Public Health Advisory – Overdose

 

 

I wanted to bring to your attention that RIDOH sent out a public health advisory to city and town leadership, first responders, treatment and recovery professionals, and others today about a recent increase in drug overdoses.

Hospitals are required to report overdoses to RIDOH within 48 hours. We have a baseline number of overdoses that we expect each week in 11 different regions throughout the state. (Every city and town is in one of these regions.) If the number of overdoses in a week in a given region exceeds a threshold that we have set, then we send an alert to local leadership in that region. I usually don’t flag these regional alerts for reporters because they are common. They happen three or four times a month.

We also have a baseline for the state. The alert below was sent this afternoon because we exceeded the threshold we have set for the state as a whole. Through the reporting system we have developed with hospitals, we have been seeing roughly 29 overdose a week in 2018 (that number includes reports about fatal and non-fatal overdoses from hospitals). From May 21st to May 27th, there were 44 overdoses in Rhode Island. Please note that all of these were non-fatal.

We do not yet know the exact cause of this spike. However, we do know that fentanyl is driving Rhode Island’s drug overdose crisis at this point. Three important messages for the public are:

  • If someone is using heroin or other opioids, they should assume that they are also using the extremely lethal drug fentanyl.
  • Naloxone is available without a prescription at CVS, Walgreens, and other pharmacies. If someone you know is using drugs, you should have naloxone on hand.
  • If someone is using drugs, there is help available right now. If you pick up the phone and call 401-942-STOP, there will be someone on the line to help you get on the road to recovery today. No one needs to struggle alone.

Public Health Advisory – Overdose

 

 Public Health Advisory: Rhode Island Overdose Action Area Response (ROAAR)
Statewide Alert

The Rhode Island Department of Health (RIDOH) is issuing a Rhode Island Overdose Action Area Response (ROAAR) due to increases in drug overdose activity throughout the state.

For the first five months of 2018, the average number of suspected drug overdoses reported by all Rhode Island hospital emergency departments was 29 per week. From Monday, May 21st to Sunday, May 27th, 2018, RIDOH received 44 reports of suspected, non-fatal drug overdoses from hospital emergency departments. All hospitals are required to report suspected overdoses to RIDOH within 48 hours. All of these overdoses were non-fatal.

RIDOH and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) review weekly overdose data by 11 different regions, or “overdose action areas.” When the number of overdoses in an overdose action area exceeds the threshold for that area, a ROAAR alert is sent to local officials and local first responders. A weeklong threshold is also set for the state. Today’s ROAAR was prompted by an exceedance of the statewide threshold for May 21 – May 27. Although increases were seen throughout the state during this period, only two of the 11 different individual overdose action areas exceeded their thresholds: Woonsocket and the Cumberland-Lincoln-Central Falls area. RIDOH’s policy on small numbers prevents the release of specific numbers for these areas. (This small numbers policy is intended to protect patient privacy.)

Emergency responders, emergency department (ED) providers, and overdose treatment providers should be aware that in 2017, more than 63% of Rhode Island’s overdose deaths involved fentanyl. Fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. Most cases of fentanyl-related overdoses have been linked to illicitly-manufactured fentanyl.

Emergency Medical Services, Fire Departments, and Law Enforcement:

  • Promptly identify signs and symptoms of opioid overdose, including central nervous system depression (i.e., coma, lethargy, or stupor); constipation; nausea; vomiting; respiratory depression; and seizures.
  • If fentanyl is suspected, multiple doses of naloxone may be required to reverse overdose. Intramuscular injection is preferred.
  • Train your staff and use personal protective equipment to prevent occupational exposure to fentanyl and other synthetic opioids.
  • Share 401-942-STOP (7867), Rhode Island’s recovery hotline that connects individuals in crisis with treatment and recovery support.  English and Spanish-speaking counselors licensed in chemical-dependency are available 24 hours a day, 7 days a week.

 Emergency Department and Hospital Providers:

  • If fentanyl is suspected, multiple doses of naloxone may be required to reverse overdose. Intramuscular injection is preferred.
  • Screen for fentanyl in all blood and urine toxicology tests for all suspected overdose patients.
  • Dispense intranasal/intramuscular naloxone kits to emergency department patients, family members, and/or other caregivers at risk for opioid overdose.
  • Encourage overdose patients to connect with a peer recovery specialist prior to ED discharge.
  • Refer patients to the Rhode Island Centers of Excellence where Medication Assisted Treatment (MAT) options for opioid use disorder are available at outpatient programs throughout the state.
  • Share 401-942-STOP (7867), Rhode Island’s recovery hotline that connects individuals in crisis with treatment and recovery support.  English and Spanish-speaking counselors licensed in chemical-dependency are available 24 hours a day, 7 days a week.
  • Report suspected overdoses using RIDOH’s 48-hour reporting system.
  • Review RIDOH and BHDDH treatment and recovery resources.

Overdose Treatment Providers and the Rhode Island Centers of Excellence:

  • Be prepared for transition care of overdose patients to and from community resources.
  • Screen for fentanyl in all blood and urine toxicology tests for all suspected overdose patients.

 

Pharmacists:

  • Ensure naloxone is readily available for dispensing without a prescription.
  • When appropriate, educate customers of the serious health riskassociated with being prescribed opioids, including accidental overdose, coma, and/or death.
  • When appropriate, educate customers of the serious health risks associated with being co-prescribed opioids and benzodiazepines and/or other central nervous system (CNS) depressant medicines.
  • Print and share “Knowing the Risks of Taking Opioid Prescription Pain Medications” with customers who are being dispensed opioids.
  • Prescribe naloxone when appropriate, especially if customers are being co-prescribed an opioid and a benzodiazepine.

 

General Public:

  • Visit PreventOverdoseRI.org, a user-friendly website offering many resources for people who may be at risk of overdose, health care professionals who would like to learn more about treating addiction, as well as concerned family members and friends.
  • Use and share 401-942-STOP (7867), Rhode Island’s recovery hotline that connects individuals in crisis with treatment and recovery support. English and Spanish-speaking counselors licensed in chemical-dependency are available 24 hours a day, 7 days a week.
  • Carefully follow dosage instructions for opioid prescription pain medications. Opioids should only be taken as directed. Misuse and abuse of opioids can be illegal, extremely harmful, and even deadly.
  • Safely store opioid prescription pain medications in a locked container and out of reach of children – only one dose can cause an accidental overdose.
  • Get rid of medicines safely by locating a safe disposal site near you. Many locations in the state also offer opioid prescription pain medication disposal; make sure the drug disposal location accepts controlled substances. If a drug disposal site cannot be reached, the Food and Drug Administration (FDA) recommends flushing opioid prescription pain medications down the toilet.
  • Get life-saving naloxone at Rhode Island pharmacies without a prescription from a doctor. Learn how to properly use naloxone by asking your pharmacist, or watch this video.