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From Underground to State-Funded: The History of Overdose Prevention/Naloxone Distribution in Massachusetts
Adam Butler, Jon Zibell, Kathy Day, Monique Tula and Gary Langis
To describe in timeline format the history of Overdose Prevention in Massachusetts
To describe how OD Prevention went from an underground effort to a comprehensive, state-sanctioned & funded program that includes naloxone distribution
To describe the various initiatives that have been developed and integrated into other services over time.
To share successes, challenges, key opportunities and identify ways for different types of organizations (underground, CBO, state) to all play a part in developing a successful program and initiatives .
Purpose
National and Regional Drug Threat
Co
cain
e
He
roin
Me
tha
mp
he
tam
ine
Ma
riju
an
a
Ph
arm
ace
utic
als
Source: National Drug Threat Assessment, 2007
Co
cain
e
He
roin
Me
tha
mp
he
tam
ine
Ma
riju
an
a
Ph
arm
ace
utic
als
11%8.5%
38.8%36.5%
3.9%
15.5%
1.9%
37.6%
33.2%
9.3%
United States New England
Opioid-related Health Problems 2007, rates per
100,000 by Town
Rates suppressed for towns with less than 5 cases
Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
Opioid-Related Poisoning Deaths 1990-2008
Source: Massachusetts Registry of Vital Records and Statistics (MA-RVRS)
94 111
160193
220246
178218
261
329363
487449
574
425
544
637 637594
0
100
200
300
400
500
600
700
#o
f D
ea
ths
2000
Active players:• Underground• Community-Based
Organization
2001
Active players:•Underground
•Community-Based Organization
2002
Active players:•Underground
•Community-Based Organization
2003
Active players:•Underground
•Community-Based Organization
2004
Active players:•Underground
•Community-Based Organization
2005
Active players:•Underground•Community
•City
Media Shit Storm
No Response = Death
2005 – Boston Herald front page photo
Media Shit Storm
2006
Active players:•Underground•Community
•City
2007
Active players:•Underground•Community
•City•State
Gloucester
Lynn
BostonCambridge
QuincyProvincetown
Hyannis
New Bedford
Fall River
Massachusetts Department of Public Health
funded Naloxone Programs
NorthamptonSpringfield
Brockton
2007
Media in 2007
2008
Active players:•Underground•Community
•City•State
Media in 2008 All Things Considered
Overdose Rescue Kits Save Lives by Richard Knox January 2, 2008
Every year, overdoses of heroin and opiates, such as Oxycontin, kill more drug users than AIDS, hepatitis or homicide. And the number of overdoses has gone up dramatically over the past decade.
But now, public health workers from New York to Los Angeles, North Carolina to New Mexico, are preventing thousands of deaths by giving $9.50 rescue kits to drug users. The kits turn drug users into first responders by giving them the tools to save a life.
One of the new rescue operations is located off a side street behind St. Peter's Episcopal Church in Cambridge, Mass. Clients enter through an innocuous-looking door and climb a flight of wooden stairs to the Cambridge Cares About AIDS program for harm reduction.
The group says its mission is to provide prevention, education, advocacy and support services to the economically and socially disadvantaged.
At CCAA, drug users can obtain condoms, sterile needles, syringes and other resources to reduce their vulnerability to disease and death. Health educators also cajole their clients to undergo HIV and hepatitis testing, urge them not to share needles, and find them slots in detoxification programs and methadone treatment.
Drug Used as a Nasal Spray
On one recent wintry morning, health educator Eliza Wheeler teaches a 34-year-old client named Elissa how to rescue her friends from a fatal overdose.
"All right, Elissa," Wheeler says in a getting-down-to-business manner. "The first thing I'm going to do is ask a series of questions about your current drug use. So, we're going to talk about just the last 30 days."
Elissa has been on methadone for six years, but she confesses that she used heroin a couple of days in the previous month because she was under a lot of stress.
Eliza Wheeler, left, a health educator with the group Cambridge Cares about AIDS, is teaching a client named Elissa how to rescue her friends from a fatal overdose.
MassCall2 15 Municipalities received funding through
MDPH to build capacity to address fatal overdose
Communities were chosen due to high OD rates
All identified barrier of calling 911 as variable
Most communities work closely with state funded naloxone programs
Engaged law-enforcement, treatment providers, harm reduction personnel, and community members
Good Samaritan Legislation Two GS bills were introduced in
MA in 2008 Several groups advocated and
lobbied legislators Both bills failed during this
legislative session
2009
Active players:•Underground•Community
•City•State
More Work to Do
State report says deaths from opioid-related overdoses declined in 2008By Vicki-Ann Downing Enterprise Staff Writer Posted Dec 19, 2010 @ 06:00 AMBROCKTON —
“The overdose rate for the South Shore in 2009 was high and it was steady throughout the year,” said Dubois. “As a whole, 2010 was lower in the amount of fatal overdoses compared to 2009, but still too high.”That the governor’s report contained any information at all about deaths from drug overdoses – in addiction to cancer, heart disease, Alzheimer’s disease and diabetes – shows it “is still something that the Commonwealth deems to be a critical issue,” said Dubois.The report, based on statistics from the state Department of Public Health, showed 594 deaths from opioid-related overdoses in 2008, compared to 637 in both 2006 and 2007.The number of overdose deaths began to climb beginning in 1996, when there were 178, according to the state…
2010
Active players:•Underground•Community
•City•State
Gloucester
Lynn
Boston
Cambridge
Quincy
Provincetown
Hyannis
LawrenceLowell
New Bedford
Fall River
Worcester
Massachusetts Department of Public Health funded Naloxone Programs
Holyoke
NorthamptonSpringfield
Brockton
2010
Good Samaritan Legislation Good Samaritan Coalition formed
Three GS bills introduced, another with a provision to address GS
Garner community support Parent support groups Treatment and Recovery
Community support Community forums conducted Students for Sensible Drug Policy
2011
Active players:•Community
•City•State
Screening Brief Intervention, Referral to Treatment (SBIRT)
Eight Hospitals funded by MDPH for SBIRT Harm reduction strategies have been
incorporated Motivational Interviewing (MI) HPA’s provided with training to train and
enroll participants into state naloxone program
Learn To Cope
Support group for family members and loved ones of opioid users
Five groups in eastern MA 14 members are approved MDPH
Naloxone trainers Training of peers take place at their
meeting’s
2012
Active players:•Community
•City•State
Challenges Slow pace Needed legal backing and buy-in from
“authorities” before could become legitimized
Getting over ego stuff Staff buy-in to risks of distributing
naloxone pre-pilot years Negative press/media Limited research made it difficult for
public health people to buy in
Looking Forward Expanding into more ER’s (SBIRT) Expanding first responder involvement Persons in Recovery and Treatment
become partners ODP being incorporated into standards of
care for short-term drug treatment Research possibilities that contributes to
the case being made for OTC sale of Narcan
FDA approval of nasal Narcan use ODP being incorporated into the DOC Education on Good Samaritan laws
Successes Collaborative process between
underground and funded programs Philosophy shift in State (BSAS) Acceptance of harm reduction
philosophy by treatment programs, parents of users, etc.
Buy in from many stakeholders to legitimize naloxone distribution
Good Samaritan Law passed Lives saved
More Successes2006-2012
Enrollments 15,000+ individuals 300 per month 1500+ reported reversals 30 per month RFD has more than 70 OD
reversals
