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Naloxone

Description

The number of unintentional overdose deaths in New York City (NYC) has increased for seven consecutive years. In 2017, there were 1,487 unintentional drug overdose deaths in NYC. Over 80% of these deaths involved an opioid, including heroin, fentanyl, and prescription pain relievers.1 As part of a comprehensive strategy to reduce overdose mortality in NYC, the NYC Department of Health and Mental Hygiene’s (DOHMH) Overdose Education and Naloxone Distribution (OEND) Program makes naloxone kits available to laypeople free-of-charge through registered Opioid Overdose Prevention Programs (OOPPs). Naloxone kits contain two doses of naloxone and educational materials. The OEND Program distributes kits to registered OOPPs, which then dispense kits to individuals via community-based trainings. In this context, distribution refers to kits shipped to programs, whereas dispensing refers to kits given to individuals. Increased NYC funding has enabled recruitment of more OOPPs including syringe exchange programs, public safety agencies, shelters, drug treatment programs, health care facilities, and other community-based programs and greater dispensing of naloxone kits to laypeople. Naloxone distribution has undergone a dramatic expansion, from 2,500 kits in 2009 to 61,706 kits in 2017.2 In 2018, DOHMH aims to distribute more than 100,000 kits to OOPPs. In order to target naloxone dispensing to neighborhoods in NYC with the highest overdose burden, we developed a tracking system able to capture individual-level geographic data about naloxone kit recipients. Prior to the development of the tracking system, DOHMH collected quarterly, aggregate-level naloxone dispensing data from OOPPs. These data included only the OOPPs™ ZIP Codes but not recipient residence. OOPP ZIP Code was used as a proxy for kits dispensed to individuals. Without individual-level geographic information, however, we could not determine whether naloxone kit dispensing reached people in neighborhoods with high overdose mortality rates. To overcome these barriers, DOHMH developed a comprehensive but flexible individual-level data collection method.

Objective: Describe the development of an individual-level tracking system for community-based naloxone dispensing as part of New York City's (NYC) comprehensive plan to reduce overdose deaths. We present data from the first year of the initiative to illustrate results of the tracking system and describe the potential impact on naloxone dispensing program.

Submitted by elamb on
Description

The opioid overdose crisis has rapidly expanded in North Carolina (NC), paralleling the epidemic across the United States. The number of opioid overdose deaths in NC has increased by nearly 40% each year since 2015.1 Critical to preventing overdose deaths is increasing access to the life-saving drug naloxone, which can reverse overdose symptoms and progression. Over 700 EMS agencies across NC respond to over 1,000,000 calls each year; naloxone administration was documented in over 15,000 calls in 2017.2 Linking EMS encounters with naloxone administration to the corresponding ED visit assists in understanding the health outcomes of these patients. However, less than 66% of NC EMS records with naloxone administration in 2017 were successfully linked to an ED visit record. This study explored methods to improve EMS and ED data linkage, using a multistage process to maximize the number of correctly linked records while avoiding false linkages.

Objective: To improve linkage between North Carolina's Emergency Medical Services (EMS) and Emergency Department (ED) data using an iterative, deterministic approach.

Submitted by elamb on
Description

Drug overdoses are now the leading cause of accidental death in the United States, with an estimated 60,000 deaths in 2016. Nationally, EMS overdose responses with naloxone administration have nearly doubled from 2012 to 2016 from 573.6 to 1004.4 per 100,000 EMS events. Resuscitation using the opioid antagonist, naloxone is recommended in cases of suspected opioid ODs, and has been increasingly used by EMS agencies, law enforcement, healthcare providers, and Good Samaritans. While naloxone can save lives, it is not clear how often its use is appropriate; delivering the right care to the right patient at the right time. It has been suggested that community paramedic programs teamed with recovery services may help link OD patients to recovery and rehabilitation services and establish mechanisms for follow-up care. Prior to implementing community EMS programs, it is important to understand the EMS utilization patterns of the OD population. I-EMS interactions may present an opportunity for behavioral intervention and linkage to services to prevent future OD and death in the opioid-using population. Accurately documenting substances involved in drug overdose deaths has been of increasing interest to Marion County and Indiana with a recent law requiring toxicology testing 5,6. This project linked individual-level data across public health information systems to assess the appropriateness of naloxone administration, the frequency of I-EMS service utilization until final death outcome among the I-EMS OD deceased cohort, and underlying causes of death among the cohort.

Objective: To characterize the appropriateness of naloxone administration, causes of death, and history of Indianapolis Emergency Medical Services (I-EMS) service utilization among the drug overdose population in Marion County, Indiana between 2011 to 2017.

Submitted by elamb on

Drug overdose claimed the lives of more than 63,000 Americans in 2016. The majority of these deaths, over 42,000, involved opioids such as heroin, prescription painkillers, and, increasingly, illicitly manufactured fentanyl. Indiana is not immune to this national crisis. In 2003, for example, only three Indiana residents died from heroin-related overdose. In 2016, the number was 296.

Submitted by ctong on