Health Dept. issues Naloxone order for pharmacies
Allegheny County Health Department Director Dr. Karen Hacker has issued a countywide standing order for naloxone, or Narcan. The standing order allows any licensed pharmacy in the county, which chooses to participate, to dispense naloxone to individuals at risk of a heroin or opioid-related overdose, or those who may witness one.
“Heroin and opioid-related use, overdoses and fatalities are on the rise nationally, and Allegheny County is no exception. This is a public health crisis that we must work cooperatively to address,” said Dr. Hacker. “Act 139 has given us additional tools to do that, and issuing a standing order for naloxone will allow individuals throughout the County to have access to what can be a life-saving antidote. Ultimately, our goal is to ensure that those who are struggling with addiction receive the treatment and recovery supports they need to live a healthy and productive life.”
Act 139 of 2014 allows first responders, including law enforcement, firefighters, EMS and other organizations, the ability to administer naloxone, an opioid reversal medication, to individuals experiencing an opioid overdose. The law also allows individuals such as friends or family members that may be in a position to assist a person at risk of experiencing an opioid-related overdose to obtain a naloxone prescription. Act 139 provides immunity from prosecution for those responding to and reporting overdoses.
The signs and symptoms of an opioid overdose include a history of current narcotic or opioid use of fentanyl patches on skin or a needle in the body; unresponsiveness or unconsciousness; not breathing or slow/shallow respirations; snoring or gurgling sound (due to partial upper airway obstruction); blue lips and/or nail beds; pinpoint pupils; and clammy skin. Individuals in cardiac arrest from all causes may share many symptoms with someone with a narcotic overdose. If there is no pulse, the person is in cardiac arrest and requires Cardio-Pulmonary Resuscitation (CPR).
Naloxone is a medication that can reverse an overdose that is caused by an opioid drug (prescription pain medication or heroin). When administered, the naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes. It is not a narcotic, and is not addictive. It can be administered in three ways: intra-nasally, automatic injection and manual injection.
Dr. Hacker’s standing order will apply to intranasal and automatic injection administration, and will allow pharmacies operating under that order to dispense take-home naloxone rescue kits: “These types of administration of naloxone are easy to administer and safe, which is why they are covered by this standing order. This is an evidence-based harm reduction strategy that will save lives.”
For those pharmacies which choose to dispense under Dr. Hacker’s order, an informational pamphlet will be provided for distribution to the recipient of the rescue kit. The pamphlet, which can also be found on the Health Department’s website also refers patients and caregivers to additional online resources, including videos, at http://www.prescribetoprevent.org. Caregivers should take advantage of the available online training.
The registered pharmacist is also required to provide instructions to the recipient of the rescue kit including:
· Call 9-1-1 for EMS to be dispatched immediately.
· In cardiac arrest or pulseless patients, start cardio-pulmonary resuscitation (CPR). Any attempt to administer naloxone should not interrupt chest compressions and rescue breathing.
• Naloxone should only be given to someone suspected of opioid overdose.
• In respiratory arrest or a non-breathing patient, start rescue breathing. Rescue breathing takes priority over naloxone administration. Administer naloxone if possible while doing rescue breathing.
• Individuals should become familiar with assembly and administration of naloxone prior to the need to use it.
It is vitally important that a person who receives naloxone receive medical treatment following administration. The duration or effect of naloxone is 30 to 90 minutes, and patients should be observed after this time frame for the return of overdose symptoms. More than one dose of naloxone may be needed to revive someone who is overdosing. Most rescue kits contain two doses in the event such a step is necessary.
When given to individuals who are not experiencing an opioid-related overdose, naloxone provides no negative effects, even at high doses. Recipients should also make certain to be aware of the expiration date on the naloxone.
To make sure that the antidote lasts as long as possible naloxone should be kept in a dark and dry place between 25º C/80º F and 5º C/40º F.
A Friends and Family Guidance Toolkit is also available on the Pennsylvania Department of Drug and Alcohol Programs’ website. According to the site, 17 pharmacies in Allegheny County currently carry naloxone, but most would require a prescription. Pharmacies that utilize Dr. Hacker’s standing order will be listed on the Health Department’s website, and the information will also be shared with the state.
Members of the public are encouraged to inquire at their local pharmacy, or to call Prevention Point Pittsburgh at 412-247-3404, for information about locations where naloxone is available and how to get it.
“Deaths due to opioid overdose have grown to an epidemic proportion since 2010 in Allegheny County,” said Michael Zemaitis, R.Ph. PhD, a pharmacist and professor at the University of Pittsburgh School of Pharmacy. “The establishment of a standing naloxone order for county pharmacists is an important tool to make this life-saving medication available to at-risk patients and concerned parents and caregivers. Having naloxone readily available at pharmacies in the county will save lives.”
Dr. Hacker’s standing order will be made available upon request to interested pharmacists. Participating pharmacists are required to have the order signed by the pharmacy manager, must keep a signed copy of the order on the pharmacy premises, and must return a signed copy to the Health Department for tracking purposes. Pharmacies may contact Nancy Carraciolo, the Health Department’s Pharmacist, by phone at 412-687-ACHD (2243), or e-mail at email@example.com with questions, for more information, or to receive the standing order.
“We have been on the front lines of this epidemic for years,” said Prevention Point Pittsburgh’s Alice Bell. “The access that emergency personnel have to this drug is critical, but bystanders have a role to play as well. With education, support and access to naloxone, we can help them be ready.”
In addition to participating pharmacies, a limited supply of intranasal naloxone will be available for purchase at the cost of $50 at the Health Department’s Immunization Clinic, located on the third floor of 3441 Forbes Avenue in Oakland. Each kit will contain two doses. Insurance is not accepted at the clinic, but recipients will receive a receipt for payment which can be submitted with a claim to their carrier.
Many insurance companies do cover naloxone, but insureds should inquire with their provider directly.
The immunization clinic hours are Monday, Tuesday, Thursday and Friday from 9 a.m. to 4 p.m. and Wednesday from 1 to 8 p.m. Individuals are eligible to purchase a rescue kit if they are an opioid user or family member or friend that may be in a position to assist a person at risk of experiencing an opioid-related overdose.
Data provided by the Allegheny County Medical Examiner’s office reflects that there were 299 overdose deaths in Allegheny County in 2014. Of those, sixty percent of the individuals had heroin in their system. More data on overdoses may be found online at http://www.overdosefreepa.pitt.edu. The site also provides information and resources for overdose prevention.
Publicly funded substance abuse management services and supports are provided through the Allegheny County Department of Human Services’ Office of Behavioral Health Bureau of Drug and Alcohol Services. Those seeking non-emergency drug and alcohol services may call the Bureau, Monday through Friday, from 8:30 a.m. to 4:30 p.m. at 412-350-3328. Individuals experiencing a substance use related emergency should immediately call 9-1-1 for assistance.