Posts Tagged naloxone

Alabama Opioid Overdose and Addiction Council Issues Formal Report

Alabama Opioid Overdose and Addiction Council Issues Formal Report

MONTGOMERY — Co-chairs of the Alabama Opioid Overdose and Addiction Council, Attorney General Steve Marshall, Commissioner Lynn Beshear of the Alabama Department of Mental Health, and Acting State Health Officer Dr. Scott Harris, announced the issuance of the Council’s formal report of its findings.

The Council was created in August 2017 by an executive order of Gov. Kay Ivey, and tasked with developing a strategic plan “that establishes recommendations for policy, regulatory and legislative actions to address the overdose crisis in Alabama.” The Council and its subcommittees have met several times since then, and have submitted its formal plan to the Governor.

“Families, health care professionals and government officials at every level seek real solutions concerning the impact the opioid crisis has on Alabamians,” said Commissioner Beshear. “The next step in our effort will convene the Implementation Team of the Alabama Opioid Overdose and Addiction Council, as well as quarterly meetings of the full council to implement researched opportunities. We believe the work of the council offers preventive strategies, intervention and treatment options, and a community response that addresses this dire need. Working together, it will require organized sustained engagement of citizens and government with healthcare professionals.”

Dr. Harris said, “Opioid addiction and abuse is a tremendous problem that affects Alabama in many different ways. Our hospitals, schools, churches and prisons are all struggling to deal with the problems caused by addiction and by increasing numbers of opioid deaths. The comprehensive action plan the council has developed includes improvements to the Alabama Prescription Drug Monitoring Program that make it easier for prescribers to identify opioid abuse and to motivate abusers to find help for themselves, their families and communities. We are encouraged that the council has offered strategies that have the potential to reverse this crisis that affects so many Alabamians, and appreciate the input of so many individuals to find effective solutions.”

“After working with the dedicated people who have given so much of their time and concern to this council and its subcommittees, I am heartened that we can make progress to fight the terrible blight of opioid abuse in Alabama,” Attorney General Marshall said. “I want to thank Gov. Ivey for bringing us together in a commitment to search for solutions and work toward implementing them. I have been proud to serve with Commissioner Beshear and Dr. Harris in this vital endeavor, and I am grateful to all the members of this Council and its subcommittees for their outstanding achievement in bringing forth these valuable recommendations.”

The Council’s report presents a four-pronged action plan to address prevention of opioid misuse, intervention within the law enforcement and justice systems, treatment of those with opioid use disorders, and community response that engages the people of Alabama in finding solutions at a local level.

Some of the major findings are summarized below:

PREVENTION

  • Improve and modernize the Alabama Prescription Drug Monitoring Program so that it will be more user-friendly, and more prescribers will participate and be better informed; the Governor is requested to support a legislative appropriation of $1.1 million to the Alabama Department of Public Health for this;
  • Strengthen prescription data and research capabilities and create a unique identifier for each individual patient;
  • Promote efforts to educate current and future prescribers, better implement current guidelines, adopt guidelines specific to opioid prescribing and impose mandatory opioid prescribing education;
  • Create a website and messaging campaign to reduce the stigma of opioid addiction; and implement an outreach program to teach young people the dangers and to avoid opioids;
  • Create a website and social media campaign to motivate opioid abusers to seek help and to effectively connect them and family members with ways to get help; and
  • Create a partnership for the Alabama Department of Mental Health to provide training about addiction to law enforcement agencies and the judiciary.

INTERVENTION

  • Advocate legislation in the 2018 session to specifically prohibit trafficking in fentanyl and carfentanil, which is particularly important because vastly smaller amounts of these than other opioids can be deadly; for example, a lethal dose of fentanyl is 1,000 times less than that of heroin, and the threshold amounts for the crimes of trafficking in fentanyl and carfentanil would better be measured in micrograms; and
  • As overdoses are 50 times greater for those leaving incarceration or other enforced abstinence, establish a process for the Department of Mental Health to reduce the stigma of medication-assisted treatment, and begin a pilot program by the Department of Corrections in partnership with the Board of Pardons and Paroles to use naloxone, counseling and life skills to help released inmates remain drug free.

TREATMENT AND RECOVERY

  • Promote adequate funding for treatment services and recovery support;
  • Establish collaboration between the Department of Mental Health and recovery support providers to increase access;
  • Support creating two addiction medicine fellowships to train Alabama physicians to recognize and treat substance abuse;
  • Expand access and target effective treatment and prevention programs to areas where there is greater need; and
  • Improve education of professionals through continuing education for licensing and expand postsecondary and graduate curriculums.

COMMUNITY RESPONSE

  • Increase access to naloxone, and maintain a list of participating pharmacies;
  • Prioritize naloxone to law enforcement and for distribution in areas of greatest need;
  • Provide naloxone training for first-responders;
  • Encourage prescribing naloxone for high-risk patients;
  • Have a Community Anti-Drug Coalitions of America program in each judicial circuit and work toward having them at municipal levels;
  • Engage employers, businesses, higher education and private-sector in a network to get resources into communities;
  • Encourage having a Stepping Up Initiative in each county to work with the criminal justice system regarding incarceration of those with mental health problems; and
  • Develop ways to provide service to veterans regarding opioid issues.

A copy of the Council’s report is available for download here.

Posted in: Opioid

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UPDATE: BCBS New Opioid Management Strategy Effective April 1

UPDATE: BCBS New Opioid Management Strategy Effective April 1

UPDATED MARCH 21, 2018 — Blue Cross and Blue Shield of Alabama is launching an opioid management strategy in an effort to battle the growing opioid epidemic in Alabama, as well as a response to concerns for customers’ care and safety and the rising costs of health care. The new requirements will be effective April 1, 2018.

BCBS Alabama’s opioid management strategy implements the following requirements:

  • Members will be limited to a seven-day supply the first time they fill a short-acting opioid medication. If an initial fill for a supply of more than seven days is needed, a member can ask his or her doctor to submit a one-time prior authorization for an initial fill of a supply greater than seven days. Short-acting opioid medications include Lortab, Vicodin, Percocet, etc.
  • Members will be required to obtain a prior authorization for all first-time prescriptions for long-acting opioid medications, including OxyContin and MS Contin.
  • Naloxone (the generic of Narcan), the antidote for an opioid overdose, will be available to most members for the generic copayment. This includes both the prefilled syringes and nasal spray. Evzio is no longer covered. Evzio is naloxone packaged in an auto-injector.

In 2015, Alabama ranked first in the nation in the number of opioid scripts per capita. The recent Blue Cross and Blue Shield Association’s Health of America report on the opioid epidemic showed over 26 percent of its commercial members in Alabama filled at least one opioid prescription in 2015, and 16 per 1,000 members were diagnosed with opioid use disorder. The Centers for Disease Control and Prevention reports between 2000 and 2015 more than half a million people across the U.S. died from drug overdoses, and 91 Americans die each day from an opioid overdose.

The Medical Association’s Third-Party Task Force and Board of Censors continue to collaborate with Blue Cross to help curb the growing epidemic of opioid misuse by offering support, resources and educational tools. For more information, please contact your Blue Cross representative.

Posted in: Blue Cross Blue Shield of Alabama

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Public Restrooms Become Ground Zero in the Opioid Epidemic

Public Restrooms Become Ground Zero in the Opioid Epidemic

A man named Eddie threaded through the midafternoon crowd in Cambridge, Mass. He was headed for a sandwich shop, the first stop on a tour of public bathrooms.

“I know all the bathrooms that I can and can’t get high in,” said Eddie, 39, pausing in front of the shop’s plate-glass windows, through which we can see a bathroom door.

Eddie, whose last name we’re not including because he uses illegal drugs, knows which restrooms along busy Massachusetts Avenue he can enter, at what hours and for how long. Several restaurants, offices and a social services agency in this neighborhood have closed their restrooms in recent months, but not this sandwich shop.

“With these bathrooms here, you don’t need a key. If it’s vacant, you go in. And then the staff just leaves you alone,” Eddie said. “I know so many people who get high here.”

At the fast-food place right across the street, it’s much harder to get in and out.

“You don’t need a key, but they have a security guard that sits at the little table by the door, directly in front of the bathroom,” Eddie said. Some guards require a receipt for admission to the bathroom, he said, but you can always grab one from the trash.

A chain restaurant a few stores down has installed bathroom door locks opened by a code that you get at the counter. But Eddie and his friends just wait by the door until a customer goes into the restroom, then grab the door and enter as the customer leaves.

“For every 10 steps they use to safeguard against us doing something, we’re going to find 15 more to get over on their 10. That’s just how it is. I’m not saying that’s right, that’s just how it is,” Eddie said.

Eddie is homeless and works at a restaurant. Public bathrooms are among the few places where he can find privacy to inject heroin. He says he doesn’t use the drug often these days. Eddie is on methadone, which curbs his craving for heroin, and he says he now uses the drug only occasionally to be social with friends.

He understands why restaurant owners are unnerved.

“These businesses, primarily, are like family businesses; middle-class people coming in to grab a burger or a cup of coffee. They don’t expect to find somebody dead,” Eddie said. “I get it.”

Managing Public Bathrooms Is ‘A Tricky Thing’

Many businesses don’t know what to do. Some have installed low lighting — blue light, in particular — to make it difficult for people who use injected drugs to find a vein.

The bathrooms at 1369 Coffee House, in the Central Square neighborhood of Cambridge, are open for customers who request the key code from staff at the counter. The owner, Joshua Gerber, has done some remodeling to make the bathrooms safer. There’s a metal box in the wall next to his toilet for needles and other things that clog pipes. And Gerber removed the dropped ceilings in his bathrooms after noticing things tucked above the tiles.

“We’d find needles or people’s drugs,” Gerber said. “It’s a tricky thing, managing a public restroom in a big, busy square like Central Square where there’s a lot of drug use.”

Gerber and his staff have found several people on the bathroom floor in recent years, not breathing.

“It’s very scary,” Gerber said. His eyes drop briefly. “In an ideal world, users would have safe places to go [where] it didn’t become the job of a business to manage that and to look after them and make sure that they were OK.”

There are such public safe-use places in Canada and some European countries, but not in the U.S., at least not yet. So Gerber is taking the unusual step of training his baristas to use naloxone, the drug that reverses most opioid overdoses. He sent a training invitation email to all employees recently. Within 10 minutes, he had about 25 replies.

“Mostly capital ‘Yes!! I’ll be there for sure!’ ‘Count me in!’” Gerber recalled with a grin. “You know, [they were] just thrilled to figure out how they might be able to save a life.”

Safe Spaces and Hospital Bathrooms

Last fall, a woman overdosed in a bathroom in the main lobby of Massachusetts General Hospital in Boston. Luckily, naloxone has become standard equipment for security guards at many hospitals in the Boston area, including that one.

“I carry it on me every day, it’s right here in a little pouch,” said Ryan Curran, a police and security operations manager at the hospital, pulling a small black bag out of his suit jacket pocket.

The woman who overdosed survived, as have seven or eight people who overdosed in the bathrooms since Curran’s team started carrying naloxone in the past 12 to 18 months.

“It’s definitely relieving when you see someone breathing again when two, three minutes beforehand they looked lifeless,” Curran said. “A couple of pumps of the nasal spray and they’re doing better. It’s pretty incredible.”

Massachusetts General Hospital began training security guards after emergency room physician Dr. Ali Raja realized that the hospital’s bathrooms had become a haven for some of his overdose patients.

“There’s an understanding that if you overdose in and around a hospital that you’re much more likely to be able to be treated,” Raja said, “and so we’re finding patients in our restrooms, we’re finding patients in our lobbies who are shooting up or taking their prescription pain medications.”

Many businesses, including hospitals and clinics, don’t want to talk about overdoses within their buildings. Curran wants to be sure the hospital’s message about drug use is clear.

“We don’t want to promote, obviously, people coming here and using it, but if it’s going to happen, then we’d like to be prepared to help them and save them and get them to the [Emergency Department] as fast as possible,” Curran said.

Speed is critical, especially now, when heroin is routinely mixed with the much more potent opioid, fentanyl. Some clinics and restaurants check on bathroom users by having staff knock on the door after 10 or 15 minutes, but fentanyl can deprive the brain of oxygen and cause death within that window. One clinic has installed an intercom and requires people to respond. Another has designed a reverse-motion detector that sets off an alarm if there’s no movement in the bathroom.

Limited Public Discussion

There’s very little discussion of the problem in public, says Dr. Alex Walley, director of the Addiction Medicine Fellowship Program at Boston Medical Center.

“It’s against federal and state law to provide a space where people can use [illegal drugs] knowingly, so that is a big deterrent from people talking about this problem,” he said.

Without some guidance, more libraries, town halls and businesses are closing their bathrooms to the public. That means more drug use, injuries and discarded needles in parks and on city streets.

In the area around Boston Medical Center, wholesalers, gas station owners and industrial facilities are looking into renting portable bathrooms.

“They’re very concerned for their businesses,” said Sue Sullivan, director of the Newmarket Business Association, which represents 235 companies and 28,000 employees in Boston. “But they don’t want to just move the problem. They want to solve the problem.”

Walley and other physicians who work with addiction patients say there are lots of ways to make bathrooms safer for the public and for drug users. A model restroom would be clean and well-lit with stainless-steel surfaces, and few cracks and crevices for hiding drug paraphernalia. It would have a biohazard box for needles and bloodied swabs. It would be stocked with naloxone and perhaps sterile water. The door would open out so that a collapsed body would not block entry. It would be easy to unlock from the outside. And it would be monitored, preferably by a nurse or EMT.

There are Very Few Bathrooms that Fit this Model in the U.S.

Some doctors, nurses and public health workers who help addiction patients argue any solution to the opioid crisis will need to include safe injection sites, where drug users can get high with medical supervision.

“There are limits to better bathroom management,” said Daniel Raymond, deputy director for policy and planning at the New York-based Harm Reduction Coalition. If communities like Boston start to reach a breaking point with bathrooms, “having dedicated facilities like safer drug consumption spaces is the best bet for a long-term structural solution that I think a lot of business owners could buy into.”

Maybe. No business groups in Massachusetts have come out in support of such spaces yet.

By Martha Bebinger, WBUR | This story is part of a partnership that includes WBUR, NPR and Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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