From Underground to State-Funded: The History of Overdose Prevention/ Naloxone Distribution in Massachusetts

1. From Underground to State-Funded: The History of Overdose Prevention/NaloxoneDistribution in Massachusetts Adam Butler, Jon Zibell, Kathy Day, Monique Tula and Gary Langis

2. Purpose • To describe in timeline format the history of Overdose Prevention in Massachusetts • To describe how OD Prevention went from an underground effort to a comprehensive, state-sanctioned & funded program that includes naloxone distribution • To describe the various initiatives that have been developed and integrated into other services over time. • To share successes, challenges, key opportunities and identify ways for different types of organizations (underground, CBO, state) to all play a part in developing a successful program and initiatives .

3. National and Regional Drug Threat United States New England 38.8% 37.6% 36.5% 33.2% 15.5% 11% 8.5% 9.3% 3.9% 1.9% Cocaine Heroin Methamphetamine Marijuana Pharmaceuticals Cocaine Heroin Methamphetamine Marijuana Pharmaceuticals Source: National Drug Threat Assessment, 2007

4. Opioid-related Health Problems 2007, rates per 100,000 by Town Rates suppressed for towns with less than 5 cases Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)

5. Opioid-Related Poisoning Deaths 1990-2008 Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)

6. 2000 Active players: Underground Community-Based Organization

7. 2001 • Active players: • Underground • Community-Based Organization

8. 2002 • Active players: • Underground • Community-Based Organization

9. 2003 • Active players: • Underground • Community-Based Organization

10. 2004 • Active players: • Underground • Community-Based Organization

11. 2005 • Active players: • Underground • Community • City

12. Media Shit Storm

13. No Response = Death 2005 – Boston Herald front page photo

14. Media Shit Storm

15. 2006 • Active players: • Underground • Community • City

16. 2007 • Active players: • Underground • Community • City • State

17. Massachusetts Department of Public Health funded Naloxone Programs Gloucester Lynn Boston Cambridge Provincetown Quincy Brockton Springfield Northampton Fall River Hyannis New Bedford 2007

18. Media in 2007

19. 2008 • Active players: • Underground • Community • City • State

20. Media in 2008

21. MassCall2 15 Municipalities received funding through MDPH to build capacity to address fatal overdose Communities were chosen due to high OD rates All identified barrier of calling 911 as variable Most communities work closely with state funded naloxone programs Engaged law-enforcement, treatment providers, harm reduction personnel, and community members

22. Good Samaritan Legislation Two GS bills were introduced in MA in 2008 Several groups advocated and lobbied legislators Both bills failed during this legislative session

23. 2009 • Active players: • Underground • Community • City • State

24. More Work to Do State report says deaths from opioid-related overdoses declined in 2008 By Vicki-Ann Downing Enterprise Staff Writer Posted Dec 19, 2010 @ 06:00 AM BROCKTON — “The overdose rate for the South Shore in 2009 was high and it was steady throughout the year,” said Dubois. “As a whole, 2010 was lower in the amount of fatal overdoses compared to 2009, but still too high.” That the governor’s report contained any information at all about deaths from drug overdoses – in addiction to cancer, heart disease, Alzheimer’s disease and diabetes – shows it “is still something that the Commonwealth deems to be a critical issue,” said Dubois. The report, based on statistics from the state Department of Public Health, showed 594 deaths from opioid-related overdoses in 2008, compared to 637 in both 2006 and 2007. The number of overdose deaths began to climb beginning in 1996, when there were 178, according to the state…

25. 2010 • Active players: • Underground • Community • City • State

26. Massachusetts Department of Public Health funded Naloxone Programs Lawrence Lowell Gloucester Lynn Boston Provincetown Cambridge Quincy Holyoke Worcester Brockton Springfield Northampton Fall River Hyannis New Bedford 2010

27. Good Samaritan Legislation Good Samaritan Coalition formed Three GS bills introduced, another with a provision to address GS Garner community support Parent support groups Treatment and Recovery Community support Community forums conducted Students for Sensible Drug Policy

28. 2011 • Active players: • Community • City • State

29. Screening Brief Intervention, Referral to Treatment (SBIRT) Eight Hospitals funded by MDPH for SBIRT Harm reduction strategies have been incorporated Motivational Interviewing (MI) HPA’s provided with training to train and enroll participants into state naloxone program

30. Learn To Cope Support group for family members and loved ones of opioid users Five groups in eastern MA 14 members are approved MDPH Naloxone trainers Training of peers take place at their meeting’s

31. 2012 • Active players: • Community • City • State

32. Challenges • Slow pace • Needed legal backing and buy-in from “authorities” before could become legitimized • Getting over ego stuff • Staff buy-in to risks of distributing naloxone pre-pilot years • Negative press/media • Limited research made it difficult for public health people to buy in

33. Looking Forward • Expanding into more ER’s (SBIRT) • Expanding first responder involvement • Persons in Recovery and Treatment become partners • ODP being incorporated into standards of care for short-term drug treatment • Research possibilities that contributes to the case being made for OTC sale of Narcan • FDA approval of nasal Narcan use • ODP being incorporated into the DOC • Education on Good Samaritan laws

34. Successes Collaborative process between underground and funded programs Philosophy shift in State (BSAS) Acceptance of harm reduction philosophy by treatment programs, parents of users, etc. Buy in from many stakeholders to legitimize naloxone distribution Good Samaritan Law passed Lives saved

35. More Successes 2006-2012 • Enrollments • 15,000+ individuals • 300 per month • 1500+ reported reversals • 30 per month • RFD has more than 70 OD reversals