Narcan Community Letter

Dear valued community partners, Recently, there has been a great deal of interest and questions about the local supply of Narcan (naloxone)*, the medication that can reverse opioid overdoses. This includes the April 5th Longmont Times Call article (http://www.timescall.com/longmont-local-news/ci_31785355/boulder-county-officials-surgeon-general-advisory-naloxone).

The Boulder County Managed Service Organization (MSO), administered by MHP, was given a grant in the fall of 2017 from the State Treatment Response (STR) to the Opiate Epidemic (21st Century Cures Act) to purchase and distribute Narcan kits.

In June 2015, Mental Health Partners and the MSO began distribution of Naloxone kits to local law enforcement, starting with the Boulder PD, who were the first department in the state to carry Naloxone as part of their protocols. Prescribing and providing kits to treatment and harm reduction clients had begun in the year prior. This was made possible by previous state funding and a generous donation from the Simmons Family Trust.

In the past two years, the State Attorney General’s office was also able to purchase and supply local law enforcement with Narcan kits. Most LE agencies in Boulder County received kits from this resource.

MHP maintains a deep commitment to ensuring naloxone, a life-saving medication, is as widely available to as many community agencies and law enforcement teams as possible. And, we are also faced with the realities of limited supplies and resources, as well as mandatory State Treatment Response (STR) guidelines about how to distribute the Narcan kits and to whom. The information below has been compiled to provide clarification about these topics and the full picture of the current state of Narcan distribution.

2017 Kit Distribution Facts:

In September 2017, the seven MSO’s in the state purchased 7,000 kits using funds provided by the State Treatment Response (STR) to the Opiate Epidemic (21st Century Cures Act). These kits were shared across the state to help support clients and families in treatment, discharging from Withdrawal Management programs or in Harm Reduction and other Prevention programming. Boulder County MSO, as administered by MHP, dispensed 565 kits in total, with the final kits from that allocation given out in February 2018. Breakdown of the dispensed kits:

The Works Program 162

MHP Withdrawal Management 147

MHP Longmont Adult Outpatient Services 32

MHP Teen Services 10

MHP Boulder Adult Outpatient Services 32

CU, Student Services 36

Boulder County Mountain and Park Rangers 12

Behavioral Health Group – Medication Assisted Treatment (MAT) 24

Denver Recovery Group - MAT Program 24

Options Counseling - MAT Program 18

Out Boulder, LGBTQ Community Center 6

Boulder Shelter for the Homeless 2

Behavioral Treatment Services (Boulder) 12

Behavioral Treatment Services (Longmont) 24

Behavioral Treatment Services (Boulder, 2nd site) 24

Some good news to report is that Signal, the coordinating MSO for the STR grant reviewed their ordering capacity and they were able to place a final purchase order as part of a spend-down of 2017-18 dollars, which will result in Boulder County MSO’s receiving 250 kits by the end of April 2018. However, MHP has received over 400 requests for kits from community agencies to help bridge the gap to the May 2018 grant renewal. These requests include:

Withdrawal Management 120

MHP’s Outpatient Teams 24

Boulder County Harm Reduction Program and the Works program 150

Boulder County Sheriff’s Office 100

Lafayette PD 44

Boulder PD 65

Nederland Marshall 20

Louisville PD 40

As you can see, these extra 250 kits will not meet the demand. Thus, MHP must follow the STR grant guidelines regarding the priority order of who should receive the 250 kits. According to these guidelines, persons who use opiates at risk of overdose, whom the MSO has contact with via the SUD treatment provider networks, is the first priority: The primary recipients of overdose kits are people at highest risk of overdose from opiates who touch the substance use disorder treatment system. Daily patients and other high risk early phase patients served within OTPs as well as people being discharged from withdrawal management programs who identify opiates as their primary substance of use are the highest priority. Staff should educate all clients about the availability of naloxone through over 400 pharmacies in Colorado through standing orders. All OTPs shall make it a practice of prescribing naloxone to all of their patients. These treatment facilities do not need to provide a reversal kit to patients or clients who are verified to have a reversal kit in their possession or who are able and willing to obtain one with their insurance, such as Medicaid. Every person who receives a kit shall be educated on its proper use, given information on MAT (if not in MAT), and educated about the OpiRescue application.

The next priority population are Harm Reduction programs:

The secondary recipients of overdose reversal kits are harm reduction agencies. These organizations shall ensure all recipients of an overdose reversal kit are educated on its proper use, provided passive information about the availability of MAT and offer referral to MAT when requested and educated about the OpiRescue application. These individuals will also be educated about the availability of naloxone through standing orders at over 400 pharmacies in Colorado.

Finally, law enforcement/community organizations fall in the third-priority tier:

The third target for Narcan overdose reversal kits may be other community organizations that have regular contact with people at risk of overdose. For these organizations, the goal is to provide staff with training on the use of Narcan nasal spray and to provide them with a small supply for use on site. These organizations will be required to download and use the OpiRescue application, including for the reporting of any onsite administration of the Narcan nasal spray. These organizations must also to provide referral services. Referral services for those in crisis may be made to the Rocky Mountain Crisis Partners, while non- crisis related referrals may be made to the MSO Peer Recovery Coach funded through this grant.

This means, unfortunately, there will be some requests that will go un-filled. Additionally, though the May 2018 grant renewal will make an additional 5,000 kits available, Boulder County will only receive 289 kits from this renewal, many fewer kits than they did this past year. This means that it is unlikely MHP’s resources will be able to supply law enforcement with more life-saving Narcan kits in 2018. Since the inception of local law enforcement agencies carrying Naloxone, MHP has encouraged them to include Narcan as a line item in their budgets, noting we cannot guarantee free access to these kits in the future. We also let them know that MHP reached out to the Colorado Attorney General’s office and asked if they may be able to furnish additional kits to law enforcement. We have correspondingly encouraged them to report all naloxone administrations directly through the OpiRescue website, which helps determine the number of naloxone kits needed for jurisdictions around the state. It is our hope that these efforts can help law enforcement agencies ensure they have the supply they need of Narcan moving forward.

Additionally, the general public is being advised that kits are available for them, with or without a personal prescription, thanks to the ‘standing orders’ issued by Dr. Larry Wolk, the Medical Director of CDPHE. The cost of the kits is usually covered by medical insurance, including Medicaid. Most local pharmacies carry the kits, and are providing instruction as to how they are used. The federal dollars from the STR grant are meant to offer Narcan kits to those persons who would otherwise not have access to kits, and is not meant to supplant Medicaid dollars or other private resources.

Moving forward, MHP will continue to provide as many resources, kits and information as possible to community agencies and law enforcement about naloxone/ Narcan. We continue to hope as public awareness and support for this life-saving medication grows, additional funding for kits will follow. Until then, we are working within the parameters of the resources we have been allocated.

If you have additional questions, please contact me at anoonan@mhpcolorado.org.

Sincerely,

Ann C. Noonan, MA, LPC, CAC III

Director, SUD Center of Excellence, Mental Health Partners

*Naloxone is the generic name for the medication which reverses overdose, and can be purchased in several different applications. Narcan is a trademarked named for a specific nasal unit for dispensing naloxone. The STR grant is specifically being used to purchase Narcan units, but generic naloxone in other, often less expensive dispensing versions, is also available at most pharmacies.

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