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CAPT Webinar
Strategies to Reduce the Harm of Prescription Drug Misuse
May 30, 2017
Findings from the Research Literature
Josh Esrick, Policy Analyst, SAMHSA’s CAPT
Shai Fuxman, Senior Training and Technical Assistance Associate, SAMHSA’s CAPT
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Facilitator
Molly LoweAssociate Director of Training and Technical Assistance
SAMHSA’s CAPT
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This training was developed under the Substance Abuse and Mental Health Services Administration’s Center for the
Application of Prevention Technologies task order. Reference #HHSS283201200024I/HHSS28342002T.
The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S.
Department of Health and Human Services.
This webinar is being recorded and archived, and will be available to all webinar participants. Please contact the
webinar facilitator if you have any concerns or questions.
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Objectives
• Define the core components of strategies toprevent both fatal and nonfatal overdose fromprescription drugs
• Identify potential advantages and disadvantagesof strategies to reduce the harm of prescriptiondrugs
• Describe the need for developing acomprehensive approach to reducing the non-medical use of prescription drugs and preventingoverdoses
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Preventing Prescription Drug Misuse: Strategies from the Research Literature
Strategies to Reduce Demand (4/13)
Strategies to Reduce Demand (4/13)
Strategies to Reduce Supply (4/27)
Strategies to Reduce Supply (4/27)
Strategies to Reduce Harm (Today)
Strategies to Reduce Harm (Today)
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Presenters
Josh EsrickPolicy Analyst
SAMHSA’s CAPT
Shai FuxmanSenior T/TA Associate
SAMHSA’s CAPT
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Strategies to Prevent the Non-medical Use of Prescription Drugs
Strategies to Prevent
Supply
Strategies to Prevent
Harm
Strategies to Prevent Demand
• Patient Education• Prescriber Education• Social Marketing
Campaigns• Information
DisseminationCampaigns
• Prescriber Education• Tracking and Monitoring• Retail Access
Restrictions• Enforcement Strategies• Storage and Disposal
• NaloxoneEducation andDistribution
• OverdoseEducation
• PrescriberEducation
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Desired Outcomes Associated with Preventing NMUPD and Opioid Overdose
HarmHarmDemandDemandSupplySupply
Decreasing availabilityDecreasing availability
Preventing dependence and
misuse
Preventing dependence and
misuse
Reducing nonfatal and fatal overdoseReducing nonfatal and fatal overdose
• Prescriptionopioid diversion
• Multipleprescriberepisodes (“doctorshopping”)
• Inappropriateprescribing (“pillmills”)
• Prescriptionopioid diversion
• Multipleprescriberepisodes (“doctorshopping”)
• Inappropriateprescribing (“pillmills”)
• Lack ofknowledge aboutpotential dangersof prescriptionopioid misuse
• Mental healthdisorders
• Chronic pain
• Lack ofknowledge aboutpotential dangersof prescriptionopioid misuse
• Mental healthdisorders
• Chronic pain
• Loss of tolerance• Polysubstance
use and misuse
• Loss of tolerance• Polysubstance
use and misuse
OutcomesOutcomes
Example Risk
Factors
Example Risk
Factors
Strategy Strategy Strategy Strategy Strategy Strategy
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Evidence-Based Continuum1
Promising/Emerging/
Undetermined
Promising/Emerging/
Undetermined
Supported/Well-Supported
Supported/Well-Supported
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A Note About Evidence
• There is less evidence for NMUPDprevention strategies (compared tostrategies for preventing othersubstances).
• A lack of evidence does not mean that astrategy is ineffective.
• Practitioners should rely on experienceworking with other substances.
• It is important for practitioners to collectevaluation data to build the evidencearound strategies.
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Opioid Use and Misuse
Strategies to Reduce the Harm of Prescription Drug MisuseFindings From the Research Literature
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Defining Harm Reduction Strategies
Efforts aimed at decreasing fatal and nonfatal overdoses from both prescription and illicit opioids (such as heroin).
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Overdose Deaths Involving Opioids, by Type of Opioid, 1999-20152
National Center for Health Statistics (NCHS), Multiple Cause of Death 1999-2015
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Heroin
Natural and Semi-synthetic Opioids
Synthetic opioids (e.g., fentanyl)
Methadone
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Harm Reduction Strategies: Three Categories
Overdose EducationOverdose Education
Naloxone Education & Distribution
Naloxone Education & Distribution
Prescriber EducationPrescriber Education
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Is your state, tribe, jurisdiction,
or community currently
implementing any harm reduction
strategies?
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Prescriber Education3,4,5,6
Involves teaching prescribers:
• How to recognize an individual at risk
• When/how to refer a patient totreatment
• How to talk to patients about thedanger of overdose
• About using tools to identify cases ofpoly-substance use
• About strategies to prevent overdosedeaths
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Overdose Prevention Strategies that Involve Prescribers7,8
• Prescribing naloxoneto patients atincreased risk ofoverdose
• Writing third-partynaloxoneprescriptions tofamily members andpeers
Prescriber EducationPrescriber Education
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For More Information Prescriber Education
For more information on venues and delivery methods for prescriber education, visit https://captconnect.edc.org/to access the materials from the first webinar in this series.
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Potential Advantages and Challenges
+ -• Potentially cost-effective
• Opportunity to informprescribers about new bestpractices (e.g., guidelinesand alternatives to habit-forming medications)
• Target population can bebusy and difficult to reach
• More effective when usedby all prescribers andpharmacists
• Implementation mayrequire a prescriber orrecognized medical expertto implement
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Overdose Education9,10,11
Involves teaching groups close to the problem:
• How to prevent overdoses from occurring
• How to recognize when an individual is at risk foroverdose
• How to recognize when an overdose is occurring
• How to appropriately respond to an overdose
• Laws relevant to overdoses (such as GoodSamaritan laws)
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Potential Audiences for Overdose Education Strategies
Health Care ProfessionalsHealth Care Professionals
Professional First Responders
Professional First Responders
People Who Use Opioids Illicitly People Who Use Opioids Illicitly
People Who use Prescription Opioids
Medically
People Who use Prescription Opioids
Medically
Overdose EducationOverdose Education
Family Members of People Who Use Opioids Illicitly
Family Members of People Who Use Opioids Illicitly
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Law Enforcement Training on Harm Reduction12,13,14,16,16,17
Involves preparing law enforcement to better respond to and prevent drug overdoses. Topics include:
• Purpose of harm-reduction training
• Foundational information on prescription drugsand other opioids
• Signs and symptoms of an overdose
• Purpose of naloxone, how it works, and how toadminister it
Overdose EducationOverdose Education
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Overdose Education for People Who Use Drugs18,19,20,21,22,23 Overdose
EducationOverdose Education
Informs people who use drugs about:
• Behaviors that increaseoverdose risk (such aschange in tolerance, mixingsubstances)
• How to recognize when anoverdose is occurring
• Steps to take whenwitnessing an overdose
Photo source: http://findings.org.uk/PHP/dl.php?file=Horyniak_D_1.cab&s=d
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Good Samaritan Education24
• Intended to raise awareness of GoodSamaritan laws and policies, and thespecific protections they provide, andbuild confidence in them.
• Audiences include:
o Law enforcement and criminaljustice professionals
o Members of the drug-usingcommunity
o Lay first responders
Overdose EducationOverdose Education
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Potential Advantages and Challenges
+ -• Can raise
awareness ofdangers ofopioid misuse
• Can becombined withnaloxonedistribution
• Warning about dangerous substances onthe market can lead individuals withdependence to seek out other harmfulsubstances
• Good Samaritan laws are only effective ifboth law enforcement and potential 9-1-1callers are educated
• Good Samaritan laws and policies are notpresent in all states
• Accessing people who use drugs (andtheir friends/families) can be challenging
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Participant Questions
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What is Naloxone?
Source: http://www.copeaustralia.com.au/home-mobile/naloxone/
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Naloxone Education and Distribution25,26,27
• Naloxone distribution programs provide access tonaloxone to individuals at risk for overdose and firstresponders who may witness an overdose
• Naloxone education informs the followingpopulations of the role of naloxone in preventingoverdoses:
o Prescribers and dispensers
o Potential first responders (both lay andprofessional)
o Broader community
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State Naloxone Access Laws28,29
• Allow naloxone to beprescribed/dispensed to:
o substance users withdocumented risk factorsfor overdose
o lay administrators(nonmedical firstresponders, potentialoverdose bystanders,family and friends ofopioid users)
Naloxone Education and
Distribution
Naloxone Education and
Distribution
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• Traditional prescriptions
• Third-party prescriptions
• Collaborative practiceagreements
• Standing orders
• Protocol orders
Types of Naloxone Access
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Overdose Education and Naloxone Distribution Programs27,29,30,31,32,33
• Overdose education andnaloxone distribution(OEND) programs providetraining on:
o recognizing andpreventing opioidoverdoses
o how to administernaloxone.
Naloxone Education and
Distribution
Naloxone Education and
Distribution
• Program participants are also provided prescriptionsfor naloxone
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Potential Audiences for OEND Programs
Naloxone Education and
Distribution
Naloxone Education and
Distribution
• Mental health centers
• Treatment facilities(including methadoneclinics)
• Homeless shelters
• Veterans’ Affairsfacilities
• People who use opioids(and their family andfriends)
• Professional and lay firstresponders
• Broader community
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Project Lazarus8,34,35,36
Project Lazarus addresses drug overdose deaths, with a focus on prescription drug overdoses. Its overdose prevention program includes:
• Community activation and coalition building
• Monitoring and epidemiological surveillance
• Prescriber, patient, and law enforcement trainingand education
• Overdose reversal medication
https://www.projectlazarus.org/
Naloxone Education and
Distribution
Naloxone Education and
Distribution
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Potential Advantages and Challenges
+ -• Reduces rates of overdose
deaths
• When naloxone isadministered by aprofessional first responder,individuals who use drugscan be referred to services
• The education component ofthese strategies promotesproper use of naloxone
• Can reduce fatalities but notthe underlying substanceuse disorders
• Prevention practitioners mayface critiques that givingnaloxone to people who usedrugs could encouragefurther use
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Additional Strategies to Note
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Efforts to Connect Individuals to Treatment38
• Increase access and connect individuals totreatment for substance use disorders, especiallymedication-assisted treatment (MAT).
• MAT involves integrating medications (e.g.,methadone, buprenorphine, naltrexone) inconjunction with behavioral therapies and counselingto treat opioid addiction.
https://www.samhsa.gov/medication-assisted-treatment
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Strategies to Reduce Non-opioid Prescription Overdoses
• Antidotes (e.g., Flumazenilfor benzodiazepineoverdoses)
• Guidance for prescribers(e.g., risks associated withmixing prescriptions)
• Safe storagerecommendations to preventaccidental poisonings
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Participant Questions
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A Comprehensive Approach to Reduce NMUPD and Opioid Overdose
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Selection as Part of a Strategic Process
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Developing a Comprehensive Approach to Reducing NMUPD and Opioid Overdose
Anytown, U.S.
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Comprehensive Approach: Example
Risk Factors for Anytown Strategies for Anytown
Lack of knowledge about potential dangers of prescription opioid misuse
Social marketing campaign
Inappropriate prescribing Prescriber education
Polysubstance use Overdose education
Problem: Anytown experienced high rates of opioid overdose over the past five years
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What NMUPD prevention
strategies are you currently
implementing or interested in
implementing?
• Patient education• Prescriber education• Social marketing campaigns• Information dissemination
campaigns• Tracking and monitoring• Retail access restrictions• Enforcement strategies• Proper storage and disposal• Overdose education• Naloxone education and
distribution
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Where to Find Out MoreResources on Strategies to Reduce the Harm of Prescription Drug Misuse
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SAMHSA Opioid Overdose Prevention Toolkit
• Facts for Community Members
• Five Essential Steps for FirstResponders
• Information for Prescribers
• Safety Advice for Patients &Family Members
• Recovery from Opioid Overdose
Available at store.samhsa.gov
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Revised NMUPD Decision Support Tools
• Overview of Factors andStrategies
• Understanding Who is at Risk
• Programs and Strategies
Available at samhsa.gov/capt/
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Revised NMUPD Decision Support Tools (cont.)
Example: Overdose
Education and Naloxone
Distribution Programs
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Online Portal of Environmental Strategies
Available to CSAP prevention grantees at captconnect.edc.org/
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Example: State
Naloxone Access Laws
Online Portal of Environmental Strategies (cont.)
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Addressing Opioid Overdose: Understanding Risk Factors and Prevention Strategies
Available to webinar participants at the conclusion of today’s event (and at captconnect.edc.org/)
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Addressing Opioid Overdose: Understanding Risk Factors and Prevention Strategies (cont.)
Example: Harm
Reduction Strategies
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Implementing Strategies to Prevent NMUPD and Opioid Overdose
Upcoming opportunities and resources:• National webinars
• Peer sharing/learningcommunities onimplementationchallenges and bestpractices
• Stories and videos frompractitioners
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The CAPT is Here to Help
CAPT Resource Team Coordinator
Northeast Resource Team Gisela [email protected]
Central Resource Team Chuck [email protected]
Southeast Resource Team Lourdes [email protected]
Southwest Resource Team Marie [email protected]
West Resource Team Alyssa O’[email protected]
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Contact Information
If you have questions or comments about this webinar, please don’t hesitate to contact:
Amanda DoughertyTraining and Technical Assistance Associate
312-962-4558
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Evaluation
Please take the time to complete a brief feedback form:
https://www.surveymonkey.com/r/feedback-CAPT-1814
Thank you for sharing your thoughts!
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