Transcript NC Harm Reduction Coalition & CCNC

EMS Supports and
Trains Law Enforcement
to Carry Naloxone in
North Carolina
Primary Cause of Death Due to Unintentional
Poisonings: N.C., 2011
Medication/Drug--91%
-Opioids/Cocaine--56%
9%
-Other/Unspecified drugs-30%
-Anti-epileptic and
sedative-hypnotic drugs-4%
-Non-opioid--1%
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2011
Analysis by Injury Epidemiology and Surveillance Unit
91%
Poisoning Deaths: N.C., 1999-2012*
1,500
1382
Number of Deaths
1,200
1101
Unintentional
900
Suicide
Homicide
600
Undetermined
All Poisonings
300
0
248
32
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
•In 1999, the number of unintentional poisoning deaths was 279; in 2012, the
number of deaths was 1,101, an increase of over 300%.
Unintentional Poisoning Deaths by County:
N.C., 1999-2009
Naloxone
● Non-addictive prescription medication
reverses opiate overdose
● Cannot be abused nor cause overdose
● Restores breathing and consciousness
● Administer intramuscular or nasal spray
● Onset: One to three minutes
● Duration: 30 to 90 minutes
How Naloxone Works?
Signs of Overdose

Blue or pale skin
REALLY HIGH
OVERDOSE

Limp body
Muscles become relaxed
Deep snoring or gurgling
(death rattle)

Pulse (heartbeat) slow or
not there at all
Speech is slowed/slurred
Very infrequent or no
breathing
Sleepy looking
Pale, clammy skin
Nodding
Heavy nod
Will respond to
stimulation like yelling,
sternal rub, pinching, etc.
No response to
stimulation




Throwing up
Passing out
Choking, gurgling
snoring sound
Breathing very slow,
irregular, or stopped
Slow heart beat/pulse
Storage of Naloxone
Keep out of direct sunlight
 Hospira storage recommendations: 20
to 25°C (68 to 77°F)
 Gammon et al. clinical study:

 Naloxone maintained close 90%
concentration when subjected to ~21 and
~129 degrees Fahrenheit temperatures
every twelve hours for 28 days
Misconceptions of Naloxone

Naloxone makes people violent.

If you give an overdose antidote to drug
users, they will abuse more drugs.

We can't trust a person who is high to
respond appropriately in a life-threatening
situation.

Naloxone will keep drug users from
seeking treatment.
Senate Bill 20

Effective April 9, 2013
 Two components:
 Naloxone Access
 Good Samaritan Immunity
NC Legislation Overview
13
SB20: Naloxone Access
 Prescribers may prescribe naloxone to a person at risk of
overdose or any other person “in a position to assist a
person at risk of experiencing an opiate-related overdose.”
 Prescribers may prescribe naloxone via standing order
 Bystanders may administer naloxone
 All parties acting as authorized by law are immune from
civil or criminal immunity so long as they act in good faith
NC Legislation Overview July 16, 2015
14
SB20: Good Samaritan
 Provides limited criminal immunity to any person who
seeks medical assistance in good faith for person
experiencing drug overdose
•
•
Possession of small amounts of drugs
Possession of drug paraphernalia
 Same immunity applies to victim
 Provides limited criminal immunity to minors who seek
medical assistance for person experiencing alcohol
overdose
•
•
•
Must remain with victim until help arrives
Must give name when seeking help
Immunity does NOT extend to victim
NC Legislation Overview July 16, 2015
15
SB20 Supporters
This law was supported by the NC Sheriffs’ Association, NC
Association of Chiefs of Police, NC Hospital Association, the
NC Medical Board, the NC Medical Society, and the NC
Child Fatality Task Force.
US LEOs Carry Naloxone






Arundel PD, MD
Bartlett PD, IL
Benzie County Sheriff, MI
Bloomingdale PD, IL
Buffallo PD, NY
Carrboro, NC
 Starts June 2014







Countryside PD, IL
Downers Grove PD, IL,
DuPage County Sheriff, IL
Espanola PD, NM
Glen Cove, NY
Gloucester PD, MA
Grand Traverse County
Sheriff, MI
Source: NC Harm Reduction Coalition






Hinsdale PD, IL
Indianapolis Metropolitan
PD, IN
Lorain PD, OH
Nassau County PD, NY
New York City PD (120th
Precinct), NY
Oakland County Sheriff, MI
Quincy PD, MA
 202 OD Reversals as of
12/18/2013




Rensselaer Sheriff, NY
Suffolk County PD, NY
Wheaton PD, IL
Wood Dale PD, IL
Step 1: Buy In
Get Buy-In from Sheriff and/or Police
Chief and Local EMS Authority
 Video: Lieutenant Detective Pat
Glynn: Saving Lives with Narcan

 Lieutenant Detective Pat Glynn: Saving
Lives with Narcan
 https://vimeo.com/47686862
Step 2: Get EMS Director to
Approve Program

Have chief/sheriff and EMS director
develop policies and procedures in line
with operating a program
 Orange County has developed a policy that
can be edited for the needs of other
jurisdictions

Submit to EMS director James “Tripp”
Winslow
Step 3: Figure Out How to Pay for
the Naloxone

Cost per unit
 Nasal Naloxone Kits cost $33-67
 Inter muscular naloxone kits cost under $10
 New Evzio kit will cost $150-$300

Payment Options





Can have EMS pay
Use drug seizure money
Work with health department on funding
Use local Project Lazarus Funding
Other…
Step 4: Order Naloxone and
Naloxone Storage
Can use existing EMS relationship with
medication order
 Order through manafactuer and ship to
local pharmacy

 Contact NCHRC if you need help
Step 5: Set Up Documentation
System

Have a meeting to discuss how you
would like to document dispensing
naloxone and overdose reversals.
 OC Health Department and NCHRC have
sample forms you can edit
Step 6: Set Up A Training

Introductions
 5min

Law Enforcement Use of Naloxone
 5min
 Have Police Chief and EMS Trainer lead this

State and Local Context (Overdose in Specific City/County, SB
20 Good Samaritan/Naloxone Access, etc.)
 20min
 Have NC Harm Reduction Coalition lead

Naloxone Protocol Training





40min
Have EMS Trainer lead
Include skill practice session
OC EMS has extra nasal naloxone demo kits for use
Q+A/Closing
 10min
Step 7: Set Up A Naloxone
Dispensing Day
Could be the same day as training
 Dispense to all the officers in the same
week so you can set up a date to
replace expired naloxone for everyone
when it expires
 Have Set up a standing order for the
EMS official to dispense to LEOs

 See OC Health Department or NCHRC for
examples
Contact Information

Robert Childs
 NCHRC Executive Director
 336-543-8050
 [email protected]

Tessie Castillo
 Law Enforcement Relations
Coordinator
 919-809-7718
 [email protected]

Mike Lancaster
 CCNC