URI pharmacy professors play key role in state effort to prevent narcotic overdoses

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Work makes R.I. a national leader


KINGSTON, R.I. – October 1, 2014 – Rhode Island has one of the highest opioid overdose rates in the country, but the University of Rhode Island’s College of Pharmacy is playing a key role in helping to reverse that trend.


Clinical Professor of Pharmacy Jeffrey Bratberg and Associate Clinical Professor of Pharmacy Kelly Orr have led efforts to make an anti-overdose drug more accessible to Rhode Islanders.


Until 2013, naloxone, also known as Narcan, was only in the hands of emergency medical professionals in Rhode Island and participants in a community-based effort called PONI (Preventing Overdose through Naloxone Intervention) — a pilot effort to train people at needle-exchange sites, drug-abuse treatment centers and homeless shelters in the use of naloxone.


But that changed after Attleboro, Mass. resident Bratberg and Orr collaborated with health professionals and government officials to create a statewide agreement that makes naloxone available without a prescription at Rhode Island pharmacies. Orr, as chair of the Rhode Island Board of Pharmacy, was instrumental in having the requirement for individual prescriptions for naloxone waived, Bratberg said.


Because of optimal collaboration, “We have the greatest pharmacy-based access to naloxone here in Rhode Island,” the pharmacy professor said.


Bratberg, who has earned a national reputation as an expert promoting the widespread distribution of Narcan, was in a strong position to advocate for an improved response in Rhode Island.


Because Rhode Island is one of several states with an overdose epidemic – a death rate of 17 per 100,000 people – health officials have focused attention on how to make the emergency drug naloxone easily available to the public, especially family and friends of people at risk for addiction.


When breathing has nearly stopped from overdoses of painkillers or heroin, naloxone kicks the opioid off the brain’s receptors and clings to them, preventing any other substance from reaching the nervous system, Bratberg said. Breathing and consciousness are temporarily restored.


Bratberg was an early proponent of pharmacy distribution of naloxone. Walgreens agreed to Bratberg’s proposal to train 10 of its pharmacists at four pilot locations in December 2012, who then trained other pharmacists in the retail chain.


Bratberg’s former student Tara Thomas, now a retail pharmacist in Rhode Island, created the digital slides used in the training sessions. The training materials are still in use in continuing education programs run by the College of Pharmacy.


“We are teaching pharmacists how to recognize the symptoms of addiction and assist in the treatment and management of opiate addiction,” Bratberg said. “A pharmacist who fills a prescription for a pain medication like oxycodone can consider if the dosage is at a threshold for concern, counsel the patient that he is receiving a dose that has potential for overdose and recommend naloxone as a safety measure.”


The state’s collaboration agreement formalizes a process in which a doctor makes a diagnosis, supervises patient care, and refers patients to a pharmacist under strict protocols, which allow the pharmacist to perform specific patient care functions, such as medication management. With Narcan, a physician authorizes the dispensing of kits from multiple pharmacies to anyone who may encounter an overdose victim.


“Narcan is like a fire extinguisher, in that it treats a very serious condition quickly, but only if you have it and know how to use it. But it doesn’t end there in Rhode Island,” Bratberg said.


“Training is being delivered to all kinds of folks, such as behavioral health professionals, the State Police, Warwick Police and of course pharmacists,” Bratberg said. “Rhode Island is the absolute leader in the nation in the number of people trained to respond to overdoses and people with Narcan in their possession.


“Most overdoses are witnessed by someone,” Bratberg said. “So if your sister is at high risk of a prescription drug overdose, the pharmacist can train you in the use of Narcan so you can help her. Pharmacists are ideally situated to help with prescription drug overdoses.”


Bratberg said that while most overdoses in Rhode Island are related to heroin, the gateway is often prescription painkiller addiction.


Due to the efforts of a broad coalition that includes URI, today anyone can walk into one of 26 Walgreens in Rhode Island and buy a naloxone kit for $45, or less with health insurance, Medicare and Medicaid. CVS Pharmacies are also now participating.


That Bratberg became an expert in preventing overdose deaths is tied to his involvement in preparedness for public health emergencies. He is a member of the Rhode Island Medical Reserve Corps, a group of volunteer medical professionals and allied personnel who help state and local officials prepare for public health emergencies, such as the H1N1 flu outbreak, which led to a successful vaccination campaign.


Bratberg’s leadership in the fight against opioid overdoses continues. He co-authored national guidelines adopted this year for the American Pharmacists Association, the first one of which states that “APhA supports education for pharmacists and student pharmacists to address issues of pain management, palliative care, appropriate use of opioid reversal agents in overdoses, drug diversion, and substance-related and addictive disorders.”


Bratberg will speak this month at the New England Pharmacists Convention in Ledyard, Conn. He will compare laws among the states and put out a call for advocates to stock naloxone in local pharmacies. He will also speak this month in October in Baltimore, at the 10th National Harm Reduction Conference, a venue for those interested in understanding drug use and the philosophy and practice of harm reduction.