Saves Lives

Oklahoma’s Plan to Reduce Prescription Drug Abuse and Prevent Overdose

• Drug overdose is now the leading cause of injury death in the United States.1

• Opioid analgesics, such as prescription

painkillers, account for about 80 percent of those deaths.1

• Overdose rates have increased five-fold since 1990.1

Background

Oklahoma • Oklahoma ranked number one nationally for the nonmedical use of painkillers (opioids) for all ages in 2010.

• Oklahoma consumption of painkillers for nonmedical use exceeded the national average by 232%.

• Prescription painkillers were involved in 9 out of 10 prescription drug-related deaths, with 460 opioid-involved deaths in 2012 alone.

Oklahoma• Oklahoma’s ranks 5th highest in drug overdose

deaths nationally. 2

Drug overdose death rates compared to motor vehicle-related death rates, Oklahoma residents, 1999-2012

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database

Mortality Rates by Age Group and Gender, Unintentional Poisoning, Oklahoma, 2007-2011

<15 15-24 25-34 35-44 45-54 55-64 65-74 75+05

1015202530354045

MalesFemales

Age Group

Rate

per

100

,000

Pop

ulat

ion

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database

Deaths Involving Prescription Drugs, Illicit Drugs, or Alcohol by Year of Death, Unintentional Poisoning,

Oklahoma, 2007-2012

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)

Number of drug overdose deaths involving opioid pain relievers and other drugs, Oklahoma residents, 2004-2012

Substances Involved in Unintentional Poisoning Deaths, Oklahoma, 2007-2011

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)

Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database

Five most common substances involved in unintentional poisoning deaths,

Oklahoma, 2007-2012

OklahomaOverdose

Unintentional Overdose Death, 2007-2011

The Solution• A multi-faceted approach

to overdose prevention is required.

• A comprehensive array of efforts are underway in Oklahoma, including:

P R E V E N T I O N & E D U C AT I O N

M O N I T O R I N G & D I V E R S I O N C O N T R O L

I N T E R V E N T I O N & T R E AT M E N T

• Opioid Prescribing Guidelines

• Prescriber/Dispenser Training

• SBIRT Requirements

• Disposal/Storage Methods

• Media Campaign

• Prescription Drug Monitoring Program

• Overdose Antidote (Naloxone) Program

Solutions

• Naloxone is a drug used to reverse the effects of opioids.

• Naloxone is safe and effective.

• Naloxone has no effect on non-opioid overdoses.

• In the United States6, there are:

Over 180 naloxone programs

Over 50,000 people trained

Over 10,000 overdose reversals (lives saved)

Narcan® (naloxone)

Opioids

Natural

opiummorphinecodeine

Semi-synthetic

heroinhydrocodone

oxycodone

Fully synthetic

fentanylmethadone

Demerol

All categories have overdose risk

Opioids are used primarily in medicine for pain relief, treatment of opioid use disorders, and cough relief.

Narcan knocks the opioid off the opiate receptor Only blocks opioid receptors; no opioids = no effect Not harmful if no opioids in system Temporarily takes away the “high,” giving the person the

chance to breathe Narcan works in 1 to 3 minutes and lasts 30 to 90 minutes Narcan can neither be abused nor cause overdose Only known contraindication is sensitivity, which is very rare Too much Narcan can cause withdrawal symptoms such as:

• nausea/vomiting• diarrhea• chills

• muscle discomfort• disorientation• combativeness

Narcan® (naloxone)

How do opioids affect breathing?

Opioid Receptors, brain

Opioid

OVERDOSE

How does Narcan affect overdose?

Restores breathing

1. Increase capacity of first responders to administer naloxone.

2. Increase capacity of family members of opioid users to administer naloxone.

3. Increase capacity of people at risk for overdose, including patients with opioid analgesic prescriptions and people with substance use disorders, to obtain naloxone.

4. Increase access to naloxone products.

5. Decrease misperceptions of naloxone.

Overdose Prevention Objectives

2013

First responders and family members can carry and administer naloxone with Good Samaritan protection

House Bill 1782

Standing Orders

Public Education

Law Enforcement Program

Oklahoma Medical Licensure Board approves rule to allow for standing

orders for naloxone

Naloxone training video and materials published for the public on TakeAsPrescribed.org

Naloxone law enforcement pilot program launched in the County of

Tulsa

Naloxone can be sold or dispensed by licensed pharmacists to the public

House Bill 2666

EMS/EMRA Program

Public Sales

Emergency Medical Service and Emergency Medical Response Agency

training and protocol adoption program launches for basic and intermediate-level

personnel

Walgreens and Economy Pharmacy launch 34 retail locations where naloxone may be purchased by the public

Today

• ABLE Commission

• Absentee Shawnee Tribal Police

• Bixby Police Department

• Broken Arrow Police Department

• Bureau of Narcotics

• Enid Fire Department

• Enid Police Department

• Garfield County Sheriff

• Glenpool Police Dept

• Jenks Police Department

• Moore Police Department

• Oklahoma Highway Patrol

• Owasso Police Department

• Rogers County Sheriff

• Sand Springs Police Department

• Skiatook Police Department

• Tulsa County Sheriff

• Tulsa Police Department

Agency Agreements

1. Stimulate

2. Alert EMS

3. Administer naloxone

4. CPR – Rescue breathing/ventilations

5. Repeat 3 & 4, if necessary

6. Recovery position, if breathing

TrainingApproach

Mucosal Atomization Device (MAD)

Prefilled ampule of naloxone

Luer-lock syringe

883 law enforcement officers trained

• 30% of those trained have been present at an overdose scene within the last 12 months

• 77% of those trained support law enforcement officials being authorized to administer naloxone (56% positive change from pre training)

• 89% of those trained are willing to administer naloxone (21% positive change from pre training)

PilotTrainingResults

• No physically aggressive or combative reactions reported

• Positive response within 3 minutes every time on the first administration of naloxone

• 17 naloxone saves, nearly 2 per month

PilotAdministration

Results

For Campaign Information:

Oklahoma Department of Mental Health and Substance Abuse ServicesOdmhsas.org405.522.3908

Visit TakeAsPrescribed.org

References1. Centers for Disease Control and Prevention. Wide-ranging OnLine Data for Epidemiologic Research (WONDER) [online]. (2012) Available from URL: http://wonder.cdc.gov/mortsql.html. Massachusetts Department of Public Health

2. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/mcd-icd10.html (accessed July 2013).

3. Oklahoma State Department of Health, Injury Prevention Service. Unintentional Poisoning Fatality Surveillance System (abstracted from medical examiner reports).

4. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, Automation of Reports and Consolidated Orders System (ARCOS) Reports, Retail Drug Summary Reports by State, Cumulative Distribution Reports (Report 4).

5. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death, 2010 on CDC WONDER Online Database, released 2012.

6. Centers for Disease Control and Prevention. Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010, Morbidity and Mortality Weekly Report. February 17, 2012 / 61(06);101-105

The Oklahoma Department of Mental Health and Substance Abuse Services wishes to acknowledge the DuPage County Department of Public Health and the Massachusetts Department of Public Health for permitting use of training content.