The Opioid Crisis: A Multidisciplinary Perspective on Effective Management - Episode 11

December 2020 CDC Health Alert Highlights and Implementation

Jeffrey Bratberg, PharmD, FAPhA, and Joshua Lynch, DO, EMT-P, FAAEM, FACEP, discuss highlights from the December 2020 CDC Health Alert and application.

Peter Salgo, MD: What are the recommendations the CDC put out, and are they being implemented? Are they mandatory? What’s the deal here, Jeffrey?

Jeffrey Bratberg, PharmD, FAPhA: This is what I said before. Everyone is a first responder, so everyone needs naloxone. My colleagues had a federal grant-funded program where you can go online, watch a training, and they will mail you naloxone. This is fantastic. Actually, in more than half the states in the country, the pharmacy-based naloxone nonprescription laws allow you to call your pharmacy, fill it, and have your insurance pay for it, and they will mail it to you.

We made these adaptations for COVID-19. This helps decrease that stigma. If an officer or off-duty officer comes to my house because my neighbor overdosed or someone is at risk in my apartment complex, they say you need naloxone, and they either drop it off or, if they do not have enough, they say you can call your pharmacy and they’ll ship it right here. Those are the things that are necessary. This report also said the majority of opioids being used illicitly are synthetic opioids, and that’s what’s killing people. There were more overdoses in the 12-month period leading into and including May 2020. There were more overdoses than ever reported, over 81,000, and the majority of those involved synthetic opioids. There is not just a rise in synthetic opioids where I live on the East Coast; it is happening in the Northeast, California, Washington, Oregon, New Mexico, Utah. In these places, the number of overdoses as a result of the misuse of synthetic opioids is still increasing.

Dr Lynch, I think, talked about making sure that naloxone gets in the hands of people after prison. I know New York has that. Rhode Island has that, and we are expanding that. Now we are expanding drug treatment for opioid use disorder treatment in prisons. Treatment is prevention as well, but we are making sure that we prescribe and dispense naloxone with people who are on pharmacotherapy for opioid use disorder. That is where that ties in with the health alert.

Peter Salgo, MD: Not only do we need—and I think the CDC said this—to be sure naloxone gets out there, but people have to understand naloxone and how to use it. For example, the half-life of naloxone may be shorter than the half-life of some of the opioids, so you may need another dose. People need to understand that. There needs to be a widespread education program. Nobody is jumping in on this.

Joshua Lynch, DO, EMT-P, FAAEM, FACEP: In regard to the public health aspect, we have also worked hard educating the public about good Samaritan laws. When naloxone is used, you still should call 911. When the police come, they are not hauling everybody away in most cases. It is still recommended that you call for emergency services after naloxone is used. We have partnered with some local health departments and put naloxone rescue boxes on walls. They are similar to what an AED [automated external defibrillator] cabinet would look like. At the site of an overdose, someone from the health department will usually come out within a couple of days with a box that has naloxone in it, some gloves, a little business card of instructions, and on the outside, instructions to call 911. We have colocated those with AED boxes, but we have also put them in odd spots such as bathrooms of certain places, public transportation, etc. There is no alarm or anything that goes off when you open the door. Somebody watches them, and when they are empty, the health department replenishes them.

Transcript edited for clarity.