4/27/2015. Learning Objectives. Rate of Unintentional Drug Overdose Death, United Column2 States,

Transcription

1 Rate per 100,000 Population /27/2015 Saves Lives State Initiatives to Reduce Prescription Drug Abuse Oklahoma Osteopathic Association s 115 th Annual Convention May 1, 2015 Pam Archer, Oklahoma State Department of Health Jessica Hawkins, Oklahoma Department of Mental Health & Substance Abuse Services Learning Objectives Obtain baseline understanding of the opioid overdose problem Learn about Oklahoma s strategy to prevent and reduce opioid overdose Become familiar with the Take As Prescribed campaign Rate of Unintentional Drug Overdose Death, United Column2 States, Prescription drugs Crack cocaine Heroin Source: Len Paulozzi, MD, MPH National Center for Injury Prevention and Control Centers for Disease Control and Prevention Year 1

2 National Landscape Drug overdose is now the leading cause of injury death in the United States. Since 1999, overdose deaths involving prescription painkillers have increased four-fold. Prescription painkillers now account for more deaths than heroin and cocaine combined. National Landscape 46 Each day, 46 people die from an overdose of prescription painkillers in the U.S. 259 M Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills of highest prescribing states for painkillers are in the South. Source: Centers for Disease Control and Prevention,

3 Rate per 100,000 Population Rate per 100,000 Population 4/27/2015 Tip of the Iceberg Unintentional Poisoning and Motor Vehicle Crash Death Rates, Oklahoma, Unintentional Poisoning MVC Source: WISQARS, Centers for Disease Control and Prevention Mortality Rates by Age Group and Gender, Unintentional Poisoning, Oklahoma, Males 15 Females Age Group Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports) 3

4 Number of Deaths 4/27/ Deaths Involving Prescription Drugs, Illicit Drugs, or Alcohol by Year of Death, Unintentional Poisoning, Oklahoma, Year of Death All poisonings Prescription drugs Alcohol Methamphetamine Cocaine Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports) Substances Involved in Unintentional Poisoning Deaths, Oklahoma, Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports) Unintentional Poisoning Death Rates by County of Residence, 1 Oklahoma,

5 The Solution A multi-faceted approach to overdose prevention is required. A comprehensive array of efforts are underway in Oklahoma, including: P R E V E N T I O N & E D U C AT I O N M O N I T O R I N G & D I V E R S I O N C O N T R O L I N T E R V E N T I O N & T R E AT M E N T Oklahoma Strategy Prescription Drug Monitoring Program Opioid Prescribing/Dispensing Guidelines Prescriber/Dispenser Training SBIRT Requirements Disposal/Storage Methods Media Campaign Overdose Antidote (Naloxone) Program Opioid Prescribing Guidelines Emergency Dept and Urgent Care Opioids only if needed Lowest effective dose and short course No long acting opioids Check the PMP Do not replace lost/stolen pills Discuss safe storage/disposal Office-Based Acute pain Chronic pain 5

6 Prescription Drug Monitoring Program Oklahoma has first real-time reporting system Includes all prescriptions for controlled substances Pharmacies, providers, and law enforcement can access Powerful tool to reduce fraud, intervene with abuse, and enhance patient safety Case Study Data from the 2013 Oklahoma PMP Date Doctor Pharmacy Days Supply 1/2 Dr. A Pharm X 30 2/17 Dr. A Pharm Y 30 3/1 Dr. A Pharm X 30 3/5 Dr. B Pharm Z 28 4/12 Dr. A Pharm X 30 4/15 Dr. B Pharm Z 28 6/10 Dr. A Pharm X 30 6/14 Dr. B Pharm Z 28 7/15 Dr. A Pharm X 30 7/18 Dr. B Pharm Z 28 8/7 Dr. B Pharm Z 28 10/4 Dr. A Pharm X 30 11/5 Dr. A Pharm Z 28 12/2 Dr. A Pharm X 30 Case Study Data from the 2013 Oklahoma PMP Date Doctor Pharmacy Days Supply 1/2 Dr. A Pharm X 30 2/17 Dr. A Pharm Y 30 3/1 Dr. A Pharm X 30 3/5 Dr. B Pharm Z 28 4/12 Dr. A Pharm X 30 4/15 Dr. B Pharm Z 28 6/10 Dr. A Pharm X 30 6/14 Dr. B Pharm Z 28 7/15 Dr. A Pharm X 30 7/18 Dr. B Pharm Z 28 8/7 Dr. B Pharm Z 28 10/4 Dr. A Pharm X 30 11/5 Dr. A Pharm Z 28 12/2 Dr. A Pharm X 30 6

7 Narcan (naloxone) Widespread support for Naloxone programs: The White House, Office of National Drug Control Centers for Disease Control and Prevention Federal Drug Administration Substance Abuse and Mental Health Services Administration Recommendation D: Equip Health Care Providers and First Responders to Recognize and Manage Overdoses Narcan (naloxone) Most users attempt to achieve abstinence from drugs, but on average this process takes 9 years and 4 episodes of care. Naloxone is a drug used to reverse the effects of opioids. Naloxone is safe and effective. Naloxone has no effect on non-opioid overdoses. In the United States, there are: Over 180 naloxone programs Over 50,000 people trained Over 10,000 overdose reversals (lives saved) Narcan (naloxone) Narcan knocks the opioid off the opiate receptor Only blocks opioid receptors; no opioids = no effect Not harmful if no opioids in system Temporarily takes away the high, giving the person the chance to breathe Narcan works in 1 to 3 minutes and lasts 30 to 90 minutes Narcan can neither be abused nor cause overdose Only known contraindication is sensitivity, which is very rare Too much Narcan can cause withdrawal symptoms such as: nausea/vomiting diarrhea chills muscle discomfort disorientation combativeness 7

8 Oklahoma Naloxone Law Okla. Stat. tit. 63, Administration of opiate antagonists effective November 1, A. First responders shall have the authority to administer, without prescription, opiate antagonists when encountering an individual exhibiting signs of an opiate overdose. For the purposes of this provision, a first responder shall include: 1. Law enforcement officials; 2. Emergency medical technicians; 3. Firefighters; and 4. Medical personnel at secondary schools and institutions of higher education. B. Any first responder administering an opiate antagonist in a manner consistent with addressing opiate overdose shall be covered under the Good Samaritan Act. Mucosal Atomization Device (MAD) Prefilled ampule of naloxone Luer-lock syringe Oklahoma Naloxone Law Okla. Stat. tit. 63, Prescription of opiate antagonists to family members A. Upon request, a provider may prescribe an opiate antagonist to an individual for use by that individual when encountering a family member exhibiting signs of an opiate overdose. B. When an opiate antagonist is prescribed in accordance with subsection A of this section, the provider shall provide: 1. Information on how to spot symptoms of an overdose; 2. Instruction in basic resuscitation techniques; 3. Instruction on proper naloxone administration; and 4. The importance of calling 911 for help. C. Any family member administering an opiate antagonist in a manner consistent with addressing opiate overdose shall be covered under the Good Samaritan Act. 8

9 OK Naloxone Plan Objectives 1. Increase capacity of first responders to administer naloxone. 2. Increase capacity of family members of opioid users to administer naloxone. 3. Increase capacity of people at risk for overdose, including patients with opioid analgesic prescriptions and people with substance use disorders, to obtain naloxone. 4. Increase access to naloxone products. 5. Decrease misperceptions of naloxone House Bill 1782 First responders and family members can carry and administer naloxone with Good Samaritan protection Oklahoma Medical Licensure Board approves rule to allow for standing orders for naloxone Standing Orders Public Education Naloxone training video and materials published for the public on TakeAsPrescribed.org Naloxone law enforcement pilot program launched in the County of Tulsa Law Enforcement Program House Bill 2666 Naloxone can be sold or dispensed by licensed pharmacists to the public Emergency Medical Service and Emergency Medical Response Agency training and protocol adoption program launches for basic and intermediate-level personnel EMS/EMRA Program Public Sales Walgreens and Economy Pharmacy launch 34 retail locations where naloxone may be purchased by the public Today 9

10 Agency Agreements ABLE Commission Absentee Shawnee Tribal Police Bixby Police Department Broken Arrow Police Department Bureau of Narcotics Enid Fire Department Enid Police Department Garfield County Sheriff Glenpool Police Dept Jenks Police Department Moore Police Department Oklahoma Highway Patrol Owasso Police Department Rogers County Sheriff Sand Springs Police Department Skiatook Police Department Tulsa County Sheriff Tulsa Police Department Pilot Training Results 883 law enforcement officers trained 30% of those trained have been present at an overdose scene within the last 12 months 77% of those trained support law enforcement officials being authorized to administer naloxone (56% positive change from pre training) 89% of those trained are willing to administer naloxone (21% positive change from pre training) Pilot Administration Results No physically aggressive or combative reactions reported Positive response within 3 minutes every time on the first administration of naloxone 17 naloxone saves, nearly 2 per month 10

11 For Information: Pam Archer, OSDH x Jessica Hawkins, ODMHSAS jhawkins@odmhsas.org Visit TakeAsPrescribed.org References Centers for Disease Control and Prevention. Wide-ranging Online Data for Epidemiologic Research (WONDER) [online]. (2012) Available from URL: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. (accessed July 2013). Trust for America s Health, Prescription Drug Abuse: Strategies to Stop the Epidemic 2013, (accessed May 2014). Oklahoma State Department of Health, Injury Prevention Service. Unintentional Poisoning Fatality Surveillance System (abstracted from medical examiner reports). Oklahoma Bureau of Narcotics and Dangerous Drugs Control, Prescription Monitoring Program (PMP), (accessed May 2014). Centers for Disease Control and Prevention. Community-Based Opioid Overdose Prevention Programs Providing Naloxone United States, 2010, Morbidity and Mortality Weekly Report. February 17, 2012 / 61(06); The Oklahoma Department of Mental Health and Substance Abuse Services wishes to acknowledge the DuPage County Department of Public Health and the Massachusetts Department of Public Health for permitting use of training content. 11