International Overdose Awareness Day News and Opinion Roundup

As we mark International Overdose Awareness Day today, there is more attention than ever to the subject and a number of excellent articles online. Here's a quick rundown of some of them:

The amazing New York City organization VOCAL is campaigning for the NY Police Department to   support New York's recent 911 Good Samaritan law by training officers and conducting community outreach. The law, which goes into effect on September 18, will provide protection against arrest or prosecution for illegal drug possession (including alcohol possession for minors) for people who call an ambulance in response to an overdose. Do you live in NYC? You can support VOCAL's campaign here.

The Drug Policy Alliance (DPA) is pushing a similar 911 Good Samaritan bill in California, and has published an open letter to Governor Jerry Brown today. More information on DPA's work on overdose can be found here, including ways to get involved.

OPA editor Roxanne Saucier has an article on the Open Society Foundation's website on the "I'm the Evidence: Naloxone Works" video campaign organized by the Eurasian Harm Reduction Network and the Harm Reduction Coalition. Join the campaign's Facebook page here and have a look at OPA's explanation of how to contribute your own videos.

Music executive and DPA board member Jason Flom has a good op-ed in today's New York Post reflecting on overdose and the music industry. Have a look here. 

The drugs, addiction and recovery magazine The Fix has a story on International Overdose Awareness Day, including links to events happening around the world.

Shawn Norton has a moving story about struggling with her daughter's overdose death and how she came to be involved in overdose prevention advocacy.

What did we miss? Please send OPA more news or your own thoughts on International Overdose Awareness Day and we'll be happy to post them.

At your service: Overdose Q&A from the Thai national overdose training

The Thai AIDS Treatment Action Group (TTAG) recently organized a national overdose training for harm reduction groups in Thailand. Participants raised a number of questions about overdose, some of which were passed on to me by TTAG’s Karyn Kaplan. We thought it made for a nice Q&A, and so we share the results below.  ---Matt Curtis

Karyn Kaplan: There was definitely confusion about the role of CPR in a heroin OD, or a poly-drug OD. They got the breathing-is-essential thing, but does one STOP the breathing to administer CPR and when? Or, never with heroin OD, just do rescue breathing?

Matt and Karyn on the Chao Phraya River in Bangkok

Matt Curtis: The point is that you don't want to do chest compressions on someone who's heart is still doing its job, which will be the case in most heroin/opioid or benzo overdoses. Opioids don't cause the heart to stop; in this case an extended period of oxygen deprivation causes the heart to stop, at which point chest compressions are indicated, but probably not going to help much.

In treating an opioid OD, it's best to focus on airway management, breathing, and naloxone, and even better to do all that plus get the person professional medical attention. I’d say it’s also especially important to focus in on this point in our OD prevention work, like when delivering a short (e.g. 5-10 min) training in a harm reduction setting. If there's time, it's always appropriate to teach people to check the ulnar (wrist) and jugular (neck) pulse, but again I'd stress oxygen always + naloxone if available.

Also, a small nomenclature issue: CPR = rescue breathing + chest compressions, which isn't really the normal recommended standard of care for any situation anymore – see for example the American Heart Association guidelines on rapid chest compression for heart failure, which the Harm Reduction Coalition has nicely summarized specifically in relation to overdose.  

KK: Once naloxone wears off, can you OD again from any residual heroin? There was this question about heroin still being in your body.

MC: Yes. Heroin continues to be metabolized while naloxone is active, but naloxone does not remove heroin from the body. This is why people will generally stop feeling dopesick and potentially high again as naloxone starts wearing off after 30 minutes or so. Although there is risk of OD’ing again after naloxone is administered – and certainly a much greater risk of OD if people use again soon after being revived – in practice this seems to be very rare.

A typical example is from a 2006 paper published out of the Chicago Recovery Alliance overdose project. Among 319 documented overdose reversals with naloxone there were NO cases of re-treatment being needed after the initial dose of naloxone wore off.  And for that matter, there were only five cases where more than one dose of naloxone was needed, two cases of non-withdrawal complications (1 vomiting, 1 seizure), and only one death. Other studies, including ones that have looked for deaths after people were discharged from hospital emergency departments after treatment for heroin overdose, have confirmed the Chicago findings.

All that said, it’s important to promote aftercare, because the risk of going back into OD is real, because there can be other complications of nonfatal overdose, and because it’s just good to take care of people.

Another place for Discussing OD Issues

While not new they have some unique videos there...

Issues In Injecting Drug Use
A BLOG for people implementing projects for people who use drugs

http://issuesinidu.blogspot.com/2010/01/take-home-naloxone.html

or by joining https://psi-org.socialcast.com/groups/injectingdrugusers

Pubmed August 2011 Update

Two notable papers in this report:

1) Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania
Bennett AS, Bell A, Tomedi L, Hulsey EG, Kral AH
J Urban Health. 2011 Jul 20 [Epub]Comments: A substantial contribution to the growing literature evaluating naloxone programs, this paper is a must-read for anyone interested in opioid overdose prevention.

2) Drug overdose deaths --- Florida, 2003-2009
Centers for Disease Control and Prevention
MMWR Morb Mortal Wkly Rep. 2011 Jul 8; 60(26):869-72Comments: Again, oxycodone has arisen as a major source of overdose mortality. The use characteristics that lead to mortality, however, remain unexplained.

Another Great place for Naloxone and Wisdom About it!

Deported migrants struggle to survive in Tijuana

People deported from the U.S. often end up taking refuge in the gritty Tijuana River canals.

In this photo taken June 22, 2011, one man injects a saline solution into another man who is believed to have overdosed on heroin, in hopes of reviving him, in Tijuana, Mexico. The two men live in the Tijuana River canals where many of the people deported from the U.S. end up taking refuge. With no where else to go, the deportees live among drug addicts or people with mental health problems. Emergency medical services came for the man who is believed to have overdosed, but it is unclear if he survived. (AP Photo/Alejandro Cossio).

http://news.yahoo.com/photos/deported-migrants-struggle-to-survive-in-tijuana-1312588328-slideshow/photo-taken-june-22-2011-one-man-injects-photo-043527688.html

Program report: Training family members and loved ones to respond with naloxone

By Stephen Malloy

As you’ve read on this blog, programs that train drug users to respond to opiate overdose with naloxone are expanding across the globe. An important intervention that’s often overlooked, however, is training family members and “carers” - friends, housemates, and loved ones - of drug users to use naloxone. A program in the UK is doing just that, as Stephen Malloy reports:

In July 2009 the National Treatment Agency (NTA) supported a 16 site pilot project, entitled “overdose prevention and naloxone training for families and carers.” The pilot sites, which were spread across England, recruited and trained family members/carers of people at risk of opiate-related overdose death in overdose prevention; signs and symptoms of overdose; and naloxone administration and basic life support techniques. The family member/carer was also supplied with naloxone IF the person at risk of overdose was available to give written or oral consent for the supply to be made.

A new report shows that 495 family members/carers were trained, and at the time of its writing 20 lives had been saved thanks to naloxone use (18) and basic life support (2). These results demonstrate the need a wider circle of family/carers to be engaged around overdose prevention and crucially, be supplied with naloxone.

Global Fund Reaffirms Support for Overdose Prevention

In its latest Harm Reduction Information Note (pdf), which provides guidance for grant applicants, the Global Fund to Fight AIDS, Tuberculosis and Malaria continues to encourage national HIV programs to include overdose prevention activities as part of a basic set of HIV services for people who use drugs.  

The Global Fund has been supporting overdose education and naloxone for several years, initially in Russia and later in Tajikistan, Kyrgyzstan, Thailand and elsewhere. The Fund first explicitly called on applicants to implement overdose programs in its Round 10 funding guidance in 2010. As the new Round 11 guidance states:

"[O]verdose prevention should be a core component of “targeted information, education and communication” for people who use drugs. Overdose is a major cause of mortality and morbidity among people who use drugs, impacting directly on HIV-related harm reduction services. Therefore, applicants are strongly encouraged to consider interventions such as peer and staff training in overdose prevention. In addition, applicants should also consider the strengthening of overdose responses – including legislative and policy reform where needed, and the low-threshold provision of naloxone (a WHO Essential Medicine that can reverse opioid overdoses) to communities of people who use drugs as well as through emergency health services. These low-cost approaches can empower health care workers and people who use drugs to save lives."

Created in 2002, the Global Fund is a public-private financing body that has devoted more than $21 billion to controlling HIV, TB and Malaria in 150 low- and middle-income countries.  Russian, French and Spanish versions of the Round 11 Information Note will be available soon and posted here.

New York Law Protects People from Criminal Prosecution When Reporting an Overdose

Great news today from the State of New York, where Governor Andrew Cuomo has signed legislation to protect people who call emergency services to report an overdose from arrest or prosecution for drug possession. As State Senator John DeFrancisco said when passing the legislation last month:

"The primary reason people do not call 911 or go to the hospital for an overdose is fear of prosecution. This bill doesn't condone drug use, but rather, acknowledges the importance of helping a victim and spurring a response from witnesses that may help protect the well-being of another person."

More background on the law can be found here, and the complete text of the legislation is available on the NYS Senate website.

Just Another Life Saved...

The Chicago Recovery Alliance has been assisting opiate overdose prevention with naloxone training and distribution since 1996 through our harm reduction outreach in Chicago. Through June of 2011 we have received 2,601 reports of peer opiate-involved overdose reversal. What follows is a first hand account of one of those reversals as written up by a CRA participant in early July 2011.

Anonymous Report from Chicago July 4, 2011

I had been drifting away from my heroin addiction along with my partner, for most of 2011. While neither of us made the commitment to permanently abstain, there were several reasons to back things down, not the least of which was the level of financial support we could give our children. Either way, we were well underway in reducing dose and frequency. We used the mix it all up and boil it down to a desired level such as 100ml in order to create a uniform purity and allow a predictable decreasing dependency. Our support of each other is the backbone of this approach and we were doing very well...bills were easier to pay and the worry of financial hardship became rarer and rarer...Until a reason to celebrate came...

How to Create Videos for “I’m the Evidence: Naloxone Works”

By Erin Russell

I am writing to follow up on the recent I’m the Evidence, Naloxone Works post. I’m the Evidence is a global overdose awareness campaign, which speaks about the life saving power of naloxone through video advocacy.  Please visit the website for the campaign if you have not already, and use these instructions to quickly and easily record and contribute your own videos!

My name is Erin Russell and I have been managing the campaign through the Harm Reduction Coalition in New York City.  Although I have not exhausted the stories available in New York, we want to obtain more stories from other parts of the state, country, and world.  This is why I would like to share how easy it is to make your own Evidence video!  It has never taken me more than ten minutes to record a story, typically 1-2 minutes long, and all I have is a simple flip camera that fits in my pocket.  Even cell phones record good quality video these days, and almost everyone has one!

Join Us in Exploring How Laws and Policies Can be Used to Address the Opioid Overdose Epidemic

By Leo Beletsky

Leo Beletsky is a lawyer and a longtime advocate for overdose prevention programs, and is currently with the Division of Global Public Health at the University of California, San Diego School of Medicine. This is the first in a series of articles on overdose law and policy that Leo will be spearheading here at OPA.

As others have pointed out on this blog, there is a growing recognition of the toll that overdose is taking on families and communities in the United States and around the globe. As the issue has started to become too large to ignore, governments' knee-jerk response has always harkened back to the same old “supply reduction” policy strategies, such as closing down clandestine labs, going after rogue doctors and ‘pill-mills,’ creating barriers to drug diversion from the pharmaceutical supply chains, and interrupting drug trafficking routes from abroad.

This approach is the cornerstone of the White House ONDCP Prescription Drug Abuse Prevention Plan published earlier this year.  Although “demand reduction” approaches such as public education about overdose risks figure among the report’s recommendations, the document does little to acknowledge that many of these well-worn promises of ever-stricter enforcement and requirements for educational outreach have continued to fail.  Even in the best-case scenario, many of the solutions offered by the White House would take years to implement and even longer to evaluate to determine their effectiveness.  

Getting naloxone into the hands of people who use drugs in Thailand

by Karyn Kaplan, Thai AIDS Treatment Action Group (TTAG)

“Is it legal?” “What if you inject it in a vein?” “Does it work on a benzo OD?” ”Can you buy it in a pharmacy?” “Does it lead to more drug use?”

These were some of the many questions about naloxone posed by 40 harm reduction project staff and people who inject drugs (PWID) from 14 drop-in centers and NGOs across Thailand, at our first National Overdose Prevention and Management TOT in Bangkok (July 13-14, 2011). We had just distributed over 800 doses to the participants, along w/3mL syringes and 24G/1” needles. Most of them had never seen, let alone heard of, this miraculous drug.

Thailand, despite having roughly 50% IDU HIV prevalence for the past 20 years (HCV prevalence is even higher), does not embrace harm reduction, has no official policy to support it, and has just started “piloting” evidence-based HIV prevention interventions for PWID with Round 8 Global Fund money. Given that Thailand has known only violent government-endorsed drug crackdowns and stigmatizing anti-drug campaigns, it is no wonder our trainees were concerned about being seen as “promoting drug use” or being arrested for implementing a pioneering intervention that promotes the health and rights of people who use drugs.

How parents can stop an overdose: Scenes from 'Vanguard'

This is a short video based on the very impressive Massachusetts naloxone distribution program.

"I'm the Evidence" Campaign Collects Personal Testimony on Naloxone

This summer the Eurasian Harm Reduction Network and the Harm Reduction Coalition launched a campaign called "I'm the Evidence. Naloxone Works" in order to collect video and testimony from people who have used naloxone to rescue people from overdose, or survived overdose themselves with the help of the medication. A great example from the campaign from Louie Jones, one of the founders of VOCAL, the New York drug users union, is embedded below.

Got a story to tell or otherwise want to get involved? Contact Dasha Ocheret, who runs the campaign for EHRN (and who's an editor here at OPA), at dasha.ocheret@gmail.com.  Dasha explains the campaign further here. You can also join the I'm the Evidence Facebook group or subscribe to the campaign's Youtube page.

Introducing the Overdose Prevention Alliance

Drug overdose is increasingly getting the attention it deserves.  People who use drugs and others working in harm reduction have long known that overdose is a major health concern and have been on the vanguard of taking positive steps to deal with it. As support has grown over the past two decades for action on drug user health and human rights, medicine, public health, and government policies are finally starting to catch up with an urgent problem that kills or injures thousands in our communities.

There’s been great progress already. Overdose prevention programs have now offered training and naloxone to tens of thousands of people and sharply reduced overdose mortality in a number of cities. Safe injection facilities in several countries have been proven to reduce overdose deaths. And innovative work to stop overdose is being done by harm reduction groups in dozens of countries, from the USA to Russia, China to Germany, Great Britain, Ukraine, Vietnam, Tajikistan and many others.

Amid this progress, we see a need for a central source of information and discussion on all aspects of drug overdose, which is what we hope, over time, the Overdose Prevention Alliance (OPA) becomes. Our goals are to collect and document major issues in overdose worldwide, to encourage overdose prevention initiatives, and to promote good practice from a harm reduction perspective, disseminate new research findings, and correct misinformation. In order to tackle all this, we’ll have several recurring series of articles:

·    Project Reports that offer good ideas, experience, and evaluation from existing overdose programs

·    Policy and legal analysis that keeps track of what governments and international organizations are doing and where the money’s going

·    Opinion pieces exploring major issues in the field and personal experience that cuts to the heart of why we do this work

·    Research Briefs that present findings from public health and other research in terms that will be useful for everyone working on the issue

·    Toolkit posts that will direct readers toward the best practical tools for starting, managing, and evaluating overdose programs

·    and News on all the latest developments related to overdose prevention.

To kick things off, we have an article on overdose prevention projects in China, an analysis of recent CDC and media hype about use of mephedrone and MDPV marketed as “bath salts,” a reminder of why rescue breathing training is crucial for overdose response, reviews of recent research, and some fresh news from Wales.  There’s much more to come, so for now please have a look, let us know what you think, and spread the word about the site.

Most importantly, we ask you to help shape OPA into something that will help all of us who work on the issue to better understand overdose and to take steps to save lives.  We’ve assembled a team of editors to guide the site and make sure that the content is consistent, and we strongly encourage you to submit original writing, news, or anything else you feel is important. Please contact us at ODPreventionAlliance@gmail.com to talk about contributing.

With thanks, the OPA editing team,

Dan Bigg, Phillip Coffin, Luciano Colonna, Matt Curtis, Nabarun Dasgupta, Dasha Ocheret, and Roxanne Saucier