Expanded Overdose Prevention Efforts in Michigan With Nalox - PowerPoint Presentation

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Expanded Overdose Prevention Efforts in Michigan With Naloxone Rescue Kits

Steve Alsum

The Grand Rapids Red Project

steve@redproject.org

(616) 456-9063Slide2

IntroductionOverdose EpiNaloxone Distribution: Core ComponentsDistribution ModelsCommunity Based

Law Enforcement

PharmacyCo-PrescriptionNaloxone Distribution: MichiganWhat’s Next?

Outline Slide3

Intro To Red ProjectSlide4

A 501c3 non-profit founded in 1998Mission: Improve Health, Reduce Risk, Prevent HIVWe utilize a Harm Reduction philosophyThe space in between prevention & treatmentMeeting people where they are at

Providing a range of options

Client centeredLow threshold approachPre-recovery supportsHealth Issues: HIV, Hepatitis C, and Overdose

Red Project BasicsSlide5

Overdose PreventionRapid HIV/Hepatitis C TestingRisk Reduction CounselingSyringe AccessHIV Linkage To Care & Case ManagementRecovery Coaching/Access To Treatment

Support Groups

Red Project provides comprehensive programming along the continuum of care

Red Project ProgrammingSlide6

Overdose EpidemiologySlide7

these deaths are preventable…Slide8

Mortality: MichiganSlide9
Slide10
Slide11

The Silver LiningSlide12

Core Components of Naloxone DistributionSlide13

Naloxone can be prescribed like any other medication- the issue is physician awarenessPA 311 of 2014 allows prescription to:Third parties, ie

family members, friends, etc

An organization that:Acts at the direction of a prescriberStores the naloxone properlyDispenses the

naloxone

under a valid prescription to a patient

Performs requirements without charge or compensation

PA 462 of 2014- Law Enforcement

No matter what model: a physician must be involved at some point in the process

Core Components- PhysicianSlide14

Why are we here?To train community health respondersWhat is an overdose?Why do people die of overdoses?

What do people overdose on?

Opioids, and the role of naloxoneOverdose risk/preventionMixing, tolerance, quality, using alone, etc…Recognizing an overdose

The line…

Responding to an overdose

S.C.A.R.E. M.E.

and the 3 A’s

Naloxone

kit assembly/storage/legality

Core Components- TrainingSlide15

Naloxone Rescue Kit OptionsIntramuscular ($40-75)Intranasal

($75-105

)Auto-injector ($650-3,000)Stocking and assembling the kitWill you do this yourself?Or work with a pharmacy?

Paying for the kit…

Some options are more affordable than others

Work with your insurance companies-

this is cost effective

no longer cost effective at a cost of $4,480/kit- Coffin et al.

AIM

2013; 158: 1-9.

Core Components-

NaloxoneSlide16

NaloxoneSlide17

National ModelsSlide18

Piloted by Chicago Recovery Alliance, Harm Reduction Coalition’s DOPE Project, Massachusetts programsTypically provided in conjunction with other harm reduction/SUD services:Syringe accessMethadone maintenance

Detox

Recovery housingFamily GroupsReach very high risk individuals and their social networksCommunity BasedSlide19

CDC MMWR, June 18, 2015Nationally there were 136 local overdose prevention programs that distribute Naloxone

From 1996-2014

Trained 152,283 people26,463 reported reversalsMultiple Models For Successful Programming

Syringe Access/Harm Reduction-Chicago Recovery Alliance, etc

Point of Prescription/Medical Model-Project Lazarus

State Health Department- Massachusetts, etc

The Take Away:

Finding ways to put tools in hands to save lives…

National Model ProgrammingSlide20

The Chicago Recovery AllianceSlide21

RationaleLaw enforcement are first respondersBetter serve the public/improve relationsPrevent unnecessary death/potential PTSDSuccessfully Modeled In:

MA, IN, NC, NY, RI, VT, CT, etc

…http://www.nchrc.org/law-enforcement/us-law-enforcement-who-carry-naloxone/Most successful when people feel comfortable calling 911

Law Enforcement

NaloxoneSlide22

Almost over the counterThrough a CPA, pharmacists can issue a naloxone rescue kit, without a preexisting prescription for a patientCVS and Walgreens have taken the lead, nationallyPlans to expand to most states

Is new

legislation necessary in Michigan- we already do this with other medications?Think flu shots and vaccinationsBenefits…

Pharmacy Access: Collaborative

Practice AgreementsSlide23

www.prescribetoprevent.orgA comprehensive online resource to encourage naloxone prescribing

Inclusion Criteria for a Naloxone Rescue Kit

Received

emergency medical care involving opioid intoxication or poisoning

Suspected history of substance abuse or nonmedical opioid use

Prescribed methadone or buprenorphine

Higher-dose (>50 mg morphine equivalent/day) opioid prescription

Co-Prescription With OpioidsSlide24

Receiving any opioid prescription for pain plus:Rotated from one opioid to another because of possible incomplete cross tolerance

Smoking, COPD, emphysema, asthma, sleep apnea, respiratory infection, or other respiratory illness or potential obstruction.

Renal dysfunction, hepatic disease, cardiac illness, HIV/AIDSKnown or suspected concurrent alcohol use

Concurrent benzodiazepine or other sedative prescription

Concurrent antidepressant prescription

Patients who may have difficulty accessing emergency medical services (distance, remoteness)

Voluntary request from patient or caregiver

Inclusion

Criteria, continuedSlide25

Community Engagement2008: Wilkes County, NC has 6th highest OD mortality rate in nation

Fatality is caused primarily by prescription opioids

Work with doctors to train individuals receiving opioid prescriptions in how to respond to overdose with NaloxoneOD deaths down 69% between 2009 and 2011Less than 1% change in how many residents had a prescription for an opioid pain reliever in Wilkes County

In 2008 82% of OD fatality victims had a prescription from a Wilkes County prescriber, in 2011 this decreased to 0%

Project Lazarus and

Chronic Pain InitiativeSlide26

Project LazarusSlide27

“The prevention of drug overdoses is consistent with the Board's statutory mission to protect the people of North Carolina.  The Board therefore encourages its licensees to cooperate with programs like Project Lazarus in their efforts to make naloxone available to persons at risk of suffering opioid drug overdose.” 

North Carolina

Medical Board StatementSlide28

Naloxone Distribution: MichiganSlide29

Clean Works Program- October 2008Cherry St Health Methadone Clinic- 2012Network 180 and SUD Treatment- 2013SA Turning Point, Arbor Circle IOP, Our Hope,

Jellema

House, Freedom House, Cherry St Health Methadone Clinic, Degage Open Door Women’s Shelter, Network 180 Access Center, etcResults (as of 6/30/2016)3,150 individuals trained which has led to 345+ reported reversals

The

Future

Increased collaboration/partnerships

Multiple points of distribution

GR Area ProgrammingSlide30

Direct Client Service DeliveryAllegan, Ottawa, Muskegon, lake, Mason, and Oceana countiesTechnical Assistance/Program Start-UpRegion 10 PIHP- 4 County Region Flint to Port Huron

SWMBH- Kalamazoo and 8 Counties in SW

MILansing and Montcalm CountiesLaw Enforcement Training

2016 ExpansionsSlide31

Local Task Force CreationThis epidemic is bigger than what the capacity of a few scattered not-for-profits can handle- it requires a community responseLocal Law Enforcement TrainingIntegration into the medical community- co-prescription along with opioids

2016/17 ExpansionsSlide32

Naloxone is an unscheduled prescription medication both nationally and in MichiganPA 311 – 314 signed into law October 2014Allow prescription to anyone

Allows prescription to an organization

Allow administration to anyoneEliminates potential criminal and civil liability, and professional disciplinary action, for prescribers and end-usersNaloxone is one of the easiest/safest medications to prescribe, we need to make it easier to obtain

Still no Good Samaritan legislation

Legal Status In MichiganSlide33

Naloxone In MI: 2016Slide34

Southwest MichiganSlide35

Central MichiganSlide36

Southeast MichiganSlide37

By The Bay and ThumbSlide38

Up NorthSlide39

Governor Snyder’s office has endorsed this, and it will be the standard for LE agencies to be equippedCurrently carrying kits (and trained through Red Project):Hastings PD, Barry Sheriff, Nashville PD,

Barrein

Sheriff, Berrein Springs-Oronoko PD, Buchanan PD, Coloma PD, Bridgmen PD, Pokagon Tribal PD, Three Oaks PD, Grand beach PD, New Buffalo PD, Niles PD, Michiana PD, Coldwater PD, Branch Sheriff, Bronson PD, Union City PD, Albion PD, Calhoun Sheriff, Battle Creek PD, Marshall PD,

Dowgiac

PD,

Ontwa

Township PD, Cass Sheriff, Cassopolis PD, Kalamazoo Sheriff, MSP- Specialty Teams, MSP-Wayland, MSP Post 54, MSP 5

th

District HQ,

MSp

-Niles, MSP-Paw Paw, St Joe Sheriff, Three Rivers PD, Centreville PD, Decatur PD, Van Buren Sheriff, Bangor PD, Hartford PD, Covert PD, Oceana Sheriff, Lake Sheriff, Mason Sheriff, Baldwin PD, Hart PD, Ludington PD,

Benzie

County

Sheriff*, Macomb County Sheriff*, etc

…

*not trained through Red Project

Michigan: Law EnforcementSlide40

PA 462 makes it legal for law enforcement officers and agencies to purchase, possess, dispense, and administer naloxoneRemoves potential civil and criminal liability

To carry, and administer, officers must:

Receive trainingBelieve someone is experiencing an opioid related overdose

Law Enforcement- LegalitySlide41

Pharmacy AccessSpartan/Nash Stores (Duthler’s, D&W, Family Fare)- have a CPA operating at three stores in the GR areaResults:Medical Community/Co-Prescription

The epidemic is primarily among prescription opioid users in Michigan

We need statewide leadership in this areaTo be addressed:Physician awareness/educationBillingStocking Naloxone Rescue Kits

The Medical CommunitySlide42

What’s Next?Slide43

Clear and direct leadership from the stateWe are at least 10 years into this epidemic…Legislative changeBroad Good Samaritan protectionsClear Standing Orders

Other access points

Full Integration Into Various System PointsLaw Enforcement/Criminal JusticeMedical community, co-prescription and pharmacy accessSubstance use, and addressing the trauma

A statewide epidemic…Slide44

Massachusetts provides overdose education and naloxone distribution on a statewide level, supported through their health departmentWalley et al. BMJ

2013; 346: f174. found that:

0 kits per 100,000 people resulted in a 0% change1-100 kits/100,000 people resulted in a 27% reduction in community overdose mortality rates>100 kits/100,000 resulted in a 46% reductionDecreasing overdose mortality is dependent on increasing naloxone

kit distribution

What is the point?Slide45

Anyone currently using opioidsIndividuals using opioids as prescribedIndividuals abusing prescription

opioids

Individuals using or abusing other opioidsAnyone with a history of opioid abuseRelapse can be a part of recovery, and in relapse there is extreme danger of overdose

If an individual is allergic to bee-stings they have an

epi

-pen:

We need to look at

naloxone

rescue kits in the same way…

Inclusion Criteria: Simplified Slide46

A common concern addressed…Just because you own one of these…

Does not mean you will start one of these…Slide47

The Chicago Recovery Alliance and Dan BiggNetwork 180/CMH of Ottawa County/Health West/SWMBH/Region 10 PIHPOur Physicians

Dr Vernon Proctor

Dr Sandra DettmannDr Cara PolandOur StaffOur ClientsThey do the real work

A Special Thanks…Slide48

CDC: Injury Prevention and ControlMDHHSKent County Medical ExaminerMAPSPhysicians Desk Reference

CDC MMWR, June 18, 2015-Community-Based

Opioid Overdose Prevention Programs Providing Naloxone – United States, 2010The Grand Rapids Red ProjectWalley

et al.

BMJ

2013; 346: f174.

North Carolina Harm Reduction

Coalition

Coffin et al.

AIM

2013; 158: 1-9.

Sources