Preventing Opioid Overdose with Education and Naloxone Rescue …… · 2019-01-28 · 1 Preventing Opioid Overdose with Education and Naloxone Rescue Kits Alexander Y. Walley, MD,

1

Preventing Opioid Overdose with

Education and Naloxone Rescue Kits

Alexander Y Walley MD MSc Boston University School of Medicine Boston Medical Center

Association for Medical Education and Research in Substance Abuse (AMERSA)

Alexander Y Walley Disclosures

2

bull No financial relationships to disclose

The contents of this activity may include discussion of off label or investigative drug uses The

faculty is aware that is their responsibility to disclose this information

Target Audience

3

bull The overarching goal of PCSS-MAT is to make

available the most effective medication-assisted

treatments to serve patients in a variety of settings

including primary care psychiatric care and pain

management settings

Educational Objectives

4

bull At the conclusion of this activity participants should

be able to

Review the epidemiology of opioid overdose

Describe the rationale for and scope of overdose education

and naloxone distribution (OEND) programs

Implement OEND in settings that offer medication for opioid

use disorder

ndash Educate patients about overdose risk reduction

ndash Prescribe naloxone rescue kits

Case 29 yo woman presents to

clinic for buprenorphine treatment

5

bull Age 18 an accomplished athlete with collegiate prospects

When she tore her ACL she was prescribed opioids after surgery

Developed an opioid use disorder by 6 months

Age 20 injection heroin daily out of college

bull Ages 20-26 multiple detoxification and residential programs

Not able to sustain gt3 months without relapse

bull Age 26 pregnant at her last detoxification and transferred to methadone

Able to stop using heroin engage in 12 step program

Delivered a healthy baby breastfed retained custody

bull Age 28 she tapered off of methadone

Wanted more time with the baby and to work

Boyfriend incarcerated for selling drugs

Relapsed lost custody now seeking treatment with buprenorphine

Does not want to go to the methadone clinic every day

Case 29 yo woman on

buprenorphine treatment

6

bull Age 29-30 Good response to office-based buprenorphine treatment

Regular clinic visits with urine toxicology only positive for buprenorphine

Re-engages in 12-step program and with her family

Works with child protection to regain custody

Case 29 yo woman on


7





bull Age 30 Hospitalized in intensive care for overdose

Her boyfriend was released from jail and returned to stay with her

He relapsed and overdosed on heroin on the 3rd night ndash likely fentanyl

minus Packed his underwear with ice tried to rescue breathe but did not

respond so she called 911 and they were unable to save him

minus Child protection was notified about the incident and they removed

her son from the home

She stopped buprenorphine started drinking alcohol then relapsed

to heroinfentanyl and overdosed

Case 29 yo woman on


8














How could overdose prevention improve this case

Overdose continues to increase and is the

leading cause of accidental injury death

10

Rates of Drug Overdose Deaths

by State Change from 2010 to 2015

Rudd et al 2016

bull Opioid death rates increased by 156 from 2014 to 2015

bull Increase driven by synthetic opioids (illicitly-manufactured fentanyl and heroin)

bull Increases in these opioid subcategories occurred overall and across all demographics and regions

Alpert A Powell D Pacula RL Supply-Side Drug Policy in the

Presence of Substitutes Evidence from the Introduction of

Abuse-Deterrent Opioids National Bureau of Economic

Research 2017 Jan 5

Overdose deaths since

2010 are driven by

heroin and fentanyl

not prescription opioids

Katz J The First Count of Fentanyl Deaths in 2016 Up 540 in Three

Years NYT ndash The UpShot 922017

Fentanyl is Driving Overdose Surge

12

13

Strategies to Address Overdose

bull Prescription monitoring programs

Delcher et al DAD 2015 150 63-68

bull Prescription drug safe storage and disposal

Gray et al Arch Intern Med 2012 172 1186-87

bull Safe opioid prescribing education

Alford et al Pain Med 2015 17(1)52-63

bull Medication for opioid use disorders

Sordo et al BMJ 2017 357j1550

bull Supervised injection facilities

Marshall et al Lancet 20113771429-37

bull Overdose Education and Naloxone Distribution

14













15













16













17

Boston Globe ndash December 27 2015













18













Public health response to address overdoses related to illicitly made fentanyl

1 Fentanyl should be included on standard toxicology screens

2 Adapt existing harm reduction strategies such as direct observation of anyone using illicit

opioids and ensuring bystanders are equipped with naloxone

3 Enhanced access and linkage to medication for opioid use disorders

ldquoSo now what they [people selling illicit drugs] are doing is theyrsquore cutting the heroin with the fentanyl to make it stronger

And the dope [heroin] is so strong with the fentanyl in it that you get the whole dose of the fentanyl at once rather than

being time-released [like the patch] And thatrsquos why people are dyingmdashplain and simple You know they [people using

illicit drugs] are doing the whole bag [of heroin mixed with fentanyl] and they donrsquot realize that they canrsquot handle it their

body cant handle itrdquo -- Overdose bystander

Strategies to Address Fentanyl

Overdose Deaths

19

ldquoThe AMA has been a longtime supporter of increasing the availability of Naloxone for patients first responders and bystanders who can help save lives and has provided resources to bolster legislative efforts to increase access to this medication in several statesrdquo

wwwama-assnorgamapubnewsnews20142014-04-

07-naxolene-product-approvalpage

ldquoAPhA supports the pharmacistrsquos

role in selecting appropriate therapy

and dosing and initiating and

providing education about the

proper use of opioid reversal

agents to prevent opioid-related

deaths due to overdoserdquo

wwwpharmacistcompolicycontrolled-substances-and-

other-medications-potential-abuse-and-use-opioid-

reversal-agents-2

Overdose education and naloxone distribution is

a key tool in addressing the overdose crisis

ASAM Board of Directors April 2010

ldquoNaloxone has been proven to be an effective fast-acting inexpensive and non-addictive opioid antagonist with minimal side effects Naloxone can be administered quickly and effectively by trained professional and lay individuals who observe the initial signs of an opioid overdose reactionrdquo

wwwasamorgdocspublicy-policy-

statements1naloxone-1-10pdf

Naloxone Basics

21

Patients can go back into overdose if long acting opioids were taken

(fentanyl patch methadone extended release morphine extended release oxycodone)

Patients should avoid taking more opioids after naloxone administration so they do not go back into overdose after naloxone wears off

Patients may want to take more opioids during this time because they may feel withdrawal symptoms

Wears off in 30 - 90 minutes

Store at room temperature to minimize degradation

Shelf-life is 12-24 months

If patient is not responding in this time a second dose may need be administered

Takes effect in 2 - 3 minutes

21

Naloxone Formulations

Intranasal with atomizer attachment Auto-Injector

Intranasal spray Intramuscular injection

Rationale for Overdose Education

and Naloxone Rescue Kits bull Most people who use opioids do not use

alone

bull Known risk factors

Mixing substances loss of opioid

tolerance using alone unknown

source

bull Opportunity window

Opioid overdoses take minutes to hours

and is reversible with naloxone

Fentanyl reduces the window to seconds

to minutes

bull Bystanders are trainable to

recognize and respond to overdoses

bull Fear of public safety 23

Evaluations of Overdose Education and Naloxone Distribution Programs

24

Feasibility

bull Piper et al Subst Use Misuse 2008 43 858-70 bull Doe-Simkins et al Am J Public Health 2009 99 788-791 bull Enteen et al J Urban Health 201087 931-41 bull Bennett et al J Urban Health 2011 88 1020-30 bull Walley et al JSAT 2013 44241-7 (Methadone and detox programs)

Increased knowledge and skills

bull Green et al Addiction 2008 103979-89 bull Tobin et al Int J Drug Policy 2009 20 131-6 bull Wagner et al Int J Drug Policy 2010 21 186-93

No increase in use increase in drug

treatment

bull Seal et al J Urban Health 200582303-11 bull Doe-Simkins et al BMC Public Health 2014 14297 bull Jones et al Addictive Behaviors 201771104-6

Reduction in overdose in communities

bull Maxwell et al J Addict Dis 200625 89-96 bull Evans et al Am J Epidemiol 2012 174 302-8 bull Walley et al BMJ 2013 346 f174 bull Bird et al Addiction 2015 Dec 1 bull Coffin et al Ann Intern Med 2016 1-8

Cost-effective

$438 (best) to $14000 (worst ) per quality-

adjusted life year gained

bull Coffin and Sullivan Ann Intern Med 2013 Jan 1158(1)1-9

25

Objective Determine the impact of

opioid overdose education with

intranasal naloxone distribution

(OEND) programs on fatal and non-

fatal opioid overdose rates in

Massachusetts

Walley et al BMJ 2013 346 f174

INPEDE OD (Intranasal Naloxone and Prevention Educationrsquos Effect on

Overdose Study)

Opioid Overdose Related Deaths

Massachusetts 2004 - 2006

26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+

OEND programs 2006-07

27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+



Fatal Opioid Overdose Rates by

OEND Implementation

31

Cumulative enrollments per 100k RR ARR 95 CI

Absolute model

No enrollment Ref Ref Ref

Low implementation 1-100 093 073 057-091

High implementation gt 100 082 054 039-076

Adjusted Rate Ratios (ARR) All rate ratios adjusted for the citytown

population rates of age under 18 male race ethnicity (hispanic white black other) below poverty level medically supervised

inpatient withdrawal treatment methadone treatment BSAS-funded buprenorphine treatment prescriptions to doctor shoppers and

year


Naloxone coverage per 100K

0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

Opioid overdose death rate

27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation

Wheeler E et al Morb Mortal Wkly Rep 201564631-635

Community Naloxone Programs 2014

34

Implementing Overdose Prevention in

Addiction Treatment Settings

35

Model Advantages Disadvantages

bull Staff provide OEND

on-site

bull Good access to OEND

bull Opioid overdose prevention

integrated

bull Patients may not

disclose risk

bull Outside staff provide

OEND on-site

bull Opioid overdose prevention integrated

bull Interagency cooperation

bull Low burden on staff

bull Community OEND

program needed

bull OE provided onsite

naloxone received off-

site



bull Increased patient burden

to get naloxone

bull Outside staff recruit

near methadone

maintenance treatment

(MMT) or detoxification

bull Confidential access to opioid overdose prevention

bull Opioid overdose prevention not re-

enforced in treatment

bull Not all patients reached

Donrsquot forget the staff Among 29 MMT and 93 detoxification staff who received OEND 38 and

45 respectively reported witnessing an overdose in their lifetime

Walley et al JSAT 2013 44241-7

Other Venues and Models

36

bull Buprenorphine and naltrexone treatment

bull First responder ndash police and fire

bull Emergency Department (ED) SBIRT

bull Post-incarceration

bull Prescription naloxone

Prescribetopreventorg

Overdose Prevention for Patients

37

bull Review medications ndash Communicate with other prescribers

bull Take a substance use history

bull Check the prescription monitoring program

Overdose history Ask your patients

How do you protect yourself against overdose

How do you keep your medications safe at home

And their loved ones

What is your plan if you witness an overdose in the future

Have you received training to prevent recognize or respond to an

overdose

What they need to know

bull Prevention - the risks Mixing substances

Abstinence- low tolerance

Using alone

Unknown source

Chronic medical disease

Long acting opioids last longer

bull Recognition Unresponsive to sternal rub with slowed or

absent breathing

Blue lips pinpoint pupils

bull Response - What to do Call for help

Rescue breathe

Deliver naloxone and wait 3 minutes

Stay until help arrives

Patient education videos and

materials at

prescribetopreventorg

38


Rescue breathe chest compressions per rescuerrsquos level of training

3 4

How to Respond in an Overdose

Steps to teach patients family friends caregivers

Recognize overdose

Call 911 for help

Administer naloxone as soon as it is available

Stay until help arrives Place in recovery

position if breathing

5

1

2

Multi-step nasal

spray

Single-step nasal spray

(NARCANreg)

Intramuscular injection

Auto-injector (EVZIOreg)

39

American Heart Association Guidelines October 2015

httpseccguidelinesheartorgwp-contentuploads2015102015-AHA-Guidelines-

Highlights-Englishpdf

Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40

bull Objective To evaluate the feasibility and effect of implementing naloxone

prescription to patients prescribed opioids for chronic pain at 6 safety-net primary

care clinics

bull Results

38 of 1985 patients receiving long term opioids co-prescribed naloxone

rescue kits

Patients with higher opioid doses and previous opioid-related ED visits were

more likely to be prescribed naloxone kits

Opioid-related ED visits were reduced by 47 at 6 months and 63 at 12

months among those who were co-prescribed naloxone compared with those

who were not

No change was detected in the net prescribed opioid doses for patients who

were co-prescribed naloxone

41 Coffin PO et al Nonrandomized intervention study of naloxone

coprescription for primary care patient receiving long-term opioid therapy

for pain Ann Intern Med 2016 1-8

Innovations Models for

Pharmacy Naloxone

Setting clinic with insured patients

Informational brochure patient fills

Pharmacies alerted to prescribing plans

May need to have atomizers on-site if intranasal formulation

Prescriber writes prescription

Patient fills at pharmacy

Without prescriber contact under a standing order

Pharmacy provides naloxone directly to customer

Training needed Passive or active models Naloxone co-prescription Universal offer may require clear policy direction

Without prescriber or pharmacy contact under a standing order distribution model

Pharmacy provides naloxone to patients in treatment

centerclinic

Patient training done on-site at clinic facilitates facility-level compliance and sustainability

42

Offer Naloxone to Everyonehellip

bull Any opioid prescription

bull Any opioidbenzodiazepine rx combination

bull Any diseaseopioid combination

bull Any methadone

bull Any buprenorphine

bull Any naltrexone for opioids

bull Transitions of care

bull Friends and family of those at risk

bull Syringe buyer request

bull Addiction treatment

bull Correctional institution

bull Behavioral health

43

Practical Barriers to Prescribing Naloxone

44

1 Prescriber knowledge and comfort

2 How to write the prescription

3 Does the pharmacy stock rescue kits

bull Work with your pharmacy to get it stocked

4 Who pays for it

bull Work with your pharmacy to see if they will

cover it

bull Advocate with insurance (eg Medicaid) to

get naloxone on formulary

Legal Barriers to Prescription Model

45

ldquoPrescribing naloxone in the USA is fully consistent with state and federal laws regulating drug prescribing The risks of malpractice liability are consistent with those generally associated with providing healthcare and can be further minimized by following simple guidelines presented

bull Only prescribe to a person who is at risk for overdose

bull Ensure that the patient is properly instructed in the

administration and risks of naloxone

Does your state permit prescribing to people NOT at risk of overdose

Does your state have a Good Samaritan law

bull Go to pdapsorg ndash to find out

Burris S at al ldquoLegal aspects of providing naloxone to heroin users

in the United States Int J of Drug Policy 2001 12 237-248

Example of Overdose-Naloxone Law

Good Samaritan limited liability for patientsprescibers and 3rd party prescribing

Enforcement Tools 46

Good Samaritan provision

bull Protects people who overdose or seek help for someone overdosing from being charged or prosecuted for drug possession

Protection does not extend to trafficking or distribution charges

Patient protection

bull A person acting in good faith may receive a naloxone prescription possess naloxone and administer naloxone to an individual appearing to experience an opioid-related overdose

Prescriber protection

bull Naloxone or other opioid antagonist may lawfully be prescribed and dispensed to a person at risk of experiencing an opioid-related overdose or a family member friend or other person in a position to assist a person at risk of experiencing an opioid-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

Massachusetts - Passed in August 2012

An Act Relative to Sentencing and Improving Law



47








Able to stop using heroin engage in 12-step









48















Counseled about the risks of overdose addiction and safe storage

Prescribed naloxone rescue kit when prescribed opioids for pain



49















Received a new naloxone kit from needle exchange





50
















Started tester shots respecting her tolerance at each relapse - Rescued boyfriend x2





51

















Overdose prevention education during orientation





52


















Overdose prevention education and rescue kit part of her taper and discharge plan



Case 29 yo woman on


53


Regular clinic visits with urine tox only positive for buprenorphine







Case 29 yo woman on


54

Overdose prevention education and naloxone kit part of her orientation





bull Age 30 Continues in her recovery despite BFrsquos relapse and overdose

Her boyfriend had been released from jail and returned to stay with her

He relapsed and overdose on heroin on the 3rd night

minus She called 911 started rescue breathing and administered one

dose of nasal naloxone He was transported observed and

transferred to a residential program for formerly incarcerated with

drug problems

minus Police and EMS praised her for her response ldquoIt saved his liferdquo

She called her buprenorphine program counselor and went to

group counseling that week where she received support

Case 29 yo woman on


55

Regular clinic visits with urine tox only positive for buprenorphine Overdose prevention education and naloxone kit part of her orientation

Case 29 yo woman on


56

And she lived happily ever after











drug problems





Helpful Websites

57

bull For prescribers and pharmacists


bull News + research on overdose prevention

Overdosepreventionallianceorg

bull International overdose prevention efforts

Naloxoneinfoorg

bull Opioid overdose prevention education

Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-

contentuploads201211od-

manual-final-linkspdf

bull 2013 National Drug Control Strategy

wwwwhitehousegovondcp2013-

national-drug-control-strategy

bull ASAM 2010 Policy Statement



bull SAMHSA Toolkit

httpsstoresamhsagovproductO

pioid-Overdose-Prevention-

ToolkitSMA16-4742

bull SAMHSA Letter to prescribers

wwwdptsamhsagovpdfdearCollea

gueSAMHSA_fen tanyl_508pdf

References

58

bull Alford DP Zisblatt L Ng P Hayes SM Peloquin S Hardesty I White JL SCOPE of pain an evaluation of an opioid risk

evaluation and mitigation strategy continuing education program Pain Medicine 2016 Jan 117(1)52-63

bull Alpert A Powell D Pacula RL Supply-Side Drug Policy in the Presence of Substitutes Evidence from the Introduction of

Abuse-Deterrent Opioids National Bureau of Economic Research 2017 Jan 5

bull American Heart Association Guidelines October 2015 httpseccguidelinesheartorgwp-contentuploads2015102015-

AHA-Guidelines-Highlights-Englishpdf

bull Bennett et al 2011 Characteristics of an overdose prevention response and naloxone distribution program in Pittsburgh

and Allegheny County Pennsylvania J Urban Health 881020-30

bull Bird SM12 McAuley A34 Perry S5 Hunter C6 Addiction 2016 May111(5)883-91 doi 101111add13265 Epub 2016 Feb

4 Effectiveness of Scotlands National Naloxone Programme for reducing opioid-related deaths a before (2006-10) versus

after (2011-13) comparison

bull Boscarino JA1 Kirchner HL2 Pitcavage JM1 Nadipelli VR3 Ronquest NA3 Fitzpatrick MH4 Han JJ5 Subst Abuse

Rehabil 2016 Sep 167131-141 eCollection 2016

bull Factors associated with opioid overdose a 10-year retrospective study of patients in a large integrated health care system

bull Florence CS1 Zhou C Luo F Xu L Med Care 2016 Oct54(10)901-6 doi 101097MLR0000000000000625

bull The Economic Burden of Prescription Opioid Overdose Abuse and Dependence in the United States 2013

bull Burris S at al 2011 Legal aspects of providing naloxone to heroin users in the United States Int J of Drug Policy 12237-

248

bull Clausen et al 2009 Mortality among opiate users opioid maintenance therapy age and causes of death Addiction 1041356-

62

bull Coffin and Sullivan 2013 Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal Ann Intern

Med 1581-9

bull Doe-Simkins et al 2009 Saved by the nose bystander-administered intranasal naloxone hydrochloride for opioid overdose

Am J Public Health 99 788-791

References

59

bull

bull Doe-Simkins M et al 2014 Overdose rescued by trained and untrained participants and change in opioid use among

substance-using participants in overdose education and naloxone distribution programs a retrospective cohort study BMC

Public Health 14297

bull Enteen et al 2010 Overdose prevention and naloxone prescription for opioid users in San Francisco J Urban Health 87931-

41

bull Evans et al 2012 Mortality among young injection drug users in San Francisco a 10-year follow-up of the UFO study Am J

Epidemiol 174302-8

bull Gray and Hagemeir 2012 Prescription drug abuse and DEA-sanctioned drug take-back events characteristics and outcomes

in rural Appalachia JAMA intern Med 721186-7

bull Green et al 2008 Distringuishing signs of opioid overdose and indication for naloxone an evaluation of six overdose training

and naloxone distribution programs in the United States Addiction 103979-89

bull Inocencio TJ et al 2013 The economic burden of opioid-related poisoning in the United States Pain Medicine 141534-47

bull Katz J The First Count of Fentanyl Deaths in 2016 Up 540 in Three Years NYT ndash The UpShot 922017

bull McAuley A1 Aucott L2 Matheson C2 nt J Drug Policy 2015 Dec26(12)1183-8 doi 101016jdrugpo201509011 Epub

2015 Oct 1 Exploring the life-saving potential of naloxone A systematic review and descriptive meta-analysis of take home

naloxone (THN) programmes for opioid users

bull Marshall et Al 2011 Reduction in overdose mortality after the opening of North Americas first medically supervised safer

injecting facility a retrospective population-based study Lancet 3771429-37

bull Maxwell et al 2006 Prescribing naloxone to actively injecting heroin users a program to reduce heroin overdose deaths J

Addict Dis 2589-96

bull Rudd RA Seth P David F Scholl L MMWR Morb Mortal Wkly Rep 2016 Dec 3065(5051)1445-1452 doi

1015585mmwrmm655051e1 Increases in Drug and Opioid-Involved Overdose Deaths - United States 2010-2015

References

60

bull Patrick SW1 Fry CE2 Jones TF3 Buntin MB4 Health Aff (Millwood) 2016 Jul 135(7)1324-32 doi101377hlthaff20151496

Epub 2016 Jun 22 Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-

Related Death Rates

bull Paulozzi et al 2011 Prescription drug monitoring programs and death rates from drug overdose Pain Medicine 12747-54

bull Piper et al 2008 Evaluation of a naloxone distribution and administration program in New York City Subst Use Misuse 43858-

70

bull Seal et al 2005 Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin

overdose death a pilot intervention study J Urban Health 82303-11

bull Tobin et al 2009 Evaluation of the Staying Alive programmed training injection drug users to properly administer naloxone and

save lives Int J Drug Policy 20131-6

bull Wagner et al 2010 Evaluation of an overdose prevention and response training programmed for injection drug users in the Skid

Row area of Los AngelesCA Int J Drug Policy 21186-93

bull Walley et al 2013 Opioid overdose prevention with intranasal naloxone among people who take methadone JSAT 44241-7

Walley et al 2013 Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in

Massachusetts interrupted time series analysis BMJ 346f174

bull Wheeler E et al 2012 Community-based opioid overdose prevention programs providing naloxone - United States 2010Morb

Mortal Wkly Rep 61101-5

PCSS Mentor Program

bull PCSS Mentor Program is designed to offer general information to

clinicians about evidence-based clinical practices in prescribing

medications for opioid addiction

bull PCSS mentors are a national network of providers with expertise in

addictions pain evidence-based treatment including medication-

assisted treatment

bull 3-tiered approach allows every mentormentee relationship to be unique

and catered to the specific needs of the mentee

bull No cost

For more information visit

pcssNOWorgclinical-coaching

61

PCSS Discussion Forum

Have a clinical question

62

Funding for this initiative was made possible (in part) by grant nos 5U79TI026556-02 and 3U79TI026556-02S1 from SAMHSA The

views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the

official policies of the Department of Health and Human Services nor does mention of trade names commercial practices or

organizations imply endorsement by the US Government

PCSS-MAT is a collaborative effort led by the American Academy of Addiction Psychiatry (AAAP) in

partnership with the Addiction Technology Transfer Center (ATTC) American Academy of Family

Physicians (AAFP) American Academy of Neurology (AAN) American Academy of Pain Medicine (AAPM)

American Academy of Pediatrics (AAP) American College of Emergency Physicians (ACEP) American

College of Physicians (ACP) American Dental Association (ADA) American Medical Association (AMA)

American Osteopathic Academy of Addiction Medicine (AOAAM) American Psychiatric Association (APA)

American Psychiatric Nurses Association (APNA) American Society of Addiction Medicine (ASAM)

American Society for Pain Management Nursing (ASPMN) Association for Medical Education and

Research in Substance Abuse (AMERSA) International Nurses Society on Addictions (IntNSA) National

Association of Community Health Centers (NACHC) National Association of Drug Court Professionals

(NADCP) and the Southeast Consortium for Substance Abuse Training (SECSAT)

For more information wwwpcssNOWorg

PCSSProjects

wwwfacebookcompcssprojects

Alexander Y Walley Disclosures

2

bull No financial relationships to disclose

The contents of this activity may include discussion of off label or investigative drug uses The

faculty is aware that is their responsibility to disclose this information

Target Audience

3





management settings


4


be able to





use disorder





5















Case 29 yo woman on


6





Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Target Audience

3





management settings


4


be able to





use disorder





5















Case 29 yo woman on


6





Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



4


be able to





use disorder





5















Case 29 yo woman on


6





Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




5















Case 29 yo woman on


6





Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Case 29 yo woman on


6





Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Case 29 yo woman on


7














Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Case 29 yo woman on


8

















10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


10



Rudd et al 2016







Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects





Research 2017 Jan 5


2010 are driven by

heroin and fentanyl





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects





12

13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


13













14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


14













15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


15













16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


16













17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


17














18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


18
























Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects













Overdose Deaths

19













reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects














reversal-agents-2







Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Naloxone Basics

21










21






alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects







alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




alone




source





to minutes





24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



24

Feasibility





treatment




Cost-effective




25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


25






Massachusetts



Overdose Study)



26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




26

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+


27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



27

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



2007-08

28

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



2007-08

2009

29

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



2007-08

2009

Towns without

30

Number of Deaths

No Deaths

1 ndash 5

6 - 15

16 - 30

30+




OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



OEND Implementation

31


Absolute model







year



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



0

250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl


27 reduction

32



OEND Implementation


0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



0


250 100

90

200 80

70

150 60

50

100

50

40

30

20

10

0

No coverage

1-100 ppl

100+ ppl

46 reduction

33



OEND Implementation



34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




34



35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




35



on-site



integrated


disclose risk


OEND on-site




bull Community OEND

program needed



site




to get naloxone


near methadone











36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



36








37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



37










overdose




Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects





Using alone

Unknown source




absent breathing



Rescue breathe




materials at


38



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



3 4



Recognize overdose

Call 911 for help




5

1

2

Multi-step nasal

spray


(NARCANreg)



39




Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects





Updated Opioid

Associated Life

Threatening

Emergency

(ADULT) Algorithm

40



care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




care clinics

bull Results


rescue kits





who were not







Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



Pharmacy Naloxone












centerclinic


42





bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects






bull Any methadone









43


44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



44





4 Who pays for it


cover it




45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects



45
















Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects








Patient protection








47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




47

















48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




48



















49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




49




















50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




50





















51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




51






















52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




52





















Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Case 29 yo woman on


53









Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects






Case 29 yo woman on


54












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects












drug problems




Case 29 yo woman on


55


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Case 29 yo woman on


56












drug problems





Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


Helpful Websites

57






Naloxoneinfoorg


Stopoverdoseorg

bull Family support

Learn2Copecom

httppdapsorg

bull Project manual

harmreductionorgwp-









bull SAMHSA Toolkit



ToolkitSMA16-4742




References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


References

58


















248


62


Med 1581-9



References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


References

59

bull



Public Health 14297


41


Epidemiol 174302-8













Addict Dis 2589-96



References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


References

60



Related Death Rates



70












PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects


PCSS Mentor Program






assisted treatment



bull No cost



61



62

















PCSSProjects




62

















PCSSProjects


















PCSSProjects


Documents

Preventing Opioid Overdose with Education and Naloxone Rescue …… · 2019-01-28 · 1 Preventing Opioid Overdose with Education and Naloxone Rescue Kits Alexander Y. Walley, MD,