Academic Detailing

Intervention for Opioid Safety:

ADIOS

Phillip O Coffin MD

San Francisco Department of Public Health

University of California San Francisco

Disclosures

• No financial disclosures

• Discussion of intranasal use of naloxone, a route of

administration not yet FDA-approved

Naloxone Enrollments, Refills, and Reversal Reports to the Drug Overdose

Prevention and Education Project, 2003-2013; Heroin Poisoning Deaths 2000-2012

*Heroin death data (left axis) compiled from San Francisco Medical Examiner Reports, www.sfgsa.org, fitted to tailing fiscal year, no data for 2001-02/2013-14; Naloxone data (right axis) from DOPE Project enrollments and refills

0

20

40

60

80

100

120

140

2000 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

0

200

400

600

800

1000

1200

New Enrollments

Reversals

Heroin deaths (no 2013/14 data)

Naloxone distribution begins, 2003

? ?

http://www.sfgsa.org/

Opioid Overdose Deaths in San Francisco,

2010-2012

• 6 safety net clinics

• Staff trained

• Prescribe to any patient using opioids chronically

• Atomizer/brochure in ziplock bag

• IM or IN naloxone prescribed (covered by all public insurance)

• Pharmacists trained as needed

Naloxone for

Opioid Safety Pilot

Program

• Epidemiologic data

• Risk factors

• Naloxone pharm.

• Effectiveness

• Indications

• Patient interaction

• Legislative protection

• How to prescribe

• Pharmacy access

• Other resources

Target Population

• Primary care providers who prescribe opioids to Medi-Cal

patients

• List obtained from Medi-Cal

• Manually reviewed to select valid prescribers

• Active practice

• Outpatient

• Provide primary care services

• Include selected providers from subspecialties including infectious disease,

rheumatology, hematology (non-malignant), others

• Randomly order prescribers to allow for a comparison

group of those providers not contacted

Detailer Training

• NaRCAD

• Detailers

• Phillip Coffin MD

• Emily Behar MS

The Approach

• Email

• Call

• In-person visit

Results

46 Providers Contacted

3 “Not interested”

3 “Too busy”

40 (87%) Detailed

35MD, 4NP, 1PA

Getting In

Number of Attempts

1 8 (20%)

2 12 (30%)

3 11 (28%)

4 6 (15%)

5 3 (7%)

Successful Medium

Email 18 (45%)

Phone 21 (53%)

In-Person 1 (2%)

Service Delivered

• Mean duration of detailing = 28 minutes

• Mean # atomizers provided = 22

Training Topics Covered

0%

25%

50%

75%

100%

Follow-Up

• Out of 19 providers reached for follow-up, 11 (58%)

had prescribed naloxone.

• Naloxone and opioid prescription data pending from

Medi-Cal.

Conclusions

• Public health detailing can be successfully delivered

• Detailing on naloxone for opioid safety generated a

high level of interest and was well-received by

prescribers

Acknowledgments

• Funded by California Healthcare Foundation; developed

from NIH grant R21DA036776

• Project Coordinator: Emily Behar