Facilitator Molly Lowe Associate Director of Training and Technical - PDF document

CAPT Webinar May 30, 2017 Strategies to Reduce the Harm of Prescription Drug Misuse Findings from the Research Literature Josh Esrick, Policy Analyst, SAMHSA’s CAPT Shai Fuxman, Senior Training and Technical Assistance Associate, SAMHSA’s CAPT Facilitator Molly Lowe Associate Director of Training and Technical Assistance SAMHSA’s CAPT 2 1

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. 3 Objectives • Define the core components of strategies to prevent both fatal and nonfatal overdose from prescription drugs • Identify potential advantages and disadvantages of strategies to reduce the harm of prescription drugs • Describe the need for developing a comprehensive approach to reducing the non- medical use of prescription drugs and preventing overdoses 4 2

Preventing Prescription Drug Misuse: Strategies from the Research Literature Strategies to Reduce Strategies to Reduce Demand (4/13) Demand (4/13) Strategies to Reduce Strategies to Reduce Supply (4/27) Supply (4/27) Strategies to Reduce Strategies to Reduce Harm (Today) Harm (Today) 5 Presenters Josh Esrick Shai Fuxman Policy Analyst Senior T/TA Associate SAMHSA’s CAPT SAMHSA’s CAPT 6 3

Strategies to Prevent the Non- medical Use of Prescription Drugs • Patient Education • Prescriber Education • Prescriber Education Strategies • Tracking and Monitoring • Social Marketing • Retail Access to Prevent Campaigns Restrictions • Information Supply • Enforcement Strategies Dissemination • Storage and Disposal Campaigns Strategies Strategies to Prevent to Prevent • Naloxone Education and Demand Harm Distribution • Overdose Education 7 • Prescriber Education Desired Outcomes Associated with Preventing NMUPD and Opioid Overdose Demand Demand Supply Supply Harm Harm Preventing Preventing Decreasing Decreasing Reducing nonfatal Reducing nonfatal dependence and dependence and Outcomes Outcomes availability availability and fatal overdose and fatal overdose misuse misuse Strategy Strategy Strategy Strategy Strategy Strategy • • Prescription Prescription • • Lack of Lack of opioid diversion opioid diversion knowledge about knowledge about • • Multiple Multiple potential dangers potential dangers • • Loss of tolerance Loss of tolerance Example Example prescriber prescriber of prescription of prescription • • Polysubstance Polysubstance Risk Risk episodes (“doctor episodes (“doctor opioid misuse opioid misuse use and misuse use and misuse Factors Factors shopping”) shopping”) • • Mental health Mental health • • Inappropriate Inappropriate disorders disorders prescribing (“pill prescribing (“pill 8 • • Chronic pain Chronic pain mills”) mills”) 4

Evidence-Based Continuum 1 Supported/ Supported/ Well-Supported Well-Supported Promising/ Promising/ Emerging/ Emerging/ Undetermined Undetermined 9 A Note About Evidence • There is less evidence for NMUPD prevention strategies (compared to strategies for preventing other substances). • A lack of evidence does not mean that a strategy is ineffective. • Practitioners should rely on experience working with other substances. • It is important for practitioners to collect evaluation data to build the evidence around strategies. 10 5

Strategies to Reduce the Harm of Opioid Use Prescription and Misuse Drug Misuse Findings From the Research Literature 11 Defining Harm Reduction Strategies Efforts aimed at decreasing fatal and nonfatal overdoses from both prescription and illicit opioids (such as heroin). 12 6

Overdose Deaths Involving Opioids, by Type of Opioid, 1999-2015 2 14,000 Heroin Natural and 12,000 Semi-synthetic Opioids 10,000 Synthetic opioids (e.g., 8,000 fentanyl) 6,000 4,000 Methadone 2,000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 13 National Center for Health Statistics (NCHS), Multiple Cause of Death 1999-2015 Harm Reduction Strategies: Three Categories Prescriber Prescriber Overdose Overdose Education Education Education Education Naloxone Naloxone Education & Education & Distribution Distribution 14 7

Is your state, tribe, jurisdiction, or community currently implementing any harm reduction strategies? 15 Prescriber Education 3,4,5,6 Involves teaching prescribers: • How to recognize an individual at risk • When/how to refer a patient to treatment • How to talk to patients about the danger of overdose • About using tools to identify cases of poly-substance use • About strategies to prevent overdose deaths 16 8

Overdose Prevention Strategies Prescriber Prescriber that Involve Prescribers 7,8 Education Education • Prescribing naloxone to patients at increased risk of overdose Writing third-party • naloxone prescriptions to family members and peers 17 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. 18 9

Potential Advantages and Challenges + - • Potentially cost-effective • Target population can be busy and difficult to reach • Opportunity to inform prescribers about new best • More effective when used practices (e.g., guidelines by all prescribers and and alternatives to habit- pharmacists forming medications) • Implementation may require a prescriber or recognized medical expert to implement 19 Overdose Education 9,10,11 Involves teaching groups close to the problem: • How to prevent overdoses from occurring • How to recognize when an individual is at risk for overdose • How to recognize when an overdose is occurring • How to appropriately respond to an overdose • Laws relevant to overdoses (such as Good Samaritan laws) 20 10

Potential Audiences for Overdose Overdose Overdose Education Strategies Education Education Health Care Health Care Family Members of Family Members of People Who use People Who use Professionals Professionals People Who Use People Who Use Prescription Opioids Prescription Opioids Opioids Illicitly Opioids Illicitly Medically Medically People Who Use People Who Use Professional First Professional First Opioids Illicitly Opioids Illicitly Responders Responders 21 Law Enforcement Training on Overdose Overdose Harm Reduction 12,13,14,16,16,17 Education Education Involves preparing law enforcement to better respond to and prevent drug overdoses. Topics include: • Purpose of harm-reduction training • Foundational information on prescription drugs and other opioids • Signs and symptoms of an overdose • Purpose of naloxone, how it works, and how to administer it 22 11

Overdose Education for People Overdose Overdose Who Use Drugs 18,19,20,21,22,23 Education Education Informs people who use drugs about: • Behaviors that increase overdose risk (such as change in tolerance, mixing substances) • How to recognize when an overdose is occurring • Steps to take when Photo source: http://findings.org.uk/PHP/dl.php?file=Horyniak_D_ 1.cab&s=d witnessing an overdose 23 Good Samaritan Education 24 Overdose Overdose Education Education • Intended to raise awareness of Good Samaritan laws and policies, and the specific protections they provide, and build confidence in them. • Audiences include: o Law enforcement and criminal justice professionals o Members of the drug-using community o Lay first responders 24 12

Potential Advantages and Challenges + - • Can raise • Warning about dangerous substances on awareness of the market can lead individuals with dangers of dependence to seek out other harmful opioid misuse substances • Can be • Good Samaritan laws are only effective if combined with both law enforcement and potential 9-1-1 naloxone callers are educated distribution • Good Samaritan laws and policies are not present in all states • Accessing people who use drugs (and their friends/families) can be challenging 25 Participant Questions 26 13

What is Naloxone? Source: http://www.copeaustralia.com.au/home-mobile/naloxone/ 27 Naloxone Education and Distribution 25,26,27 • Naloxone distribution programs provide access to naloxone to individuals at risk for overdose and first responders who may witness an overdose • Naloxone education informs the following populations of the role of naloxone in preventing overdoses: o Prescribers and dispensers o Potential first responders (both lay and professional) o Broader community 28 14