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Policy to prevent opioid overdose presented at national meeting

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PITTSBURGH, Oct. 31, 2016 – Training Allegheny County Jail inmates in the use of the heroin overdose antidote drug naloxone, distributing free naloxone to the family and friends of local veterans at risk for overdosing, improving overdose data collection–these are among the main recommendations that an innovative public health law class at the University of Pittsburgh presented recently to the Allegheny County Health Department.

The recommendations — and the extensive policy review that went into developing them — are being shared today at the American Public Health Association 2016 Annual Meeting & Exposition in Denver.

"Heroin-related deaths have tripled in the past decade. There is no quick fix to the opioid overdose epidemic," said Elizabeth Van Nostrand, J.D., assistant professor of health policy and management at Pitt's Graduate School of Public Health, and adjunct professor at Pitt's School of Law. "And that is why carefully implemented, evidence-based policy is so crucial. We have limited resources, and they need to be used as effectively as possible, which is what good health policy does."

Van Nostrand's graduate class — Law in Public Health Practice — was developed with support from the Robert Wood Johnson Foundation. Now in its second year, the class tackles a policy issue of interest to local agencies, spends the semester researching the issue and existing laws, and then makes extensive recommendations to the agencies, backed by suggested legal avenues toward implementation. About a dozen students pursuing degrees in diverse fields, including medicine, public health, law, genetics and economics, take the class.

Policy regarding naloxone–which can reverse an opioid overdose — was the most recent topic tackled (last year's was tattoo parlor regulation). The class focused on three at-risk populations: veterans, inmates and school children.

In a 122-page report, the class provided five recommendations to the Allegheny County Health Department:

  • Offer naloxone and appropriate training on its use to inmates with a history of opiate abuse upon release from the Allegheny County Jail.
  • Offer medication-assisted treatment to inmates with opiate use disorders.
  • Collaborate with the VA Pittsburgh Healthcare System and community partners to provide naloxone to veterans and their families who may need it.
  • In conjunction with the county's Department of Human Services, conduct large-scale, in-person naloxone distribution and training to first responders and bystanders.
  • Expand data-sharing initiatives with community and governmental partners, as well as expand publicly available data sources specific to the opioid epidemic.

"Of the populations we studied, our research suggests that people recently released from incarceration would benefit the most from naloxone distribution because they are highly susceptible to overdosing," said Van Nostrand. "When someone with an opioid use disorder is released from jail, they may not be as motivated to maintain recovery in comparison to those who voluntarily seek treatment. And if they resume drug use at the levels used before incarceration, it could kill them."

Ultimately the team did not find sufficient evidence to make recommendations regarding naloxone policies in grade schools.

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Authors of the report, "Addressing the Opioid Epidemic: Naloxone Availability as a Public Health Intervention in Allegheny County," are Alexandria Ashraf, B.S., Sara Brooks, B.A., Michael Coutinho, Kathleen Creppage, B.S., Alex Dulin, B.S., Spencer Keil, B.S., Julie Murphy, B.S., John Ries, B.S., Natalie Suder, M.P.H., Abby Talbert, B.S., and Lauren Torso, M.P.H., all of Pitt; and Andrew Cobb, B.A., of Carnegie Mellon University.

About the University of Pittsburgh Graduate School of Public Health

The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at http://www.publichealth.pitt.edu.

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