Overdose Prevention:
An Overview
Before the Overdose Prevention Project was established, 64% of overdose deaths in Allegheny County involved heroin. Implemented in 2003,t he ODP Project focused its initial efforts primarily on reaching heroin users. , Prevention Point Pittsburgh began to see a decline in heroin-related overdose deaths. This decline has continued, with a significant drop since the start of the Naloxone Prescription Program in 2005.
In 2006, heroin was involved in only 16% of overdose deaths in Allegheny County. According to data available from the PA Department of Health, the reduction in heroin- related overdose deaths in Allegheny County does NOT appear to be a result of decreased heroin USE. In fact, this data indicates an INCREASE in heroin use in Allegheny County over the past 6 years.
Unfortunately, the reduction in overdose deaths involving heroin has been overshadowed by a dramatic increase in overdose death from prescription opioids. The total number of overdose deaths has continued to climb. This increase is consistent with national trends. The CDC reported an increase of 160% in overdose deaths from opioid analgesics between 1999 and 2004.
In addition, in 2005/2006 we saw a dramatic spike in overdose deaths throughout the Midwest and northeastern U.S. as a result of illegally manufactured Fentanyl.
A Community Crisis
In 2006, there were 252 overdose deaths in Allegheny County, more than the combined total of deaths from traffic accidents and homicides and more than double the 104 deaths reported in 1999.
While overdose deaths have increased, nationally, the increase in Pittsburgh has been greater than the
national average.
Between 1999–2004, overdose deaths increased by 62% nationally. In Allegheny County the increase for the same period was 97%.
Overdose deaths in Allegheny County, and throughout the U.S., have primarily involved opioids -- heroin as well as pharmaceutical opiates and synthetic opiates.
The Prevention Point Pittsburgh Response
The Overdose Prevention Project (ODP) was started in 2002 in response to the alarming increase in overdose deaths in Allegheny County. In 2003 Prevention Point facilitated establishment of an Overdose Prevention Task Force, including representatives from law enforcement, corrections, emergency medical services, drug treatment and mental health providers, medical professionals, human services, and the needle exchange program.
Studies on overdose indicate that while people who die of overdose are often found alone, they are generally NOT alone when they overdose. There is time and opportunity for others to intervene.
The ODP Project provides training on Overdose Prevention & Response to individuals at risk of drug overdose as well as to staff of agencies who work with individuals at risk and other individuals, family and friends, who might be present at the scene of an overdose and might be in a position to save someone's life.
Trainings provide practical information about
- ways to reduce the risk of overdose
- how to identify symptoms of an overdose
- what to do (and what NOT to do) if you are present when someone overdoses
Trainings are offered at
- the Oakland Needle Exchange, 3333 Forbes Avenue
- in the Allegheny County Jail
- at methadone and other treatment programs
- other community settings
Outcomes Achieved
As of May 2008, more than 6,500 individuals had participated in the Overdose Prevention & Response training, including about 4,700 inmates in the County Jail. Trainings have been extremely well received.
Nationally, the jail program is recognized as a model . Prevention Point Pittsburgh has been asked to present on this program at national conferences and the program is now being emulated in other parts of the country.
http://www.post-gazette.com/pg/05206/543249-114.stm
Pre/Post Test Evaluation indicates a 250% increase in knowledge!
More significant are the stories we have heard:
From one training attendee: “if I would have had this training a year ago, I think my daughter would be alive today.”
Another said: “ I had this training a year ago when I was in jail. Last week my girlfriend overdosed and I knew just what to do…I saved her and she is alive because of what I learned.”
Free Resources
If you are interested in scheduling a training or workshop for staff or clients of your program, or would like other information on how to participate in a training, please contact Project Coordinator Alice Bell at 412-247-3404 or abell@pppgh.org.
In addition, Prevention Point Pittsburgh offers a Naloxone Prescription Program at the Oakland Needle Exchange Site (3333 Forbes Avenue at the back of the health department) on Sundays starting at 1:30p.m. Naloxone (more commonly known by the brand name “Narcan” is a safe, effective medication that quickly reverses an opiate overdose. Naloxone is routinely administered by paramedics and in emergency room settings as well as through many harm reduction programs around throughout the U.S. and around the world. http://www.acms.org/bulletin/07Jan.pdf (see page 8)
Based on surveys at the needle exchange in Pittsburgh, individuals who have witnessed an overdose, report calling 911 only about one-third of the time. Because people often do not call 911 AND because naloxone is so safe and effective, programs have been initiated in a number of cities, counties, and states to provide naloxone on a prophylactic basis to individuals who use opiates.
This program is free of charge. All participants will receive training on Overdose Prevention & Response training and learn how to perform rescue breathing and how to administer naloxone. Individuals who use opiates and are at potential risk of opiate overdose, also will be given a prescription for naloxone AND RECEIVE NALOXONE TO TAKE HOME AT THE TIME OF THE TRAINING. Only individuals who use opiates can be prescribed naloxone, but anyone can take the training.
Successful Intervention
Between July 2005 - October 1, 2008, 400 individuals received naloxone, through this program.
These 400 individuals reported witnessing 1,848 overdoses in the course of their lives and 144 deaths from overdose. As of May 2008, we received first-hand reports of 220 successful overdose reversals using naloxone obtained through Prevention Point Pittsburgh.
An evaluation of the project conducted by Eric Hulsey, DrPh., Graduate School of Public Health, University of Pittsburgh, found no increase in drug use as a result of having naloxone. With 220 reversals among 400 individuals given naloxone, Pittsburgh has a 50% ratio of reports of naloxone use. This is an extremely high ratio compared to other programs that programs that report a 10-25% rate of use .
In 72% of the cases where 911 was not called, the reason given was fear of police involvement, anecdotally, people also reported concern about stigma associated with drug use.
Additional Community Programs
The Overdose Prevention Project is building on our success, developing strategies to make Overdose Prevention & Response education and naloxone accessible to prescription opiate users with equal effectiveness as our efforts to reach heroin users have shown.
These strategies include:
- Reducing obstacles to calling 911 through collaboration with police and the District Attorney to reduce
fear of arrest by considering policy changes similar to those implemented in New Mexico with the 911
Good Samaritan Law.
- Working with methadone clinics to facilitate prescription of naloxone to clients of their programs:
The Western Psychiatric Institute and Clinic (WPIC) methadone clinic recently began to include naloxone prescriptions as part of its orientation process.
Call 412-363-7383
Location: 6714 Kelly Street, Pittsburgh, PA 15208
Primary health care settings: The Birmingham Free Clinic is planning to begin to offer naloxone prescription to individuals who may be at risk for opiate overdose.
Location: 54 South 9th Street, Pittsburgh, PA 15203
Hours: Monday 6 -9 p.m.
Wednesday 1 -4 p.m.
Friday 2 – 5 p.m.
Saturday 10 a.m.-1 p.m.
Pain clinics and other settings where opiates are prescribed: Prevention Point Pittsburgh is seeking to develop a model similar to North Carolina’s Project Lazarus, where they plan to implement naloxone prescribing as a routine measure when opiates are prescribed. http://www.ncmedboard.org/Clients/NCBOM/Public/PublicMedia/lazarus.pdf
http://www.ncmedboard.org/Clients/NCBOM/Public/PublicMedia/slayingdragon.pdf
Click here to view downloadable PDF: Intervening Factors: Overdose Prevention Project
Click here for additional information about Overdose Prevention
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