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Expanding Intranasal Naloxone Availability among Emergency Medical Personnel in Oklahoma

Posted By Rachel Jantz, Friday, October 16, 2015
Updated: Friday, October 16, 2015

Unintentional poisoning has become the leading cause of injury death in Oklahoma. Of the more than 4,600 unintentional poisoning deaths from 2007-2013, 78% involved prescription drugs and 87% of those deaths involved opioid analgesics. In Oklahoma, a particular challenge to preventing opioid-related mortality is opioid use in rural areas that have long transport times from the scene to an emergency room. Some emergency medical service agencies report transport times of 45 minutes or longer; in the case of an opioid overdose, this is critical time in ensuring patient survivability. In such a scenario, the use of naloxone, an opioid antagonist that reverses the effects of opioids, can be lifesaving.

Legislation passed during the 2013 session in Oklahoma that authorized trained family members, friends, and first responders to obtain and administer naloxone. Although HB 1782 became law, few emergency medical service agencies adopted the protocol to carry naloxone (paramedics, however, were previously authorized to administer the drug). In Oklahoma, these non-paramedic-level agencies cover the majority of the rural areas of the state, and the lack of naloxone coverage represented a crucial gap in the prevention of opioid-related mortality.

To expand naloxone usage, the Oklahoma State Department of Health (OSDH) developed a training program to educate emergency medical personnel across Oklahoma about intranasal naloxone administration and to equip agencies with naloxone kits. As a CDC/CSTE Applied Epidemiology Fellow in the Injury Prevention Service at the OSDH, I had the opportunity to become involved in this important learning experience: using epidemiologic skills to evaluate a public health program and policy effectiveness involving other partner agencies to address the epidemic of prescription drug overdose.

From January to July 2015, the OSDH provided eight trainings across the state for emergency medical personnel and encouraged trainees to train others at their agency and nearby agencies. An interagency collaboration with the Oklahoma Department of Mental Health and Substance Abuse Services provided naloxone kits and training materials. As of August 31, 2015, a total of 754 emergency medical personnel representing 160 agencies have been trained on intranasal naloxone administration. The OSDH has distributed 328 doses of naloxone and 405 atomizers. Excitingly, the OSDH has received reports of 22 appropriate administrations of naloxone.

In order to evaluate the success of the program, databases were created and maintained to assess the following outcome measures:

  • Number of emergency medical personnel trained in intranasal naloxone administration;
  • Results of pre- and post-training surveys;
  • Number of emergency medical service agencies that adopt an intranasal naloxone protocol;
  • Number of emergency medical service agencies that sign an MOA and receive naloxone kits and/or atomizers;
  • Number of naloxone kits and atomizers distributed (starter and replacement);
  • Number of intranasal naloxone doses administered by emergency medical service agencies; and
  • Number of appropriate administrations or “overdose reversals.”

As a result of the trainings, the number of agencies adopting the protocol to carry and administer naloxone in Oklahoma has increased by 50%, but further efforts are needed to ensure 100% coverage of naloxone in the state. Next steps include identifying, training, and providing naloxone kits and/or atomizers to emergency medical service agencies that have not been trained on intranasal naloxone administration.

Educating emergency medical personnel about the opioid epidemic and equipping them with a tool to reverse an overdose may reduce opioid-related mortality in Oklahoma. These trainings may also increase the ownership emergency medical personnel feel for the health of their own community. Based on pre- and post-training surveys administered during naloxone trainings, support for the administration of naloxone by emergency medical personnel increased from 71% to 87%, and willingness to administer naloxone to an overdose victim increased from 77% to 91%. As noted by a first responder at a training, “I really wasn't aware of the problem and what we can do for patient care. This is another tool we can use to save lives.”

Rachel Jantz, MPH is a CDC/CSTE Applied Epidemiology Fellow for the Injury Prevention Service at the Oklahoma State Department of Health. For related CSTE discussion and projects, consider joining the Substance Abuse Subcommittee and the Injury Surveillance and Control Subcommittee. The Applied Epidemiology Fellowship application opens October 20, 2015. Apply online by January 13, 2016.

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