Prevention Point Pittsburgh-1

Case Study 1

Pittsburgh, PA
Prevention Point Pittsburgh works with local physicians and pharmacists at the the Duquesne University School of Pharmacy’s Center for Pharmacy Services to increase the accessibility to naloxone for individuals who are legitimately prescribed opioids for pain, in addition to those who may be abusing prescription pain medications.

Drug poisonings are the number one cause of accidental death among adults in the United States. Accidental drug overdoses are responsible for over 90% of poisoning deaths, largely opioid overdoses. Naloxone is an opiate antagonist used routinely in emergency medicine to reverse opiate overdose. Distribution of naloxone to lay persons at potential risk of overdose has been demonstrated to be a feasible and effective component to lowering opiate-related mortality.1, 2 However, naloxone prescription programs primarily reach injection drug users through syringe exchange and similar programs.3

Project Lazarus in Wilkes County, North Carolina pioneered the idea of making naloxone available through the regular prescription process in traditional medical settings where opioids are prescribed. Education on opioid safety and naloxone administration is provided there by the local pharmacist. Project Lazarus recently published data indicating a decrease in overdose fatalities achieved by their program in the first year of operation.4

The Overdose Prevention Project of Prevention Point Pittsburgh (PPP) is building on the successful Project Lazarus model to make naloxone and opioid safety education accessible to pain patients in Allegheny County. PPP works with local physicians and pharmacists to increase the accessibility to naloxone for individuals who are legitimately prescribed opioids for pain, in addition to those who may be abusing prescription pain medications. Making naloxone widely accessible when opioids are used may reverse the spiraling rate of poisoning fatalities in Allegheny County.

The Evolution of Community Pharmacy Collaboration

The Duquesne University School of Pharmacy recently opened a community pharmacy, The Center for Pharmacy Services (CPS), in the Hill District of Pittsburgh. The Overdose Prevention Project and CPS collaborated to develop an evolutionary model for opioid overdose prevention. The model uses pharmacists to educate patients and physicians about opioid safety and the effectiveness of prophylactic prescription of naloxone to prevent fatal overdose. It is now a routine part of opioid safety training for patients prescribed opioids for pain.

Beginning in February 2011, patients presenting at CPS with a prescription for an opioid analgesic are offered counseling on opioid safety, including potential side effects, how to take opioid pain relievers safely, possible signs of opioid over medication and/or overdose and safe disposal of unused prescription medicines. Patients are provided with opioid safety educational materials. The patient and/or caregiver also receives instruction on how to identify and effectively respond to an overdose and how to administer naloxone.

A patient who receives the opioid safety education can request a prescription for naloxone. The pharmacist facilitates this by fax, sending a simple form to the prescribing physician requesting they sign an order to prescribe naloxone along with the opioids prescribed for an emergency. This would be analogous to the prescription of an Epipen® as a preventative safety measure for individuals allergic to bee stings.

Once the physician approves the request, the prescription is filled and naloxone is dispensed. A form is then initialed by the patient indicating completion of training on opioid safety and naloxone administration. The form is faxed back to the physician for patient chart inclusion. With initial protocols in place and a handful of successful training and dispensing efforts already completed, CPS is seeking to broaden awareness of the opioid safety education and naloxone service that they offer to physicians and patients in Allegheny County. For further information, contact CPS, 412-246-0963 or PPP 412-247-3404.

References

1. Sherman SG, Gann DS, Scott G, et al. A qualitative study of overdose responses among Chicago IDUs. Harm Reduction Journal. 2008.

2. Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Society for the Study of Addiction. 2008.

3. Bennett AS, Bell A, Tomedi L, et. al. Characteristics of an overdose prevention, response, and naloxone distribution program in Pittsburgh and Allegheny County Pennsylvania. J Urban Health. 2011.
4. Albert S, Brason FW, et. al. Project Lazarus: Community-Based Overdose Prevention in Rural North Carolina. Pain Medicine. 2011.
Written by Terri Kroh, Director of the Center for Pharmacy Services and Alice Bell, Coordinator of the Overdose Prevention Project. Excerpt from the Allegheny County Overdose Prevention Coalition, Fall Issue, October 2011

 

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