Preventing Opioid Overdose

Death: Naloxone Rescue Kits

Our Utah Experience

Jennifer Plumb, MD, MPH

University of Utah Health Care

School of Medicine Department of Pediatrics

Utah Naloxone

Disclosures

• Dr. Plumb has no commercial or financial

relationships nor any conflicts of interest to

disclose

Utah 2013-2014 Overdose Deaths

4th Highest in the U.S.

CDC, 2016

Injury Deaths in Utah

UTDOH, 09/2014

De

ath

Ra

te P

er

10

0,0

00

5

Drug Overdose Death Rate

in the U.S. 2003-2014

National Vital Statistics System

U.S. Overdose Deaths 2014

CDC, 2015

U.S. Opioid and Heroin Deaths

1999 vs. 2014

Common Opiates/Opioids

• Heroin

• Codeine

• Demerol

• Morphine

• Darvocet

• Fentanyl

• Dilaudid

• Methadone

• Opium

• Hydrocodone

• Oxycodone

• Vicodin

• OxyContin

• Tylenol 3

• Tylox

• Levorphanol

• Percocet

• Percodan

Dependence can develop in 7 days

Number of Prescription Pain

Medication Deaths per 100,000 Adults

Utah 2009-2012

Fondario, UTDOH, 2014

Rate of Opioid-related ED Visits per

10,000 Population by Age Group,

Utah 2009-2013

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Less than 1year

1-4 years 5-14 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 85+ years

Cru

de

Rat

es p

er 1

0,0

00

ED

Tre

at a

nd

Rel

ease

En

cou

nte

rs Heroin

Prescription Opioids

UTDOH 2015

Heroin related visits higher for MalesPrescription opioids higher for Females

Number of Unintentional/Undetermined

Opioid Deaths, Utah 2000-2014

0

50

100

150

200

250

300

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014*

Nu

mb

er

of

De

ath

s

Year

Heroin

Rx Opioid Only (no illicit drugs)

UTDOH, 2016

We averaged one opioid-related

death every day in 2014

The Role for Naloxone

NALOXONE, What is It?

• Naloxone (Narcan®) is a non-addictive

prescription medication that helps to block the

effects of opiates on the body

• It has been used by EMS and in EDs routinely

for 45 years, since 1971

• There are no effects on a person if an opiate has

not been used

• ONLY works on opiates

• Works quickly

• Very safe

What Happens in an Opiate Overdose?

The brain has

many, many

receptors for

opioids. Too much

opioid fitting in too

many receptors

slows and stops the

breathing.

Opioid fits exactly in

receptor

Opioid receptor

on brain

Naloxone Reversing an Overdose

Naloxone has a stronger

affinity to the opioid

receptors than the other

opioids or heroin, so it

knocks the heroin off the

receptors for a short time

and lets the person

breathe again.

Opioid

receptor

Naloxone

Opioid/

Heroin

Naloxone Distribution Programs

• U.S. Starting in 1996, first legislation passed 2001

• Morbidity and Mortality Weekly Reports (CDC)

– Between 1996-2014, U.S. programs distributed

152,283 rescue kits with 26,463 reversals reported

– 1 in 6 saving a life

• Has not been shown to increase use or lead to

riskier use

– Actually shown to increase motivation to seek treatment

Who is at Risk of Overdose Death?

• History of substance abuse

• Prescribed high dose opioids

• Current or history of psychiatric illness

• Those with benzodiazepines and opioids in their

possession

• History of mis-using medications

• Taking more than prescribed

• Drinking alcohol with meds

• Past history of overdose, currently in ED for overdose

• Have medical co-morbidities

• Veterans

• After release from prison, treatment, supervised care

Naloxone Rescue Kits

Opiate

Antagonist

(Naloxone)

Act

2014 HB 119, Emergency

Administration of Opiate

Antagonist Act

• It is not unlawful or unprofessional conduct for health professionals to prescribe or dispense an opiate antagonist to:

• A person at increased risk of experiencing an opiate-related drug overdose event; or

• A family member, friend, or other person in a position to assist a person who is at increased risk of experiencing an opiate-related drug overdose (at increased risk of witnessing an overdose); and

• No physician-patient relationship required

• Requires a person who prescribes or dispenses an opiate antagonist to advise a person to seek a medical evaluation after experiencing a drug overdose and taking an opiate antagonist

• Clarifies that the administration of an opiate antagonist is voluntary and that the act does not establish a duty to administer an opiate antagonist

Opiate

Antagonist

Response

Act

Bills

2016 HB 238, Opiate Overdose

Response Act – Overdose

Outreach Providers

• Authorizes “Overdose Outreach Providers” to furnish naloxone without civil/criminal liability:

• Law enforcement

• Fire departments

• EMS providers

• Orgs providing treatment for drug/alcohol use

• Orgs providing services for an individual, or a family of an individual, with a substance use disorder

• Orgs providing substance use/mental health services under contract with a local substance abuse/mental health authority

• Orgs providing services to the homeless

• Local health departments

• Individuals

• Pharmacy Practice Act licensure exemptions

Opiate

Antagonist

Response

Act

Bills

2016 HB 192, Opiate Overdose

Response Act – Pilot Program

• Licensed providers may prescribe an opiate antagonist to:

• An individual who is at increased risk of experiencing an opiate-related drug overdose; and

• A family member, friend, or other person who is in a position to assist at-risk individuals, including:

– Law enforcement

– Health department

– Orgs that provide drug/alcohol treatment

– Orgs that serve the homeless

– Orgs that provide opiate antagonist training

– Schools

• An org defined by DOH rule as being in a position to assist at-risk individuals

Opiate

Antagonist

Response

Act

Bills

2016 HB 240, Opiate Overdose

Response Act – Standing

Orders

• Authorizes the use of a standing prescription

drug order issued by a physician to dispense

an opioid antagonist in accordance with a

protocol

• Allows for a “behind the counter” model for

naloxone access

• No prescription required if a standing order

agreement is in place

First Year Successes Utah Naloxone

• 126 Reversals reported (as of 9/1/16)– Over 2,800 free kits distributed

– Parents, spouses, friends, law enforcement, strangers

• 12 law enforcement entities trained and equipped– Reversals reported within 24 hours in 2 agencies

– 14 reversals in the 1st 4 months

• Trainings provided statewide in over 60 settings

• Statewide awareness campaign and billboards