From Underground to StateFunded:
The History of Overdose
Prevention/Naloxone
Distribution in
Massachusetts
Adam Butler, Jon Zibell,
Kathy Day, Monique Tula and Gary Langis
Purpose
 To describe in timeline format the history of Overdose
Prevention in Massachusetts
 To describe how OD Prevention went from an
underground effort to a comprehensive, statesanctioned & funded program that includes naloxone
distribution
 To describe the various initiatives that have been
developed and integrated into other services over time.
 To share successes, challenges, key opportunities and
identify ways for different types of organizations
(underground, CBO, state) to all play a part in
developing a successful program and initiatives .
National and Regional Drug
Threat
United States
New England
38.8%
36.5%
37.6%
33.2%
15.5%
11%
8.5%
9.3%
Pharmaceuticals
Marijuana
Methamphetamine
Heroin
1.9%
Cocaine
Pharmaceuticals
Marijuana
Methamphetamine
Heroin
Cocaine
3.9%
Source: National Drug Threat Assessment, 2007
Opioid-related Health Problems
2007, rates per 100,000 by Town
Rates suppressed for towns with less than 5 cases
Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
Opioid-Related Poisoning Deaths
1990-2008
700
574
500
544
487
449
400
425
363
329
300
200
193
220
100
261
246
218
178
160
94 111
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
0
19
90
#of Deaths
600
637 637
594
Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
2000
 Active players:
• Underground
• Community-Based
Organization
2001
Active players:
•Underground
•Community-Based Organization
2002
Active players:
•Underground
•Community-Based Organization
2003
Active players:
•Underground
•Community-Based Organization
2004
Active players:
•Underground
•Community-Based Organization
2005
Active players:
•Underground
•Community
•City
Media Shit Storm
No Response = Death
2005 – Boston Herald front page photo
Media Shit Storm
2006
Active players:
•Underground
•Community
•City
2007
Active players:
•Underground
•Community
•City
•State
Massachusetts Department of
Public Health
funded Naloxone Programs
Gloucester
Lynn
Boston
Cambridge
Quincy
Provincetown
Brockton
Springfield
Northampton
Fall River
Hyannis
New Bedford
2007
Media in 2007
2008
Active players:
•Underground
•Community
•City
•State
Media in 2008
All Things Considered
Eliza Wheeler, left, a
health educator with the
group Cambridge Cares
about AIDS, is teaching a
client named Elissa how to
rescue her friends from a
fatal overdose.
Overdose Rescue Kits Save Lives
by Richard Knox January 2, 2008
Every year, overdoses of heroin and opiates, such as Oxycontin, kill more drug users than AIDS, hepatitis or homicide.
And the number of overdoses has gone up dramatically over the past decade.
But now, public health workers from New York to Los Angeles, North Carolina to New Mexico, are preventing
thousands of deaths by giving $9.50 rescue kits to drug users. The kits turn drug users into first responders by giving
them the tools to save a life.
One of the new rescue operations is located off a side street behind St. Peter's Episcopal Church in Cambridge, Mass.
Clients enter through an innocuous-looking door and climb a flight of wooden stairs to the Cambridge Cares About
AIDS program for harm reduction.
The group says its mission is to provide prevention, education, advocacy and support services to the economically and
socially disadvantaged.
At CCAA, drug users can obtain condoms, sterile needles, syringes and other resources to reduce their vulnerability to
disease and death. Health educators also cajole their clients to undergo HIV and hepatitis testing, urge them not to share
needles, and find them slots in detoxification programs and methadone treatment.
Drug Used as a Nasal Spray
On one recent wintry morning, health educator Eliza Wheeler teaches a 34-year-old client named Elissa how to rescue
her friends from a fatal overdose.
"All right, Elissa," Wheeler says in a getting-down-to-business manner. "The first thing I'm going to do is ask a series of
questions about your current drug use. So, we're going to talk about just the last 30 days."
Elissa has been on methadone for six years, but she confesses that she used heroin a couple of days in the previous
month because she was under a lot of stress.
MassCall2
 15 Municipalities received funding through
MDPH to build capacity to address fatal
overdose
 Communities were chosen due to high OD rates
 All identified barrier of calling 911 as variable
 Most communities work closely with state
funded naloxone programs
 Engaged law-enforcement, treatment providers,
harm reduction personnel, and community
members
Good Samaritan Legislation
 Two GS bills were introduced in MA in
2008
 Several groups advocated and lobbied
legislators
 Both bills failed during this legislative
session
2009
Active players:
•Underground
•Community
•City
•State
More Work to Do
State report says deaths from opioidrelated overdoses declined in 2008
By Vicki-Ann Downing
Enterprise Staff Writer
Posted Dec 19, 2010 @ 06:00 AM
BROCKTON —
“The overdose rate for the South Shore in 2009 was high and it
was steady throughout the year,” said Dubois. “As a whole,
2010 was lower in the amount of fatal overdoses compared to
2009, but still too high.”
That the governor’s report contained any information at all
about deaths from drug overdoses – in addiction to cancer,
heart disease, Alzheimer’s disease and diabetes – shows it “is
still something that the Commonwealth deems to be a critical
issue,” said Dubois.
The report, based on statistics from the state Department of
Public Health, showed 594 deaths from opioid-related
overdoses in 2008, compared to 637 in both 2006 and 2007.
The number of overdose deaths began to climb beginning in
1996, when there were 178, according to the state…
2010
Active players:
•Underground
•Community
•City
•State
Massachusetts Department of Public Health
funded Naloxone Programs
Lowell
Lawrence
Gloucester
Lynn
Boston
Cambridge
Provincetown
Quincy
Holyoke
Worcester
Brockton
Springfield
Northampton
Fall River
Hyannis
New Bedford
2010
Good Samaritan Legislation
 Good Samaritan Coalition formed
 Three GS bills introduced, another with





a provision to address GS
Garner community support
Parent support groups
Treatment and Recovery Community
support
Community forums conducted
Students for Sensible Drug Policy
2011
Active players:
•Community
•City
•State
Screening Brief
Intervention, Referral to
Treatment (SBIRT)
 Eight Hospitals funded by MDPH for SBIRT
 Harm reduction strategies have been
incorporated
 Motivational Interviewing (MI)
 HPA’s provided with training to train and enroll
participants into state naloxone program
Learn To Cope
 Support group for family members
and loved ones of opioid users
 Five groups in eastern MA
 14 members are approved MDPH
Naloxone trainers
 Training of peers take place at their
meeting’s
2012
Active players:
•Community
•City
•State
Challenges
 Slow pace
 Needed legal backing and buy-in from




“authorities” before could become
legitimized
Getting over ego stuff
Staff buy-in to risks of distributing naloxone
pre-pilot years
Negative press/media
Limited research made it difficult for public
health people to buy in
Looking Forward
 Expanding into more ER’s (SBIRT)
 Expanding first responder involvement
 Persons in Recovery and Treatment become





partners
ODP being incorporated into standards of
care for short-term drug treatment
Research possibilities that contributes to
the case being made for OTC sale of Narcan
FDA approval of nasal Narcan use
ODP being incorporated into the DOC
Education on Good Samaritan laws
Successes
 Collaborative process between
underground and funded programs
 Philosophy shift in State (BSAS)
 Acceptance of harm reduction
philosophy by treatment programs,
parents of users, etc.
 Buy in from many stakeholders to
legitimize naloxone distribution
 Good Samaritan Law passed
 Lives saved
More Successes
2006-2012
 Enrollments
 15,000+ individuals
 300 per month
 1500+ reported reversals
 30 per month
 RFD has more than 70 OD reversals