Microsoft PowerPoint - Staying Alive The City of Baltimores

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     Staying Alive Program
    Overdose Prevention and
         Management
                        Serio-
                  Chris Serio-Chapman
           Chief-
    Bureau Chief-Community Risk Reduction Services
           B lti      Cit H lth D     t   t
           Baltimore City Health Department
        chris.serio-chapman@baltimorecity.gov
        chris.serio-
                     443-984-
                     443-984-4081




 Baltimore City and Drug Use
           617 000        US
Population 617,000 (2000 U.S. Census)
6% of the total population IDU (40,000)
50% of Baltimore’s homeless are
estimated to have substance abuse
addictions
2002- 2 90        i i        l d
2002-12,904 ER visits were related to
drug use
  The Catalyst for Staying Alive
 Heroin related ER visits increased 4% between
 2001-
 2001-2002
 17% increase in overdose deaths from 2001-2001-
               88%-
 2002 (340, 88%-heroin alone or in combination
 with other drugs)
                                          program
 After implementation of Staying Alive program,
 illicit drug overdose fell 12% to its lowest rate in
 5 years. (261 deaths from 300 in previous year)




            Program History

Program Goal: create a comprehensive
  community-based solution that combines
  community-
  education on overdose prevention with
  instruction on practical intervention.
  Modeled after existing programs in
  Chicago and San Francisco
            Stakeholders
 Baltimore City Health Department
 Needle Exchange Program (recruitment of
 folks from Needle Exchange van, street
 outreach as well as word of mouth)
 Baltimore City Police and Fire Departments
    i    i   f      l d
 University of Maryland
 Johns Hopkins University School of Public
 Health




          Legal Challenges
            General’s
 Attorney General s Advice
 -Liability of prescribing physician
                                 non-
 -No standing orders given to non-medical
 staff
 -Vulnerability of participant receiving
    l             i i l
 Naloxone to criminal prosecutioni
SOLUTION: Train IDUs or those new to
 recovery in pairs
          Staying Alive Program
            How does it work?
Individuals are recruited via:
  Needle Exchange Program clients at various
  sites
  Methadone Clinics/Naltrexone/Treatment Centers in
  Baltimore City
  -Powell Recovery Center
  -Glenwood Life
  -Walter P. Carter
  -Johns Hopkins ATS
  -Baltimore Behavioral Health




        Staying Alive Logistics
                              trained,
  Drug Treatment Providers trained but not
  prescribed Naloxone
  Classes are held in Community Centers for many
  organizations requesting OD prevention services
  (at least in groups of 3, but may train upwards
  of 15 at one time)
  Provide training at local family support centers in
  West Baltimore (Bon Secours)
           Program Format
 Brief participant intake
 Review of group rules
                              hands-
 Training and education, with hands-on
 experience learning rescue breathing
 Post-
 Post-test
 Medical history review
 Prescription and dispensing
 Sometimes incentives provided ($5.00 gift cards)




         Curriculum Overview

Content:
                  overdose-
 Definition of an overdose-signs and
 symptoms
 Signs and symptoms of an overdose
 Dispel street myths and remedies
 Risk factors for overdose
    -Harm Reduction techniques
      Curriculum, continued

 Overdose response
 Call 911
 Naloxone administration
 Rescue breathing

 Participants learn to make an overdose
 plan




Prescription-What Is in the Kit?
Prescription-

                      completion,
Upon successful test completion a
 participant will receive:
 3 - 5cm3 intramuscular syringes
 1 - 10ml of 0.4mg/ml Naloxone
 shield
 1 sharps container
       Volunteer Physicians

                        sites,
Currently 5 operational sites each has its
own volunteer physician
Each physician credentialed by the city
health department prior to participation
         -Liability
Review client medical history with the
client and prescribes the Naloxone




    Staying Alive Successes

More than 3700 participants/providers trained
1600 participants received Naloxone
2200 providers trained
More than 190 reversals reported
ACT-SAP Program-collaboration with Drug Court
ACT-     Program-
and the Baltimore City Jail, 4000 participants
have been trained
        Program Challenge
Overdose deaths still plague Baltimore
Need to change legislation so more people may
be trained to respond to an overdose
Update-
Update- BCHD’s Office of Epidemiology has
released its 2008 Annual Report and has found
that overdose deaths due to opiates are down
substantially in Baltimore, almost 36% from
2007 (86 less deaths).




       Acknowledgements


Dr. Susan Sherman, JHU Associate
Professor, Risk Reduction Program Advisor
                                   2004-
Nathan Fields, Project Coordinator 2004-
2008) Baltimore, MD

				
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