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Opioid Safety

Opioid Safety

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Opioid Safety

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Presentation Transcript

  1. Opioid Safety Phillip Coffin, MD, MIADirector of Substance Use Research San Francisco Dept. of Public Health Assistant Clinical Professor University of California San Francisco

  2. Heroin vs. Opiate Analgesic Deaths: 2010-2011

  3. Heroin-related Deaths, San Francisco, 1999-2012 *Heroin death data (left axis) compiled from San Francisco Medical Examiner Reports,, fitted to tailing fiscal year, no data for 2001-2002; Naloxone data (right axis) from DOPE Project enrollments and refills

  4. Opioid Safety Model in Clinical Care

  5. Prescribing restrictions initiated Naloxone distribution initiated

  6. California Law: AB635 Allows naloxone prescription/distribution throughout state. Protects licensed health care professionals from civil & criminal liability when they prescribe, dispense, or oversee distribution via a standing order of naloxone via an overdose prevention program or standard medical practice. Permits individuals to possess and administer naloxone in an emergency and protects these individuals from civil or criminal prosecution for practicing medicine without a license. Clarifies that licensed prescribers are encouraged to prescribe naloxone to individual patients on chronic opioid pain medications to address prescription drug overdose.

  7. Naloxone provided in SF County

  8. Naloxone Pilot in SF County Jail

  9. Patient Interviews • Feelings about opioid use after getting naloxone • “It made me think that I was playing with my life” • “I’ve probably been a little more cautious. Just being careful to take the right amount, count the hours, you know, think more cautiously about dosing” • How it feels to be offered naloxone by primary care provider • “It just reassures me that if I do have a breathing problem, that drug is there to solve the problem” • “It’s a great idea … There have been at least 1 or 2 times where I’ve been the one to go ‘oh wait, I just took a pill 20 minutes ago and I just took another – oops!’ it does happen, even to young people who aren’t fuzzy …” • “I’m kind of a suspenders and belt person when it comes to safety and backups and life preservers or whatever”