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1st responder nasal naloxone

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Narcan

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1st responder nasal naloxone

  1. 1. 1st Responder Nasal Naloxone
  2. 2. Objectives – By the end of this program the participant will:  Define & give examples of opiates & opioids;  Understand the history & epidemiollogy of opiates & opioids in the US & MA specifically;  Describe what an opiate/opioid overdose looks like.  Explain what naloxone is and how it works on an opiate/opioid  Dispel common myths about reversing an opiate/opioid overdose;  Articulate the opiate/opioid treatment modality using nasal naloxone;  Demonstrate proper assemblage & administration of nasal naloxone to an opiate/opioid overdose;  Explain the Department’s Policy for maintaining, administrat ing, replacing, and
  3. 3. History  Poppy to Opium to Heroin  Harrison Narcotic Tax Act 1914  Controlled Substance Act 1970  FDA / DEA
  4. 4. Opiates vs. Opioids  Poppy Plant  Natural to Semi- synthetic  Central Nervous System Depressant  Slows down Breathing, pulse, overall metabolism  Pain reduction  Similar to opiates  CNS Depressant  Fully Synthetic
  5. 5. DEA vs. FDA  FDA  Department of Health & Human Services  Science & Medicine  DEA  1973 Executive Order 11727  Department of Justice  Full Authority for Scheduling & Enforcement  Drug Scheduling (I – V)  Schedule I  Very High Abuse Potential  Very High Dependence Potential  Very High Public Risk  NO CURRENTLY accepted medical value  Schedule V  Very Low Abuse Potential  Very Low Dependence Potential  Very Low Public Risk  High Medical Value
  6. 6. Massachusetts Nasal Narcan History  Narcan part & parcel of Paramedic Treatment (IM, IV, IO)  Antagonist to Opioids (Mu Receptor)  2004 Statewide Treatment Protocols added Nasal for Paramedics  2005 started process 2006 approved SPW BLS Narcan / CAS & BEMS  CAS: Data 24 months= 105 BLS uses 5 protocol outliers  2007  Statewide BLS SPW Approval must follow CAS or BEMS  Revere Fire Department  EMS 1st Responders
  7. 7. Mass. Nasal Narcan Hx. Con’t  2007 Outside of EMS  Mass DPH Public Narcan Responder Program  July 2010 Presentation to DPH  CAS & BEMS  2011 – approved as standing orders for 2012 Statewide protocols  2012 – SWTP Service & Medical Director Option for BLS Nasal Narcan!
  8. 8. 0 200 400 600 800 1000 1200 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Deathsperyear All Poisoning Deaths Motor Vehicle-Related Injury Deaths The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths, MA Residents (1997-2008) More Opioid Overdose Deaths than MVA Deaths in Massachusetts
  9. 9. 0 200 400 600 800 1000 1200 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Deathsperyear All Poisoning Deaths Opioid-related Poisoning Deaths Motor Vehicle-Related Injury Deaths The source of the data is: Registry of Vital Records and Statistics, MA Department of Public Health Poisoning Deaths vs. Motor Vehicle-Related Injury Deaths, MA Residents (1997-2008) More Opioid Overdose Deaths than MVA Deaths in Massachusetts Rate of opioid-related fatal overdoses in MA in 2006 was 9.9 per 100K
  10. 10. What is Driving the Increase in Overdose?  New Drug Use Patterns New Initiates to prescription drugs Oxycontin to Heroin  Heroin Availability/Purity/Lethal Mixture Heroin is the leading drug threat in New England From ‘93-’10 Heroin reported as primary drug increased from 20% - 40% of treatment admissions in MA  Prescribing Patterns Number of Schedule II Opioid prescriptions has more than doubled in the past decade
  11. 11. Strategies to address overdose  Prescription monitoring programs  Paulozzi et al. Pain Medicine 2011  Prescription drug take back events  Safe opioid prescriping education  Albert et al. Pain Medicine 2011; 12: S77-S85  Expansion of opioid agonist treatment  Clausen et al. Addiction 2009:104;1356-62  Safe injection facilities  Marshall et al. Lancet 2011:377;1429-37
  12. 12. 2010 States w/ OENDs 15 Programs 188 People enrolled 53,032 OD rescues 10,171 Wheeler E et al. Morb Mortal Wkly Rep 2012;61:101-5. Overdose Education and Naloxone Rescue Kits
  13. 13. Mass: where & who  Boston, Brockton, Cambridge, Fall River, Gloucester, Holyoke, Hyannis , Lawrence, Lowell, Lynn, New Bedford, North Hampton, Provincetown, Quincy, S pringfield  Lowell’s site:  Lowell House Inc. 555 Merrimack Street  Lawrence’s site:  Greater Lawrence Family Health Center 100 Water Street
  14. 14. Opiate Overdose  Narcan Treatment  Antagonistic Agent to Opiates  Higher but short lived affinity for the Resp. Receptor sites  IV, IM, Nasal = MAD device  Rx when:  AMS or Resp. Depression  List off the S & S of the above:  Prehospital Rx  SAFETY / BSI / O2 / Monitor / IV  Urban Myths: “Screwed My High” / “Street OD Education” (c) Jeffrey M. Stewart - 2001 - update 2011 15
  15. 15. Intranasal Medication Administration (c) Jeffrey M. Stewart - 2001 - update 2011 16
  16. 16. How to assemble nasal naloxone
  17. 17. Urban Myth – “Screwed my High…”  CNS Depressant  Hypo-oxygenated to Hyper-oxygenated  Survival Instinct!!
  18. 18. Department Specific Policies & Procedures  Paperwork / process for  Storage  Usage  Replacement post usage  Documentation for use on patient  Replacement for  Expired  Broken  Lost

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