers/firefighters for their help to find help.

The Township also created a tri-fold brochure that is used an education tool for our residents. The brochure is provided during "Door to Door" canvassing efforts in our most affected neighborhoods. In our first neighborhood, five families called and asked for help, when only receiving the brochure. The brochure contains 24-hour help telephone numbers and the "signs of an overdose" along with our "Drug Drop Box" hours. This brochure is also provided at any public event to reach as many of our 60,000 residents as possible.

In July 2015, the work done to that point was not enough and more was necessary. At that time, the Police and Fire Departments partnered with the Cincinnati Addiction Services Council professionals to provide "on-site triage and assessments" for persons who experienced an overdose within a three-five period. The team reviews police incident reports and conducts follow up to any resident who overdoses and enrolls that person in the Medicaid system, if necessary. The team has also purchased birth certificates to assist in the obtaining of a state identification card as well as meals, when the need arises. Since July 2015, the team conducted more than 200 follow up investigations, with an 80% success rate of getting the addicts to treatment. The team also provides Narcan to family members to help them save a life, if/when a relapse occurs within their ability to respond.

Attached resources:

Jason Lucey Respondent Replied at 1:02 PM, 7 Nov 2016

The definition of a "successful" overdose prevention and response program can be measured in various ways but the most obvious is to look at the numbers of overdose deaths in a community. By this measure, my home state of NH still has significant challenges ahead despite a number of efforts to expand naloxone access over the last couple of years. Projected numbers for 2016 will be close to 500 deaths, an increase of around 10% from last year. (http://www.wmur.com/article/overdose-deaths-in-new-hampshire-projected-to-nea...)

NH represents an example of a state that has done some things right but still has miles to go before it can claim a robust and effective overdose prevention program. Of the things suggested years ago by experts to expand access to naloxone, NH is relatively underdeveloped. (see 2009 article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661437/) In May 2015, NH passed legislation allowing 3rd party prescribing of naloxone and standing orders as well as liability protection for prescribers. Soon after, good Samaritan legislation was passed that barred the arrest, prosecution or conviction of someone who seeks medical help for an overdose victim. Unfortunately however, in spite of both laws being in effect for several months, the actual distribution of naloxone to community members was hindered by numerous barriers including prescriber hesitancy, corporate pharmacy policies challenging implementation of standing orders, and lack of pharmacy stocking the actual drug or equipment (nasal atomizers).

Another barrier to naloxone access that was quickly realized in NH was the practical problem of who would pay for it and how. While some things have improved regarding access to insurance since the ACA(Affordable Care Act), there are still uninsured and underinsured residents and the cost of a naloxone kit at a retail pharmacy is at times prohibitive (average cost in my informal survey this summer of local pharmacies was approx. $80).

One potential solution to the cost problem was the distribution of state-purchased kits. In September 2015, the NH Department of Health and Human Services bulk-purchased and then distributed kits to several community health centers where they were then distributed either at community events or to individuals who requested them. While this is a step in the right direction for sure, we have also realized that there are still ways for the program to improve. For instance, at community events, there is a question as to whether or not the overdose kits are getting to the people who need them the most. For example, while it is great that a parent of an adult who uses heroin, for instance, has access to naloxone, if the person who uses drugs is not with their parent while using, then the naloxone will clearly not help them. Another strange phenomenon we have experienced is the stagnation of kits on the shelves of some of the places they are kept. It is not clear if this is still related to lack of organizational or prescriber comfort in liberally dispensing or if there is hesitation to dispense for fear of running out but the fact of the matter is that naloxone on a shelf cannot save a life.

There are some innovative and ongoing programs happening in NH that show promise towards the ultimate goal of widespread naloxone access and use (which in turn will hopefully lead to that metric of reduced overdose deaths). Since January 2016, in Strafford County, a pilot program was approved by DHHS to begin peer-to-peer kit distribution where recovery advocates or willing community members who are in contact with people who use drugs are trained to teach users and then given a number of kits to then go and distribute (getting those kits off those shelves!). This program now is being continued by SOS Recovery Community Organization ( http://straffordrecovery.org/ ) and will likely be replicated by other recovery community organizations in the state. The outreach capacity for naloxone distribution from a recovery community organization that has the capacity to do direct "friendly" outreach into the community holds greater potential for success than a traditional brick and mortar location like a hospital or health center or police department as people who use drugs may not readily access those places (perhaps as a result of past stigmatizing experiences in those venues). In NH, which in large part has rural communities, the concept of peer-to-peer or "secondary" exchange of services like naloxone or syringes seems to just plain make sense. The concept of using outreach as a quick-to-implement and cost effective approach to delivering syringe services in rural communities is supported by a number of organizations including the WHO (http://apps.who.int/iris/bitstream/10665/43816/1/9789241596275_eng.pdf).

The concept of syringe access is another potential avenue towards a more "successful" overdose prevention program in NH. Although a bill last year that would have ultimately allowed dispensing of syringes by non-pharmacists (HB1681) did not pass the senate , it did establish a multi-disciplinary commission which will provide recommendations to the legislature this year. Work is ongoing to craft legislation that would allow syringe service programs to be opened. Although the primary and noble purpose of syringe exchange is to reduce the burden of preventable blood borne pathogens for people who use syringes, one of the major secondary benefits will be to provide additional resources like education and equipment (naloxone kits) to prevent overdose among other things like referral to treatment. Similar to the recovery community organizations that represent a safe and welcoming place to people who use drugs, syringe service programs will expand access to the people who need overdose prevention the most.

Alexander Walley Panelist Replied at 5:06 AM, 9 Nov 2016

Thank you to Marie, Daniel and Jason for providing insight and examples of successful overdose prevention and response efforts in Ohio and New Hampshire - two states particularly hard hit by the opioid crisis.

The increased attention on overdose deaths provides an opportunity to bring multiple stakeholders together in communities to implement known and innovative overdose prevention and response strategies. Here are some examples:
-- Development of community overdose prevention programs and needle syringe access programs - http://harmreduction.org/
-- Overdose education and naloxone rescue kit resources for prescribers and pharmacists- http://prescribetoprevent.org/
-- Prescriber education to improve opioid safety - https://www.scopeofpain.org/
-- Support groups for family of people who use opioids - http://learn2cope.org/ and http://grasphelp.org/
-- Law enforcement naloxone toolkit - https://www.bjatraining.org/tools/naloxone/Naloxone-Background
-- Summaries of the latest peer-reviewed research on overdose prevention - http://www.overdosepreventionalliance.org/

Pierre Bush, PhD Replied at 10:24 PM, 9 Nov 2016

Hello Alexander,
The Naloxone prescription toolkit is an important and useful measure that can prevent overdose. This is also one of the measures discussed during the recent work shop on pain management, prescription opioid-related harms: Exploring the state of evidence. One participant Richard Dart talked about Oxycodone ER which is used as abuse deterrent. The whole discussion can be found on page 5 of the final document published by the National Academies of Science, Engineering and Medicine ( https://www.nap.edu/read/23694/chapter/1#5). I have seen a program where patients on Opioids undergo scheduled Urine drug screen, to monitor the levels. I think that it is a good program too.

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Shimon Waldfogel Replied at 6:46 AM, 12 Nov 2016

Thanks to GHDonline for hosting this panel and to the participants.
I found the questions and resources quite helpful and I hope to incorporate some in a project regarding the opioid epidemic I have been developing.
Here is brief intro to the project..

Shortly I will launch The Pain Opioid Epidemic Project to address the devastating toll that the Opioid Epidemic has taken on individuals, families, communities and the nation in the past decade. The overall goal of the project is to provide a framework and action plan that allows individuals, and systems to achieve the right care for the right person at the right location at the right cost.
More specifically the project provides meaningful solutions and ways to manifest them that address the entire arc of the Opioid Ecosystem, including: pain management, opioid use disorders, opioid overdoses, public policy, law enforcement, criminal justice and related challenges. A secondary objective is to experiment with providing a citizen focused approach to address social and political challenges.

The project is a (personal) response to feeling increasingly concerned as a citizen with the growing challenges faced by our American Democracy.

The Pain Opioid Epidemic Project is inspired by the belief that we as citizens must engage with fellow citizens and relevant stakeholders to achieve solutions to the challenges that face our communities and our nation.

Here is link to information about The Pain Opioid Project.
http://shimonwaldfogel.wixsite.com/the-opioid-epidemic/about-

WIll be happy to get any feedback...

Amado Alejandro Baez Respondent Panelist Replied at 7:00 PM, 14 Nov 2016

Here in Miami we have been working at integrating police for Narcan administration, as well as developing a community-centered program for patient administered Narcan. There is a Clinton Foundation gran for Narcan donations

Joe Welfeld Replied at 8:29 PM, 20 Nov 2016

I have been working with a startup fullsightrx.com that focuses on (in many cases) the start of the epidemic - the diversion of opioids from hospital settings. We see this as a great opportunity to have significant impact.

This Expert Panel is Archived.

This Expert Panel is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.