Overdose Events

Collected through the MO-HOPE Project:

Emergency Responder Overdose Field Reports: 119
(12-01-16 to 09-11-17)

  • Naloxone administered: 100
    • By EMS: 52
    • By Police: 42
    • By Fire: 5
    • By other Emergency Responder: 1
  • Doses of Naloxone administered per event:
    • 1 dose: 67
    • 2 doses: 24
    • 3+ doses: 9
  • Survival (to the best knowledge of the emergency responder):
    • Yes: 106
    • No: 12

General Public Overdose Field Reports: 27
(12-23-16 to 09-11-17)

  • Naloxone administered: 23
    • By a friend: 3
    • By a partner/spouse: 2
    • By a clinician/provider: 3
    • By another family member: 2
    • By a police officer: 2
    • By paramedic/fire/emergency responder: 8
    • By a stranger: 2
    • By someone else: 1
  • Doses of Naloxone administered per event:
    • 1 dose: 10
    • 2 doses: 10
    • 3+ doses: 2
  • Survival (to the best knowledge of the reporter):
    • Yes: 27
    • No: 0

 

Naloxone Distribution

Emergency Responders trained through MO-HOPE: 1097

(As of 08-28-17)

Participating Agencies:
* denotes that the agency has been trained but is not yet actively carrying naloxone

  • Bellefontaine Neighbors Police
  • Berkeley Fire Department
  • Berkeley Police Department
  • Columbia Police Department *
  • Eureka Police Department
  • Franklin County Sheriff’s Department
  • Kansas City Postal Inspector
  • Kirkwood Police Department
  • Marthasville Police Department
  • Miller County Sheriff Department
  • Missouri Department of Natural Resources
  • Missouri Narcotics Officer Association*
  • Missouri Probation and Parole Officers
  • Morgan County Sheriff Department
  • New Haven Police Department
  • Normandy Police Department
  • St. Charles County Ambulance District
  • St. Charles City Police Department
  • St. Charles County Police Department *
  • St. Charles County Sheriff’s Department
  • St. Louis Health Department *
  • St. Louis Metropolitan Police Department *
  • Sullivan Police Department
  • Town and Country Police Department *
  • Troy Police Department *
  • Troy Fire Department *
  • U.S. Probation and Parole Officers
  • Warrenton City Police Department
  • Warrenton Fire District
  • Washington University in St. Louis Police Department
  • Wright City Fire District

** St. Louis County Police Department, St. Charles County Police Department, Pulaski County Sheriff’s Department, and Metro West Fire Protection District implemented naloxone programs prior to MO-HOPE and are actively carrying

Treatment and Social Service Providers trained through MO-HOPE: 283

(As of 08-28-17)

Participating Agencies:

  • Better Family Life
  • Center for Life Solutions
  • COMTREA (High Ridge and Arnold locations)
  • Gateway Foundation
  • Missouri Recovery Network
  • NCADA
  • New Beginnings
  • Places for People
  • Preferred Family Healthcare/Bridgeway
  • Queen of Peace
  • Reality House
  • St. Patrick’s Center

** Missouri Network for Opiate Reform and Recovery and the MO-Safe Project implemented naloxone programs prior to MO-HOPE

Medical Providers trained through MO-HOPE: 20

(As of 6-16-2017)

Participating Agencies:

  • Family Health Center – Columbia

If you are aware of an agency or organization in Missouri carrying naloxone that is not yet listed above, please email Sarah Phillips at: mohopeproject@mimh.edu.

Other opioid-related metrics to watch in Missouri:

Opioid Use

  • Percent of People 12+ Reporting Drug Dependence (2016): 2.47%
  • Percent of Population 12+ Reporting Non-Medical Use of Pain Relievers (2016): 4.21%

**Data Source: http://opioid.amfar.org/MO

Opioid-related Deaths

  • Opioid-related Deaths (2016): 908

**Data Source: Missouri Department of Health and Senior Services

  • Opioid-related Deaths per 100,000 (2015): 9.2

**Data Source: Centers for Disease Control and Prevention, CDC WONDER Online Database.

Treatment and Prevention Services

  • Physicians Licensed to Administer Buprenorphine (2017): 351
  • Facilities Providing Substance Use Disorder Services (2017): 311

**Data Source: http://opioid.amfar.org/MO

  • Number of Pregnant Women with Opioid Use Disorder Served in Missouri Department of Health Substance Use Disorder Treatment Programs (2016): 607
  • Number of Pregnant Women with Opioid Use Disorder Served in Missouri Department of Health Substance Use Disorder Treatment Programs (2015): 522

**Data Source: Missouri Department of Mental Health

Overdose Prevention and Harm Reduction

Overdose Prevention and Harm Reduction: Just like with any behavior that carries risk, the only way to completely prevent an overdose is by not consuming any opioids, but that is not always realistic. However, we can learn specific techniques to reduce the risk of overdose (see here). These techniques are overdose prevention strategies and fall under the broad heading of a harm reduction approach to drug use.

Information provided on this site is not intended to cover everything –there are many places to find helpful information about overdose prevention and harm reduction.

For information on opioid overdose prevention and education:

To learn more specific to harm reduction philosophies and approaches, we suggest visiting the following sites:

One specific harm reduction strategy is the distribution of naloxone (an overdose reversal medication) to aid in the prevention of fatal overdoses. For information on naloxone:

For information about overdose prevention among veterans through the national VA Overdose Education and Naloxone Distribution program, please see the following: OEND Fact Sheet and OEND: Preventing and Responding to an Opioid Overdose Presentation

For Overdose Education and Naloxone Distribution (OEND) literature, visit the following sites:

 

 

Opioid Use Disorder Treatment

Medication Assisted Treatment (MAT) in combination with behavioral therapies to treat opioid use disorders helps reduce rates of illicit use and overdose by reestablishing normal brain functioning, reducing drug cravings, and preventing relapse (Kampman et al., 2015). MAT also lowers the risk of contracting infectious diseases (Tsui et al., 2014; Metzger et al., 1993).  Research supports the perspective that opioid addiction is a chronic medical disorder that can be treated effectively with medications and supportive services such as psychosocial counseling, treatment for co-occurring disorders, motivational counseling, and vocational rehabilitation (SAMHSA, 2005).

For more information on Medication Assisted treatment, visit:
SAMHSA- Medication Assisted Treatment
PCSS-MATT- Medication Assisted Treatment
Missouri Department of Mental Health – Medication Assisted Treatment
Medication-Assisted Treatment Improves Outcomes for Patients with Opioid Use Disorder

The primary medications used to treat OUD are:

*Information provided on this site is not intended to cover everything –there are many places to find helpful information about opioid use disorder treatment. To learn more, we suggest visiting the following sites:

For information on available drug treatment:

Below are links to a small subset of research conducted on opioid use disorder treatment. For a more comprehensive reference list, please see: Overdose Prevention Alliance and CTN Dissemination Library

World Health Organization: Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence

AHQR Technical Brief 28: Medication- Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings

Long term retention in Office Based Opioid Treatment with buprenorphine

Models of Integrated Patient Care through OTPs and DATA 2000 Practices

Integrated Service Delivery Models for Opioid Treatment Programs in an Era of Increasing Opioid Addiction, Health Reform, and Parity

Increasing Access to Medication Assisted Treatment for Opioid Addiction in Drug Courts and Correctional Facilities and Working Effectively with Family Courts and Child Protective Services

For training, webinars, toolkits and additional resources related to addressing opioid misuse, visit: Taking Action to Address Opioid Misuse , Reducing Substance Use Disorders, and Opioid Use, Misuse, and Overdose in Women

 

Research and Data

Providing overdose education and naloxone distribution (OEND) in various settings (i.e., emergency departments, primary care, prisons/jail, treatment facilities, community centers, etc.) has been strongly recommended by the CDC , World Health Organization , and the American Society of Addiction Medicine based on empirical evidence. This page is not intended to cover everything, but is designed to connect you with some of the research literature and data related to opioid overdose mortality and morbidity, prevention and intervention initiatives, policy impact, and more.

For a comprehensive list of research literature related to overdose prevention, visit:

For systematic reviews of Overdose Education and Naloxone Distribution Programs, Legal Research and literature on opioid overdose prevention, visit:

For publications and reports on naloxone and harm reduction, visit:

For publications and resources on drugs and drug policy, visit:

For additional information, visit the SAMHSA publications on opiates/opioids, heroin, prescription drugs, buprenorphine, methadone, and treatment, prevention and recovery

Emergency Responders

In an emergency, calling 911 is often the first reaction people have. In the instance where 911 is called in response to an opioid related overdose, it is critical that emergency responders be trained and equipped to administer naloxone. Simply put, when emergency responders have naloxone on hand, they are able to save lives.

What is naloxone?

Naloxone is a medication that quickly reverses the effects of an opioid overdose, usually within 1-3 minutes. It can be injected under the skin or into muscle or a vein. A nasal spray version of naloxone is also available. Naloxone does not have harmful side effects, get people “high,” or reverse overdoses caused by substances other than opioids.

Naloxone has been in use in the medical field for decades, but as of August 2014 it is available to all emergency responders in Missouri.

What to do when you report to the scene of an overdose:
(For complete information about respond at the scene of an overdose and administer naloxone, request a MO-HOPE Emergency Responder training *here*)

  • Assess the individual – look for signs and symptoms of an opioid/heroin overdose
  • Once you have identified that you are responding to an opioid/heroin overdose, begin rescue response (while waiting for EMS to arrive):
    1. Administer 1 dose of naloxone
    2. Administer rescue breathing (if pulse); Administer chest compressions (if no pulse)
    3. Place person in recovery position if you stop administering rescue breaths or leave the person’s side
    4. Give 2nd dose of naloxone if after 2-3 minutes the first dose was not successful* Prepare: In some cases, naloxone can precipitate withdrawals among those with physical dependence.

What to do after an overdose:

  • Remember to avoid guilt, stigma, and shame – this is not a moral issue or right vs wrong
  • Lean toward offering support, empathy, and resources for treatment rather than punishment
  • Encourage the person to seek medical treatment and care coordination at a hospital, but know they have the right to refuse this

Resources
*Information provided on this site is not intended to cover everything–there are many places to find helpful information about naloxone and overdose prevention programs. To learn more, we suggest the following sites:

*For additional information see our Resources Page or access the following links for resources for Overdose Prevention and Harm ReductionOpioid Use Disorder TreatmentResearch and Data, and Legislation and Advocacy.

An officer describes his thoughts on naloxone

 

Missouri Law Enforcement and Public Safety Officers

Law Enforcement and Public Safety departments across Missouri received an email from the Missouri Department of Public Safety regarding the MO-HOPE opioid overdose reporting system (field reports). Many of the departments have expressed similar questions and concerns, which are addressed below:

Is the overdose reporting system mandatory?

  • Although field reports are not yet mandatory, their use has been requested by the Missouri Department of Public Safety. Tracking these incidents will inform state-wide prevention and intervention efforts and allow us to most effectively support our law enforcement and first responders. As such, each police department will have different protocols regarding filling out the MO-HOPE field report.

Why did the email state that these reports must be submitted within 12 hours of the overdose event?

  • We strongly recommend entering the field report as soon as possible to avoid forgetting and to ensure accurate information regarding the overdose event. Within 12 hours is ideal, but we understand that that may not always be possible/plausible to do so, therefore personnel can still fill out the field report after 12 hours has passed.

What is being done with the data collected through the field reports?

  • The data collected through the MO-HOPE field report will help us better understand overdoses are occurring, naloxone administration patterns, and success rates of overdose reversal attempts.
  • The data will be utilized in a few ways. Primarily, the MO-HOPE project will use these numbers to ensure we are training and equipping those most likely to respond to opioid overdose events to the best of our abilities. Additionally, this information will be used to help develop future programs and obtain funding for grants. Aggregated information is available to the public on our website (under ‘Results’) to help other programs and departments gain insight to how opioid overdoses have impacted communities across Missouri, and to use that information to implement or strengthen efforts to combat the opioid crisis.

Is the field report confidential?

  • The field reports are submitted through REDCap, which is a secure database that is only accessible to the MO-HOPE evaluation team. No personal information is collected and all reports will remain confidential.

What we offer

The primary goal of the MO-HOPE Project is to create system level changes that will result in fewer opioid overdose deaths. A key component of that effort is to offer those who are at highest risk of experiencing or encountering an opioid overdose with the tools and knowledge to act.

MO-HOPE currently offers overdose education and response trainings for emergency responders and substance use treatment providers. Over the coming months, trainings will expand to other professional groups and the general public. A brief description of the emergency responder and substance use treatment provider trainings are provided below:

Overdose Response and Naloxone Training Program for Emergency Responders:

  • Opioid Overdose Background: Learn about substance use disorder and opioid overdose causes and trends
  • Opioid Overdose Recognition and Response: Learn how to correctly identify and respond to an overdose event, including how to properly administer naloxone
  • Managing Overdose Situations: Learn how to effectively and compassionately work with individuals who have just experienced or witnessed an overdose
  • MO-HOPE Evaluation: Learn how to participate in MO-HOPE evaluation protocols, including the completion of “Overdose Field Reports” when naloxone is used to reverse an overdose

*A supply of naloxone (AdaptPharma Narcan nasal spray) will be given to participating agencies for use in the field.

Overdose Education and Naloxone Distribution (OEND) Training for Substance Use Treatment Providers:

  • Opioid Overdose Background: Learn about opioid overdose causes and trends, including existing efforts to combat the opioid crisis and legislative protections for naloxone use and dispensing
  • Opioid Overdose Prevention, Recognition, and Response: Learn how to correctly identify and respond to an overdose event, including how to administer naloxone
  • OEND programming: Learn about the empirical basis for OEND programming and how to conduct OEND with your clients/patients at risk of experiencing or witnessing an overdose

*A supply of naloxone (AdaptPharma Narcan nasal spray) will be available for participating agencies and organizations if eligible. For more information on eligibility (e.g., non-profit status, presence of a facility standing order), please complete the “Request a Training” form and a MO-HOPE staff member will contact you.

Legislation and Advocacy

Missouri Legislation:

  • Statute Section 190.255.1, HB 2040, enacted August 28th, 2014.
    Relevant topics covered by this bill:
    – Distribution to first responders
    – First Responder administration immunity
  • House Bill No. 1568. Enacted August 28, 2016.
    Relevant topics covered by this bill:
    – Pharmacy availability (without a prescription)
    – Pharmacist criminal and civil immunity
    – Criminal and civil immunity for any person administering naloxone “in good faith”
    – Immunity from disciplinary action from licensing boards
    – Right to store/dispense for free if acting under a standing order from a health care professional
  • St. Louis City – Board Bill 40
    – A 911 Good Samaritan Law passed in the city of St.Louis providing limited immunity to those who call 911 for someone experiencing an overdose.
    * A statewide Good Samaritan law has not yet passed.

  • Missouri does not currently have a statewide Prescription Drug Monitoring Program (PDMP), though a municipality-level PDMP was created by St. Louis County Department of Public Health.
    – Since March, 2016, six jurisdictions ( Louis City, St. Charles County, Ste. Genevieve County, Jackson County, Kansas City, City of Independence) have adopted legislation to join County’s PDMP. Numerous other jurisdictions across Missouri are currently pursuing or considering legislation as well.
    * For more information, visit: http://www.stlouisco.com/HealthandWellness/PDMP

For additional information on laws and policies, visit: Good Samaritan Overdose Prevention Laws, Naloxone Overdose Prevention Laws, and Syringe Possession Laws

For state-specific naloxone related legislation and Good Samaritan laws, visit the Prescription Drug Abuse Policy System (PSAPS) and the Network for Public Health Law

For more information on prescription drug monitoring programs, visit SAMHSA- Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices

For legal assistance and support on overdose prevention and harm reduction, access the Network for Public Health – Drug Overdose Prevention and Harm Reduction

For more information about how to get informed and get involved:

Treatment Providers

Incorporating  overdose education and naloxone distribution (OEND) into clinical practice has been strongly recommended by the CDC , World Health Organization , and the American Society of Addiction Medicine. This page is designed to provide treatment providers with brief pieces of information and available resources to help them establish OEND within substance use, mental health, and medical settings.

After an overdose, use the first meeting as an opportunity to:
– Start the OEND conversation about use patterns and fluctuations in risk
– Acknowledge the patient’s struggle with substance use
– Discuss a harm reduction approach to drug use and recovery
– Highlight naloxone as a way to keep the patient alive to pursue treatment
– Emphasize this as standard practice; not a personal judgement
* Educate families & friends when possible – remember, if people are unresponsive due to an overdose, they will not be able to administer naloxone to themselves!

What to include in the OEND conversation:
(For complete information about how to conduct OEND with patients, request a MO-HOPE provider training *here*)

  1. Risk Factors
  • Talk with the person about what makes them at risk of experiencing an overdose- both in general and on any given day
  1. Recognize Signs
  • Explain what an overdose looks like and provide specific signs/”what to look for” (e.g, unresponsiveness, shallow breathing)
  1. Reversal Myths
  • Discuss reversal myths (e.g., injecting cocaine, placing in a bath of ice)
  • Emphasize that the only method to reverse an opioid overdose that has proven to be safe and effective is to administer naloxone.
  1. Introduce Naloxone:
  1. Rescue Response
  • Outline a specific rescue response:
    1. Administer 1 dose of naloxone
    2. Call 911 (review 911 Good Samaritan laws)
    3. Administer rescue breaths
    4. Place person in recovery position if you stop administering rescue breaths or leave the person’s side
    5. Give 2nddose of naloxone after 2-3 minutes if 1st dose is not successful
    6. Stay with the person until medical help arrives
    ( Naloxone has an effective time of 30 minutes to an hour, and after that time elapses, the individual can go back into an overdose state.)
  1. Accessibility
  • Explain how naloxone can be obtained
  • Discuss keeping naloxone readily available and how to store it appropriately
  1. Prevention Strategies Use the harm reduction approach to discuss overdose prevention
  • Use phrases like “If you choose to use…” followed by prevention strategies
    – For example: If you choose to use, always have naloxone nearby (and someone who knows how to use it)

Resources
*Information provided on this site is not intended to cover everything. There are many places to find helpful information about naloxone and overdose prevention programs.

For additional information on opioid overdose prevention and education:

  • Access the SAMHSA Opioid Overdose Toolkit
  • Access StopOverdose for additional information specific to treatment providers including talking about overdose, overdose prevention, naloxone, and treatment
  • Review the Opioid Overdose Basics including recognizing an opioid overdose, responding to an opioid overdose, and risks and prevention strategies
  • Access patient education and training materials here
  • Access the Healthcare Professional Toolbox for additional information on understanding overdose and addition, professional development, and patient education resources

For Buprenorphine Waiver- Medication-Assisted Treatment Trainings offered throughout the state of Missouri, visit here.

For clinical support (provided by the American Academy of Addiction Psychiatry in collaboration with others with support from SAMHSA) and training related to opioid use disorder, visit the Provider’s Clinical Support System

For free Continuing Medical Education courses funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), visit here

*For additional information see our Resources Page or access the following links for resources for Overdose Prevention and Harm Reduction, Opioid Use Disorder Treatment, Research and Data, and Legislation and Advocacy.