The Opioid Crisis in Monroe County: Overdose Prevention ... · Naloxone Training Michael D. Mendoza, MD, MPH, MS, FAAFP Commissioner of Public Health Monroe County Department of Public

The Opioid Crisis in Monroe County: Overdose Prevention and Naloxone Training

Michael D. Mendoza, MD, MPH, MS, FAAFP Commissioner of Public Health Monroe County Department of Public Health

Associate Professor, Departments of Family Medicine, Public Health Sciences, and Nursing, University of Rochester

MonroeHealth DrMikeMendoza

1. Addiction is a chronic illness.

2. Overdose is a separate but related epidemic that deserves distinct interventions.

3. Know how to identify and manage an opioid overdose using naloxone.

4. Next steps for community, your agency, and you

Outline

Addiction is a Chronic

Medical Illness

Risk Factors for

Addiction

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At Risk for Addiction

Self-Reported Substance Use, Monroe County

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OTC Drugsto Get High

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Source: Monroe County, YRBS, 2017

Self-Reported Substance Use, Monroe County

• The stories

• Cost of $1 trillion from 2001-2017 – Additional $500 billion by 2020.

• 1 in 10 children in the US – lives with at least one adult who

suffers from a substance use disorder

– majority of these children are younger than age 5

Impact of Addiction

Trends in Binge Drinking and Past 30-Day Use of Illicit Drugs among Persons Aged 12 Years or Older

THE OVERDOSE EPIDEMIC IS A PUBLIC HEALTH CRISIS

• Complicated

• Pain as “5th” vital sign – Prescriber behavior

– Enough painkillers prescribed in 2010 to medicate every US adult around the clock for a month

• Industry marketing

• Decrease in prescription opioids leading to abuse of other opioids

• Mixing of heroin with other more lethal opioids

Why the Overdose Epidemic?

Lethal Doses of Heroin and Fentanyl

Opioid Prescribing in NYS and Opioid Overdose Mortality are Poorly Correlated

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Source: NYSDOH SPARCS includes overdoses and abuse/dependence diagnoses. Age/sex adjusted rates calculated by Common Ground Health.

14

2016 Opioid Driven ED

Visit Rates, per 100,000 population

America’s Worst Public Health Crisis Drug overdoses kill more Americans than HIV/AIDS at its peak

Deaths involving Drugs, Motor Vehicle, Firearms, United States, 2004-2013

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Opioid Deaths investigated by Monroe County

Office of Medical Examiner,

occurring in Monroe County

OVERDOSE PREVENTION AND NALOXONE

• Mixing of multiple substances

– Switching from one source of drugs to another source

• Use alone

• Loss of tolerance after period of abstinence

• Co-existing mental Illness, depression

Target known risk factors for

overdose

How Opioids and Narcan Work

• How it works: Opioid antagonist

• Time: takes 2-5 minutes to work

• Effects last 30-90 minutes

• Has no affect/causes no harm to a person who is not suffering from an opioid OD

• Can be given by many routes – Intranasal spray

• Store at room temperature, protect from light

Naloxone

• Pinpoint pupils

• Slowed, uneven or stopped breathing

– No chest rise/fall

– Do not feel air moving through nose/mouth

• Blue or purple lips, fingernails or pale skin

• Unconscious

Signs of an opioid

overdose

1. Confirm unresponsiveness

– Verbal cues, shaking, and sternal rub/grind

2. CALL 911 / Activate EMS

3. Administer Naloxone

4. Rescue Breathing

5. Re-administer Naloxone in 2-5min if necessary

6. Place the victim in the rescue position

7. Stay with victim until EMS arrives

8. Ensure transportation to a medical setting

9. Report the use of naloxone via form and get refill

Action steps

Recovery Position

http://www.womens-health-advice.com/treatments/electric-shock.html

• NY Public Health Law §3309 (2006)

– Protects person who administers naloxone in an OD

• “shall be considered first aid or emergency treatment”.

• “shall not constitute the unlawful practice of a profession”.

• 911 Good Samaritan Law (2011)

– In OD situation, if witness calls 911, the witness and the OD victim are protected from criminal charges and prosecution for drug possession even if the drugs were shared

• Controlled substances, MJ and Drug paraphernalia

https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/good_samaritan_law.htm

NYS Good Samaritan

Law

• Lawsuit against opioid industry

• Commissioner’s Advisory Panel

• Data Coordination

• New Forensic Pathology Fellowship, New Toxicologists

• Ongoing education schools, community, businesses, churches

• Narcan training and distribution to restaurants, public places, libraries

• Grant application in support of the Opioid Response Partnership

Monroe County Opioid Action

Plan

• Raise your own awareness, reverse the stigma

• Dispose of unused medications safely

• Spread the word about naloxone (Narcan)

– Health Department, 4th Wednesday of Month, Register!

– Go to your pharmacy and obtain a naloxone kit and learn how to use it

– Know about naloxone copay assistance program (NCAP)

• www.monroecounty.gov/opioids

• Get help for yourself, loved ones.

• Addiction is a disease. Overdose is preventable.

What can you do?