Module 16: Preventing Opioid Overdose with Education ...

Module 16: Preventing Opioid Overdose with Education and Naloxone Rescue Kits

Alexander Y. Walley, MD, MSc 1

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 Researchin Substance Abuse (AMERSA)

Alexander Y. Walley Disclosures

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• 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

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• 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

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• At the conclusion of this activity participants shouldbe 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

– Educate patients about overdose risk reduction

– Prescribe naloxone rescue kits

Case: 29 yo woman presents toclinic for buprenorphine treatment

5

• Age 18, an accomplished athlete with collegiate prospects

When she tore her ACL she was prescribed opioids aftersurgery

Developed an opioid use disorder by 6 months

Age 20, injection heroin daily, out of college

• Ages 20-26, multiple detoxification and residential programs

Not able to sustain >3 months without relapse

• 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

• 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 onbuprenorphine treatment

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• 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




7





• 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 – likely fentanyl− Packed his underwear with ice, tried to rescue breathe but did not

respond, so she called 911 and they were unable to save him− Child protection was notified about the incident and they removed

her son from the home She stopped buprenorphine, started drinking alcohol, then relapsed

to heroin/fentanyl and overdosed


8





• 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 – likely fentanyl− Packed his underwear with ice, tried to rescue breathe but did not

respond, so she called 911 and they were unable to save him− Child protection was notified about the incident and they removed

her son from the home She stopped buprenorphine, started drinking alcohol, then relapsed

to heroin/fentanyl and overdosed

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 Deathsby State: Change from 2010 to 2015

Rudd et al., 2016

• Opioid death rates increased by 15.6% from 2014 to 2015.

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

• 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 – The UpShot 9/2/2017.

Fentanyl is Driving Overdose Surge

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13

Strategies to Address Overdose

• Prescription monitoring programs

Delcher et al. DAD 2015; 150: 63-68.

• Prescription drug safe storage and disposal

Gray et al. Arch Intern Med 2012; 172: 1186-87

• Safe opioid prescribing education

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

• Medication for opioid use disorders

Sordo et al. BMJ 2017; ��:j1550

• Supervised injection facilities

Marshall et al. Lancet 2011:377;1429-37

• Overdose Education and Naloxone Distribution

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Delcher et al. DAD 2015; 150: 63-68.










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Delcher et al. DAD 2015; 150: 63-68.












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Delcher et al. DAD 2015; 150: 63-68.










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Boston Globe – December 27, 2015



Delcher et al. DAD 2015; 150: 63-68.










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Delcher et al. DAD 2015; 150: 63-68.












Public health response to address overdoses related to illicitly made fentanyl1. 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 naloxone3. Enhanced access and linkage to medication for opioid use disorders

“So, now what they [people selling illicit drugs] are doing is they’re 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 that’s why people are dying—plain and simple. You know, they [people using illicit drugs] are doing the whole bag [of heroin mixed with fentanyl] and they don’t realize that they can’t handle it; their body can't handle it.” -- Overdose bystander

Strategies to Address Fentanyl Overdose Deaths

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“The 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 states.”

www.ama‐assn.org/ama/pub/news/news/2014/2014‐04‐

07‐naxolene‐product‐approval.page

“APhA supports the pharmacist’s 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 overdose”

www.pharmacist.com/policy/controlled‐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 DirectorsApril 2010

“Naloxone 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 reaction.”

www.asam.org/docs/publicy‐policy‐

statements/1naloxone‐1‐10.pdf

Naloxone Basics

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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

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Naloxone Formulations

Intranasal with atomizer attachment Auto-Injector

Intranasal spray Intramuscular injection

Rationale for Overdose Educationand Naloxone Rescue Kits

• Most people who use opioids do not usealone

• Known risk factors:

Mixing substances, loss of opioid tolerance, using alone, unknownsource

• Opportunity window:

Opioid overdoses take minutes to hours and is reversible with naloxone

Fentanyl reduces the window to seconds to minutes

• Bystanders are trainable torecognize and respond to overdoses

• Fear of public safety23

Evaluations of Overdose Education and Naloxone Distribution Programs

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Feasibility

• Piper et al. Subst Use Misuse 2008: 43; 858-70.• Doe-Simkins et al. Am J Public Health 2009: 99: 788-791.• Enteen et al. J Urban Health 2010:87: 931-41.• Bennett et al. J Urban Health. 2011: 88; 1020-30.• Walley et al. JSAT 2013; 44:241-7. (Methadone and detox programs)

Increased knowledge and skills

• Green et al. Addiction 2008: 103;979-89.• Tobin et al. Int J Drug Policy 2009: 20; 131-6.• Wagner et al. Int J Drug Policy 2010: 21: 186-93.

No increase in use, increase in drug

treatment

• Seal et al. J Urban Health 2005:82:303-11.• Doe-Simkins et al. BMC Public Health 2014 14:297.• Jones et al. Addictive Behaviors 2017:71:104-6

Reduction in overdose in communities

• Maxwell et al. J Addict Dis 2006:25; 89-96.• Evans et al. Am J Epidemiol 2012; 174: 302-8.• Walley et al. BMJ 2013; 346: f174.• Bird et al. Addiction 2015; Dec 1.• Coffin et al. Ann Intern Med 2016; 1-8.

Cost‐effective $438 (best) to

$14,000 (worst ) per quality‐adjusted life year gained

• Coffin and Sullivan. Ann Intern Med. 2013 Jan 1;158(1):1-9.



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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 Education’s Effect on

Overdose Study)

Opioid Overdose Related Deaths:Massachusetts 2004 - 2006

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Number of DeathsNoDeaths

1 –5

6 -15

16 -30

30+

OEND programs2006‐07

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1 –5

6 -15

16 -30

30+





2007‐08

28


1 –5

6 -15

16 -30

30+



2007‐08

2009

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1 –5

6 -15

16 -30

30+



2007‐08

2009

Townswithout

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1 –5

6 -15

16 -30

30+




Fatal Opioid Overdose Rates byOEND Implementation

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Cumulative enrollments per 100k RR ARR* 95% CI

Absolute model:

No enrollment Ref Ref Ref

Low implementation: 1-100 0.93 0.73 0.57-0.91

High implementation: > 100 0.82 0.54 0.39-0.76

* Adjusted Rate Ratios (ARR) All rate ratios adjusted for the city/town

population rates of age under 18, male, race/ ethnicity (hispanic, white, black, other), below poverty level, medically supervised inpatientwithdrawal treatment, methadone treatment, BSAS-funded buprenorphine treatment, prescriptions to doctor shoppers, andyear


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

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Naloxone coverage per 100K

0

Opioid overdose death rate250 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





Wheeler E et al. Morb Mortal Wkly Rep2015;64:631-635.

Community Naloxone Programs, 2014

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Implementing Overdose Prevention in Addiction Treatment Settings

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Model Advantages Disadvantages

• Staff provide OENDon-site

• Good access to OEND• Opioid overdose prevention

integrated

• Patients may notdisclose risk

• Outside staff provideOEND on-site

• Opioid overdose preventionintegrated

• Interagency cooperation• Low burden on staff

• Community OENDprogram needed

• OE provided onsite,naloxone received off-site

• Opioid overdose preventionintegrated

• Interagency cooperation

• Increased patient burdento get naloxone

• Outside staff recruitnear methadone maintenance treatment (MMT) or detoxification

• Confidential access to opioidoverdose prevention

• Opioid overdoseprevention not re-enforced in treatment

• Not all patients reached

Don’t 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;44:241-7.

Other Venues and Models

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• Buprenorphine and naltrexone treatment • First responder – police and fire• Emergency Department (ED) SBIRT• Post-incarceration• Prescription naloxonePrescribetoprevent.org



Overdose Prevention for Patients

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• Review medications – Communicate with other prescribers• Take a substance use history• Check the prescription monitoring program

Overdose historyAsk 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• Prevention - the risks:

Mixing substances Abstinence- lowtolerance Usingalone Unknown source Chronic medicaldisease Long acting opioids last longer

• Recognition Unresponsive to sternal rub with slowedor

absentbreathing Blue lips, pinpointpupils

• Response - What to do Call forhelp Rescuebreathe Deliver naloxone and wait 3minutes Stay until helparrives

Patient education videos and materials at

prescribetoprevent.org

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Overdose Prevention for Patients

Rescue breathe/ chest compressionsper rescuer’s 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 arrivesPlace in recovery

position if breathing

5

1

2

Multi-step nasal spray

Single-step nasal spray (NARCAN®)

Intramuscular injection

Auto-injector (EVZIO®)

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American Heart Association Guidelines October 2015https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf

Updated Opioid Associated Life

Threatening Emergency

(ADULT) Algorithm

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• 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

• 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

41Coffin 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 patientsSetting: clinic with insured patients

Informational brochure, patient fillsInformational brochure, patient fills

Pharmacies alerted to prescribing plansPharmacies alerted to prescribing plans

May need to have atomizers on‐site if intranasal formulation

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‐prescriptionUniversal offer, may require clear policy direction

Without prescriber or pharmacy contact under a standing order, distribution model

Pharmacy provides naloxone to patients in treatment

center/clinic

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

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Offer Naloxone to Everyone…..

• Any opioid prescription• Any opioid/benzodiazepine rx combination• Any disease/opioid combination• Any methadone• Any buprenorphine• Any naltrexone for opioids• Transitions of care

• Friends and family of those at risk• Syringe buyer request• Addiction treatment• Correctional institution• Behavioral health

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Practical Barriers to Prescribing Naloxone

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1. Prescriber knowledge and comfort2. How to write the prescription?3. Does the pharmacy stock rescue kits?

• Work with your pharmacy to get it stocked4. Who pays for it?

• Work with your pharmacy to see if they will cover it

• Advocate with insurance (e.g. Medicaid) to get naloxone on formulary

Legal Barriers to Prescription Model

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“Prescribing naloxone in the USA is fully consistent with state and federal laws regulating drug prescribing. The risks ofmalpractice liability are consistent with those generally associatedwith providing healthcare, and can be further minimized byfollowing simple guidelines presented."

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

• Ensure that the patient is properly instructed in theadministration and risks of naloxone

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

Does your state have a Good Samaritan law?

• Go to pdaps.org – to find out

Burris S at al. “Legal aspects of providing naloxone to heroin users

in theUnited States. Int J of Drug Policy 2001: 12; 237-248.



Example of Overdose-Naloxone Law:Good Samaritan, limited liability for

patients/prescibers and 3rd party prescribing

EnforcementTools 46

Good Samaritan provision:• 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:• A person acting in good faith may receive a naloxone prescription, possess

naloxone and administer naloxone to an individual appearing to experiencean opioid-related overdose.

Prescriber protection:• 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 ImprovingLaw


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Able to stop using heroin, engage in 12-step








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Counseled about the risks of overdose, addiction, and safe storage

Prescribed naloxone rescue kit when prescribed opioids for pain




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Received a new naloxone kit from needle exchange




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




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Overdose prevention education during orientation






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Overdose prevention education during orientation

Overdose prevention education and rescue kit part of her taper and dischargeplan




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Regular clinic visits with urine tox only positive for buprenorphine








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Overdose prevention education and naloxone kit part of herorientation







• Age 30: Continues in her recovery despite BF’s 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,− 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

− Police and EMS praised her for her response: “It saved his life” She called her buprenorphine program counselor and went to

group counseling that week where she received support


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Regular clinic visits with urine tox only positive for buprenorphineOverdose prevention education and naloxone kit part of herorientation


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And she lived happily everafter!!!





• Age 30: Continues in her recovery despite BF’s 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,− 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

− Police and EMS praised her for her response: “It saved his life” She called her buprenorphine program counselor and went to

group counseling that week where she received support

Overdose prevention education and naloxone kit part of herorientation

Helpful Websites

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• For prescribers and pharmacists Prescribetoprevent.org

• News + research on overdose prevention Overdosepreventionalliance.org

• International overdose prevention efforts Naloxoneinfo.org

• Opioid overdose prevention educationStopoverdose.org

• Family support Learn2Cope.com http://pdaps.org/

• Project manual harmreduction.org/wp-

content/uploads/2012/11/od-manual-final-links.pdf

• 2013 National Drug Control Strategy www.whitehouse.gov/ondcp/2013-

national-drug-control-strategy• ASAM 2010 Policy Statement

www.asam.org/docs/publicy-policy-statements/1naloxone-1-10.pdf

• SAMHSA Toolkit https://store.samhsa.gov/product/O

pioid-Overdose-Prevention-Toolkit/SMA16-4742

• SAMHSA Letter to prescribers www.dpt.samhsa.gov/pdf/dearCollea

gue/SAMHSA_fen tanyl_508.pdf



References

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• 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 1;17(1):52-63.

• 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.

• American Heart Association Guidelines October 2015 https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf

• Bennett et al. 2011. Characteristics of an overdose prevention, response, and naloxone distribution program in Pittsburgh and Allegheny County, Pennsylvania. J. Urban Health. 88:1020-30.

• Bird SM1,2, McAuley A3,4, Perry S5, Hunter C6. Addiction. 2016 May;111(5):883-91. doi: 10.1111/add.13265. Epub 2016 Feb 4. Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.

• Boscarino JA1, Kirchner HL2, Pitcavage JM1, Nadipelli VR3, Ronquest NA3, Fitzpatrick MH4, Han JJ5. Subst Abuse Rehabil. 2016 Sep 16;7:131-141. eCollection 2016.

• Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system.• Florence CS1, Zhou C, Luo F, Xu L. Med Care. 2016 Oct;54(10):901-6. doi: 10.1097/MLR.0000000000000625.• The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013.• Burris S at al. 2011. Legal aspects of providing naloxone to heroin users in the United States Int J of Drug Policy 12:237-

248.• Clausen et al. 2009. Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction 104:1356-

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

Med. 158:1-9• 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

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.

• 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 14:297

• Enteen et al. 2010. Overdose prevention and naloxone prescription for opioid users in San Francisco. J Urban Health 87:931-41.

• 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 174:302-8

• Gray and Hagemeir. 2012. Prescription drug abuse and DEA-sanctioned drug take-back events: characteristics and outcomes in rural Appalachia. JAMA intern Med 72:1186-7.

• 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 103:979-89.

• Inocencio TJ et al. 2013. The economic burden of opioid-related poisoning in the United States. Pain Medicine 14:1534-47• Katz, J. The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years. NYT – The UpShot 9/2/2017• McAuley A1, Aucott L2, Matheson C2. nt J Drug Policy. 2015 Dec;26(12):1183-8. doi: 10.1016/j.drugpo.2015.09.011. 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.

• Marshall et. Al. 2011. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet 377:1429-37.

• Maxwell et al. 2006. Prescribing naloxone to actively injecting heroin users: a program to reduceheroin overdose deaths. JAddict Dis25:89-96.

• Rudd RA, Seth P, David F, Scholl L. MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(5051):1445-1452. doi: 10.15585/mmwr.mm655051e1. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015.

References

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• Patrick SW1, Fry CE2, Jones TF3, Buntin MB4. Health Aff (Millwood). 2016 Jul 1;35(7):1324-32. doi:10.1377/hlthaff.2015.1496. Epub 2016 Jun 22. Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-Related Death Rates.

• Paulozzi et al. 2011. Prescriptiondrug monitoring programs and death rates from drug overdose. Pain Medicine12:747-54.• Piper et al. 2008. Evaluation of a naloxone distribution and administration program in New YorkCity. Subst Use Misuse43:858-

70.• 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 Health82:303-11.• Tobinet al. 2009. Evaluation of the StayingAlive programmed: training injection drug users toproperly administer naloxone and

save lives. Int J Drug Policy 20:131-6.• Wagner et al. 2010 Evaluation of an overdose prevention and response training programmed forinjection drug users in the Skid

Row area of LosAngeles,CA. Int J Drug Policy 21:186-93• Walley et al. 2013. Opioid overdose prevention with intranasal naloxone among people whotake methadone. JSAT44:241-7.

Walley et al. 2013. Opioid overdose rates and implementation of overdose education andnasal naloxone distribution inMassachusetts: interrupted time series analysis. BMJ 346:f174.

• Wheeler E et al. 2012. Community-based opioid overdose prevention programs providing naloxone- United States, 2010.MorbMortal Wkly Rep61:101-5.



PCSS Mentor Program

• PCSS Mentor Program is designed to offer general information to clinicians about evidence-based clinical practices in prescribing medications for opioid addiction.

• PCSS mentors are a national network of providers with expertise in addictions, pain, evidence-based treatment including medication-assisted treatment.

• 3-tiered approach allows every mentor/mentee relationship to be unique and catered to the specific needs of the mentee.

• No cost.

For more information visit:

pcssNOW.org/clinical-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 theofficial policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or

organizations imply endorsement by the U.S. 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: www.pcssNOW.org

@PCSSProjects

www.facebook.com/pcssprojects/

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