Opioid Overdose Prevention
Strategies in MA
Sarah Ruiz, MSW
Bureau of Substance Abuse Services
MA Department of Public Health
October 30, 2014
March 27, 2014
Governor Deval Patrick declares opioid
use a Public Health Emergency in MA
This action provided emergency powers to the
DPH Commissioner. The Public Health Council
passed orders that:
• Universally permit first responders to carry
and administer naloxone
• Facilitate access to naloxone through standing
orders at pharmacies
• Accelerate enrollment in the PMP
Governor also ordered that an
Opioid Task Force be formed to make
recommendations about policy and resource
development in the areas of prevention,
intervention, treatment and recovery support
http://www.mass.gov/eohh
s/feature-story/end-opioidabuse-in-mass.html
Opioid Task Force
Recommendations
• BSAS is implementing a total of 15 recommendations
which requires 11 procurements for new services such as:
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Acute Treatment Services
Clinical Stabilization Services
Residential Treatment Services
Recovery High School
Assessment Centers (pilots)
Central Navigation System
New Funding included in
FY15 GAA for BSAS
4512-0200: Substance Abuse Services
• $2,000,000 added to this line item to support & strengthen public access
to substance abuse services in the commonwealth, including the
following:
• $500,000 for a voluntary training and accreditation program for alcohol
and drug free housing
4512-0204: Naloxone Pilot Expansion
• New line item for $1,000,000 for naloxone purchase, and administration
and training for first-responder and bystander naloxone distribution
programs
• Not less than 10 first-responder pilot communities and 7 bystander
distribution communities
4512-0210: Substance Abuse Treatment Trust Fund
• $10,000,000 new line item to increase the number of clients receiving
substance abuse treatment through BSAS utilizing a range of treatment
settings
Naloxone (Narcan®)
• Treatment of choice for the reversal of an opioid
overdose by emergency responders for decades
(Paramedics, Emergency Department Physicians)
• Displaces opioids from the brain receptors and
restores consciousness and breathing = pure
opioid antagonist
• Extremely safe with no potential for abuse - not
psychoactive
• Acts within 2 to 8 minutes, lasts 30 to 90 minutes
• Overdose may return, naloxone may be repeated
Naloxone was FDA
approved in 1971
Dr. Jake Fishman 1930-2013
•In March 1961, Dr. Fishman and Dr. Mozes Lewenstein applied for one of the
first patents for naloxone
•In 1971, the Food and Drug Administration approved using naloxone to treat
overdoses
Intranasal Administration
• Naloxone may be given by needle into a vein
(IV) or muscle (IM) or it may be sprayed up the
nose (intranasal or IN).
• In Massachusetts we are distributing intranasal
naloxone
• Avoids the risk of secondary needle exposure
and eliminates concerns with disposal
• Kit requires assembly but is easy to administer
Naloxone and Mucosal
Atomization Device (MAD)
DPH Pilot Program
Components
• Approved staff enroll people in the program and
distribute naloxone
– http://www.mass.gov/eohhs/docs/dph/substance-abuse/naloxoneinfo.pdf
• Curriculum delivers education on OD prevention,
recognition, and response
– http://www.mass.gov/eohhs/docs/dph/substance-abuse/corecompetencies-for-naloxone-pilot-participants.pdf
• Referral to treatment available
• Kits include instructions and 2 doses
• Data collected on everyone who receives
a kit and returns for a refill
DPH Overdose Education &
Naloxone Distribution Program Sites
Site
Coming Soon
Learn to Cope
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AIDS Action Committee
AIDS Project Worcester
AIDS Support Group of Cape Cod
Brockton Area Multi-Services Inc. (BAMSI)
Boston Public Health Commission
Greater Lawrence Family Health Center
Learn to Cope
Center for Human Development
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Lowell House/ Lowell Community Health Center
Manet Community Health Center
MAPS/ Health Innovations
North Suffolk Mental Health
Seven Hills Behavioral Health
Tapestry Health
Center for Social Innovation
Parents Support
Groups
“Learn to Cope” www.learn2cope.org
• Currently has 13 meetings weekly
throughout the state
• Parents are trained and approved to
distribute naloxone at their meetings
Also “Parents Supporting Parents” on Cape
Cod
Learn to Cope
Current Weekly Meeting Locations:
Brockton
Cambridge
Gardner
Gloucester
Holyoke
Lowell
New Bedford
Norwell
Quincy
Salem
Tewksbury
Worcester
Yarmouth
Coming Soon:
Taunton, Pittsfield &
Framingham
Massachusetts - Passed in August 2012:
“An Act Relative to Sentencing and Improving
Law Enforcement Tools”
Law allowing broader prescribing of naloxone
Patient Protection:
• A person acting in good faith may receive a naloxone prescription,
possess naloxone and administer naloxone to an individual appearing
to experience an opiate-related overdose.
Prescriber Protection:
• Naloxone or other opioid antagonist may lawfully be prescribed and
dispensed to a person at risk of experiencing an opiate-related
overdose or a family member, friend or other person in a position to
assist a person at risk of experiencing an opiate-related overdose. For
purposes of this chapter and chapter 112, any such prescription shall
be regarded as being issued for a legitimate medical purpose in the
usual course of professional practice.
Pharmacy Access
• Many pharmacies in MA are now stocking
intra-nasal naloxone to fill prescriptions
– Walgreens, CVS, Eaton Pharmacies in
Community Health Centers, MGH
• MA Board of Pharmacy recently released
guidance on Pharmacy Standing Orders
for dispensing naloxone
http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/pharm
acy/dispensing-of-naloxone-by-standing-order-.html
Prescribe naloxone
Prescribetoprevent.org
Auto-injector Naloxone
• Each auto-injector contains only 1 dose
• Inject into muscle or skin of the outer
thigh
• Can be injected through clothing if
needed
• Device injects intramuscularly or
subcutaneously, delivers the naloxone,
and retracts the needle fully into its
housing
• Needle not visible before, during, or
after
Auto-injector Naloxone
• Practice with the Trainer to make sure you are able to
safely use the auto-injector in an emergency
• The Trainer does not contain a needle or medicine
• It can be reused to practice your injection
• The red safety guard can be removed and replaced on the
Trainer
First Responder Pilot
2010-2014
• DPH provided the medical direction and naloxone,
approved training & monitored overdose reports
• All Police Officers or Fire Fighters in 6 participating
departments were trained with DPH approved
curriculum
• Annual refresher incorporated into annual required
first responder training
• A one page data collection form is completed each
time the naloxone is used
EMT & First Responder
Regulations (2014)
DPH Drug Control Program and EMS regulations
& clinical protocols now incorporate both EMT
(required) and First Responder (optional)
administration of naloxone.
• Training rolling out in collaboration between
public health, law enforcement, fire, and EMS
• Resources and Technical Assistance:
http://masstapp.edc.org/first-responder-naloxonenarcan-technical-assistance
Helpful overdose weblinks….
For prescribers and pharmacists
2013 National Drug Control Strategy
•Prescribetoprevent.org
•www.whitehouse.gov/ondcp/2013national-drug-control-strategy
Family support
•Learn2cope.org
•Grasphelp.org
News + research on overdose prevention
•Overdosepreventionalliance.org
ASAM 2010 Policy Statement
•www.asam.org/docs/publicy-policystatements/1naloxone-1-10.pdf
SAMHSA toolkit
International overdose prevention efforts
•store.samhsa.gov/product/Opioid-OverdosePrevention-Toolkit/SMA13-4742
•Naloxoneinfo.org
SAMHSA Letter to prescribers
Opioid overdose prevention education
•www.dpt.samhsa.gov/pdf/dearColleague/
SAMHSA_fentanyl_508.pdf
•Stopoverdose.org
Legal interventions
•www.networkforphl.org/_asset/qz5pvn/networknaloxone-10-4.pdf
Project manual
•harmreduction.org/issues/overdose-prevention/
Contact Information
Sarah Ruiz, MSW
MA Dept. of Public Health
Bureau of Substance Abuse Services
Sarah.Ruiz@state.ma.us
617-624-5136