Naloxone Training (Updated 06/19/18)

Number of individuals who have attended a MO-HOPE Community Member Training: 1236

Number of individuals who have attended a MO-HOPE Train the Trainer Training: 583

Number of individuals who have attended a MO-HOPE Emergency Responder Training : 1414

Agencies Receiving Narcan Through MO-HOPE:

  • Bellefontaine Neighbors Police
  • Berkeley Police Department
  • Calverton Park Police Department
  • Columbia Police Department
  • Creve Coeur Police Department
  • Department of Social Services
  • Eureka Police Department
  • Florissant PD
  • Franklin County Sheriff’s Dept.
  • Hazelwood Fire Department
  • Kirkwood Police Department
  • Lake St. Louis PD
  • Manchester PD
  • Marthasville Police Department
  • Mid Missouri Drug Taskforce
  • Miller County SD
  • Missouri Department of Conservation
  • Missouri Gaming Commission
  • Missouri Park Rangers
  • Missouri State Highway Patrol
  • MO Probation and Parole
  • MODoT
  • Morgan County Sherrif
  • Multi-County Narcotics and Violent Crimes Enforcement Unit
  • New Haven Police Department
  • Normandy Police Department
  • Postal Inspector
  • St. Charles City Police Department
  • St. Charles County Ambulance District
  • St. Charles County Sheriff
  • St. Louis Metropolitan Police Department
  • Sullivan Police Department
  • Town and Country Police Department
  • US Probation and Parole
  • Warrenton City Police Department
  • Warrenton Fire District
  • Washington University Police Department
  • Wright City Fire Department

Number of individuals who have attended a MO-HOPE Treatment and Social Service Provider Training: 653

Agencies Receiving Naloxone Through MO-HOPE:

  • BHN Project
  • Boone County Health Department
  • Center for Life Solutions
  • Community Prevention of the Ozarks
  • Comtrea
  • Dallas County Department of Health
  • FCC Inc.
  • Freedom Center for Recovery
  • Gateway Foundation
  • Healing Action
  • Independence Center
  • Missouri Recovery Network
  • NCADA
  • Phoenix Health Programs
  • Places for People
  • Preferred Family Health
  • Queen of Peace
  • Reality House
  • Safe to Sleep
  • Southeast Missouri Behavioral Health
  • Ste. Genevieve County Health Department
  • St. Louis City Health Department
  • St. Patrick Center
  • Turning Point
  • Valley Hope

Number of individuals who have attended a MO-HOPE Medical Provider Training: 221

Agencies Receiving Naloxone Through MO-HOPE:

  • Affinia Healthcare
  • Family Health Center – Columbia
  • Piedmont Family Clinic

 

Naloxone distributed through MO-HOPE:

5062 kits of Narcan (and an additional 1,448 doses of intramuscular naloxone)

Other opioid-related metrics to watch in Missouri:

Opioid Use in 2016

  • 2.47% of people 12+ reporting drug dependence (1)
  • 4.21% of population 12+ reporting non-medical use of pain relievers (1)

Opioid-related Deaths in 2016

  • 921 Opioid-related deaths in Missouri (2)
  • 1 out of every 66 deaths in Missouri involved opioids(3)

Treatment and Prevention Services

  • Physicians Licensed to Prescribe Buprenorphine (2018)(1): 500 (315 listed online through SAMHSA’s waivered prescriber locator)
  • Facilities Providing Substance Use Disorder Services (2018)(1): 242
  • 607  pregnant women with Opioid Use Disorder were served in Missouri Department of Health Substance Use Disorder Treatment Program in 2016 (from 522 in 2015)(4).

 

References:

  1. Opioid and Health Indicators Database (http://opioid.amfar.org/MO)
  2. Hospital Industry Data Institute
  3.  DHSS – Missouri Opioids Information
  4. 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 updated systematic reviews of Overdose Education and Naloxone Distribution Programs, Legal Research and literature on opioid overdose prevention, visit Prescribe to Prevent.

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:

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*)

♦ Risk Factors:
Talk with the person about what makes them at risk of experiencing an overdose- both in general and on any given day

♦ Recognize Signs
Explain what an overdose looks like and provide specific signs/”what to look for” (e.g, unresponsiveness, shallow breathing)

♦ 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.

♦ Introduce Naloxone:
Review the basics about naloxone

♦ 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.)

♦ Accessibility
Explain how naloxone can be obtained
Discuss keeping naloxone readily available and how to store it appropriately

♦ 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 meant 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.

 

Community Members

Watching someone struggle with opioid use disorder can be hard to understand. Opioid use disorder is complicated but this 5 minute video below gives a simple but insightful explanation on pain, endorphins, opioid receptors, prescription medications, tolerance, withdrawal, risks of addiction, and recovery:


There are many ways we can help people who struggle with substance use disorders. The video below talks about one important way is to look at the way we think about people who use drugs and what biases we might have:


When someone is using heroin or prescription painkillers – or has a friend or family member using them – they are at risk of experiencing or witnessing an overdose. This can be scary, but doesn’t need to be deadly. It is important to know what makes someone at risk of an overdose, how to respond when one happens, and prevent one from happening again.

What makes someone at risk of an overdose?

While every person is different, there are some people who have a higher chance of experiencing an overdose than others. This can vary greatly over time and by circumstance.

You have a higher chance of overdosing if you have ever:

  • overdosed before
  • had a history of a substance use disorder
  • attempted suicide before
  • had problems with lung functioning (like sleep apnea or even the flu),
  • are on a high dose of opioid medications, and/or
  • have a history of major depressive disorder

Your immediate risk of overdose might be higher if you:

  • have been sober (abstinent) for a period of a few days or more (like coming out of rehab or jail),
  • you mix heroin or opioids with other “downers” like alcohol, benzos, or stronger opioids like fentanyl or carfentanil,
  • you’re using alone, or
  • you’re injecting drugs (as opposed to snorting or swallowing).

How do I know if someone is overdosing?

An overdose is different than being “really high.” Some signs and symptoms of an opioid overdose are:

  • unresponsive (won’t wake up),
  • shallow breathing or not breathing,
  • small “pinpoint” pupils,
  • grey or blue lips and fingernails, and/or
  • cold or clammy skin.

What reverses an overdose?

Many have said they’ve had success reversing an overdose through methods like packing someone in a bathtub full of ice, injecting them with milk, salt, or cocaine, or slapping and yelling at the person. In reality, none of these methods have been shown to be safe or effective. The only overdose reversal strategy that is safe and effective is using naloxone.

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, and has become increasingly available to emergency responders and “layperson” (as in, community members who use drugs or may witness an overdose outside of a medical setting). To learn more about naloxone, click here.

Who should have naloxone? 

Anyone at risk of witnessing or experiencing an overdose should have naloxone on hand – especially people who use drugs, their family members, and associates. Think of it like a fire extinguisher. We have them on hand, but hope that we never have to use them. To learn how and where to get naloxone, click here.

What to do if someone overdoses:

  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.)

How long does it take for naloxone to take effect? 

Anywhere from 30 seconds to 5 minutes, depending on the route of administration and the amount of opioids in someone’s system.


Relapse, and possibly overdoses, are often a part of recovery for many people with substance use disorder. This video, from the Phoenix Recovery Home in Chicago, talks about how they teach their residents that is important to support and help each other and how to save someone who is having an overdose:


How can I prevent an overdose from happening in the future?

Just like with any behavior that carries risk, the only way to completely prevent an overdose is by not using any opioids. However, that is not always realistic. If you or your family member does choose to use, it’s best to practice harm reduction strategies like not using alone, not injecting, “tasting your shot” if you do inject (use just a small amount at first to see how strong it is), avoid really strong opioids like fentanyl and carfentanil, don’t combine opioids with other “downers” like alcohol or benzos, and, importantly, if you’ve gone a few days since you last used, always start at a smaller dose than what you’re used to.

Is naloxone all that’s needed to get over an opioid use disorder?

No. Naloxone is not treatment (and neither is detox). If you’re interested in learning more about treatment for opioid use, visit here.

Fentanyl

Recently, articles about fentanyl (a powerful, man-made opioid that can be used to “cut” heroin or in counterfeit prescription pills) have flooded social media sites and the news. Since fentanyl is stronger than heroin and hard to detect, death rates involving fentanyl have continued to increase. Fentanyl overdoses occur much faster than heroin overdoses and may require more naloxone to reverse. To learn more about fentanyl, visit our FAQ page here.

Resources

Interested in connecting with other people who use drugs and their families? Check out some of these resources:

For specific information on opioid overdose, including recognizing and opioid overdose, responding to an opioid overdose, and risks and prevention strategies, visit here.