Community Based
Prevention
Overview, Trends, and Response
Gary Langis
TA Specialist
Education Development Center
Carl Alves
TA Specialist
Baystate Community Services
New England Institute of Addiction Studies
Massachusetts Technical Assistance Partnership for Prevention
June 8, 2015
The MassTAPP Team
Kat Allen, Amanda Doster,
Rachel Stoler, Jeanette Voas
Tracy Desovich, Lauren
Gilman, Gary Langis, Alfredo
Hernandez, Ben Spooner, Sue
Vargo, Aubrey Ciol
Carl Alves, Alejandro Rivera,
Deborah Milbauer
http://masstapp.edc.org
2
Web Site: http://masstapp.edc.org
3
AGENDA
•
2:15 - Welcome and introductions
•
2:30 - Scope, Opioids and Naloxone background/history
•
3:45 - Break
•
4:00 - OD- State Strategies
•
4:45 – Local Strategies
•
5:30 - Adjourn
Welcome!
Introductions
Name, Where you’re from, What you do,
What you’d like to get from this workshop.
Scope of the Problem
National Drug Threat
Cocaine
Heroin
Meth Marijuana
Controlled prescription drugs
Regional Drug Threat
8
Percentage of NDTS Respondents Reporting
High Heroin Availability in their Jurisdictions
9
10
http://www.scribd.com/doc/185260574/DEA-2013-National-Drug-Threat-Assessment
17
18
http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf
19
Heroin
• The number of past year heroin users nearly doubled
between 2007 (373,000) and 2012 (669,000)
• The number of people with heroin dependence or misuse
doubled between 2002 – 2012 (467,000 to 214,000)
• The largest increase of heroin use among young adults 18-25
• Treatment admissions for heroin misuse among 18-25
increased from 11% to 26% between 2008 and 2012
http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf
20
The Road to Heroin is
Paved with NMUPD
• Half of young people who inject
heroin surveyed in 3 recent studies
report misusing prescription opioids
before starting to use heroin
• Some individuals reported switching
to heroin because it is cheaper and
easier to obtain than prescription
opioids ($80/pill versus $5/bag)
21
Youth and Pills
• Many youth believe pills are safer than illegal
drugs because it is ‘medicine’ and prescribed
from a doctor
• After marijuana, pills most common to get high
• Two thirds of teens start using pills before age 16
• 70% get them from a friend or relative
• About 14% to 20% used prescriptions not
prescribed to them in past year. 9% past month
22
Media Articles
• Miami Herald: There are signs that heroin is returning as a cheap
alternative to prescription pills, the by-product of Florida’s successful
crackdown on pill mills.
• USA Today, Posted April 23, 2013: In Charlotte, many of the opiate
addicts in the Carolinas clinic got their start with powerful painkillers
prescribed after surgery or a broken bone… As doctors cut off their
prescriptions and the black market supply withered, they turned to
cheaper, easier-to-find heroin…"A lot of dealers, if you buy nine balloons,
they give you one free," he says. "You can call or text a dealer, and they'll
deliver.“
• Portland Press Herald, May 12, 2013: “North New England seeing surge
in heroin”
Authorities are attributing the surge to aggressive marketing by
out-of-state drug dealers and the higher cost of prescription drugs
Emergency Room
Opioid Prescriptions
• Between 2001-2010, number of opioids prescribed in US
emergency rooms increased 50%
• Significant increase in hydrocodone, hydromorphone,
morphine, and oxycodone prescriptions
• Emergency room visits for pain only increased 4%
24
Mazur-Amirshahi et al, “Rising Opioid Prescribing in Adult US ED Visits 2001-2010”, Journal Academic Emergency Medicine, March 2014
25
Corey Montieth, Heath Ledger, Phillip Seymour Hoffman, Amy Winehouse, Whitney Houston, Chris Farley, and ?
Not Just Celebrities
26
Overdose
• 38,329 overdose deaths in US in 2010
• Unintentional poisoning leading cause of
death Ages 25-64 (CDC, 2010)
• US overdose deaths have increased for 11th
consecutive year in a row
• Now exceeds motor vehicle deaths for
(probably) 7th year in a row (was 3rd year in a
row in 2010)
Centers for Disease Control and Prevention. “Pharmaceutical Overdose Deaths, United States, 2010,” in the Journal of the American Medical Association (JAMA).
http://webappa.cdc.gov/cgi-bin/broker.exe
27
Deaths are the tip of the iceberg
$37,274 per 1 OD
SAMHSA NSDUH, DAWN, TEDS data sets
Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007.
28
Drug overdose deaths outnumbered motor vehicle
traffic deaths in 10 states in 2005
More deaths from drug overdose
CDC NVSS, MCOD. 2010
29
By 2010, drug overdose deaths outnumbered motor
vehicle traffic deaths in 31 states
More deaths from drug overdose
CDC NVSS, MCOD. 2010
30
Overdose Deaths by Drug
CDC, Wonder database
31
NMUPD OD’s More than
quadrupled since 1999
2010
16,000+
Women
Increasing
faster than
men
32
Prescription opioid sales, deaths and
treatment: 1999-2010
National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System (ARCOS)
of the Drug Enforcement Administration (DEA), 1999-2010; Treatment Episode Data Set, 1999-2009
Overdose in Dollars
$20.4 billion per year
• $2.2 billion direct costs (inpatient, ED, MDs, ambulance)
• $18.2 billion indirect costs (lost productivity from
absenteeism and mortality)
• $37,274 cost per opioid overdose event
• Spent $2.6 m in May in Lynn, MA
– 69 OD’s in May. 11 fatal. Police, ambulance, hospital
Inocencio TJ et al. Pain Medicine 2013
34
Rate of Unintentional Opioid Overdose Deaths
Massachusetts Residents, 2000-2013
Rate per 100,000 Residents
12.0
10.0
8.5
7.3
8.0
6.0
4.0
10.1
9.5 9.4
5.3
6.7
8.1
8.6
10.1
9.2
9.1
8.0
7.1
Increase
of 10%
in 1 year
Doubled
from
2000
2.0
0.0
MA DPH Registry of Vital Records and Statistics, April 2014 ‘Fatal Opioid-related Overdoses among MA Residents’, 2000-2013
Number of Unintentional Opioid Overdose
Deaths, MA Residents, 2000-2014
Opioid-Related Deaths, Unintentional/Undetermined
Massachusetts: 2000-2014
Confirmed
Estimated
Number of deaths
1,200
1,000
967
800
888
600
615
549
468
400
200
456
429
614
525
1,008
668
561
599
2008
2009
603
600
526
338
0
2000
2001
2002
2003
2004
2005
2006
2007
2010
2011
2012
2013
MA DPH Registery of Vital Records and Statistics April 2014 ‘Fatal Opioid-related Overdoses among MA Residents’, 2000-2013
2014
Oveview of Opioids
Natural, Semi-Synthetic and Synthetic
Opioid = Opiate.
The term “opioid” designates a class of drugs
•Natural opiates
•Semi-synthetic opioids
•Opioids manufactured synthetically
“Opioid” is the broader term that includes the natural opiates in the
poppy plant as well as chemicals that have been synthesized in some
way to resemble an opiate
Opioids
Natural
Morphine
Codeine
Semi-synthetic
Heroin
Oxycodone
Fully synthetic
Fentanyl
Methadone
Buprenorphine
Opioids
Opiates
The term opiate is often
used as a synonym for
opioid, but it is more
properly limited to the
natural opium alkaloids and
the semi-synthetics derived
from them
Natural Opioids
Semi-Synthetic
Opioids
Fully Synthetic
Opioids
opium
morphine
codine
heroin
hydromorphone
hydrocodone
oxycodone
fentanyl
methadone
Dilaudid
Substances from all categories of opioids carry risk of overdose!!!
Opioids
42
Most commonly used opioids
•
•
•
•
•
•
•
•
•
Heroin
Codeine
Demerol
Morphine
Darvocet
Fentanyl
Dilaudid
Methadone
Opium
•
•
•
•
•
•
•
•
•
Hydrocodone
Oxycodone
Levorphanol
Vicodin
OxyContin
Tylenol 3
Tylox
Percocet
Percodan
43
DEA Alert - Desmethyl Fentanyl
44
What’s the difference ?
Vicodin
Opioids and Heroin
Oxycontin
hours
opium
opium
morphine
morphine
codeine
codeine
days
heroin
heroin
hydrocodone
hydrocodone
oxycodone
oxycodone
fentanyl
fentanyl
methadone
methadone
Demerol
Demerol
Street and Prescription
Opioid Slang
• Heroin
• Dope, H, Brown, Sheila, Betty, Hayron, Manteca, Montaga, Diesel/Diz,
Dog Food, China White, Smack, Boy, Chiba
• Oxycodone
• OC’s, Oxycotton, Perc 30s, Oxy’s, Roxy’s, Oscars, Big Boys
• Percocet
• Percs
• Vicodin
• Vike’s, Morph, Cottons, Watson 387
Non-Opioid Prescription Slang
• Benzodiazepines
– Downers, Benzos, Chill Pills, Tranx, Pins, Bars, Zani Bars (Prescribed for
anxiety, insomnia, nausea)
• Clonidine
– Deans (Prescribed for blood pressure, anxiety, opioid withdrawal)
• Phenergan or promethazine
– Finnegan (Prescribed for nausea)
• Klonopin+clonidine+phenergan:
– The Cocktail (Used by methadone patients to boost methadone)
• Neurontin (gabapentin)
– Johnnies (Prescribed for seizures, mood stabilization, neuropathy)
Overdose 101
What is an Overdose?
What is an Opioid OD?
How do opioids affect breathing?
Opioid Receptors, brain
Opioid
Opioid Overdose
• Definition
– Excess of a substance leading to central
nervous system and respiratory
depression/apnea -- unresponsive and not
breathing (not the heart)
• Opioid overdoses is rarely instantaneous
– Happens as a process- breathing slows down
before it stops
– Takes minutes to hours after the drug was used
– Someone “found dead with a needle in their
arm” rare, but could happen, especially when
using opioids + others substances
Overdose 101
Risk, Signs, Symptoms, Response
Risks
https://www.youtube.com/watch?v=2HcPS6xWbSE (5:02)
56
Risks for Overdose
•
•
•
•
Tolerance change
Mixing drugs
Physical health (liver, lung, HIV)
Variation in strength and
content of ‘street’ drugs
• Previous overdose
Risks for Overdose (con’t)
• Not having a plan
• Using alone
• Injection techniques
Mixing
• Drugs taken together interact in ways
that increase their overall effect
• Many overdoses occur when people
mix heroin or prescription opioids
and/or alcohol with benzodiazepines
such as Klonopin, Valium, and Xanax
• Most fatal overdoses are the result
of poly-drug use (concomitant use).
59
Why Mix?
• Enhance the effects of primary substance
• Mediate the withdrawal or other side effects from
primary substance
• Unintentional use due to impaired judgment from
other substances
Mixing opioids with benzos
• Combining opioids with benzodiazepines or
alcohol leads to a worse outcome
• Benzos are psychoactive drugs that have
sedative, hypnotic, anxiolytic, anticonvulsant,
muscle relaxant, and amnesic actions
• The most commonly used benzos are:
Klonopin, Valium, Ativan, Librium, and Xanax
61
Release From Incarceration
High Risk of Drug-Related Death
• Overdose is the leading cause of
death for released inmates
(suicide is 4th)
• Risk of overdose in first two
weeks after incarceration is up
to 129 times that of similar
demographic groups
Binswanger et al. NEJM 2007
Responding to an Overdose
Assess the signs
• Is the person breathing?
• Is the person responsive?
• Does he or she answer when
you shake them and call his or
her name?
• Can the person speak?
• Did he/she respond to knuckle
rub (sternum or above lip)?
63
What are the
Signs & Symptoms of an OD?
•
•
•
•
Blue skin tinge
Body very limp
Face very pale
Pulse (heartbeat) is slow
or not there at all
• Throwing up
• Passing out
• Choking sounds or a
gurgling/snoring noise
– ‘Death Rattle’
• Breathing is very slow,
irregular, or has stopped
REALLY HIGH
OVERDOSE
Muscles become
relaxed
Deep snoring or
gurgling (death
rattle)
Speech is
slowed/slurred
Very infrequent or
no breathing
Sleepy looking
Pale, clammy skin
Nodding
Heavy nod
Will respond to
stimulation like
yelling, sternal rub,
pinching, etc.
No response to
stimulation
Slow heart
beat/pulse
64
What To Do?
• CALL 911
• RESCUE BREATHE
• NARCAN
65
Video
Calling 911
https://www.youtube.com/watch?v=WYVhGaVTYXU (3:37)
66
CALL 911
● What to say
●What NOT to say
67
CALL 911
• Say ‘not breathing’
• Don’t say ‘drugs’ which
may minimize police
involvement. May decrease
response time.
• Give details of location
• Recovery position if need
to leave (leave doors open)
• Upon arrival, tell all
68
Recovery Position
What are Barriers to Calling 911?
70
Barriers to Calling 911
•
•
•
•
•
Fear of legal risk
Fear of outstanding warrants
Fear of being deported
Fear of DCF involvement
Fear of loss of public housing for
family members and self
• Fear of judgment from family and/or
community
• Personal embarrassment and shame
• Fear of homicide charge for being at
an overdose
‘GOOD SAMARATAN’ Law
Massachusetts Law Passed August 2012
“An Act Relative to Sentencing and Improving Law Enforcement Tools”
• Good Samaritan provision: Protects people who overdose or seek
help for someone overdosing from being charged or prosecuted for
drug possession. Protection does not extend to trafficking,
distribution charges, or warrants
• Patient protection: Allowed to receive, possess & administer narcan
• Prescriber protection: Allowed to prescribe and dispense. Considered
‘legitimate medical purpose’
• Your state? As of August 1,2014 23 States and the District of
Columbia have Good Samaritan Bills regarding overdose including
MA, RI, Conn, Maine, and VT.
Acts of 2012, Chapter 192, Sections 11 & 32malegislature.gov/Laws/Session Laws/Acts/2012/Chapter192
72
What To Do?
• CALL 911
• RESCUE BREATHE
• NARCAN
73
Rescue Breathing
https://www.youtube.com/watch?v=642Yjvtw-GA (6:22 total)
(3:30-4:30)
74
Rescue Breathing
•
•
•
•
•
Remove anything in mouth
2 Fingers under chin, one hand on forehead
Tilt head back gently, open mouth
Pinch nose, create seal around mouth
2 regular breaths first
– Chest rise? If no, make sure head up, nose pinched
• Then, 1 breath every 5 seconds
• Continue till help arrives
• With/without mask
75
What To Do?
• CALL 911
• RESCUE BREATHE
• NARCAN
76
NARCAN
77
Video
Administering Narcan
https://www.youtube.com/watch?v=fVk1W1yONMg (3:20)
(start 2:00-3:00)
78
Narcan reversing an overdose
How does naloxone affect overdose?
Naloxone components
Mucosal
Atomization Device
(MAD)- nasal
attachment, comes
in bag separately
Prefilled ampoule
of naloxonecomes in the box
Plastic delivery devicelooks like barrel of a
syringe, comes in the box
How to use Narcan
1. Pop off two yellow caps
and one red cap.
2. Screw medicine gently into
delivery device
3. Hold spray device and
screw it onto the top of the
delivery device.
4. Spray half of the medicine
up one side of the nose and
half up the other side.
• Tilt head back
• Spray half up one side of nose
(1cc) and half up the other
side (1cc)
• Continue rescue breathing
while waiting 3-5 minutes to
take effect
• If no effect, spray another
dose up both sides…recent
reports need to repeat this
more than twice
• Will wear off 30-90 minutes &
causes withdrawl so…
• Don’t leave him/her alone
83
What is Naloxone (Narcan)
• Opiate Antagonist (sticks to Opioid receptors – high affinity)
• Temporarily takes away high (withdrawal) allowing person to
breathe (reverses respiratory depression)
• Non-scheduled (non-addictive) prescription*
• Injectable or nasal
• Its use is standard practice in
emergency settings
• Nasal easy to administer
• Ideal for non-medical bystanders
84
What is Naloxone (Narcan) (con’t)?
•
•
•
•
•
Takes 3-5 minutes to take effect. Lasts 30-90 minutes
Won’t cause harm if not overdosing
No potential for abuse (can’t get high)
Won’t work if no Opioids
Won’t reverse effects of
Alcohol, Cocaine, Benzos or
other substances
85
Avoid old school methods of
reversing an overdose
•
•
•
•
•
Do not leave the person alone
Do not put them in a bath (they could drown)
Do not induce vomiting (they could choke)
Do not give them something to drink
Do not put ice down their pants (cooling down core temp is
dangerous)
• Do not try to stimulate them in a way that could cause harm
• Do not inject them with anything (saltwater, cocaine, milk)
• Give positive feedback for trying these things but
acknowledge we now know the difference
86
How to Avoid an Overdose
• Recovery*
• Beware of tolerance
changes
• Know your supply (drug
purity)
• Control Your Own High
• Injection Techniques
• Be Aware of the Risks of
Mixing Drugs
• Try not to use alone
• Keep a kit where you use
• Make a plan
• Talk with other users
• Train your network
(friends, family, etc)
rescue breathing, narcan,
etc
• Encourage network to get
narcan kit
87
Bathrooms are injection facilities
How to make them safer?
Make your bathrooms safer
- outfit bathrooms with:
• Secure biohazard boxes
• Good lighting
• Mirrors
• Doors that open out
• Call button
• Intercom system
• Safer injection equipment
• Naloxone rescue kit
Narcan Access
State and National Levels Differ
• Nationally
– In April 2014, the U.S. Food and Drug Administration (FDA) approved a naloxone
hand-held auto-injector called Evzio, which rapidly delivers a single dose of naloxone
into the muscle or under the skin, buying time until medical assistance can arrive.
Since Evzio can be used by family members or caregivers, it greatly expands access
to naloxone.25 NIDA and the FDA are working with drug manufacturers to support
the development of nasal spray formulations of this live-saving medication.
• Massachusetts
– Pilots, Learn to Cope, prescribers, first responders in selected communities
– Pharmacy prescription access if pharmacy carries
– Behind-the-counter access possible pending standing order (Walgreens, CVS)
89
http://www.drugabuse.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states
Status of Narcan in New England?
Your States???
90
History of Naloxone in
United States
Development of Naloxone
• Naloxone was developed in the 1960’s by
Sankyo, a global pharmaceutical company
• Naloxone is a pure opioid antagonist
• Naloxone began to be used in the US in 1970
• Naloxone was only available by prescription
for several decades
• Naloxone could only be administered by by
medical professionals until 2001
92
New Mexico
• In 2001 NM became the first state to make
Naloxone more available through prescribers
and lay administers with out the fear of leagal
repercussion
• NM also became the first state to implement
Good Samaritan laws to protect persons
calling 911 for assistance in overdoses
93
Chicago Recovery Alliance
• In the Spring 1996 after the OD death of a cofounder of CRA they implemented a limited
Narcan distribution program in the Fall of 96
• CRA director and a local physician developed
the protocol for the program
• The director became the “Johnny Appleseed”
of Naloxone
• Slowly independent programs started to
emerge
94
MA Timeline: Key events & players
• 1999-2004: underground & 1 CBO
• 2005: underground, 2 CBO
• 2006: underground suspended= incorporated(?), Boston and
Cambridge
• 2007: MDPH starts an Opioid Overdose Prevention Pilot via
standing order
• 2009: expansion to more CBOs and outreach
• 2010: first responders – police and fire
• 2011: parents organizations
• 2012: legislature passed Good Sam and limited liability
protection
New England
• While attending a Harm Reduction Conference
in Miami a founder of New England
Prevention Alliance met with Dan Bigg
(director CRA)
• NEPA began a small independent Naloxone
distribution project in selected communities
• In 2005 NEPA outreach workers were
questioned about legality their project
96
Massachusetts
• Meetings between NEPA and Boston Health
officials
• 2005 a committee was created by the Boston
Public Health Commission
• After public hearings Boston began a pilot
program through BPHC
• 2007 State funded eight sites to distribute
Naloxone
97
Overdose Prevention and Naloxone Pilot
Structure
• Bureau of Substance Abuse Services and Office of HIV/AIDS
– Steering Committee
• Data Subcommittee
• Medical Director
• Registered Program
– Program Director
– Master Trainer
• Approved Trainer
• Approved Responder
www.mass.gov/eohhs/docs/dph/substance-abuse/core-competencies-for-naloxone-pilot-participants.pdf
www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/prevention/opioid-overdoseprevention.html
Strategies
MassCall2
• 2006 SAMHSA awards MA Strategic
Prevention Framework-State Infrastructure
Grant SPF-SIG
• 3 year grant from 2009-2011
• To reduce fatal and non-fatal opioid overdose
• 15 communities awarded through MDPH
• Criteria included communities with 30+ fatal
opioid overdoses
100
Massachusetts Opioid Abuse
Prevention Collaborative (MOAPC)
•
•
•
•
MA awarded a SPF-SIG to continue work
Regional approach
MDPH awarded grants to 13 communities
Funded communities (host communities)
needed to choose 2 or more other
communities (cluster communities)
• Addresses Overdose Prevention and Opioid
consumption
101
Primary Prevention ONDCP
•
•
•
•
•
Public and clinician education
Controlled substance tracking and monitoring
Proper medication disposal
Law enforcement
Treatment and screening (SBIRT)
102
NMUPD Prevention Strategies
10 State Indicators….How does your state Rank?
Trust For America’s Health Score Card 2013
•
•
•
•
•
•
•
•
•
10 (2 states) (VT)
9 (4 states) (MA)
8 (11 states) (CT, RI)
7 (5 states)
6 (23 states & D.C.)
5 (8 states) (ME, NH)
4 (6 states)
3 (2 states)
2 (1 state)
1.
2.
3.
4.
Prescription Drug Monitoring Program in place?
Prescription Drug Monitoring Program mandatory?
Doctor Shopping Law?
Support for Substance Abuse Services
(expanded Medicaid under ACA)?
5. Prescriber Education Requirement?
6. Good Samaritan Law?
7. Support for Naloxone Use Laws?
8. Physical Exam Requirement?
9. Pharmacy ID Requirement?
10. Pharmacy Lock-In Medicaid Program (requires single
prescriber & pharmacy for suspected misuse)?
103
Free Toolkit
Equips communities and local
governments with material to
develop policies and practices
to help prevent opioid-related
overdoses and deaths.
Addresses issues for first
responders, treatment
providers, and those
recovering from opioid
overdose.
104
Connecticut
105
Maine
106
Massachusetts
107
New Hampshire
108
Rhode Island
109
Vermont
110
http://healthvermont.gov/hv2020/
dashboard/alcohol_drug.aspx
111
Local Strategies
Intervening Variables – Selected Consumption IVs
• What were some consumption IVs that Cohort 1 sites identified?
–
–
–
–
–
–
–
–
Perception of harm/risk
Peer norms/approval
Close friends who use/abuse
Parental approval/disapproval
Parental involvement
Parent knowledge/education/awareness
Availability/Ease of Access/Storage
Community norms favorable to use
• Representation across individual, peer, family, and community domains.
Source: MOAPC Cohort 1 Strategic Plans Part I (n=13)
113
IVs – Selected Consequence IVs
• What were some consequence-related IVs that Cohort 1 sites identified?
–
–
–
–
–
–
–
–
–
–
Mixing/concomitant use
Barriers to calling 911; witnesses leaving scene
Loss of tolerance
Fluctuations in purity/potency
Prior history (overdose; IDU)
Treatment involvement
Age; gender; race/ethnicity
Prescriber willingness to prescribe drugs
Lack of employment
Attitudes around pain and pain management
• Good balance between user characteristics, use patterns, contextual/
situational variables, and organizations/systems.
Source: MOAPC Cohort 1 Strategic Plans Part I (n=13)
114
IVs – What Lists or Resources Are Out There?
• Consumption IVs (Use)
– SAMHSA’s CAPT website
• Prescription Drug Abuse and Misuse Pages.
• Risk and Protective Factors Associated with Non-Medical Use of
Prescription Drugs: A Review of the Literature (2006-2012).
• A Systematic Review of Risk and Protective Factors (Nargiso, 2015).
– MOAPC Guidance Document.
• Consequence IVs (Overdose)
– MassTAPP website
• Intervening Variables And Strategies Related to the Prevention of
Opioid Overdose
– MOAPC Guidance Document.
115
Possible strategies to prevent or reduce opioid
misuse and its consequences
• A communication campaign to increase youth
perception of risk regarding opioid use
• Training of parents of eighth grade students
on how to clearly communicate disapproval of
opioid use
• Education of clinicians and pharmacists
• Prescription drug monitoring programs
116
Possible strategies to prevent or reduce opioid misuse
and its consequences
• Prescription drug take-back programs
• Good Samaritan laws that promote prompt
treatment of individuals having an overdose
• Training of potential bystanders, including
active users and family members, on how to
respond to an opioid overdose
117
Possible strategies to prevent or reduce opioid misuse
and its consequences
• Improved access to naloxone distribution
programs
• Expansion of Screening, Brief Intervention,
and Referral to Treatment (SBIRT) programs to
all EDs
• Intervention with former users who may be at
high risk for an overdose (e.g., inmates or
persons recently discharged from treatment)
118