Alice Bell, LCSW

1. Alice Bell, LCSW Project Coordinator Overdose Prevention Project, Prevention Point Pittsburgh

2. Prophylactic Prescription of Naloxone to Prevent Fatal Opioid Overdose July 2012 Overdose Prevention Project Prevention Point Pittsburgh Alice Bell, Project Coordinator 412-247-3404 abell@pppgh.org

3. Each year in Allegheny County, more people die of accidental drug overdose than die in traffic accidents and homicides, combined. Of 261 overdose deaths in 2011, 261 involved one or more substance that would respond to naloxone. Data released from CDC for 2009, indicates drug overdose is now the number one cause of injury death, exceeding motor vehicle accidents, and killing at least 37,485 people in U.S. Roughly half of these deaths involve opioids; almost 40% opioid analgesics and almost 10% heroin.

4. Motor vehicle traffic, poisoning, and drug poisoning death rates: U.S., 1980--2009 Source: NCHS Data Brief, December, 2011, updated with 2009 mortality data

5. Allegheny County Trends in Accidental Drug Overdose Deaths 2000-2011* *Data is from Allegheny County Medical Examiners Annual Reports and includes all overdose deaths where these drugs were present at time of death, not necessarily cause of death.

6. Overdose Deaths from Opioids are preventable We have the antidote, safe, highly effective, naloxone. Paramedics use naloxone (Narcan) to immediately reverse the effects of opiate overdose.

7. So, Why Are People Dying? • Failure to recognize symptoms of overdose. • Don’t know what to do results in delayed or ineffectual response. • Fear of stigma associated with drug use. • Fear of Police Involvement.

8. Strategies for Reducing Overdose Deaths • Prescription Monitoring Programs: • Reduce Diversion, not demonstrated to reduce overdose. • Concern about increase in heroin use. • Methadone and Suboxone treatment: Very effective • Abstinence-based drug treatment: • Risk of overdose increases when relapse occurs. • Community Based Education: Risk Factors, Identification of Symptoms, Effective Response, including Rescue Breathing, Calling 911 and Naloxone Administration • Naloxone Prescription Programs • Physician Prescribing when prescribing opioids for pain

9. Overdose Prevention/Naloxone Prescription Program:Prevention Point Pittsburgh Implemented in Pittsburgh July 2005 at Syringe Exchange Medication is Prescribed by Volunteer Physicians Over 800 individuals have received Naloxone Over 650 successful peer overdose rescues. Updated Data 6/15/12 Bennett, A.S., Bell, A., Tomedi, L., Hulsey, E.G., Kral, A.H. (2011); Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania. Journal of Urban Health, 88 (6):1020-1030.

10. OD Education and Naloxone Distribution (OEND) Programs in U.S. PMMWR, Centers for Disease Control, February 17, 2012, Volume 61, No. 6ngeles, Massachusetts, Mendocino County, CA, New Haven, New Mexico, New York City, Oakland, Pittsburgh, Rhode Island, San Francisco, Wilkes County, NC and more * Knox, 2008 † Wheeler, E. NOPE Working Group - Harm Reduction Coalition. 2010

11. Project Lazarus - North Carolina In response to some of the highest drug overdose death rates in the country, Project Lazarus developed a community-based overdose prevention program with routine physician prescription of naloxone when opioids were prescribed for pain. Overdose death rate dropped from 46.6 per 100,000 in 2009 to 29.0 per 100,000 in 2010. Unpublished data indicates rate of death has continued to drop to 7 deaths per 100,000 is 2011. (2010-2011 rates based on provisional data from OCME via Wilkes Co. Health Department.) Pain Med. 2011 Jun;12 Suppl 2:S77-85

12. Project Lazarus: Naloxone Rescue Pain Diagnosis Opioid prescription Identify high risk patient Prescribe naloxone Substance Abuse Treatment Prescribe naloxone 2. 3.

13. Womack Army Medical Center, Ft. Bragg, NC:Operation OpioidSAFE MAJ Anthony Dragovich MD Medical Director, Pain Medicine Ft. Bragg, NC Operation OpioidSAFE is a novel provider, patient and community education program with the added advantage of lay person diagnosis and reversal of opioid overdose by naloxone.

14. Model for Integrating Overdose Prevention and Treatment Into Standard Practice at Primary Health Centers and HIV Treatment Programs in Pittsburgh, PA. -2011/2012Cristina Elgin, PharmD Candidate Positive Health Clinic – AGH PACT - UPMC Metro Family Practice- Birmingham Free Clinic

15. DVD Opioid Medication Safety: The Role of Naloxone by Prevention Point Pittsburgh PrescribetoPrevent.org

16. If you take medicine for pain, YOU may be at risk for accidental overdose! ASK ABOUT NARCAN Multiple medications Multiple medical conditions + Opioid pain medication INCREASED RISK OF OVERDOSE Do you take opioid medicine for pain like morphine, methadone, Oxycontin, Percocet, Vicodin, fentanyl, or Opana? Do you use other opioids like heroin? Using any opioids puts you at risk. Your risk is greater if you take other medications or have other medical conditions. Opioid overdose is PREVENTABLE and REVERSIBLE Naloxone (Narcan) is a medication that STOPS overdose! You can get naloxone here at ### Family Health Center. Ask a staff member or call ##-###-#### to learn more!

17. Physician/Pharmacy Collaboration for Naloxone Prescription in Pittsburgh • Positive Health Clinic- February 2012 • UPMC – PACT-March 2012 • Center for Pharmacy Services-2011 • Metro Family Practice-June 2012 • Birmingham Free Clinic-July 2012 • Mercy Family Health Center-July 2012

18. American Medical Association Endorses Community Based Naloxone Programs “The AMA today adopted policy to support further implementation of community-based programs that offer naloxone and other opioid overdose prevention services. The policy also encourages education of health care workers and opioid users about the use of naloxone in preventing opioid overdose fatalities.” – Health News Digest June 19, 2012