Session

Saving lives with a single shot: Strategies and challenges to expanded naloxone availability

Nicholas Reuter, MPH, Indivior, PLC, Aldie, VA

APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)

Abstract

Naloxone sales preparedness among pharmacies in Massachusetts during an era of increased opioid overdose fatalities

Thomas Stopka, PhD, MHS, Ashley Donahue, MPH and Marga Hutcheson, MA, Tufts University School of Medicine, Boston, MA

APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)

background: Opioid overdose deaths have increased in Massachusetts during recent years, with an estimated high of 1,173 in 2014. Statewide initiatives, including a standing order facilitating over-the-counter (OTC) sales of Naloxone, an opioid overdose-reversal medication, have been implemented to decrease the number of fatal overdoses. Little is known about Naloxone sales preparedness (NSP) among Massachusetts pharmacies. methods: From January-July 2015, we surveyed retail pharmacies in Massachusetts, collecting data on NSP. We conducted statistical analyses to determine NSP levels among pharmacy staff. We developed GIS maps and conducted spatial analyses to determine the distribution of NSP measures across the state. results: We completed surveys with 809 of 1,042 retail pharmacies, yielding an overall response rate of 77.6%. Among respondents, 45.0% (n=365) said they stock/sell Naloxone OTC. When asked if customers must provide identification or a prescription to purchase Naloxone, which is not required by law, only 48.2% of pharmacies said nothing was required. Six in ten respondents (59.5%) said they had not been trained in overdose prevention, 75.1% were aware of the standing order, and 52.5% were interested in participating in the standing order. GIS maps and spatial analyses indicate that NSP varies across Massachusetts, with higher densities of NSP in urban areas and Cape Cod. Some regions with high overdose rates lack sufficient Naloxone access. conclusions: OTC Naloxone sales offer opportunities to curb fatal opioid overdoses. Pharmacy preparedness is a key step in expanding Naloxone access. Increased NSP levels are needed, and enhanced pharmacy staff training is recommended.

Public health or related laws, regulations, standards, or guidelines Public health or related public policy Public health or related research

Abstract

Standing orders for naloxone in pharmacies; a new policy tool in the opioid overdose epidemic

Karen Hacker, MD, MPH, Abby Wilson, JD, LL.M and Nancy Caracciolo, RPh, MBA, Allegheny County Health Department, Pittsburgh, PA

APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)

issue: The opioid addiction and overdose crisis has impacted numerous jurisdictions. In Pennsylvania's Allegheny County (1.2 million residents) opioid overdoses have been rising since 2000 with 246 deaths from opioid overdoses in 2015 alone. Access to naloxone, a drug that reverses the effects of opioids, is an important harm reduction strategy to address opioid overdose mortality. Strategies to enhance access must be expanded. description: In 2014 a PA Good Samaritan law was passed allowing for witnesses to administer naloxone in overdose circumstances. Soon thereafter, the physician general released a standing order for first responders use of naloxone. Using this template, the Allegheny County Health Department's (ACHD) Director, a physician, issued a first of its kind standing order for nasal and auto-injector formulations of naloxone in pharmacies. This relied on the legal authority of a health department director and a licensed physician in the Commonwealth of Pennsylvania. This strategy did not require a board of health regulation. The standing order was well received by the pharmacy community and to date, ACHD has enlisted over 100 independent and chain pharmacies in the program. One major Medicaid insurer documented 128 members who utilized the standing order mechanism to obtain naloxone in 2015. lessons learned: Pharmacies are important partners in the fight against opioid overdoses. The pharmacy standing order is a feasible, acceptable strategy for increasing naloxone availability. Insurers support of the program is important for affordability particularly for relatives of addicted individuals. recommendations: In states where good Samaritan laws are in place, the standing order at either a local or state level should be implemented to enhance naloxone availability.

Other professions or practice related to public health Public health or related laws, regulations, standards, or guidelines Public health or related public policy

Abstract

Barriers and Facilitators to Pharmacist Prescriptive Authority for Naloxone

Adriana Bautista, MD, MPH1, Sandra Cano, MA1, Shikhar Shrestha, MS1, Amy Bachyrycz, PharmD1, Theresa Cruz, PhD2 and Ludmila Bakhireva, MD, MPH, PhD1, (1)The University of New Mexico, Albuquerque, NM, (2)University of New Mexico, Albuquerque, NM

APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)

Background: Mortality due to prescription painkiller overdoses (OD) has quadrupled in the past decade, and rates in New Mexico are 5-7 times higher than the national average. New Mexico is the first state to allow pharmacists to prescribe Naloxone Rescue Kits (NRKs) - a well-established antidote for reversing life-threatening symptoms of OD. Since 2013, 200 NM pharmacists have received certification to prescribe NRKs; few are actively prescribing. Methods: Qualitative data were collected on barriers and facilitators to successful pharmacy-based opioid OD prevention using NRKs. A focus group was conducted with 15 pharmacists from across New Mexico. Data were coded for themes using NVivo software. Results: The sample included pharmacists practicing in independent (40%), chain (20%), or integrated health system (40%) pharmacies. Mean age of participants was 44.9±12.9 years; 53% were female, years of practice ranged from 1-43 (17.8±13.6). Major themes included: 1) pharmacists have a role in prevention of OD deaths; 2) the NRK prescription process is time-intensive; 3) reimbursement is not sufficient and does not cover counseling; 4) some pharmacists are concerned that having NRKs available may encourage more risky behavior; 5) concerns exist about attracting undesirable clientele; 6) public and patient education is needed regarding NRKs; 7) pharmacist training should include interactive exercises that demonstrate how to initiate NRK conversations with patients; 8) pharmacists are interested in being involved in future development and implementation efforts. Conclusions: While pharmacists clearly expressed a desire to help with prevention efforts to help curb the opioid OD epidemic, substantial barriers were identified.

Advocacy for health and health education Planning of health education strategies, interventions, and programs

Abstract

Findings from the New York State (NYS) opioid overdose and intranasal naloxone program for law enforcement

Kirsten Rowe, MS1, Abigail Stamm, MA2, Shu-Yin Leung, MA1, Mark Hammer, JD3, Joshua Vinehout4, Sharon Stancliff, MD5, Michael Dailey, MD6 and Valerie White7, (1)New York State Department of Health, AIDS Institute, Albany, NY, (2)University at Albany, SUNY, Rensselaer, NY, (3)New York State Department of Health, AIDS Institute, New York City, NY, (4)NYS Division of Criminal Justice Services, Albany, NY, (5)Harm Reduction Coalition, New York City, NY, (6)Albany Medical Center, Albany, NY, (7)NYS Department of Health, AIDS Institute, Albany, NY

APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)

Background: In New York State (NYS), from 2009-2013, opioid analgesic related deaths increased 30% and heroin related deaths increased 163%. Timely administration of naloxone has been shown to reverse the effects of opioid overdose and prevent related deaths. In 2014, a state health department, in collaboration with other agencies, began a statewide Naloxone Program for Law Enforcement (NPLE), to train and equip law enforcement officers to administer naloxone to those experiencing an opioid overdose. Methods: The NPLE trained law enforcement officers on how to recognize opioid overdose and administer intranasal naloxone on the scene. Following every naloxone administration, officers complete an event report and submit it to the NPLE for analysis. The NPLE analyzes this data to inform program improvement. Results: Through December 2015, trained officers administered naloxone in 1,094 cases, reversing at least 979 (89.5%) overdoses. Over 50% of the time, officers reported they arrived 5 minutes or less before EMS. Heroin or another opioid was reported in 874 (80.1%) cases. Of those aided by officers, 770 (73.6%) were under age 35, 768 (70.2%) were male, and 628 (57.4%) experienced no post-naloxone symptoms. Conclusions: The 60 minute training was widely accepted among the NYS law enforcement community. Equipping trained law enforcement officers with naloxone resulted in the reversal of nearly a thousand opioid overdoses. Diligent reporting by law enforcement was essential for program evaluation/improvement. Having police officers, who are often first to respond to overdose calls, trained to use naloxone has been an important addition to the community overdose prevention response in NYS.

Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Other professions or practice related to public health