1. 1st Responder Nasal Naloxone

2. Objectives By the end of this program the participant will: Define & give examples of opiates & opioids; Understand the history & epidemiollogy of opiates & opioids in the US & MA specifically; Describe what an opiate/opioid overdose looks like. Explain what naloxone is and how it works on an opiate/opioid Dispel common myths about reversing an opiate/opioid overdose; Articulate the opiate/opioid treatment modality using nasal naloxone; Demonstrate proper assemblage & administration of nasal naloxone to an opiate/opioid overdose; Explain the Departments Policy for maintaining, administrat ing, replacing, and 3. History Poppy to Opium to Heroin Harrison Narcotic Tax Act 1914 Controlled Substance Act 1970 FDA / DEA 4. Opiates vs. Opioids Poppy Plant Natural to Semi- synthetic Central Nervous System Depressant Slows down Breathing, pulse, overall metabolism Pain reduction Similar to opiates CNS Depressant Fully Synthetic 5. DEA vs. FDA FDA Department of Health & Human Services Science & Medicine DEA 1973 Executive Order 11727 Department of Justice Full Authority for Scheduling & Enforcement Drug Scheduling (I V) Schedule I Very High Abuse Potential Very High Dependence Potential Very High Public Risk NO CURRENTLY accepted medical value Schedule V Very Low Abuse Potential Very Low Dependence Potential Very Low Public Risk High Medical Value 6. Massachusetts Nasal Narcan History Narcan part & parcel of Paramedic Treatment (IM, IV, IO) Antagonist to Opioids (Mu Receptor) 2004 Statewide Treatment Protocols added Nasal for Paramedics 2005 started process 2006 approved SPW BLS Narcan / CAS & BEMS CAS: Data 24 months= 105 BLS uses 5 protocol outliers 2007 Statewide BLS SPW Approval must follow CAS or BEMS Revere Fire Department EMS 1st Responders 7. Mass. Nasal Narcan Hx. Cont 2007 Outside of EMS Mass DPH Public Narcan Responder Program July 2010 Presentation to DPH CAS & BEMS 2011 approved as standing orders for 2012 Statewide protocols 2012 SWTP Service & Medical Director Option for BLS Nasal Narcan! 8. 0 200 400 600 800 1000 1200 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Deathsperyear All Poisoning Deaths Motor Vehicle-Related Injury Deaths The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths, MA Residents (1997-2008) More Opioid Overdose Deaths than MVA Deaths in Massachusetts 9. 0 200 400 600 800 1000 1200 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Deathsperyear All Poisoning Deaths Opioid-related Poisoning Deaths Motor Vehicle-Related Injury Deaths The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths, MA Residents (1997-2008) More Opioid Overdose Deaths than MVA Deaths in Massachusetts Rate of opioid-related fatal overdoses in MA in 2006 was 9.9 per 100K 10. What is Driving the Increase in Overdose? New Drug Use Patterns New Initiates to prescription drugs Oxycontin to Heroin Heroin Availability/Purity/Lethal Mixture Heroin is the leading drug threat in New England From 93-10 Heroin reported as primary drug increased from 20% - 40% of treatment admissions in MA Prescribing Patterns Number of Schedule II Opioid prescriptions has more than doubled in the past decade 11. Strategies to address overdose Prescription monitoring programs Paulozzi et al. Pain Medicine 2011 Prescription drug take back events Safe opioid prescriping education Albert et al. Pain Medicine 2011; 12: S77-S85 Expansion of opioid agonist treatment Clausen et al. Addiction 2009:104;1356-62 Safe injection facilities Marshall et al. Lancet 2011:377;1429-37 12. 2010 States w/ OENDs 15 Programs 188 People enrolled 53,032 OD rescues 10,171 Wheeler E et al. Morb Mortal Wkly Rep 2012;61:101-5. Overdose Education and Naloxone Rescue Kits 13. Mass: where & who Boston, Brockton, Cambridge, Fall River, Gloucester, Holyoke, Hyannis , Lawrence, Lowell, Lynn, New Bedford, North Hampton, Provincetown, Quincy, S pringfield Lowells site: Lowell House Inc. 555 Merrimack Street Lawrences site: Greater Lawrence Family Health Center 100 Water Street 14. Opiate Overdose Narcan Treatment Antagonistic Agent to Opiates Higher but short lived affinity for the Resp. Receptor sites IV, IM, Nasal = MAD device Rx when: AMS or Resp. Depression List off the S & S of the above: Prehospital Rx SAFETY / BSI / O2 / Monitor / IV Urban Myths: Screwed My High / Street OD Education (c) Jeffrey M. Stewart - 2001 - update 2011 15 15. Intranasal Medication Administration (c) Jeffrey M. Stewart - 2001 - update 2011 16 16. How to assemble nasal naloxone 17. Urban Myth Screwed my High CNS Depressant Hypo-oxygenated to Hyper-oxygenated Survival Instinct!! 18. Department Specific Policies & Procedures Paperwork / process for Storage Usage Replacement post usage Documentation for use on patient Replacement for Expired Broken Lost