phigclinical skills workshop
TRANSCRIPT
Clinical Skills Workshop: Overdose Prevention and Response —Administering Naloxone to Save LivesPOPULATION HEALTH INTEREST GROUPSEPTEMBER 8, 2016
Conflict of Interest Disclaimer
No financial disclosures. Adapt Pharma provided one trainer of its nasal spray (no
medicine) for demonstration. Kaleo provided Evzio autoinjectable trainers (no medicine) for
demonstration.
How bad is it?
National Overdose DeathsNumber of Deaths from Prescription Drugs
20012002
20032004
20052006
20072008
20092010
20112012
20132014
0
5,000
10,000
15,000
20,000
25,000
30,000 Total Female Male
Source: National Center for Health Statistics, CDC Wonder
National Overdose DeathsNumber of Deaths from Prescription Opioid Pain Relievers
20012002
20032004
20052006
20072008
20092010
20112012
20132014
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000 Total Female Male
Source: National Center for Health Statistics, CDC Wonder
National Overdose DeathsNumber of Deaths from Heroin
20012002
20032004
20052006
20072008
20092010
20112012
20132014
0
2,000
4,000
6,000
8,000
10,000
12,000 Total Female Male
Whom are we talking about?
Break for video #1
It’s more than “use as directed”An adverse reaction can occur if:
Co-morbidities: lungs, liver, kidneys, etc. Co-pharmacy: e.g. sedative Genetic susceptibility Drinking alcohol User error Period of abstinence Switching opioids Family member may help themselves
When to write a script
If patient is prescribed an opioid medication. If patient is using opioids of any kind. After a period of abstinence (any kind, including incarceration or
drug treatment). If pt. has experienced an overdose or adverse reaction. If pt. has witnessed an overdose or adverse reaction. If pt. asks for it. If pt. has a household member who might benefit from it.
Break for video #2
Enabling? No!Safe? Yes!• Been around since 1961• Communities have been
distributing since 1996• No compensatory behavior
since it causes withdrawal.• No potential for abuse.• People use it.• Leads to treatment for
substance use disorder.• Decrease in deaths much
greater than amount supplied, indicating decrease in risky behavior as result of the educational process that is part of providing rx.
Si se puede! 150K laypersons trained. 26K OD reversed . 80% of reversals were
performed by drug users In North Carolina, their
three-year-old program has had 4,000 reversals.
FDA working on making it OTC.
FDA changing labels on all opiates and benzos.
Rx, OTC, Standing Order
To script or not to script
There may not be a standing order in your state. Standing order may only be for certain pharmacies. Pharmacist may not be aware of standing order. Patient may not know to ask for it. Patient may not remember to ask for it. Easier to pick up all rx at once. Less worry about payment and billing issues. There is no downside to writing a script.
Your new best friend:www.prescribetoprevent.orgOne-stop shopping for patients, advocates, prescribers, pharmacists: videos, online CME, research, legal info, billing, Rx pads, and things you never thought you might need.
Where do we go from here? Train your classmates: this is an easy brown-bag lunch session.
Show video(s) Give demo Tell people where to get it for themselves
Make this a national AMSA Project, educating medical students, college students, incarcerated populations, drug treatment programs, faith communities, etc.
Thank you!
Mary Beth Levin, MPHAssociate ProfessorDepartment of Family MedicineGeorgetown University School of [email protected]
Other resources:Harm Reduction Coalition: www.harmreduction.orgNorth Carolina Harm Reduction Coalition: www.nchrc.org Chicago Recovery Alliance: www.anypoisitivechange.org