“Staying Alive” Drug Overdose Prevention Program

1. “Staying Alive” Drug Overdose Prevention Program Baltimore City Health Department Community Risk Reduction Services Chris Serio-Chapman, Program Director

2. The Impetus for “Staying Alive” • Baltimore consistently ranked among the top 4 metropolitan areas in prevalence of heroin-related ED drug episodes from 1995 to 20021 • In 2000, opiate overdose deaths exceeded homicides in Baltimore (354 vs. 305) and continued to do so in the years leading up to the implementation of “Staying Alive”2 • Baltimore had the highest rates of heroin-related mortality in the U.S. with 15.8 cases per 100,000 in 20021 1Substance Abuse & Mental Health Services Administration, 2003 2Baltimore City Health Department, 2007

3. “Staying Alive” Program History • Designed and implemented by Baltimore City Health Department (BCHD) in April of 2004 as an intervention to decrease the overdose death rates in Baltimore • Overdose prevention programs in San Francisco and Chicago were used as models for guidance in program development

4. “Staying Alive” Program Description

5. “Staying Alive” Curriculum includes: • Recognition of opiate overdose signs and symptoms • How to respond to opiate overdose (including administration of Naloxone and rescue breathing) • Basic facts about Naloxone • Opiate overdose prevention strategies

6. Current Community Partners • Drug Treatment Centers • Walter P. Carter Treatment Center • New Hope • Glenwood Life • Man Alive • IBR-REACH • Tuerk House • Academic, Research, & Medical Institutions • Johns Hopkins University, Bloomberg School of Public Health, Dr. Susan Sherman • University of Maryland, Dr. Chris Welsh • Johns Hopkins NIDA • Johns Hopkins Bayview • Community groups & businesses • Fulton Family Support Center • Owners of various clubs on “The Block”: Club Circus, The Pussycat, Club Harem, The Jewel Box, The Oasis

7. Providing Support For Other Jurisdictions • Have been asked by several Maryland jurisdictions to provide technical support for the implementation of their overdose programs • Sharing of materials, brochures, etc.

8. Funding for “Staying Alive” • Previously funded by Baltimore City General Funds in the amount of $25,000 annually • Currently receive no ear marked funding for overdose prevention services • NEP absorbs cost of providing overdose prevention services for Baltimore City • Approximate cost annually is $100,000, which includes salary of program coordinator and program materials (approximately 1,200 kits)

9. Outcome Data for “Staying Alive” • More than 8,500 inmatesin the ACT-SAP Program (Drug Court) have been trained in overdose prevention • More than 4,000 vialsof Naloxone have been dispensed to clients after successful completion of the Staying Alive training • More than 1,200 providers have been trained at various drug treatment/medical facilities within Baltimore City • Just over 10,000 clients have been trained through BCHD’s Staying Alive Program Since the program’s inception in 2004, nearly 250 reversals of overdose have been reported!!

10. Impact of “Staying Alive” Program *Involvement of one substance does not preclude the possibility that other substances are involved as well Baltimore City Health Department, 2011

11. Expanding “Staying Alive” Within Baltimore City • Intranasal Pilot currently running at the city’s Wet Shelter • Overdose Awareness Day Baltimore is scheduled for 8/21/2013 and will be the first in Baltimore history

12. Cost ComparisonforInjectable vs. Intranasal Naloxone Kit Injectable Naloxone Kit Intranasal Naloxone Kit • TOTAL PER KIT : $41.24 - 49.24 TOTAL PER KIT : $38.20 (10cc vial) or $25.74 (1cc vials)

13. Barriers to Overdose Prevention in MD • Liability for the Physician • Lack of protection for those who administer Naloxone under the Good Samaritan Law • It is difficult to find volunteer Physicians; currently we rely on more than 200 volunteer physician hours • Refills require dispensing by a Physician. Only refills can be given within a twelve month time of the original prescription without requiring a brief training refresher class

14. Maryland Attorney General’s Advice • Current Attorney General’s Advice allows a physician to dispense Naloxone ONLY to current drug users, those new to recovery, and drug using partners • This allows for drug-using partners to administer Naloxone to one another in the event one suffers an overdose • Current Advice does not allow care-takers, friends, and family members of drug users (non-users) to receive Naloxone • An overdose prevention bill is currently under consideration in the Maryland General Assembly which would allow third party care-takers, family and friends to receive Naloxone for their loved ones who use opiates and who may suffer an overdose

15. Thank You! • Questions? • Contact information: Chris.Serio-Chapman@baltimorecity.gov 443-984-4081 (office) 410-977-6046 (cell)