Strategies for Incorporating
OD Prevention Into Your Work
Eliza Wheeler
Drug Overdose Prevention &
Education (DOPE) Project
Harm Reduction Coalition
510.444.6969 x 16
wheeler@harmreduction.org
Overdose Prevention & Naloxone
Distribution Programs in the U.S.
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The earliest naloxone distribution began in 1996
and some programs started as recently as this
year.
States authorizing naloxone distribution: New York,
New Mexico, Massachusetts, Illinois
California has passed legislation to provide
additional liability protection in 7 counties as a
“pilot.”
Cities, counties, local health departments, and
individual programs have implemented naloxone
distribution.
Overdose Prevention & Naloxone
Distribution Programs in the U.S.
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As of November 2010, there were 189 sites where
naloxone distribution was happening in 15 U.S. States
and the District of Columbia.
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67 % distribute 10ml vials of naloxone
42% distribute 1ml vials of naloxone
17% distribute 2ml Intranasal naloxone
**Percentages equal more than 100% because some
programs distribute multiple formulations of naloxone, or
have had different types throughout the years.
Overdose Prevention & Naloxone
Distribution Programs in the U.S.
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Between 1996 and June 2010, a total of
53,339 individuals have been trained and
given naloxone as a result of US naloxone
distribution programs.
Programs have received reports of 10,194
overdose reversals using naloxone.
38,860 units of naloxone (all types) have
been distributed during the last year, from
July 2009-June 2010.
Common barriers to implementing an
OD Prevention Program:
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Liability concerns
Resources and time
Agency policies
Community opposition
Ideological differences, lack of buy-in to
Harm Reduction model
Common concerns and criticisms
of OD prevention programs:
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Drug users are not capable of recognizing
and managing an OD with naloxone
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The person who gets naloxone will be violent
upon OD reversal
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Naloxone access will postpone peoples’ entry
into drug treatment
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Naloxone access encourages riskier drug use
Integrating overdose messages
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Informal conversations that explore the context of
drug use (i.e. do you use alone in your hotel room?
Do you have friends who live nearby who know
you use?)
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Adding assessment questions about overdose risk
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Including OD prevention as part of treatment
plans/goal setting/discharge planning
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Posting OD-related messages (i.e. “Ask me about
OD Prevention”)
Integrating Overdose Messages
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How do we talk with participants about their
overdose risk or history of overdose?
How do we provide overdose education in
our setting(s)?
Are there any programmatic barriers to
communication (i.e. abstinence requirements,
clients fear losing services if they disclose
drug use, staff attitudes)?
Is staff prepared to discuss harm reduction
options with participants?
Providing OD Response Trainings
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Overdose prevention and response trainings can be
done even if you are not yet able to distribute
Naloxone
Education on Rescue Breathing, calling an
ambulance and other basic first aid response can be
lifesaving
Incorporate into existing group meetings and oneon-one interactions with participants
Cost: staff time and printing materials, optional:
rescue breathing mouth shields and rescue
breathing dummies
Overdose Prevention, Recognition,
and Response Training
Overdose Prevention, Recognition,
& Response Trainings
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Can be done in various settings and using
different models
10 minutes60 minutes in length
 Depends on setting and experience of
trainees
Groups, pairs, individuals
Components of a Training
1.
2.
3.
4.
5.
6.
What is an overdose?
What causes an overdose?
Prevention messages
Recognition
Response
Aftercare
Naloxone Distribution
Can we do it?
How is naloxone distributed?
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Distribution—programs obtain supply of naloxone and distribute
to participants without prescriptions or medical provider
oversight.
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Standing Order—issued by Health Department or physician to
empower health care providers like nurse practitioners or trained
outreach staff to distribute naloxone
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Prescription—program has medical provider sign off on a
prescription for individuals who participate in a training and
complete a short medical history/clinical registration form, health
care professional must be present or available to sign
prescriptions.
Pros and Cons of Distribution:
Pros:
 Gets naloxone to
the people who
need it, without
having to wait for
“official” approval.
 Less paperwork,
lower threshold
Cons:
 Limited resources or funding to
support program or purchase
supplies
 Potentially inconsistent supply of
naloxone
 Could put program and/or
individuals distributing naloxone
at risk for “practicing medicine
without a license.”
 Could put program participants
at risk for arrest for carrying
prescription medication without
documentation that it was
prescribed to them
Pros and Cons of Prescriptions:
Pros
 Protects participants from
arrest for possession of a
prescription drug without a
prescription
 Documentation (paper trail)
protects prescribing medical
professional in terms of
liability
Cons
 Higher threshold (more
paperwork required)
 Some medical providers still
wary of providing naloxone
in this manner
 Technically, provider must
be present when naloxone
is distributed, which
requires time and resources
 Limited availability of
providers can mean limited
times that naloxone can be
distributed.
Pros and Cons of Standing Orders:
Pros
 Allows programs more
freedom to distribute
naloxone without the need
for a medical professional
on-site at the time of the
trainings
 In states like
Massachusetts, the
Standing Order actually
empowers NON-medical
staff (i.e. NEX workers) to
distribute naloxone
Cons
 Unclear if Standing Orders
are legally feasible for
naloxone distribution, has
not been legally “tested.”
 Medical providers can be
skeptical of using Standing
Orders and may want more
oversight of the program if
their license is on the line
Start a Naloxone Program!
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Identify the scope of the overdose problem in your
community (what drugs, who, where, etc.)
Find a medical director or licensed physician that is
willing to prescribe naloxone (cite research, enabling
laws and put in touch with currently prescribing
doctors and medical directors).
Purchase naloxone (with MD’s license number,
through pharmacy or health department) and other
supplies for kits.
Start a Naloxone Program!
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Train program participants, satellite exchangers,
peer educators, outreach workers, health educators,
etc. who can do the overdose prevention and
response trainings.
Work on getting community buy-in, especially firstresponders like ambulance workers and police to
prevent confiscation and harassment
Network with prisons, drug treatment, parents
groups, etc. to expand distribution
Considerations:
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Given your agency's facilities, policies, and
staff, what are the potential barriers to
developing an overdose prevention plan?
What training would your agency need in
order to put your plan into action?
What resources do you already have (space,
staff, time, photocopier, etc.)? And what do
you need?
Thank You
Eliza Wheeler
DOPE Project
Harm Reduction Coalition
510.444.6969 x 16
wheeler@harmreduction.org