Title
Naloxone Program Expansion
Description
This report provides the Community and Cultural Investment Subcommittee an update on the proposed Naloxone program expansion plans as part of the City of Phoenix opioid response planning and development of a City of Phoenix Naloxone Program.
THIS ITEM IS FOR INFORMATION AND DISCUSSION.
Report
Summary
Phoenix is experiencing an opioid epidemic and an overdose crisis. Opioid-specific death rates in Maricopa County increased by 23.6 percent from 2012 to 2021. In 2022, there were approximately 1,828 fatal drug overdoses in Maricopa County, 71.5 percent of these involved an opioid. Of the 1,828 people who lost their lives due to overdose in Maricopa County, 991 (54.2 percent) were in Phoenix.
Phoenix Fire/EMS responded to approximately 3,869 overdose events in 2022 in which they provided naloxone rescue medication. Of these responses, only 2,337 (60.3 percent) consented to further follow up and transport to a hospital. Arizona Department of Health Services (AZDHS) reported 52,507 opioid-related hospitalizations and emergency department visits across the state in 2021. This resulted in a total cost of $2 billion for opioid-related encounters within the state, or $42,720 per encounter. For 2022, this would be just under $100 million dollars in opioid-related hospital expenses for Phoenix alone.
Substance Use Disorder (SUD) is a chronic disease that affects a person’s health, social functioning and ability to control substance use. SUD is treatable and overdose deaths can be prevented provided the right interventions and tools are available. Naloxone is an evidence-based and nationally recognized strategy to prevent opioid overdose related deaths and highlighted by the Center for Disease Control (CDC) as one of the top 10 evidence-based strategies communities can take to prevent overdoses.
Background
Naloxone, commonly known as the brand name Narcan, is a medicine that reverses an opioid overdose and can restore breathing within minutes of administration. Naloxone is what is referred to as an opioid antagonist, meaning it attaches to opioid receptors and reverses and/or blocks the effects of opioids. Naloxone has two methods of administration. One method is injectable and the other is a prepackaged nasal spray. Since Naloxone works by blocking opioid receptors in the brain, it has no effect if administered to someone without opioids in their system and cannot be abused. Naloxone lasts about 30 to 90 minutes in the body after being administered. Depending on the quantity of opioids in a person’s system, it is possible they will need more than one dose of naloxone.
People who are most likely to witness an opioid overdose include:
- People who use opioids.
- Friends and family members of people who use opioids.
- Emergency service workers, outreach workers and all whose work brings them into contact with people who are at risk of overdose.
Programs that target those most likely to witness an opioid overdose for training and distribution of Naloxone is an evidence-based, life-saving strategy identified in the One Arizona Agreement and recommended by the World Health Organization (WHO) and the CDC.
Currently, Naloxone is available at participating pharmacy locations throughout the state. However, even with insurance, the cost is about $70 per dose. Additionally, while there are community organizations distributing Naloxone within the City, there can be physical and financial barriers to access. Including Naloxone distribution routinely as part of other services will not only increase accessibility, it may also help to normalize Naloxone within the community and reduce stigma related to substance use.
In other communities and states, Naloxone is available through various municipal departments, including but not limited to libraries, parks, community centers and fire stations.
Arizona Law
Since 2015, Arizona allows doctors, nurse practitioners, emergency medical technicians and peace officers to administer Naloxone with proper training protecting them from liability, except in cases of gross negligence or neglect (Arizona Revised Statutes [A.R.S.] section 36-2228). Arizona also has a Good Samaritan law (A.R.S. section 36-661) that provides immunity from civil liability for community members who administer Naloxone to an individual in good faith.
As of July 2021, Arizona Department of Health Services (AZDHS) has standing orders for all EMS responders to receive training on administering Naloxone, as well as leave-behind pre-packaged Naloxone nasal spray when responding to substance use-related calls (A.R.S. section 36-2266). This coincides with a standing order allowing individuals to obtain Naloxone from a pharmacy without a prescription. This also enables organizations to distribute Naloxone to community members. As of 2022, every state has a similar order or law that allows individuals to obtain Naloxone without a prescription.
City of Phoenix Naloxone Program
Currently, Naloxone is only administered by City of Phoenix staff in the Fire and Police departments when responding to an overdose. Through an expanded City of Phoenix Naloxone program, the Office of Public Health will work with City departments and labor groups to set up procedures and processes, where appropriate, for emergency administration of Naloxone and the distribution of Naloxone through take-home and leave behind programs. This program will be based on the role of the department and their likelihood of working with people who use opioids.
Naloxone Administration:
Employees who regularly interact with the public will be provided an opportunity to be trained to recognize an opioid overdose and administer Naloxone in those events. Employee participation will be voluntary. Currently, the City of Phoenix Fire and Police departments practice an administration program where employees of these departments are trained to carry and administer Naloxone as a part of their duties. Many other localities, including Chicago, Ill., San Jose, Calif. and the State of Pennsylvania, have expanded their administration programs to include other departments who regularly interact with community members, such as libraries and parks departments.
Leave-Behind Program:
Leave-behind programs are specific to emergency service personnel responding to an opioid overdose. In these programs, staff leave a Naloxone kit with the person who has overdosed or with bystanders to use in the event of a future opioid overdose. EMS personnel provide brief instructions on Naloxone administration when distributing the kit. Arizona law (A.R.S. section 36-2266) permits this program type, and the AZDHS website includes sample leave-behind policies and trainings. The City of Nogales, Ariz. and some departments in Coconino County, Ariz. currently operate leave-behind programs through their Fire Departments. Other states, such as New Jersey and North Carolina, have statewide leave-behind programs.
Take-home:
Take-home Naloxone programs include the distribution of Naloxone kits to members of the community to pick up and take home. Take-home programs primarily target people who use substances, their friends and members of their family. The goal is to equip the targeted individuals with the tools and instructions to intervene in the event of an overdose. Take-home programs are operated in other communities at libraries, community centers and fire stations. They provide accessibility in places that people are already frequenting and that provide an opportunity for enhanced outreach and education. Take-home programs can also include mobile distribution to provide outreach to community members.
Naloxone Kits
Naloxone kits include intra-nasal Naloxone, instructions for administration, instructions for identifying and responding to an overdose, and community resources for substance use in a clearly labeled carrier. Many kits also include gloves and/or rescue breathing barriers. The City of Phoenix can obtain intra-nasal Naloxone at no cost through the AZDHS and would be responsible for procuring other kit materials. Public Health staff will be responsible for ordering Naloxone and distributing kits to City departments.
Next Steps
Working with City departments and the Opioid Advisory Committee, Public Health staff will:
- Finalize Naloxone program plans with internal departments including distribution locations and outreach.
- Complete the development of educational and resource materials in partnership with the Phoenix Fire Department.
- Work with the Communications Office to develop a community awareness and education campaign.
Once launched, the Public Health staff will ensure the program is monitored. Additionally, Public Health staff will submit regular reporting on the number of Naloxone kits distributed to community.
Financial Impact
The City is eligible to order intranasal Naloxone at no cost through the AZDHS. Costs associated with outreach and communication materials, such as carrying cases, will be funded through the City’s One Arizona Opioid Settlement allocation.
Concurrence/Previous Council Action
Public Health staff presented to the Community and Cultural Investment Subcommittee on March 6, 2023, and provided an update on the opioid response planning update, which included the Naloxone Program expansion.
Department
Responsible Department
This item is submitted by Assistant City Manager Lori Bays and the Office of Public Health.