Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
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
5
At Risk for Addiction
Self-Reported Substance Use, Monroe County
0
5
10
15
20
25
30
35
40
45
50
E-Cig Use DrankAlcohol
BingeDrinking
MarijuanaUse
Heroin Use Rx Drugs toGet High
OTC Drugsto Get High
9th 10th 11th 12th
PAST MONTH EVER
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
0
10
20
30
40
50
60
0
200
400
600
800
1000
1200
1400
SULL
IVA
NC
HEM
UN
GW
AR
REN
NIA
GA
RA
CH
AU
TAU
QU
AU
LSTE
RG
REE
NE
ERIE
CA
TTA
RA
UG
US
BR
OO
ME
OR
AN
GE
RIC
HM
ON
DST
EUB
ENSC
HU
YLER
CLI
NTO
ND
ELA
WA
RE
NA
SSA
UC
OLU
MB
IATO
MP
KIN
SW
ASH
ING
TON
DU
TCH
ESS
ALL
EGA
NY
GEN
ESEE
CO
RTL
AN
DSC
HO
HA
RIE
MO
NTG
OM
ERY
TIO
GA
ON
EID
AO
TSEG
OSU
FFO
LKFR
AN
KLI
NO
SWEG
OW
AYN
EW
YOM
ING
OR
LEA
NS
MA
DIS
ON
SAIN
TLA
WR
ENC
EO
NO
ND
AG
AO
NTA
RIO
NEW
YO
RK
REN
SSEL
AER
LIV
ING
STO
NES
SEX
FULT
ON
MO
NR
OE
HER
KIM
ERSE
NEC
AC
AYU
GA
PU
TNA
MSA
RA
TOG
ASC
HEN
ECTA
DY
CH
ENA
NG
OA
LBA
NY
RO
CK
LAN
DYA
TES
JEFF
ERSO
NB
RO
NX
LEW
ISW
ESTC
HES
TER
QU
EEN
SK
ING
S
Overdosedeathsper100,000pop,2016 MMEpercapita,2015
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
8
23
47
81 69
169
220
0
50
100
150
200
250
2011 2012 2013 2014 2015 2016 2017
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?