{"id":5033,"date":"2015-10-28T00:00:00","date_gmt":"2015-10-28T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2015\/10\/28\/ed-at-uch-looks-to-broaden-distribution-of-overdose-antidote\/"},"modified":"2021-09-07T17:20:22","modified_gmt":"2021-09-07T23:20:22","slug":"ed-at-uch-looks-to-broaden-distribution-of-overdose-antidote","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/ed-at-uch-looks-to-broaden-distribution-of-overdose-antidote\/","title":{"rendered":"ED at UCH looks to broaden distribution of overdose antidote"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>The Emergency Department at University of Colorado Hospital is making a concerted effort to get a lifesaving drug that reverses the effects of opioid overdose into more hands.<\/p>\n<p>The drug, naloxone, is available at all UCH pharmacies and a growing number of others around the state. That\u2019s the result of a law passed last summer that gives the chief medical officer for the Colorado Department of Public Health and Environment (CDPHE) the authority to issue <a href=\"https:\/\/www.colorado.gov\/pacific\/cdphe\/naloxoneorders\" target=\"_blank\" rel=\"noopener noreferrer\">standing orders<\/a> for pharmacies and \u201charm reduction agencies\u201d to dispense the drug to those at risk of an overdose or those in a position to prevent injury or death from an overdose, such as a family member, friend, or first responder.<\/p>\n<p>The legislation emerged from a growing awareness of the toll in lives and lost productivity exacted in Colorado and around the nation by <a href=\"https:\/\/takemedsseriously.org\/the-problem\/colorado-statistics\/\" target=\"_blank\" rel=\"noopener noreferrer\">misuse of opioid painkillers<\/a>. The cost and tighter scrutiny of prescription drugs have also helped to fuel an increase in heroin use in both the state and the nation. Currently, pharmacies in nine communities in Colorado dispense naloxone; King Soopers plans to approve standing orders for its pharmacies on Nov. 11.<\/p>\n<p>At UCH, the Center for Dependency, Addiction, and Rehabilitation (CeDAR) began <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145332\/cedar20naloxone20kit.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">dispensing<\/a> naloxone <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145332\/cedar20naloxone20kit.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">kits<\/a> last year to families and loved ones of patients in recovery from opioid addiction. Staff at CeDAR give instructions in administering naloxone intranasally to a patient whose respiratory system has shut down because of a drug overdose. Naloxone restores breathing and allows the individual to recover.<\/p>\n<p>\u201cIt\u2019s an avenue to save someone\u2019s life,\u201d said Dawn O\u2019Keefe, RN, an ED nurse at UCH.<\/p>\n<p>O\u2019Keefe comes to her advocacy of naloxone through experience. Her son, now in recovery from addiction, overdosed on drugs in her family\u2019s home two years ago. When she broke a door down to reach him, O\u2019Keefe found her son unresponsive and used a naloxone injection to revive him. He\u2019s been sober for about a year, she said. \u201cI can\u2019t imagine my life if I hadn\u2019t had it.\u201d<\/p>\n<figure id=\"attachment_1809\" aria-describedby=\"caption-attachment-1809\" style=\"width: 206px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1809\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145333\/Ext_102815_Jason20Hoppe.webp\" alt=\"\" width=\"206\" height=\"268\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145333\/Ext_102815_Jason20Hoppe.webp 206w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145333\/Ext_102815_Jason20Hoppe-115x150.webp 115w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145333\/Ext_102815_Jason20Hoppe-200x260.webp 200w\" sizes=\"auto, (max-width: 206px) 100vw, 206px\" \/><figcaption id=\"caption-attachment-1809\" class=\"wp-caption-text\">Emergency Medicine physician Jason Hoppe, DO, helped to develop the protocol at UCH for assessing patients at risk of an opioid overdose.<\/figcaption><\/figure>\n<p>O\u2019Keefe said she has heard stories from individuals \u201cin all walks of life\u201d who have been faced with similar life-and-death situations with loved ones. She actively encourages people to get and learn to use naloxone, if for no other reason than to save lives. Those who miss the opportunity \u201care facing a lifetime of what ifs and lost futures,\u201d she said. \u201cThe dead addict cannot ever recover and the pain for families is forever. And as a society we will have to live with that.\u201d<\/p>\n<h2><strong>Emergency response<\/strong><\/h2>\n<p>O&#8217;Keefe recently spearheaded a new initiative naloxone initiative with inpatient pharmacists and <a href=\"https:\/\/www.uchealth.org\/provider\/jason-hoppe-do-emergency-medicine\/\" target=\"_blank\" rel=\"noopener noreferrer\">Jason Hoppe, DO<\/a>, associate professor in the University of Colorado School of Medicine\u2019s Department of Emergency Medicine.The ED at UCH now has inpatient pharmacists meet with patients who are addicted to opioids or those at risk of an overdose, such as individuals taking prescription medications for chronic pain. After completing a screening, pharmacists follow a protocol that includes discussing naloxone and demonstrating how to assemble and use the delivery system \u2013 either an intranasal or a voice-guided auto-injector kit.<\/p>\n<p>The pharmacists also explain to patients and those accompanying them the risks of overdose and the science of addiction, said Gabrielle Jacknin, PharmD, supervisor of Inpatient Pharmacy Services at UCH.<\/p>\n<p>\u201cWe talk extensively about how addiction forms,\u201d Jacknin said. She noted that opioids target the same brain hormones that help people form memories. With excessive use, the drugs \u201cdeepen the memory grooves\u201d in the brain of the pleasure the individual experienced or the stress that was relieved, she said.<\/p>\n<figure id=\"attachment_9193\" aria-describedby=\"caption-attachment-9193\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-9193\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop.webp\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop-1024x683.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2015\/10\/28140511\/Ext_102815_Dawn-OKeefe-Photoshop-200x133.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-9193\" class=\"wp-caption-text\">ED nurse Dawn O\u0092Keefe is a longtime advocate of broadening naloxone distribution.<\/figcaption><\/figure>\n<p>\u201cEven when there are negative outcomes, the body still tells the individual to use the drug,\u201d Jacknin said.<\/p>\n<p>The power of addiction helps to explain why opioid overdose is the number-one cause of unintentional death in Colorado, added Jennifer Spears, PharmD, a clinical pharmacist in the outpatient ED at UCH. Making naloxone readily available is one way to change that, said Spears, noting that the pharmacy will dispense naloxone to \u201canyone who walks to the counter,\u201d regardless of age. Spears and her colleagues will discuss naloxone with the person requesting it and walk him or her through the administration process.<\/p>\n<h2><strong>Second chance<\/strong><\/h2>\n<p>Hoppe said he hopes the ED program will boost the modest number of naloxone prescriptions written and dispensed the first half of 2015. Through June 15 of this year, ED providers wrote a total of 45 naloxone prescriptions, with just 13 dispensed. But from June 15 to Sept. 15, the ED wrote 41 more prescriptions for the drug, with 22 dispensed. Jamie Billotti, PharmD, an emergency medicine clinical pharmacist who demonstrates using the naloxone system in the ED, said she now talks with more patients and family members about the drug \u2013 perhaps three to five a week compared with three to five per month before the new approach.<\/p>\n<p>\u201cThe numbers are going up as people get more comfortable screening patients,\u201d Billotti said. She will also help to spread awareness of naloxone to the community in the near future with a trip to Arapahoe House, the largest substance abuse disorder treatment facility in Colorado.<\/p>\n<p>Pharmacists in the ED at UCH help deliver education about the dangers of overdose and how to use the OD antidote, naloxone. Left to right: Jennifer Spears, Jamie Billotti, and Gabrielle Jacknin.<\/p>\n<h2><strong>Seeking MD buy-in<\/strong><\/h2>\n<figure id=\"attachment_1810\" aria-describedby=\"caption-attachment-1810\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1810\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists.webp\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists-1024x683.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145332\/UCH20ED20Pharmacists-200x133.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1810\" class=\"wp-caption-text\">Pharmacists in the ED at UCH help deliver education about the dangers of overdose and how to use the OD antidote, naloxone. Left to right: Jennifer Spears, Jamie Billotti, and Gabrielle Jacknin.<\/figcaption><\/figure>\n<p>While the number of pharmacies stocking naloxone is increasing rapidly, physician acceptance of the medication is spotty, Hoppe said, in part because the risk posed to patients taking prescription painkiller medications is not as obvious as it is for individuals exhibiting obvious signs of IV drug abuse. Discussing naloxone could be more uncomfortable for a physician who sees a patient regularly than for an ED provider who likely will have a single encounter with a patient, Hoppe said.<\/p>\n<p>\u201cPhysicians may feel that offering patients the antidote may compromise a relationship or may not be necessary,\u201d he said.<\/p>\n<p>There are also \u201cmisconceptions\u201d nationally about the safety of naloxone among providers who believe that it may give individuals \u201ca false sense of security\u201d when they take high-risk medications, Hoppe said. He noted discomfort providers may feel with the idea of simultaneously prescribing medications for pain together with a drug designed to reverse an overdose of those same medications.<\/p>\n<p>A presentation by Ingrid Binswanger, MD, MPH, co-sponsored by CU\u2019s Division of General Internal Medicine and Kaiser Permanente, looked at the barriers among providers to assessing patients\u2019 overdose risk, offering counseling, and prescribing naloxone. In addition to practical questions about how to train people to administer Naloxone, some providers confirmed worries that prescribing naloxone gives the okay for risky behavior and that simply bringing up the question might be offensive to patients.<\/p>\n<h2><strong>Targeting misconceptions<\/strong><\/h2>\n<p>\u201cThe main concern that we try to demystify is safety,\u201d Hoppe said. He said the belief that administering naloxone increases the likelihood of a person subsequently taking a higher drug dose has been \u201crelatively debunked.\u201d Some prescribers are also concerned about their liability if an individual goes into withdrawal after receiving naloxone. Hoppe noted, however, that Colorado law <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145332\/Naloxone_Provider_FAQs.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">protects anyone who administers naloxone to another person in good faith<\/a>.<\/p>\n<p>\u201cThere isn\u2019t really an alternative,\u201d he said. \u201cAn individual with an opioid overdose revived with naloxone could go into drug withdrawal,\u201d he conceded, but without the antidote, the likelihood of injury or death from respiratory depression is great.\u201d\u00a0 Naloxone, Hoppe emphasized, is \u201cby no means a silver bullet\u201d for the problem of opioid addiction, but a stop-gap measure that \u201cgives people a second chance.\u201d<\/p>\n<p>O\u2019Keefe, who was a participant in the annual meeting of the <a href=\"http:\/\/www.corxconsortium.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Colorado Consortium for Prescription Drug Abuse Prevention<\/a> at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences Oct. 15, said overdoses too often are the result of social stigma that puts drug use in the shadows. She believes the ED\u2019s initiative is one small step toward shining a light on a deadly epidemic.<\/p>\n<p>\u201cPeople feel isolated and wonder where they can go to talk about the problem,\u201d O\u2019Keefe said. \u201cWe\u2019re saying, \u2018You\u2019re not alone in this.\u2019\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Emergency Department at University of Colorado Hospital is making a concerted effort to get a lifesaving drug that reverses the effects of opioid overdose into more hands. The drug, naloxone, is available at all UCH pharmacies and a growing number of others around the state. That\u2019s the result of a law passed last summer [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":1810,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[207,269,61,1163,63],"class_list":["post-5033","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-cedar","tag-emergency-department","tag-emergency-medical-services","tag-opioids","tag-pharmacy"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - 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