Implementation of a collaborative model for opioid overdose prevention on campus

Abstract

Drug overdose is the leading cause of death for Americans under the age of 50, a crisis that is driven by an increasingly potent supply of illicit opioids. College-aged adults are more likely than any other age group to engage in opioid misuse. Naloxone, the antidote for an opioid overdose, can save the life of an opioid overdose victim if it is readily available and administered quickly. The University of Texas at Austin implemented a collaborative model for proactive opioid overdose prevention in 2016. This model includes stocking naloxone in residence halls and providing it to police officers, training resident advisors and police officers to respond to suspected overdoses, and engaging student pharmacists in a service learning program to increase naloxone access and awareness among university students. Programmatic experiences and key recommendations for U.S. campuses are shared by faculty, student, and community leaders.     

EMTs authorized to carry buprenorphine in New Jersey

Last month, the New Jersey state health commissioner issued an executive directive allowing medical directors of New Jersey's 21 Mobile Intensive Care Unit (MICU) programs to carry buprenorphine, which can be used to mitigate opioid‐withdrawal symptoms following an overdose reversal with naloxone. People who are revived with naloxone after an overdose go through withdrawal, which can be intense and painful. Only an opioid, like buprenorphine, can reverse these symptoms.     

Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization

Abstract

Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.     

How does naloxone distribution relate to opioid overdose deaths?

The $64,000 question — or however much money has been spent on naloxone, the lifesaving medication that rescues opioid overdose victims — is whether the distribution of the medication has an effect on overdose deaths.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

What really happened? Incidence and factor assessment of abused children and adolescents

Abuse of children and adolescents is a societal problem. If health-care providers are to intervene adequately in abuse, they must identify the occurrence, elicit all pertinent information surrounding the abuse and the patient's response, and integrate pertinent abuse issues in the overall treatment plan for the patient. This study has conclusively demonstrated the failure of health-care providers to assess and plan treatment based on the comprehensive documentation of sexual and physical abuse factors. Findings clearly indicate a need for education of health-care providers in the development of comprehensive and integrated treatment plans for abused psychiatric patients based on documentation of all factors related to trauma learning and replay. Service agencies must be willing to implement in-service programs that provide nurses and other health-care providers with the cognitive and affective knowledge and skills necessary to feel comfortable in the management of abuse issues.     

Only 37% of police officers give naloxone to OD victims

According to a recent study, among police officers who responded to overdose calls in the last six months, only 37% administered naloxone on the scene, and 36% made an arrest, despite the fact that some of the states had a Good Samaritan Law — which protects people who make calls to police for overdoses — in effect. The study, “Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose,” is in the current issue of Drug and Alcohol Dependence. Most of the officers knew whether or not their state had a Good Samaritan Law, but only 26% knew that the law protects people on the scene from arrest.     

The implementation of buprenorphine/naloxone in college health practice

Opiate abuse and dependence have become important concerns for college healthcare providers. The passage of the Drug Addiction Treatment Act of 2000 and the approval of the combination buprenorphine/naloxone for office-based treatment of opiate dependence have increased the options available for college students and their healthcare providers. The authors review the pharmacology of buprenorphine/naloxone and discuss how it can be implemented in college health practice. They also present a case report.     

More harm than good? Diagnostic codes for child and adult abuse

This study sought to understand the reasons for the lack of use of ICD diagnostic codes for child and adult abuse. New Jersey professionals were recruited to participate in three focus groups on child abuse, adult or primarily woman abuse, and elder abuse. Participants included health care providers, advocates from the community, and representatives of state agencies and the insurance industry. Concerns about coding abuse included further jeopardizing victims/patients, diagnostic uncertainty, and lack of resources. Members of the child abuse group were somewhat more receptive to coding abuse. Reasons to code, such as for documentation and reimbursement were discussed and rebutted. Most participants concluded that use of the abuse codes should be judicious because they have the potential to do more harm than good. More research is needed on the implications of coding for victims/patients along with medical education in the identification of abuse in general and coding abuse in particular.     

Physicians,hospital face $9 million lawsuit following fatal OD

Two years ago, Victor Williams, a 56‐year‐old Black man, died from a fatal overdose of fentanyl and fentanyl analogs. He was at home, but his family didn't have any naloxone, because he had not been given any by his treatment provider, despite multiple previous ODs. He had an opioid use disorder (OUD) and instead of being prescribed methadone or buprenorphine, he was prescribed Schedule II analgesics in the hospital. Just hours before his fatal OD, the hospital discharged him after an accidental heroin poisoning.     

Social work students with personal experience of sexual abuse: Implications for diploma in social work programme providers

Social work training attracts a significant proportion of students with personal experience of psychosocial trauma and oppression, including various forms of abuse. This article considers some of the implications for social work educators. Sexual abuse is the oppression selected to illustrate this discussion because it is central to contemporary social work training and practice and it is the author's experience that student disclosures of sexual abuse are common. Emotive but unavoidable for both students and educators, sexual abuse issues demonstrate the need for programme providers to address their responsibilities to applicants, students, partner agencies and service users. Continued failure to do so ignores the risks of legal liability and raises questions of whether their practices are consistent with the DipSW's value base. DipSW programme providers are advised to take practical steps both to protect themselves and to provide appropriate support for students. They are asked to review application and selection procedures and urged to define the roles and expectations of course tutors and practice teachers.     

Exploring the Context of Child Sexual Abuse in Jamaica: Addressing the Deficits

Jamaican media sources have recently noted the prevalence of child sexual abuse within the country. While research has continually noted the mental health impact of child sexual abuse, there is a dearth of literature on the relationship between the two in Jamaica. The purpose of this article is to provide the context of child sexual abuse in Jamaica, including the cultural considerations, current legislation, government created agencies, and modes of treatment. Moreover, recommendations are given for public health educators, school personnel, and mental health service providers in order to improve the psychological well-being of sexually abuse children.     

Taking Control: Putting Older People at the Centre of Elder Abuse Response Strategies

Elder abuse is acknowledged to be a significant social problem in Australia, but Australia's elder abuse responses have significant limitations. These responses, as evidenced by state and territory elder abuse strategies, voice important principles and typically seek to improve the knowledge of service providers, potential victims, and the general public about elder abuse. But they tend only to identify and draw upon existing service and community care responses in their attempts to address elder abuse. This article provides a policy analysis of existing elder abuse response strategies and argues that reforms are needed to ensure that the strategies: prioritise the wishes and wellbeing of the person in question; identify and empower lead agencies; and drive collaborative responses.     

Correction

In “Is naloxone really needed in buprenorphine product?” (ADAW, June 10), there is an error. The sentence reading “But it is known that naloxone, an opioid antagonist (it is the active ingredient of Vivitrol)…” should have read “But it is known that naloxone, an opioid antagonist (it is the active ingredient of Narcan).…” We regret the error.     

"Nothing about me without me": leading the way to collaborative relationships with families

This article discusses the National Center on Addiction and Substance Abuse's CASA Safe Haven, an evidence-based, community-driven intervention program for children and families in child welfare whose lives have been adversely affected by substance abuse, and for staff in the agencies that work with them. CASA Safe Haven builds collaborative relationships that feature a blend of multidisciplinary teams that share responsibility for helping families; family group conferencing, in which families are equal and welcome participants in designing and driving a service plan; and the influence of family court to hold families and service providers accountable for progress. CASA Safe Haven is a framework for collaboration.     

Briefly Noted

Last month, the federal Food and Drug Administration (FDA) warned that combining gabapentin or pregabalin with central nervous system (CNS) depressants such as opioids could result in serious breathing problems for patients with underlying respiratory problems, or in the elderly. New labeling will be required on gabapentin and pregabalin, the FDA said. There is less evidence supporting such a risk in otherwise healthy people, the FDA said in the Dec. 19, 2019, warning. Gabapentin, first approved in 1993, is not a controlled substance. It is approved to treat various conditions, including seizures, nerve pain, fibromyalgia and restless legs syndrome. Pregabalin, first approved in 2004, is Schedule V on the Controlled Substances Act, the lowest‐risk category of controlled substance. “With the evolution of the opioid crisis, getting ahead of new concerns or addressing those that are already evident requires examining signs of misuse and abuse as soon as any signal emerges,” said Douglas Throckmorton, M.D., deputy director for regulatory programs in the FDA's Center for Drug Evaluation and Research, in announcing the warning. “Reports of gabapentinoid abuse alone, and with opioids, have emerged and there are serious consequences of this co‐use, including respiratory depression and increased risk of opioid overdose death. In response to these concerns, we are requiring updates to labeling of gabapentinoids to include new warnings of potential respiratory depressant effects.” Drug manufacturers are also being required to conduct clinical trials to evaluate the abuse potential of all gabapentinoids, particularly when combined with opioids, said Throckmorton. The downside is that prescribers could inadvertently increase opioid use by not using these medications, Throckmorton acknowledged, saying “we do not want to unintentionally increase opioid use by turning prescribers away from this class of pain medications.” For more information, go to https://www.fda.gov/drugs/drug‐safety‐and‐availability/fda‐warns‐about‐serious‐breathing‐problems‐seizure‐and‐nerve‐pain‐medicines‐gabapentin‐neurontin .