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.     

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.     

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.     

HHS OIG doubles down on constraints against contingency management

Stimulant use disorders are on the rise resulting in exacerbation of the opioid epidemic, with stimulants often present in opioid overdoses.. Subcontractors are lining up to implement the new stimulant use disorder treatment provisions of the $1 billion annual State Opioid Response (SOR) federal grant program. And contingency management (CM), in which patients are given monetary rewards for not using drugs, is the best — by far — treatment for stimulant use disorder.     

Texas pharmacist works with harm reduction on STR naloxone distribution

Legislatively, Texas may have its problems in addressing opioid overdoses and evidence‐based treatment, but the Texas Targeted Opioid Response (TTOR) grant, from the Opioid State Targeted Response (STR) from the Substance Abuse and Mental Health Services Administration (SAMHSA), is changing all of that. “We have amazing folks in the TTOR department at the Texas Health and Human Services department who are aggressively minded and are focused on trying to do the right things with the money,” said Lucas Hill, Pharm.D., clinical assistant professor in the University of Texas at Austin College of Pharmacy and director of Operation Naloxone, which is funded by TTOR.     

What does $8 billion for coronavirus say about opioid funding?

Last week, Congress gave $8 billion to the fight against coronavirus, seemingly overnight. Certainly, compared to the extra $2 billion a year for addressing the opioid epidemic, the money came much faster. It took years for the State Targeted Response to the Opioid Crisis (STR) grant to be included, as it was in the Cures Act passed by Congress in 2016 and signed into law by President Obama in December of that year. The State Opioid Response (SOR) grants continue. How did the coronavirus $8 billion — $6 billion more than the White House had asked for — materialize so quickly? We asked two Capitol Hill experts.     

Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency

Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose.     

The Kids Are All White: Examining Race and Representation in News Media Coverage of Opioid Overdose Deaths in Canada

Problematic opioid use in Canada is on the rise, and opioid overdose deaths now number in the thousands each year. While opioids have long been responsible for overdoses among certain demographics of Canadians, such as drug users on Vancouver's notoriously impoverished downtown Eastside, it is only recently that fatal overdoses have also claimed the lives of White, middle-class young people. This critical discourse analysis of Canadian news media examines the differences in racial representation in recent coverage of opioid deaths. I pay particular attention to the ways in which White opioid users are portrayed as innocent victims while other users, such as those from Indigenous communities, are often ignored or stigmatized as “addicts.” I draw on the work of Hall (1978; 2000) and Reinarman and Levine (1989; 2004) on the role of media in representing race and constructing drug scares, to frame the media narratives. I then discuss the Canadian government's current harm-reduction approach to the opioid crisis, as well as calls from Indigenous leaders for “culture as treatment.”     

Supplemental SOR grants released to states

Last month, the federal Department of Health and Human Services (HHS) released an additional $487 million to states and territories in its State Opioid Response (SOR) grant program, bringing the 2019 total to $1.4 billion, including the $933 million in second‐year, continuation SOR grants to be provided later this year. The SOR grants increase access to medication‐assisted treatment (MAT), reduce unmet treatment need and reduce opioid‐related overdose deaths.     

STR grants: How one physician in rural Florida is trying to help

If the State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) grants are like an elephant — large, especially relative to funding for addiction treatment in general — they are also almost impossible to generalize about. But seeing one piece in context of the whole is essential in trying to find out where the money is actually going. The money goes to the single state authority (SSA) in charge of the Substance Abuse Prevention and Treatment (SAPT) block grant in each state, the person who knows most about what is needed in that state. The funding comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants added $2 billion‐plus to addiction treatment services for opioid use disorders for four years — and many expect this number to be doubled. For perspective, the entire SAPT block grant is under $2 billion and has been for decades.     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.     

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.     

When naloxone alone isn't enough: Deaths in year after ED OD visits

When patients are treated for nonfatal opioid overdose in the emergency department (ED) and discharged, they have a high risk of death — 67% of the time from another overdose within the next year, and especially within the next two days — new research has found. Being offered medication such as buprenorphine, counseling and referral to treatment by the ED before discharge could reduce that risk, the researchers concluded.     

The SIF debate: Lines drawn with Rosenstein op‐ed,but truth may lie in the middle

The federal Department of Justice is not going to allow supervised injection facilities (SIFs) to go forward, with Rod J. Rosenstein, deputy attorney general, drawing a clear line in the sand in an Aug. 27 op‐ed in The New York Times ( https://www.nytimes.com/2018/08/27/opinion/opioids‐heroin‐injection‐sites.html ). “Advocates euphemistically call them ‘safe injection sites,’ but they are very dangerous and would only make the opioid crisis worse,” he wrote, calling them “B.Y.O.D.” facilities (for “bring your own drugs,” which they are). In SIFs, people can be revived by naloxone if they overdose; if they inject alone, which happens often, they can't.     

Transitioning SOR to the SAPT BG: Why not?

It's time to think about transitioning the State Opioid Response (SOR) grants to the Substance Abuse Prevention and Treatment (SAPT) block grant, Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), told the House Energy and Commerce Committee at its March 3 hearing on opioid legislation. The STR and SOR grants went directly to single state authorities (SSAs) in charge of the SAPT block grants — NASADAD members — so this makes perfect sense. These are the officials who best know how funding should be spent in their states — on what substances, including alcohol. Instead of having a designated amount set up for opioids — although that was expanded to include stimulants as well (see “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” ADAW, Dec. 23, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ) — each SSA should just have this funding added permanently to the block grant.     

2021: Making COVID-caused changes permanent,for better or worse

What started in 2020 — COVID-19 — continued with a vengeance in 2021, but last year, some of the changes put into place due to the virus became permanent, at least for now. These included relaxations of the rules regarding buprenorphine and methadone, far greater use of telemedicine and other less sanguine changes, such as to-go alcohol. In the meantime, opioid overdoses continued to go up, this time with the addition of methamphetamine and cocaine.