Naloxone prescriptions: Providing a comprehensive program for at-risk opioid abusers identified in the acute care setting Alicia ZuWallack, PharmD BCPS Kent Hospital Emergency Department Opioid overdose epidemic in RI Rhode Island is in the midst of a severe ›  prescription and street-drug overdose crisis. There have been more than 70 opioid- ›  related deaths since the start of 2014 in communities all over Rhode Island. Many of these deaths are directly related ›  to the use of fentanyl and heroin. Press release, RI Dept of Health, 4/3/14 RI a national leader…in drug abuse In the top 5 states for illicit drug use ›  In the top 12 for overdose deaths ›  Overdose leading cause of accidental death, ›  over MVAs Third highest state for illicit use of prescription ›  drugs In 2013, 360,000 Rhode Islanders — more than ›  one-third of the entire population — filled prescriptions for controlled substances. The Providence Journal, 2/8/14 Tightening up prescribing: the unintended consequence In 2013, 1400 Rhode Islanders obtained their ›  controlled drugs from ≥ 5 prescribers and ≥ 5 pharmacies suggesting widespread abuse. Programs like the PMP and efforts from the ›  DOH have attempted to regulate this type of behavior. Less access to RX opioids + ongoing addiction ›  = use of street drugs Heroin can be snorted… Not a huge leap for ›  prescription opioid abusers. Emergency Regulations “The Department [of Heath] finds that there is ›  imminent peril to the public health, safety and welfare and that these emergency regulations should be adopted to protect the public health. Due to the sharp increase in overdose deaths ›  in RI on 2014, expanded access to naloxone has become immediately necessary to save lives.” Rules and regulations pertaining to opioid overdose prevention [R23-1-OPIOID], RI DOH March 2014 Emergency Regulations One prescriber is now able to issue a non-patient- ›  specific order to numerous organizations, such as police departments, allowing for increased access to naloxone. A prescription for naloxone may be prescribed to ›  persons other than the individual who have the potential for overdosing on opioids. These regulations provide protections against any ›  professional disciplinary action resulting from such prescribing. Rules and regulations pertaining to opioid overdose prevention [R23-1-OPIOID], RI DOH March 2014 Emergency Regulations A person who is not otherwise licensed to ›  administer naloxone may in an emergency situation administer naloxone without fee if the person believes in good faith that an individual is experiencing drug overdose. A person who administers naloxone shall not ›  be subject to civil liability or criminal prosecution as a result of administering the drug. Rules and regulations pertaining to opioid overdose prevention [R23-1-OPIOID], RI DOH March 2014 Some common questions: Is naloxone safe? ›  Can we trust lay people to recognize overdose ›  and give naloxone correctly? Will 911 really be called? ›  Will people use more heroin because they know ›  they have an antidote if they overdose? Will the drug abuser try to “override” the naloxone ›  by shooting up with more heroin? Does it save lives, or is it just a theory? ›  Is it worth it? Do these people ever stop using ›  heroin or do they just live to overdose again? Is naloxone safe? Naloxone has no real intrinsic toxicity ›  Research in spinal cord injury used ›  enormous doses of 5.4mg/kg bolus then 4mg/kg/hr x 23 hrs without complication J Neurosurg 1992;76:23-31 Epi-Pen, another antidote we routinely ›  prescribe, has much more intrinsic toxicity. Can we trust the lay public to give it correctly? Well, bystander CPR saves lives… ›  Lay persons use AEDs to deliver 300 joules ›  of electricity to the hearts of victims of cardiac arrest… Is it such a stretch for a lay person to ›  administer a nasal spray to a victim of respiratory arrest?