TRENDS IN OVERDOSE EPIDEMIC, TRAINING AND NALOXONE DISTRIBUTION, AND OPPORTUNITIES FOR SCALE UP OF OD PREVENTION

Transcription

1 TRENDS IN OVERDOSE EPIDEMIC, TRAINING AND NALOXONE DISTRIBUTION, AND OPPORTUNITIES FOR SCALE UP OF OD PREVENTION Prevention Point Philadelphia 8/5/15

2 TRENDS IN PURITY AND PRICING OF HEROIN HAS HUGE IMPLICATIONS FOR OVERDOSE EPIDEMIC Philadelphia has some of the purest heroin in the northeast and country Recent purity levels topping 63%, 13% increase since 2007 Camden heroin as high as 92% with recent spike and competition Price of heroin down to $.60 per milligram, 15% decrease since 2007 Price of heroin in New York $.99 with a 37% purity Increase in people coming to Philadelphia to buy heroin Increase in number of suburbanites, youth, and pill users coming to Philadelphia to buy heroin

3 PRESCRIPTION OPIATE AND BENZO USE / MISUSE INCREASING IN PHILADELPHIA, SURROUNDING SUBURBS Trend over past few years in treatment admissions includes benzo use concurrent with opiate use While admissions and admission requests for individuals injecting opiates steady in Philadelphia, increasing trend over past few years of admissions/requests for prescription opiate users, and concurrent prescription opiate and benzo users Increase in requests for inpatient treatment specifically for benzo overuse and withdrawal Youth, suburbanites, and suburban youth beginning opiate use through prescribed and diverted pain medications Increased requests for outpatient treatment for younger and formerly out of county patients Increase in requests for long time opiate users who have never sought inpatient treatment

4 TRENDS IN OVERDOSE PREVENTION NEEDS OF PPP PARTICIPANTS Many individuals coming from Puerto Rico, other cities unprepared for availability or purity of drugs Newer users not preparing drugs or injecting themselves Many long time users affected by overdose differently due to changes in drugs available Many long time users affected by changes in their age, overall health, impact of Hepatitis C, other immune complications Up to half of long time users self-reporting recent overdose have recently left incarceration or inpatient treatment

5 CHANGE IN OVERDOSE EPIDEMIC AND PUBLIC RESPONSE PRESENT OPPORTUNITY TO RESPOND Recent trends in initiation of drug use have changed overdose epidemic As more people begin opiate use as a result of being prescribed painkillers or diverting someone else s painkillers, changes in demographics of users and victims of overdose As more previously non-county residents seek treatment in Philadelphia, and overdose in Philadelphia, county will be pressured to respond Fortunately, previous perceptions regarding overdose and od victims being challenged Reality is that public and media noticing overdose as a result of celebrity overdoses and suburban overdose deaths Parent advocacy movement has had a huge impact and biggest factor in good Samaritan and immunity legislation State encouraging MAT providers to facilitate overdose prevention efforts

6 HISTORY OF PPP OVERDOSE PREVENTION PROJECT In 2006, PPP began program in response to rising deaths Steep increase in overdose deaths followed by fentanyl epidemic Hundreds of people lost their lives and community hit hard Awareness really high and participants began to ask about naloxone PPP approached Division of Behavioral Health about beginning program Overdose Prevention Intervention & Treatment Education Project (OPIATE) OPIATE goals: reduce risk for overdose and overdose deaths OPIATE also designed to train family, friends, and partners in pairs Most important: free Naloxone with prescription after medical assessment

7 HOW PPP OPIATE PROJECT WAS INITIALLY IMPLEMENTED Advertised sessions at exchange sites Educational sessions held at PPP during busiest exchange site Educational sessions held when doctor on site to write prescription Additional sessions held on an as-needed basis on clinic days Sessions held in group format Sessions typically take 20 minutes Sessions involve chemistry of opiates and drug interactions, risk factors for overdose, symptoms of overdose, responding effectively to an overdose Try to teach S.C.A.R.E. M.E (Stimulate, Call for help, Airway gets cleared, Rescue breathing, Evaluate breathing, Muscular injection, Evaluate again)

8 CHALLENGES TO IMPLEMENTING OPIATE PROJECT Even with advertising, low uptake of education sessions Very few participants brought in family, friends, partners to be trained Did not always have doctor present to sign prescriptions Constant training of newer medical staff to get them on board Only exchange staff offered training Could not always get naloxone Low awareness of risk for overdose Awareness often based on personal history Fentanyl seen as separate issue by many

9 STRUCTURAL CHANGES IDENTIFIED All staff needed to be trained to conduct education, reverse, dispense All medical providers needed to be on board and trained Providers can t provide clinical services without prescriptions SEP presented bigger opportunity to raise awareness Could do greater in-reach in SEP Could take advantage of our drop in space There is a way to identify individuals at risk who don t ask for or refuse training If participants don t opt in, can we start to ask them to opt out Suboxone clinic first opportunity to make change Case management services next opportunity Clinics presented huge opportunity to routinize screening for risk Clinics presented huge opportunity for training and medication dispensing Nursing education sessions presented additional opportunity Need to better track reversals and capitalize on feeling of reversal Training needed to be briefer

10 STRUCTURAL CHANGES MADE IN THE SEP Raising awareness about od risk on the line each exchange through all staff Outreach to get people to trainings at every site with every staff member Identifying participants who got training to advertise training Weekly and daily handouts on fentanyl risks and new stamps at SEP Asking each person each time till they say why is everyone asking me? Special training sessions at outdoor sites Identifying parent groups, advertising trainings on web, with providers

11 NALOXONE/OD TRAINING HAS BECOME AN ADD ON DURING MEDICAL EXAMS: ROUTINIZED TRAINING After vital signs and PMH, before MD visit, patient receive a Naloxone training. Training offered as an opt-out for at-risk patients Original longer training adapted by Temple University Nursing Students Training now takes approx 5-10 minutes Can be performed by untrained staff (nursing students, med students, residents, MD s etc)

12 BEING CREATIVE AND MAKING DROP IN SPACE WORK! As part of overdose awareness day, needed multiple spaces Drop in center presented great opportunity A little bit of theater goes a long way in recruitment Model is: Come, stay, even if you did not plan on it! Fill out some forms while you re at it! And take some medication on your way out! A designated specialist to coordinate kits and paperwork All docs sign prescriptions; doctors don t leave clinic without prescribing

13 AIM OF BRIEF TRAINING IS TO TRAIN INDIVIDUALS TO Understand what is different between an opiate overdose and a stimulant overdose Understand that current training only addresses opiate overdose, though this can include speedball, other combinations Understand what puts individuals at risk for opiate overdose Understand what an opiate overdose looks like, and how it is different than a nod Understand the need to get medical attention for an opiate overdose Understand how to respond to an opiate overdose before medical attention arrives Understand that the time after an opiate overdose reversal is a high risk time for an additional opiate overdose

14 WHERE WE SUCCEEDED, WHERE WE DID NOT All staff re-trained, 80% of staff conducting trainings Increase in number of participants trained Increase in number of participants trained who had initially turned down training Increase in number of parents, partners, and peers trained who have witnessed overdoses Training and naloxone distribution an add on in all suboxone sessions Training & naloxone distribution add on in all Nurse led clinic & nursing education sessions Training & naloxone distribution becoming add on in case management Training & naloxone distribution becoming add on in ID clinic Trainings every day, all settings People coming in to report reversals! Five fold increase in trainings Some staff still not training; training not yet opt out add on in all services Many clinicians still not training and giving medication in medical visit Missed opportunities in all services

15

16

17 Age Variable Value Valid N Average Range Median Gender (%) Male Female Transgender Race (%) African American Asian Latino Caucasian Native American Mixed race

18 Being homeless* 90 day opiate use (%) 90 day cocaine use* Number of personal overdoses Variable Value Valid N Yes No Yes No Yes No Range Mean Median Number of witnessed overdoses Range Mean Median

19 QUESTIONS / COMMENTS To request a training or for help implementing a program: Jennie Coleman Silvana Mazzella Primary Care and HCV Linkage Coordinator Director of Programs Prevention Point Philadelphia Silvana@ppponline.org Jennie@ppponline.org Jose Benitez Elvis Rosado Executive Director Training and Education Specialist Prevention Point Philadelphia Prevention Point Philadelphia Jennie@ppponline.org Jennie@ppponline.org