Celebrating a Year of Expanded Naloxone Access and Overdose Education within Cuyahoga County

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1 Cuyahoga County March 2014, Issue 1 Celebrating a Year of Expanded Naloxone Access and Overdose Education within Cuyahoga County According to the Ohio Department of Health (ODH), between 1999 and 2011, Ohio experienced a 440% increase in unintentional overdose death. In 2007, 17.7% of overdose deaths in Cuyahoga County were due to heroin. Today, heroin is the most commonly abused drug associated with overdose deaths in Cuyahoga County according to the Cuyahoga County Medical Examiner. As of 2007, unintentional drug overdose became the leading cause of unintentional injury death in Ohio exceeding motor vehicle accidents (MVAs). Project DAWN (Deaths Avoided with Naloxone) was created in to order to combat Ohio s opioid overdose epidemic. Project DAWN is an overdose education and naloxone distribution (OEND) program whose aim is to reduce overdose mortality within our community. Cuyahoga County Project DAWN was launched on March 1, 2013 and has since registered over 500 participants and documented at least 31 lives saved. Read further to learn more about our program s first year; naloxone access expansion; and relevant legislation, news, and community efforts surrounding the heroin epidemic in our county and state. Inside this issue: - Naloxone kits for friends and family - Naloxone legislation - Community-wide efforts - What we ve learned from our first year Project DAWN is funded by: The Cuyahoga County Executive Ed FitzGerald s Office The MetroHealth System The Ohio Department of Health

2 To stay informed, visit our Facebook page for up-to-date news, community events, and site closings We have a new website! metrohealth.org/projectdawn What is in a Project DAWN Naloxone kit? - 2 vials of Naloxone medication - 2 nasal atomizers - 1 face mask - 1 educational DVD - 1 educational flip-book Project DAWN Quick Facts - Kits are always FREE - Services provided on a walk-in basis - Training takes approximately 20 minutes Heroin Initiative In response to the alarming increase in opioid abuse and overdose death, Cuyahoga County Executive Ed FitzGerald has lead community-wide efforts to raise awareness and reduce opioid overdose deaths within our community. This heroin initiative gathers various community stakeholders representing MetroHealth, the US Attorney's Office, the Board of Health, law enforcement and also works alongside the Cuyahoga County Board of Health's Opiate Task Force, which brings together a group of varied community experts with the common goal of tackling our county's opiate epidemic. As a part of this Opiate Collaborative, the Cuyahoga County Poison Death Review Committee was created. This committee, formed out of the Cuyahoga County Medical Examiner's Office, works to provide in-depth analysis and examination with regard to the county's overdose fatality data in order to provide information on the effectiveness and gaps of our current community prevention programs. A website was also created in order to inform the public of these developments: opiatecollaborative.cuyahog acounty.us/ Beachwood Heroin Summit hosted by Councilwoman Sunny Simon & Beachwood Mayor Merle Gordon. Panelists included Dr. Thomas Gilson, Cuyahoga County Medical Examiner; Denise Rini, Cuyahoga County Juvenile Court Judge; Philip Angelo, Cuyahoga County Sheriff s Department; Dr. Joan Papp, Cuyahoga County Project DAWN Medical Director; Steven Dettelbach, US Attorney; and David Matia, Cuyahoga County Common Pleas Court Judge.

3 Where are Project DAWN services provided? MetroHealth Hospital dispenses kits to eligible patients in the Emergency Department. Kits are also distributed at several community sites including: - The Cuyahoga County Board of Health on Fridays from 9a-12p - The Free Medical Clinic of Greater Cleveland on Fridays from 1p-5p Project DAWN also coordinates with the Free Medical Clinic of Greater Cleveland s syringe exchange program and with the Hispanic UMADAOP to provide Project DAWN services to participants who access the mobile syringe exchange program. In addition, Project DAWN also collaborates with Heroin Anonymous to provide trainings and distributions every three months at Stella Maris Naloxone has no potential for abuse detox center. Naloxone only reverses an opioid overdose There are no harmful effects of naloxone if administered to someone Educating not experiencing an opioid overdose Naloxone can be used up to 700 times the recommended our dose with medical no harmful effects Individuals providers addicted to opioids will experience withdrawal symptoms after receiving naloxone At Project DAWN, we know that much of the heroin epidemic we are facing today can be Heroin Anonymous to provide trainings and distributions every three months at Stella Maris detox center. Community Collaboration Cuyahoga County has made great efforts to collaborate across disciplines in order to tackle our community s opioid epidemic. In November of 2013, the Cleveland Clinic hosted a Heroin Summit titled, Heroin: A Crisis Facing Our Entire Community. The all day event joined hundreds of citizens and community professionals. Stakeholders recently met to discuss an action plan, which includes how our community can approach prevention and education; healthcare policy; law enforcement; and treatment. Did you know? Cuyahoga has also been a host to several public forums Start Let s Talking Face It Start Have you Talking seen the is latest an initiative, Let s Face It championed public service announcements? by Governor John Kasich and first lady The Cuyahoga County Karen Kasich, whose goal is Prosecutor s Office recently to prevent the incidence of launched the Let s Face It drug abuse among our state s youth. Campaign The to raise initiative awareness helps for to begin our county s conversations growing heroin about drugs problem. between Visit their parents, website to teachers, learn more mentors about how and heroin peers in affects order our to community start a discussion and what with resources youth are available: about drug abuse. Visit their website to learn more:starttalking.ohio.gov Let s Face It Have you seen the latest Let s Face It public service announcements? The Cuyahoga County Prosecutor s Office recently launched the Let s Face It campaign to raise awareness regarding our county s growing heroin problem. Visit their website to learn more about how heroin affects our community and what resources are available: LetsFaceHeroin.com 3

4 Cuyahoga county project dawn March 2014, issue 1 Cuyahoga has also been a host to several public forums started by Cuyahoga County Common Pleas Judge Michael Astrab. Forums focus on the growing heroin problem in our suburbs and include panelists from the medical, treatment, law enforcement, judicial, and prevention community. after the most recent overdose they witnessed, while 94% of survey participants said they would be more likely to call 911 in the occurrence of an overdose if there were a 911 Good Samaritan Law in place. Upcoming forums include: Wednesday April 2, 7:00 pm Garfield Heights Library Wednesday April 30, 7:00pm Brooklyn Public Library Pending Legislation Project DAWN is committed to advocating for legislation, which serves to better protect, treat, prevent disease, and save lives. We are extremely thankful for the passage of House Bill 170, which helps to expand naloxone access within our state. We also support House Bill 363, a 911 Good Samaritan Bill, whose aim is to encourage individuals to seek medical assistance in the event of an overdose. This law would provide limited immunity from arrest for minor drug possession for victims and witnesses who call 911 in the occurrence of an overdose. A recent survey conducted at both Scioto County and Cuyahoga County Project DAWN locations found that 75% of survey participants had witnessed an overdose. Only 58% of those who had witnessed an overdose reported calling 911 Project Manager Emily Metz providing proponent testimony for HB 363 in the House Judiciary Committee. Educating Our Medical Providers At Project DAW, we know At Project DAWN, we know that much of the heroin epidemic we are facing today can be traced back to prescription opioid abuse. Because of this, we are dedicated to educating medical practitioners about opioid prescribing guidelines, naloxone, and the current heroin epidemic. We know that this education must extend out into our communities, and as such, we have been active participants in community-wide discussions and collaborations in order to improve education regarding opioid abuse.

5 Seen above: Dr. Papp giving Governor John Kasich a hand signing House Bill 170 on Tuesday, March 11 th. Friends and Family Now Able to Receive Naloxone We are extremely pleased to announce that we are now able to provide friends and family in the position to save someone at-risk for opioid overdose with a naloxone kit. This is made possible by new state legislation, House Bill 170, which makes it legal for friends and family to obtain the medication. This law also extends access to first responders (police, fire, paramedics) in addition to extending prescribing abilities to nurse practitioners. If you or someone you know is at-risk for opioid overdose please visit one of our community sites to get your kit. What We Have Learned from Our First Year We are proud to report over 500 participants registered in our program and fully expect that number to continue to grow, especially in light of recent naloxone access expansion. We have learned a lot from our colleagues, the community and our patients. Registrants are referred to Project DAWN from various sources including, but not limited to drug court, treatment centers, detox centers, the Free Clinic Syringe Exchange Program, Heroin Anonymous groups, and local media. 67% of registrants are male and 80% are white. The average age of registrants is 36 while registrant ages range from The demographics of our patient population reflect similar trends in heroin arrestees and fatal overdose victims. When asked which drugs registrants have ever used, individuals most commonly cite alcohol, heroin, prescription opioids, cocaine/crack, benzodiazepines, and suboxone/subutex/buprenorphine. Only 7% of registrants currently take prescription opioids for the management of chronic pain under a physician and 60% of registrants identified with being addicted to prescription opioids prior to using heroin. 50% of registrants were currently in detox/rehab for the treatment of opioid abuse, while overall, 83% of registrants had taken time off from using during the past year. Multiple factors can put an individual at-risk of opioid overdose including lowered tolerance or a period of abstinence, mixing drugs, increased dosage, using alone, or illness/medical conditions. 62% of registrants mix drugs when using opioids. Those drugs, which are most commonly mixed when using opioids, are other opioids, alcohol, benzodiazepines, and cocaine/crack. Only 17% of registrants identified as never using alone while 83% of registrants identified as using alone

6 sometimes or always. Each risk factor can be fatal, but when combined the risk of overdose is even greater. 45% of program registrants have experienced an overdose and 75% of registrants have witnessed an overdose. Of those who had experienced an overdose, the average number of overdoses was 3 and the greatest number of overdoses was 42. The average number of overdoses witnessed was 5 while the greatest number of overdoses witnessed was 106. The most common responses to an overdose cited by registrants were shaking, slapping, yelling and the use of cold water and ice. Over 74% of registrants had never received naloxone even though 45% had experienced an overdose. For those who had previously received naloxone, EMT paramedics and ER staff were the most likely source. Common barriers to saving someone who is experiencing an overdose identified among registrants are: - Unwillingness to contact EMS due to fear of incarceration - Misconception on how to revive someone from an opioid overdose - Limited access to Naloxone Project DAWN addresses these barriers by educating participants on the proper response to an opioid overdose and by arming them with the life-saving medication naloxone. To date, Cuyahoga County Project DAWN has helped to save 31 individuals through registrant utilization of naloxone kits, although, it is believed that the number of reversals is higher due to program participant underreporting. The following is a summary of data collected on the individuals and the circumstances surrounding the use of a Project DAWN naloxone kit in the occurrence of an overdose. 74% of overdose victims were male. Ages ranged from with an average age of 34. The majority (48%) of overdose victims were a friend of the Do you have unused prescription opioids in your medicine cabinet? Prescription opioids are often unknowingly stolen from family and friends medicine cabinets. Safely dispose of your unused prescription opioids Visit or call to find your nearest drop box location. This initiative is made possible through a collaboration between the County Executive s Administration, the Sheriff s Department, and the Common Pleas Drug Court.

7 registrant. The majority of overdoses occurred in a private house or apartment and the most commonly mixed drugs were heroin and benzodiazepines. Registrants responses to the overdose were varied. 48% of registrants reported calling 911 and 30% of registrants reported giving rescue breaths. 7% of victims were revived by paramedics following the administration of naloxone and the remaining individuals were revived because of registrants help. The majority of victims were revived 1-3 minutes after the administration of nasal naloxone and the remaining victims became responsive either in less than 1 minute, in 3-5 minutes, or in more than 5 minutes. 19% of registrants reported the consideration of treatment as a result of experiencing or witnessing an overdose, although some did not identify with considering treatment because they were already seeking treatment or were currently in treatment. Moreover, 48% of registrants reported that they will change their drug habits as a result of experiencing or witnessing the overdose. Not only do overdose education and naloxone distribution programs help to save lives, but they can also inspire drug users to make smarter choices and even propel them into seeking treatment. Contact Us: Joan Papp, MD, FACEP Cuyahoga County Project DAWN Medical Director jpapp@metrohealth.org Project DAWN Accepts Donations 1. Go to: 2. Under online tools tab, choose give to metrohealth 3. Under MetroHealth Foundation tab, choose Donate Now! 4. This will bring you to a donation form. Choose the dollar amount of your donation and then under designation, choose "other." Write in the following: Emergency Medicine-Project DAWN. Emily Metz Cuyahoga County Project DAWN Project Manager emetz@metrohealth.org