Reducing Opioid Overdose Deaths in The United States and in New Mexico

Running head: REDUCING OPIOID OVERDOsE DEATHS IN The United States & NEW MEXICO
REDUCING OPIOID OVERDOsE DEATHS IN The United States & NEW MEXICO
By Timothy L. Hallford, MPA
Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy
answers and half-baked solutions. Nothing pains some people more than having to think.
Reverend Martin Luther King, Jr.
STOP OD, INC.
89 MOYA ROAD
SANTA FE, NM 87508
505-469-5319
timothy.hallford@roadsafetytechnologies.org
www.StopODNM.com (under construction)
TABLE OF CONTENTS
Abstract.. Page 3
Definitions/Organizations.. Page 4
Introduction ... Page 6
Target Population Page 8
Opioid Abusers... Page 8
Opioid Overdose Citizens... Page 10
Where are the Opioid Overdose Deaths?................................................................ Page 12
Synthetic Opioids & Fentanyl. Page 22
Cost Benefit Analysis of Opioid Overdose Deaths.. Page 28
Statewide Naloxone Distribution. Page 30
Naloxone Cost.. Page 64
Naloxone Distribution Partners Page 68
What Should We Research & Study?................................................................................... Page 69
Critical Thinking & Analysis Page 72
Findings. Page 81
Strategic Action Plan..Page 86
Editorial. Page 89
References.. Page 94
About Timothy L. Hallford Page 101
Appendix Page 102
Abstract
This papers premise is that opioid overdose deaths in the United States, and in New Mexico have not meaningfully
reduced despite all of the research, financial resources, organizations, campaigns, legislation, political statements, and
community participation efforts. In fact, this paper describes a microcosm of the macrocosm of the current situation of
opioid overdose deaths in the United States-in almost all communities, they are unfortunately increasing. This paper offers
a strategy that will reduce opioid overdose deaths almost immediately. It is a call to action, with the already plentiful
resources targeted for this epidemic, and while making it a real emergency priority as portrayed by our leadership.
Keywords: Opioid Overdose, Opioid Abuse, Overdose Deaths, Naloxone, NARCAN, Harm Reduction, New Mexico
(Please note: While this paper is at least partly, in APA style format, bold type words are mine, they are there for emphasis and importance,
please forgive me for the violation of the style.)
DEFINITIONS AND RELATED STATE AGENCIES:

1. Epidemic -affecting or tending to affect a disproportionately large number of individuals within a population,
community, or region at the same time.
2. Epidemiology - a branch of medical science that deals with the incidence, distribution, and control of disease in a
population; the sum of the factors controlling the presence or absence of a disease or pathogen
3. Naloxone -a potent synthetic antagonist of narcotic drugs (as morphine and fentanyl) that is administered
especially in the form of its hydrochloride C19H21NO4HCl. Naloxone is typically administered by injection to
reverse the effects of opioids and especially in the emergency treatment of opioid overdose. It is also administered
in combination with buprenorphine in the form of a dissolvable tablet placed under the tongue or a film placed
inside the cheek to treat opioid dependence. Trademarks for preparations containing naloxone include Bunavail,
Evzio, Narcan, Suboxone, and Zubsolv.
4. Reversal term used by the New Mexico Department of Health to mean that a citizen who is overdosing does not
die because of the use of the drug, Naloxone or other antagonist of narcotic drugs which revives them.
5. Emergency Declaration - Emergency clause, meaning the law takes effect immediately.
6. Opioid Overdose - Opioid overdoses happen when there are so many opioids or a combination of opioids and other
drugs in the body that the victim is not responsive to stimulation and/or breathing is inadequate. This happens because
opioids fit into specific receptors that also affect the drive to breathe. If someone cannot breathe or is not breathing
enough, the oxygen levels in the blood decrease and the lips and fingers turn blue- this is called cyanosis. This oxygen
starvation eventually stops other vital organs like the heart, then the brain. This leads to unconsciousness, coma, and
then death. Within 3-5 minutes without oxygen, brain damage starts to occur, soon followed by death. With opioid
overdoses, surviving or dying wholly depends on breathing and oxygen.
ORGANIZATIONS:
NEW MEXICO DEPARTMENT OF HEALTH
Mission Statement:
Our mission is to promote health and wellness, improve health outcomes, and assure safety net services for all people in
New Mexico.
Public Health Division:
Coordinated system of community based public health services focusing on disease prevention and health promotion.
Epidemiology & Response Division:
Tracks infectious diseases, injury and health statistics, trains organizations in disease control, injury
prevention, responds to public health emergencies and provides vital records services. We also issue
228,000 birth and death certificates and register 28,000 births and 14,000 deaths each year.
Environmental Health Epidemiology Bureau:
Reduce the prevalence of environmentally-related adverse health outcomes by:
Conducting surveillance of relevant, prioritized health outcome

Identifying environmental exposures of concern Implementing public health promotion through
evidence-based approaches
Evaluating program activities to further develop and improve effectiveness
NEW MEXICO DEPARTMENT OF HUMAN SERVICES

Mission Statement:
To reduce the impact of poverty on people living in New Mexico by providing support services that help
families break the cycle of dependency on public assistance.
Behavioral Services Division Mission Statement:
The Behavioral Health Services Division (BHSD) primary role is to serve as the Mental Health and
Substance
Abuse State Authority for the State of New Mexico. The Authority's role is to address need, services,
planning,
monitoring and continuous quality systemically across the state.
UNIVERSITY OF NEW MEXICO
Health Sciences Center Division:
Our mission is to provide an opportunity for all New Mexicans to obtain an excellent education in the health sciences. We
will advance health sciences in the most important areas of human health with a focus on the priority health needs of our
communities. As a majority-minority state, our mission will ensure that all populations in New Mexico have access to the
highest quality health care. In order to realize our Vision and Mission, we will achieve the following goals:
Improve health and health care to the populations we serve with community-wide solutions
Build the workforce of New Mexico by providing a premier education and transformative experience
that prepares students to excel in the workplace
Foster innovation, discovery and creativity; and translate our research and discoveries into clinical
or educational practice;
Provide the environment and resources to enable our people and programs to do their best
Deliver a well-integrated academic health center that provides high quality of care and service
while being accessible to all New Mexicans
Nurture and embrace an environment of diversity, integrity and transparency
Project Echo Program:

Mission Statement:
Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and
exponentially increases workforce capacity to provide best-practice specialty care and reduce health
disparities. The heart of the ECHO model is its hub-and-spoke knowledge-sharing networks, led by expert
teams who use multi-point videoconferencing to conduct virtual clinics with community providers. In this
way, primary care doctors, nurses, and other clinicians learn to provide excellent specialty care to patients
in their own communities.
INTRODUCTION
New Mexico, consistently has always been at the top of the list for opioid overdose deaths in the United States,
currently #2 (although recent unclear data is indicating we are #9 for all overdose deaths), per capita. As it is in the United
States, it is a true epidemic. We, as a nation, and in New Mexico, were, and are still not ready, to focus ourselves on this
specific issue, marshaling the available resources to reduce this quite manageable problem. Its actually been going on for
a long time in some parts of the United States, including New Mexico, and our government officials, law enforcement,
politicians, criminal justice, social services, treatment agencies, churches, and community organizations have
strategies in place. What has changed significantly, in the last 5 years, is that now it is epidemic everywhere in the
United States, across all age groups and races, in rural and metropolitan areas, in wealthy, middle class, and poor
communities, among the educated and the illiterate, among the young, adult, and elderly population. Substance
abuse has always been a huge challenge for policymakers, treatment agencies, the medical community, emergency services
personnel, law enforcement, judicial, social services and now suddenly they are asked to deal with this epidemic which has
reached its tentacles out into the whole United States. Frankly, it is unfair to ask them, by themselves, to now address
what was already a huge problem turned epidemic. I submit that, if it is affecting all states, all communities, all
Americans, then we all must stand up together to address it. My daughter, Ashley Seidner, D.O. is a physician in
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residency at a hospital in Ohio, she reports that overdoses coming into the emergency room there are now routine. Ohio,
in the middle of the conservative Midwest, now leads the nation in overdose deaths:
Ohio leads the nation in deaths due to heroin and other opioid overdoses. According to the Kaiser Family Foundation, the toll climbed from 2,106
in 2014 to 3,050 last year, with an even higher number projected for 2016. Ohio outpaces New York and California, states with much larger
populations Epidemic is the fitting description, and state lawmakers, along with Gov. John Kasich, have responded with additional resources for
communities. The recent lame-duck session produced stronger regulations for opioid prescriptions, improved access to naloxone (medication to
reverse overdoses) and support for treatment programs Ohio law gives the governor and lawmakers the authority to declare
emergencies. That is what the heroin and opioid epidemic presents. Will they respond adequately in the new year ? {74}
While research (already completed en masse) on education, prevention, and treatment are critical factors to address the
problem, I submit that we must first address keeping opioid abuse citizens alive otherwise the rest of these strategies
mean nothing to that citizen for they are, needlessly, unfortunately already deceased. Several government agencies, even
the Governors office, have received significant federal funding to augment state resources for this expressed purpose.
This papers premise is that some, in fact, a relatively small amount of these financial resources, already available,
need to be redirected toward reducing opioid overdose deaths in New Mexico and exponentially in the United
States.
The Good News
There is good news about the possibilities of reducing opioid overdose deaths significantly in New Mexico. We
have the drug Naloxone, available to reverse immediately the citizen who is overdosing on opioids, no matter what the
reason accidental overdose, illicit drug use, or suicide attempt. The cost of the drug is infinitesimal considering all the
available resources, the significant medical, legal, criminal justice, and societal costs of opioid overdose deaths, and the
cost to families, friends, emergency responders, doctors, hospitals, and innocent witnesses to an opioid overdose death.
And finally, the cost of deceased New Mexico citizen themselves-literally their life. New Mexico has garnered a great deal
of grant monies to address opioid abuse and overdose deaths. Federal and state resources are at multi-million dollars each
year, every year. And now there is even more with President Obamas recent signature of the bill directing $1.8B
expressly for opioid drug abuse and overdose deaths. In New Mexico, we have passed and signed innovative legislation
that includes a standing order for the prescription of the drug Naloxone where it can be distributed by all pharmacies in
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New Mexico without an individual prescription. We have a new Good Samaritan Law, passed in 2016 (which actually
already had one years before), signed by Governor Martinez, which provides that there can be no civil liability or criminal
penalties for any citizen administering Naloxone in good faith, to an overdosing citizen in New Mexico. We have at least
some supply (the number of which I cannot determine) of the drug Naloxone, currently under control of the New Mexico
Department of Health, which can be, and is, distributed to a small number of pharmacies in New Mexico and to some
community organizations and treatment centers. We even have some big pharmaceutical companies willing to donate for
free or at a reduced cost, Naloxone to our State. And yet we remain, #2 in the nation for overdose deaths. Why? Because
it time that we think critically now, analyze what we have done, are doing, efficiency and effectiveness, and what can be
done immediately to reduce this death rate epidemic. And we must do it now, for, as I write this paper, a few more New
Mexico citizens have died from an opioid overdose.
Target Population. So, who are we targeting in this mission? Any New Mexico citizen who may accidentally, abuse,
or purposely overdose on opioids-legal or illegal. There is a strong belief that most of these citizens are at the street
level, homeless, lifelong drug abusers, and for some, lost causes. And as if, somehow, their lives are worth less than those
who are not overdosing. If they were treated the same as any New Mexico citizen, then why are they still dying at the
same rate? Why arent more resources not dedicated towards stopping their deaths? And what if, lets say, half of the
overdose citizens, get help for the problem, and change their lives. And maybe they then become Naloxone advocates
themselves, saving others like they were saved, exponentially, Suddenly, we have someone still alive saving at least one
more life in New Mexico. Are these reversal citizens worth it now? What do we know about opioid overdose citizens?
A plethora of data, studies, and presentations continue to say the same things:
Opioid abusers. The first population to consider is those who accidentally take too many opioids or choose to abuse
opioids but do not actually overdose. They are the potential overdose citizens. They are not just street level addicts, they
are people who may be in chronic pain, have an injury requiring opioids for pain, handicapped, elderly, etc. What do we
know about them? While I could not find demographics for New Mexico for all opioid users, including illicit users (except
for youth), here are the demographics for prescribed opioids by participating pharmacies in Department of Health
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program (please note this was from a presentation in 2014 using data only through 2012) a small percentage of
pharmacies, less than 20% of the 300 pharmacies in New Mexico:
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The age group for those filling prescription opioids is wide with the highest rate for New Mexicans age 85+. Males are
more prevalent than females. Significant usage begins at age 15 and increases in every age group through age 85+.
While this is eye opening, I still do not have more detailed demographics (race, location, prescribed reason, etc.) on
the legal use of opioids that I could find. Perhaps the answer is that opioid prescriptions are crossing all
demographics at an epidemic rate? I suspect the latter. Anyway, I digress {1}
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Total Opioid Prescribing in New Mexico:
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Opioid Overdose Citizens Data Conclusions:

So, lets sum this up in a few sentences.: Opioid overdose emergency visits have increased 30% and are increasing in both
sexes. Both men and women between the ages of 15-54 have the highest rates of opioid overdoses with men ages 25-34 the
highest, women 35-44 the highest, and these women are in reproductive age thus increasing the neonatal abstinence
syndrome. Now one overdose can kill or seriously harm two New Mexicans.
Overdose Deaths. This is the hardest part of the research, the ones who have already died from opioid overdose, many
needlessly, where I believe many could have still been here today. Perhaps their sacrifice will save others yet to come.
How bad is the death now in America? Well, heroin overdoses only have surpassed the homicide rate for guns in
America:
{70}
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This data represents those who died from opioid overdoses in New Mexico. What we know about this data: Substance
abuse is ravaging the Native American reservations and unfortunately it is no different for deaths from opioids.
Native Americans are dying at rate double or triple the rate of the rest of the population. {2}
White, Black, and Hispanic New Mexicans have very similar overdose death rates.
So, opioid pain reliever overdose deaths occurred 89.2% of the time with those with chronic medical conditions.
And almost 70% of the time they occurred in the home and with bystanders yet only 20%
of the heroin users were given Naloxone and only 10% of the opioid pain reliever overdose
deaths received Naloxone. {3}
Who is dying of opioid overdoses? Native American citizens at rate 2 or 3 times the rest of the New Mexico population.
Hispanic, Black and White New Mexicans are dying at about the same rate. So, those who overdose from prescription
opioids, almost 90% of them have chronic medical conditions. Overdoses predominantly occur at home and with
somebody else there. Only 20% of heroin users received Naloxone and only 10% prescription users received Naloxone,
therefore less than 80% of overdose opioid deaths received Naloxone. And I suspect that rural New Mexicans are
dying at disproportionate rates over more populated areas.
Where Are the Deaths in New Mexico? Now that we know the Who of opioid overdose New Mexican citizen deaths,
the next important determination is where they are most happening per capita? First, given the rural considerations of New
Mexico, it is important to see that opioid overdose deaths are happening at a rate 45% higher than in rural areas and that
there is rarely any help for substance abuse treatment services nearby when they do not die from an overdose: {4}
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Recently, Governor Suzanna Martinez and the Department of Health announced a reduction in overdose deaths in New
Mexico and this was spread across the United States media as a triumph. {5} While, we must applaud any and all deaths
saved in New Mexico, and we must thank each and every person who had any involvement in that reduction, 69 New
Mexicans stayed alive in 2015 and total overdose deaths declined by 9% statewide. Yet, we must also think critically
about this newest data. The article, entitled, Overdose Deaths Decline in Nearly Two-Thirds of New Mexicos 33
Counties, we must look closer and think critically about these results. First, this is all overdoses which would include
alcohol, other drugs, etc. Second:
What is the opioid overdose rate for 2015?
The heroin overdose death rate increased although it is not stated by how much?
The drug overdose rate declined by 7.5%, not 9%.

The prescription opioid overdose rate death rate decreased but we do not know by how much?
If we look at where the decreases were, 36% of the death reduction happened in 3 more populated counties:
Valencia, Sandoval, and San Juan counties. If we count in Rio Arriba Countys reduction, 53% of the death
reduction were in these 4 counties. What might have changed in these counties to reflect the decrease? The
drug supply on the street through interdiction by law enforcement, excellent pharmacy participation, better EMS
resources, Naloxone distribution, well-staffed hospital emergency rooms, new and effective education and
prevention programs? We should be studying these 4 counties right now with an eye for things like: what kind
of abusers are overdosing still here and what kind arent (prescription, illicit, heroin, age, sex, race, location of
overdoses, changes in local programs, law enforcement interdiction, supply of drugs on the street, interviews of
overdosed citizens, etc.)

How many of these 69 people were reversals using Naloxone?
Rio Arriba County, Ground Zero:
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Rio Arriba County has steadily remained beyond epidemic for too many years leading New Mexico, and America in opioid
overdose deaths. Opioid abuse is almost acceptable, endemic, in the community:
,
February 2000
Beautiful Land, Ugly Addictions
Comparison of heroin overdose death rates per 100,000 people per year from 1996-1998:
US national rate: 2.2
New Mexico Rate: 9.4
Rio Arriba County rate:
35.5
Chimayo is the "heroin capital" of Rio Arriba County, a rural region of 34,000 people with one of the highest rates of
drug overdose in the United States {6}
And this very insightful, although parts are questionable, article:
NewMexicohasnotstoodbyasfataloverdosesskyrocketedinRioArribaCountyfrom7in1990to40in2014,
accordingtostatehealthdepartmentdataandstatewide,from131tomorethan500.Thestateboastsoneofthemost
sweepingharmreductionprogramsinthenation.RioArribaCountyishometoanationallyrecognizeddoctorwho
prescribesprovenantiaddictionmedications,severallocaldrugtreatmentcenters,andanantioverdosestrategythat
putslifesavingdrugsintothehandsoflawenforcement.Drugriddentownselsewherearejustdiscovering
strategiesEspaolahasbeenpracticingfordecades.
Sowhy,givenNewMexicospioneeringefforts,hasntthesituationimproved?
FernandoEspinozahasknowndozensofpeoplekilledbyaddictiontodrugsandothersubstances.Anaunt.Anuncle.A
cousin.Toomanyfriendsandfellowinmatestocount.Espinoza,32,hasspent14consecutivebirthdaysinjail.Whenhes
out,heliveswithhismotheratherhomeinEspaola.Hehastwodaughters,aGED,andanaddictiontoherointhatfeels
likesomethingscratchinginsidehisbrain.HereinRioArribaCounty,whereoneinfiveresidentslivesinpoverty,
peopleoverdoseanddiemoreoftenthanalmostanywhereelseinthecountry.Overthepastfiveyears,thecountys
overdoseratewasthreetimesthestatewideaverage,andmorethanfivetimesthenationalrate.Accordingtoa2013
surveyof969Espaolateenagers,nearly5percentofhighschoolstudentshadusedheroinwithinthelastmonth,as
opposedto2.9percentstatewide.
Attemptstotreataddictionherehavebeenunderminedbyafailuretofocusonprevention,alackofresourcesandan
unanticipatedboominprescriptiondrugsales.Andforallthestateandcountyhavetried,theireffortshavenot
changedthefactorsthatdrivepeopleheretoaddictioninthefirstplace.Amongthem:generationsofpovertyandalack
ofjobsthatleavepeoplewithfewgoodalternatives.TheNaloxoneprogram:
FivedaysaweekFiutyandharmreductionprogrammanagerDaveKoppadrivethestreetsofEspaola,visitinghomes,
stoppinginparkinglotsandopenfields,andpullingoverwhenpeoplewaveatthemfromsidewalks.Theyoffertipson
howtoshootheroinwithoutcreatinginfectedabscesses.Theyexplainthedangersofmixingpillsandalcohol,andgive
outforfreeanoverdosereversaldrugcalledNaloxone.Inthepastyearalone,theSantaFeMountainCenters
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needleexchangeprogramscollectedover1millionneedles,gaveawaymorethan3,000dosesofNaloxone,and
recordedmorethan700successfuloverdosereversals.
ThatsuchrecidivismpersistsdespitethestateseffortshauntsSalazarandotheradvocates.Foronething,the
communitysneedhasalwaysexceededitsresources.Exceptforpregnantwomen,Hayes,thebuprenorphine
prescribingdoctor,hashardlytakenanewpatientinthreeyears.Alocalresidentialtreatmentcenter,Hoy
Recovery,hasnearly50bedseightofthemfordetoxbuttheyareregularlyfullofpeoplefromaroundthestate.
OnarecentafternoonatHoy,thewaitlistformenwas28peoplelong.
Theservicesthatareavailablework,saidLaurenReichelt,headofthedepartmentofhealthandhumanservicesin
RioArribaCounty.Justnotatascaletomeettheneed.{7}
Kudos to the Santa Fe Mountain Center and its efforts to distribution Naloxone, 3,000 units and 700 recorded
reversal, in one year. That means that four every 4 doses of Naloxone given out, 1 reversal was achieved. The death
rate did go down here some in 2016, perhaps because of their efforts. And yet it remains now 16 years later, by far, the
highest in New MexicoThis county has suffered long enough and if anywhere, why dont we begin here?
Sanches, still a certified paramedic, joined Rio Arriba County Sheriff James Lujan, U.S. Attorney Damon Martinez and
other law enforcement leaders at a news conference in Albuquerque on Monday, announcing a program to help local
agencies get funding to start carrying the overdose-reversing drug Narcan, also known by its generic name,
naloxone. Law enforcement is sworn to protect life, limb and property, and amongst that is dealing with the opiate
crisis that is so prevalent right now, Sanches said, highlighting the need for officers to carry and administer Narcan.
The antidote wasnt around when he first started as a medical technician and the awareness surrounding the issue is long
overdue. All 28 Rio Arriba County deputies have been `. Despite the week presenting an opportunity for Rio Arriba
County to highlight the fact that its people suffer from overdose rates well above national averages, the County did not
participate in these events, did not host any events or make any official announcements. Every week is Heroin
Awareness Week for Rio Arriba County government and has been for several decades, Health and Human
Services Director Lauren Reichelt wrote in an email Tuesday. Were glad everybody else in the country has caught
up and realized. She said her Department is working to develop a local diversion program and a provider network
to get Narcan on the streets. In June, she started purchasing goods and services that will become the backbone of the
Behavioral Health Investment Zone, paid for through the first installment of a five-year, $2.5 million grant from the
state of New Mexico, meant to address behavioral health problems associated with drug abuse in the County
Sanches said, at a minimum, and as soon as possible, the County needs a 100-bed in-house recovery facility. He said the
entire north central region of the state has no recovery services after a program in Taos closed this summer, and the
state as a whole, does not have enough space available for recovering addicts. No change is ever going to occur until
the people in power empower those who can make change, he said. {8}
Kudos to Ms. Reichelt and Officer Sanches, they get itThis story is not about Ms. Reichelt not attending the
promotional awareness week efforts. She has been on the front lines of this epidemic in the worst county in the
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state. Maybe she is tired of hearing all the pronouncements, proclamations, promises, and poor strategies that have not
worked. When everyone goes home after the awareness week, she faces more deaths. This story is about her seeing
that Naloxone needs to be on the streets of Rio Arriba County. And it is about a law enforcement officer who has
seen all the deaths and equipping the department with Naloxone. The story is about the fact that deputies just
started using the Narcan a month ago, in September 2016, in the worst epidemic at the county level in the United
States. It is about them already using it 5 times in a month, which would be 60 lives saved in a years time. And it
is about the fact that there is no safety net and treatment for these citizens after they overdose at ground zero in
New Mexico. That means they will be back and more Narcan is used to save their lives, again or they may just die.
I do not know why, with the money we have allotted for this state, that there are not construction companies
building a recovery hospital in the heart of Rio Arriba County right now, where it belongs, with the American and
New Mexican flags flying in front of it? All of these questions are really what needs to be studied, so why arent we?
Wouldnt we want to know this most immediately, then fund and export these strategies to the rest of New Mexico? All we
know is what Cabinet Secretary Designate of the Department of Health, Lyn Gallagher states:
We are working hard to reduce overdose deaths in New Mexico. The recent decrease shows were making progress, but we
still have a lot more work to do, said Department of Health Secretary Designate Lynn Gallagher. The fact is,
our state continues to suffer from drug abuse. One overdose death is one too many. And until we have zero fatalities
related to drugs, were going to continue to do all that we can to address the issue with our partners. {5}
The truth is the Department of Health does not really know why and I know more about what is not working in the
voluminous data than what does. But at least we have the same goal, zero fatalities.
The Behavioral Health Collaborative, headed by Wayne Lindstrom, PhD, who also an employee of the New Mexico Human
Services Division indicates in his annual report:
The Behavioral Health Collaborative administers a yearly $1M dollar federal grant:
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Mr. Lindstroms organization had to withdraw some initiatives that would have also been helpful for opioid abuse
reduction in general in New Mexico.
{9}
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The Rest of New Mexico: We also know where else there are serious issues with drug overdose deaths: {10}
Why this is 2014 data presented in 2016, I dont understand? In any event, I suspect that the rates are similar now unless
there has been a community suddenly hit (like Lincoln County, see below) {} So, in the concern for total overdose deaths, I
am very concerned that Bernalillo and Santa Fe Counties are above the state average.
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This shows that Lomas/Broadway in Bernalillo County, the Agua Fria Neighborhood in Santa Fe County, McKinley County, for
example, are problem areas which will allow more targeting of efforts by area. This is very important and excellent data,
well done Dr. Landen and staff. I am also interested that Dona Ana County, the second largest county in population in
the state, and so near El Paso (see below) and the Mexican Border, would have much lower rates, why? Thats worth a
study
The Native American Reservations. As with most every other Native American issue in the United States, the Native
American community is often forgotten and/or marginalized. For a culture and people who were in New Mexico before most
of the rest of New Mexicans by many generations, and only had illicit substances that have turned into addictions in the last
few generations, we must devote resources here if they are dying at rate 2 to 3 times the rest of us. And not that it should
matter, but many Native Americans reservations are within or near metropolitan areas where there is not a reservation
hospital. So, they are often taken to New Mexican hospitals, if we want to just look at the economic impact. There are
some promising efforts: {73}
HHS Secretary Sylvia M. Burwell has made addressing opioid abuse, dependence and overdose a priority and through an
evidence-based initiative focused on three promising areas: informing opioid prescribing practices, increasing the use of
naloxone and using medication-assisted treatment to move people out of opioid addiction. The Obama administration
is also committed to combatting the prescription drug and heroin epidemic, proposing significant investments to intensify
efforts to reduce opioid use disorder. The new agreement formalizes the partnership between IHS and BIA to reduce
opioid overdoses among American Indians and Alaska Natives. In 2016, the more than 90 IHS pharmacies will dispense
naloxone to as many as 500 BIA Office of Justice Services officers and will train these first responders to administer
emergency treatment to people experiencing opioid overdose. The partnership will be reviewed annually by IHS and BIA
and will continue as long as the agencies agree it is delivering the desired results. I am deeply grateful to the IHS for
working with us to create another level of safety throughout Indian Country for those trapped by the vicious cycle of drug
addiction," said BIA Director Michael S. Black. "Law enforcement officers are usually the first responder to a drug
overdose situation in a tribal community. This partnership greatly strengthens our public safety mission by
enabling our BIA officers to take immediate action to save a life endangered by an overdose. .an immediate action
to save a life endangered by an overdose."
While I continue to stress within this paper that giving Naloxone to BIA officers is still not going to reach the users
themselves as effectively, it is much better than no Naloxone at all, and as first responders, it will, definitely, save
some lives. And again, we see the belief that the pharmacies should be the gatekeepers for Naloxone, based on an
assumption that is not working.
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Also, critical to understand is exactly where the overdose death occurred and how often Naloxone was given by drug
type. Here is a study completed in 2012, by The Center For Disease Control, in New Mexico, by using the records of the
Office of Medical Examiner death records: {13}:
Of the 489 overdose deaths reviewed, 49.3% involved OPR, 21.7% involved heroin, 4.7% involved a mixture of OPR and
heroin, and 24.3% involved only non-opioid substances. The majority of OPR-related deaths occurred in non-Hispanic
whites (57.3%), men (58.5%), persons aged 4059 years (55.2%), and those with chronic medical conditions (89.2%).
Most overdose deaths occurred in the home (68.7%) and in the presence of bystanders (67.7%). OPR and heroin deaths did
not differ with respect to paramedic dispatch and CPR delivery, however, heroin overdoses received naloxone twice as
often (20.8% heroin vs. 10.0% OPR; p<0.01).
Most unintentional overdose deaths were due to prescription opioids or heroin.
Most overdose deaths occurred in the home, often in the proximity of family.
Decedents most often had a known history of drug dependency or prior overdose.
Heroin overdoses received naloxone twice as often as prescription opioid overdoses.
Fentanyl and Synthetic Opioids. As if it isnt bad enough, new, even more dangerous and addictive, synthetic opioids
are being sold on the street of the United States, and New Mexico:
officials are investigating the deaths of at least 20 people who overdosed on the powerful painkiller fentanyl in New
Mexico this year, apparently after taking what they thought was black-market oxycodone. The victims ranged in age
from 17 to 63; 17 of the 20 were men. The price of oxycodone is normally $1 per milligram, or $30 for one 30milligram pill, but the fentanyl pills have been sold for as little as $5 a pill around the country. The counties of
residence of those who died were Bernalillo, Chaves, Lea, Lincoln, Colfax, Eddy, Guadalupe, Otero, Sandoval, San
Miguel, Santa Fe, Valencia and one unknown. Fentanyl has long been prescribed for people suffering from chronic
pain, often associated with cancer, but in recent years, fentanyl has shown up on the illegal drug market, leading to many
overdose deaths in New England and mid-Atlantic states. There, the drug is often mixed with heroin by dealers to give
their product an extra kick or to cheaply produce more usable heroin. Now the odorless white powder is being made
into pills and passed off as another drug. {14}
Drug Enforcement Agency agents say the pills were likely manufactured in Mexico using fentanyl powder from
China that can cost a few thousand bucks for a kilogram and be turned into counterfeit oxycodone pills that can net
traffickers millions of dollars. Toxicology tests in the 20 New Mexico deaths showed fentanyl and slightly different
chemical versions of it, called analogs, which can be stronger than legally produced fentanyl and may take more
naloxone (Narcan) to counter than it would to counter a heroin overdose. If that scares you, and it should, consider
the growing use of carfentanil, a synthetic anesthetic designed to tranquilize elephants and other large animals. It is
not approved for use in humans, but drug traffickers are mixing it with heroin and it has become popular in some states
among addicts looking for ever stronger highs. It has caused hundreds of overdoses and several deaths in states like Ohio,
which has been particularly hard hit. Carfentanil is 10,000 times more potent than morphine and 100 times stronger
than fentanyl, as reported by columnist Diane Dimond in a recent Albuquerque Journal article. So, we have Chinese
chemists and Mexican drug pushers, to thank for introducing even more powerful ways to make obscene profits at
American addicts. But part of the solution must lie with slowing the demand on the U.S. side of the border for highrisk drugs that damage and destroy lives and families. Which is why the HOPE (Heroin and Opioid Prevent and
24
25
Education) Initiative of the U.S. Attorneys Office for the District of New Mexico and the University of New Mexicos
Health Sciences Center is so important. In addition to prosecution, its focus is on diversion, rehabilitation and re-entry
programs and it is working with community organizations, such as the Bernalillo County Opioid Accountability Initiative.
The fact that people are so addicted that they are willing to turn to knock-off drugs or buy pills they think hope
are the real thing says a lot about how serious the drug epidemic has become. This is a new kind of drug war. {15}
Well said, Albuquerque Journal, you get it. And these new drugs are inherently dangerous to everybody:
Right now were seeing the emergence of a new class thats fentanyl-type opioids, Dyes boss, Jill Head, explained.
Based on the structure, there can be many, many more substitutions on that molecule that we have not yet seen.
Entrepreneurial chemists have been creating designer alternatives to cannabis, amphetamine, cocaine and Ecstasy for
years. But this new class of synthetics is far more lethal. Back in 2012 and 2013, when reports of fentanyl derivatives
started coming in to the U.N. Office on Drugs and Crime in Vienna, chemists chucked them in the other category. Today
those other substances are one of the fastest-growing groups of illicit chemicals tracked by the agency. New opioids
keep emerging, said Martin Raithelhuber, an expert in illicit synthetic drugs at the U.N. They deserve their own category,
he added, but that will take time. Once, forensic chemists like Dye confronted a familiar universe of methamphetamine,
cocaine and heroin. Drug dealers, users and DEA agents generally knew what substance they were handling. Today, things
are different. This is a golden age of chemical discovery and subterfuge. Dealers may not know that the high-purity
heroin from Mexico theyre selling has been laced with fentanyl. Users may not realize the robins-egg-blue
oxycodone tablets theyre taking are spiked with acetylfentanyl. If field agents bust a clandestine drug lab and see a
cloud of white powder in the air, they no longer assume its cocaine. They run. {16}
So, our law enforcement personnel are themselves in danger of accidental poisoning and possible death in busting
these labs. If we are to be so unlucky as to come into a place with unknown white powder floating around, we can die on
the spot and we may not even be users at all. And here is Chinas role with a link to our neighboring state, Utah, using the
internet to buy fentanyl:
Baer said the DEA is actively investigating U.S.-based vendors who use dark net markets to sell fentanyl and related
compounds, as well as Chinese companies that use U.S. servers to sell carfentanil. But the extent to which those U.S.
companies are merely retailing made-in-China drugs is not clear. Baer said the DEA doesnt believe fentanyl is massproduced in the U.S., though authorities have uncovered mom-and-pop pill press operations. One of them was run by
a 28-year-old in Utah, who was busted late last month with a pill press, piles of powder and cash, and nearly 100,000
pills laced with suspected fentanyl in his Cottonwood Heights home. According to the criminal complaint, the young
man hired people to accept packages shipped to their homes, which theyd hand over, unopened. The packages
came from China. {16}
And the newest study, just released, from the Center for Disease Control on opioid overdose deaths, using 2015,
data: {17}
During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid.
There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of
deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily
by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states. A multifaceted,
collaborative public health and law enforcement approach is urgently needed. Response efforts include implementing
the CDC Guideline for Prescribing Opioids for Chronic Pain (4), improving access to and use of prescription drug
monitoring programs, enhancing naloxone distribution and other harm reduction approaches, increasing
25
26
opioid use disorder treatment capacity, improving linkage into treatment, and supporting law enforcement
strategies to reduce the illicit opioid supply.
TABLE 1. Number and age-adjusted rate of drug overdose deaths* involving natural and
semisynthetic opioids and methadone,, by sex, age group, race/ethnicity, ** U.S. Census region,
and selected states United
States, 2014 and 2015
Natural and semisynthetic opioids
Methadone
Characteristic
Overall
Sex
Male
Female
Age group (yrs)
014
1524
2534
3544
4554
5564
65
201
4
No. (Rate)
201
5
No. (Rate)
12,159 (3.8)
6,732 (4.2)
5,427 (3.3)
12,727
(3.9)
7,117 (4.4)
5,610 (3.4)
42 (0.1)
726 (1.7)
2,115 (4.9)
2,644 (6.5)
3,488 (8.0)
2,437 (6.1)
706 (1.5)
Sex/Age group (yrs.)

Male
1524
529 (2.3)
2544
2,869 (6.8)
4564
3,015 (7.4)
Female
1524
197 (0.9)
2544
1,890 (4.5)
4564
2,910 (6.8)
Race/Ethnicity**
White, non-Hispanic
10,308 (5.0)
Black, non-Hispanic
814 (2.0)
Hispanic
727 (1.4)
U.S. Census region of residence
Northeast
1,851 (3.3)
Midwest
2,205 (3.3)
South
5,101 (4.2)
201
4
No. (Rate)
201
5
No. (Rate)
4.8
3.0
3,400
(1.1)
2,009 (1.3)
1,391 (0.9)
3,301
(1.0)
1,939 (1.2) -7.7
1,362 (0.8) -11.1
48 (0.1)
715 (1.6)
2,327 (5.3)
2,819 (6.9)
3,479 (8.1)
2,602 (6.4)
736 (1.5)
0.0
-5.9
8.2
6.2
1.3
4.9
0.0
14
241 (0.5)
796 (1.8)
768 (1.9)
854 (2.0)
629 (1.6)
98 (0.2)
13
201 (0.5)
0.0
735 (1.7)
-5.6
739 (1.8)
-5.3
843 (2.0)
0.0
642 (1.6)
0.0
127 (0.3) 50.0
493 (2.2)
3,139 (7.4)
3,095 (7.5)
-4.3
8.8
1.4
173 (0.8)
969 (2.3)
808 (2.0)
149 (0.7)
926 (2.2)
777 (1.9)
-12.5
-4.3
-5.0
222 (1.0)
2,007 (4.8)
2,986 (6.9)
11.1
6.7
1.5
68 (0.3)
595 (1.4)
675 (1.6)
52 (0.2)
548 (1.3)
708 (1.6)
-33.3
-7.1
0.0
10,774 (5.3)
878 (2.1)
780 (1.5)
6.0
5.0
7.1
2,845 (1.4)
256 (0.6)
228 (0.5)
2,725 (1.4)
247 (0.6)
235 (0.5)
2,095 (3.6)
2,302 (3.4)
5,374 (4.4)
9.1
3.0
4.8
587 (1.0)
675 (1.0)
1,298 (1.1)
643 (1.1)
10.0
673 (1.0)
0.0
1,228 (1.0) -9.1
%
chang
e in
rate,
2.6
%
change
in
rate,
-9.1
0.0
0.0
0.0
26
27
27
28
28
29
TABLE 1. (Continued) Number and age-adjusted rate of drug overdose deaths* involving natural and
semisynthetic opioids and methadone,, by sex, age group, race/ethnicity, ** U.S. Census region, and
selected states United States, 2014 and 2015
Characteristic
Natural and semisynthetic

opioids
20
20
%
14
15
chang
e in
No. (Rate)
No. (Rate)
rate,
2014 to
2015
20
14
No. (Rate)
Methadon
e
20
15
%
chang
e in
rate,
2014 to
2015
No. (Rate)
Selected states
States with very good or excellent reporting (n = 21)
Alaska
40 (5.6)
51 (6.5)
16.1
Connecticut
157 (4.3)
183 (4.8)
11.6
Iowa
81 (2.7)
75 (2.5)
-7.4
Maine
80 (6.1)
Maryland
388 (6.2)
Massachusetts
Nevada
New
Hampshire
Characteristic
New Mexico
102 (7.7)
26.2
Synthetic opioids other than
398
(6.5)
4.8
methadone
178 (2.6)20
225 (3.3)
20
26.9 %
14
15
chang
224 (7.4)
259 (8.6)
16.2
e in
No. (Rate) 63 (4.4)
No. (Rate)
81 (5.8)
-24.1
rate,
2014
to
223 (10.9)
160 (8.1)
-25.7
2015
608 (3.0)
705 (3.4)
13.3
New
York states
Selected
North
Carolina
462 (4.7)
(5.5) (n =
17.0
States
with very good
or excellent 554
reporting
21)
Alaska
Oklahoma
370 (9.6) 14 277 (7.2) 14 -25.0

Connecticut
94
(2.7)
211
(6.1)
125.9
Oregon
137 (3.2)
150 (3.6)
12.5
Iowa Island
Rhode
MaineCarolina
South
Maryland
Utah
Massachusetts
Vermont
Nevada
Virginia
New Hampshire
Washington
NewVirginia
Mexico
West
New York
Wisconsin
70 (6.7) 29 (1.0) 95 (8.3) 44 (1.5)

23.950.0
62
(5.2)
116
(9.9)
90.4
319 (6.5)
322 (6.5)
0.0
230 (3.8) 357 (12.7)

357 (5.8) 52.6-6.6
367 (13.6)
949 (14.4) 108.7

21 (3.4) 453 (6.9) 25 (3.9)
14.7
323 (3.9) 32 (1.0) 276 (3.3)32 (1.1)-15.4 10.0
151 (12.4) 261 (3.5)

285 (24.1) 94.4-7.9
288 (3.8)
66 (3.3) 356 (19.8)
42 (2.1)
363 (20.2)
-2.0-36.4
135.7
668 (3.3)
279 (4.8)294 (1.4) 249 (4.3)
-10.4
North
Carolina
217
(2.2)
300
(3.1)
40.9
States with good reporting (n = 7)
Colorado
259 (4.6) 73 (1.9) 259 (4.5)93 (2.4)
-2.226.3
Oklahoma
Georgia
388 (3.8) 33 (0.8) 435 (4.2)34 (0.9)
10.512.5
Oregon
Illinois
253
(1.9)
271
(2.0)
5.3
Rhode Island
82 (7.9)
137 (13.2) 67.1
Minnesota
South Carolina
Missouri
Utah
Ohio
Vermont
Tennessee
Virginia
102 (1.9)110 (2.3) 125 (2.2)

161 (3.3)
237 (4.0) 68 (2.5) 237 (3.9)62 (2.3)
618 (5.4) 21 (3.6) 690 (6.1)33 (5.6)
554 (8.6)176 (2.1) 643 (9.7)

270 (3.3)12.8
57.1
62 (0.8)
West Virginia
122 (7.2)
90 (1.6)
States with good reporting (n = 7)

Colorado
80 (1.5)
65 (0.9)
10
50 (1.4)
16
29 (2.2)
153 (2.4)
88
20(1.3)
14
64 (2.2)
No. (Rate)
29 (2.3)
72 (1.9)
82
20(1.2)
15
57 (1.9)
No.
25 (Rate)
(1.9)
45 (2.3)
33 (1.6)
231 (1.1)
246 (1.2)
131 (1.4)
25 (3.3)
67 (1.7)
299 (8.9)
59 (1.4)
108 (1.1)
37 (4.7)
62 (1.7)
390 (11.3)
70 (1.7)
37 (1.3)
24 (2.2)
38 (3.1)
77 (1.6)
313 (5.2)
47 (1.7)
45 (1.6)
30 (2.4)
52 (4.5)
57 (1.2)
405 (6.6)
45 (1.6)
469 (7.2)

64 (2.2)
105 (1.2)
98 (8.1)
115 (1.5)
35.7
24 (0.8)
36 (2.8)
Heroin
182 (2.9)
27.3
20.8
-7.7
%
chang
-13.6
e in
-17.4
rate,
2014
-30.4to
2015
9.1
-21.4
42.4
0.0
27.021.4
23.1
9.1
45.2
-25.0
26.9
-5.9
634
(9.6)
33.3

82 (2.7)
67 (0.8) -33.322.7
78 (6.5)
111 (1.4)
-6.7-19.8
139 (7.2)
35 (2.0)
825 (4.2)
78 (1.4)
156 (8.1)
29 (1.7)
1,05873
(5.4)
(1.3)
266 (2.8)
51 (0.9)
26 (0.7)
393 (4.1)
34 (0.6)
36 (1.0)
124 124
(3.2)(1.2)
106
66 (6.8) (0.9)
102 115
(2.5)(1.1)
99 (0.8)
45 (4.3)
12.5
-15.0
28.6
-7.1
46.4
-33.3
42.9
-8.3-21.9
-11.1
-36.8
81 (1.6)
64 (1.4)
53 (0.9)
110 (3.8)
55 (1.0)
100 (2.2)
62 (1.0)
127 (4.3)
57.1-37.5
55.6
107 (0.9)
33 (5.8)
71 (1.1)
253 (3.1)
109 (1.0)
33 (5.8)
67 (1.0)
353 (4.3)
11.1
0.0
-9.1
38.7
12.5
289 (4.1)
303 (4.2)
163 (9.8)
194 (11.8)
-2.5
-8.0
13.0
Washington
Wisconsin
43.515.8
12
217 (12.7) 76.4

112 (2.1)
31.3
270 (4.9)
287 (5.3)
64 (1.2)
-20.0
156 (2.9)
159 (2.8)
Georgia
174 (1.7)
284 (2.8) 64.7
153 (1.6)
222 (2.2)
Missouri
109 (1.9)
183 (3.1) 63.2
334 (5.8)
303 (5.3)
1,208
(11.1)
1,444
Heroin
(13.3)
11.1
13.2
2.4
20.4
8.2
-3.4
37.5
TABLE 2. Number and age-adjusted rate of drug overdose

deaths* involving synthetic opioids
Illinois than methadone and

127 (1.0)
711 (5.6)
844
(6.7)
19.6
other
heroin,, 278
by (2.2)
sex,120.0
age group, race/ethnicity,**
U.S.
Census
region,
Minnesota
44 (0.8) States,55
(1.0) and 2015
25.0
100 (1.9)
115 (2.2)
15.8
and
selected states United
2014
Ohio
Characteristic
590 (5.5)
1,234
107.3
Synthetic opioids other than
(11.4)
methadone
20
20
%
14
15
chang
e in
No. (Rate)
No. (Rate)
rate,
2014 to
20
14
No. (Rate)
20
15
No. (Rate)
-8.6
19.8
%
chang
e in
rate,
2014 to
29
Tennessee
132 (2.1)
251 (4.0) 90.5
148 (2.3)
205 (3.3)
30
43.5
Source: CDC. National Vital Statistics System, Mortality. CDC WONDER. Atlanta, GA: US Department of Health and Human
Services, CDC; 2016. https://wonder.cdc.gov/.
* Rates are for the number of deaths per 100,000 population. Age-adjusted death rates were calculated using the direct
method and the 2000 standard population. Deaths were classified using the International Classification of Diseases, Tenth
Revision (ICD10). Drug overdose deaths were identified using underlying cause-of-death codes X40X44, X60X64, X85, and
Y10Y14.
Drug overdose deaths, as defined, that have synthetic opioids other than methadone (T40.4) as contributing causes.
Drug overdose deaths, as defined, that have heroin (T40.1) as a contributing cause.
Categories of deaths are not exclusive because deaths might involve more than one drug. Summing categories will
result in a number greater than the total number of deaths in a year.
** Data for Hispanic ethnicity should be interpreted with caution; studies comparing Hispanic ethnicity on death
certificates and on census surveys have shown inconsistent reporting.
Analyses were limited to states meeting the following criteria. For states with very good to excellent reporting, 90% of
drug overdose death certificates mention at least one specific drug in 2014, with the change in percentage of drug
overdose deaths mentioning at least one specific drug differing by <10 percentage points from 2014 to 2015. States
with good reporting had 80% to <90% of drug overdose death certificates mention at least one specific drug in 2014,
with the change in the percentage of drug overdose deaths mentioning at least one specific drug differing by <10
percentage points from 2014 to 2015. Rate comparisons between states should not be made because of variations in
reporting across states.
Statistically significant at p<0.05 level. Gamma tests were used if the number of deaths was <100 in 2014 or 2015, and ztests were used if the number of deaths was 100 in both 2014 and 2015.
Cells with nine or fewer deaths are not reported, and rates based on <20 deaths are not considered reliable and not
reported.
I am unsure why this data is showing a 25% reduction in opioid overdose deaths for New Mexico, when our data and press
conferences indicate 7.5% (?) I also note the 12% increase in heroin overdose deaths in New Mexico. I submit to you
again, we are at a real war, and we are being attacked by increasingly more insidious, habit-forming, overdose death
risk heightened, drugs, brought from around the world and within our country.
Cost/Benefit Analysis of Opioid Overdose Death. When we think of resources to fight this epidemic, we must consider
what we have already. Millions of dollars are poured in annually to address the problem in New Mexico. Criminal justice
and drug treatment organizations, emergency responders, community groups and activists who care about this issue and
want it changed, agencies and organizations already existing who can better address this problem by coordination
and non-duplication of efforts, and finally, most importantly, we have the citizens of New Mexico the fathers,
mothers, brothers, sisters, neighbors, and even strangers of the opioid overdose victim. And we have the saved
overdosed citizens, who are an untapped resource in the opioid overdose death epidemic. I will focus now on the
economic costs of opioid overdose death in New Mexico because, in the end, we cannot put a price on the amount of a
saved New Mexico citizen who overdosed not to his or her family, his friends, his community, and not to all citizens of
New Mexico. And I wonder if we collectively have decided that the death of an opioid overdose citizen is somehow
expendable, deserved, or just the acceptable risk results of drug abuse that cannot be changed.
30
31
So, if we want to do a cost benefit analysis of saving opioid overdose citizens from death from a strictly economic
point of view, the numbers are as follows:
The hospital costs of opioid abuse in New Mexico is $192M ($25B in the United States) each year which
equates to a cost of $92.00 for every New Mexican citizen each year. And these are very conservative
31
32
estimates. More recent data shows it to be $28B in the United States. {18} And fatal overdoses alone
account for $21B a year. {19}
The average United States cost of every emergency room visit where the overdose victim was treated and
released is $3,640 and if admitted to the hospital, $29,497. 59% of all overdose patients are admitted to
the hospital. [69]
Other societal costs include $5B a year in criminal justice costs and another $25B per year in lost workplace
productivity. (While there is a whole plethora of data and studies in New Mexico, I could not find this data for some
reason, specifically related to New Mexico). Newer data now show criminal justice costs at $7B. [19]
And this is every year.
Statewide Naloxone Distribution. I submit to you that the best strategy for the cost is widespread Naloxone distribution
in New Mexico where it is most effective, in the hands of the drug users themselves. And this cannot be done, alone, by
pharmacies for several reasons:
1. How many citizens overdose on opioids in the parking lot of the pharmacy?
2. How many overdose at risk citizens are willing to go into a pharmacy, talk to a pharmacist, and then provide their
information which is then provided to a government agency? And how many families and friends? How many
concerned citizens, who just want to have Naloxone in case they come across an overdosing citizen, will go into a
pharmacy and ask for it?
3. How many, especially rural, overdose prevention citizens can even get to a pharmacy before the person overdosing
dies? What if they are elderly, cannot drive, handicapped, mentally unstable?
4. One big pharmaceutical company, is willing to donate Naloxone kits to every high school in New Mexico.
Have we done this? Apparently not. In addition, they provide a cellular phone application, for both Android
and Apple phones, that tells how to administer the Naloxone, safety information, education, even a video, and 911
call button- Free. And they are offering substantially discounted Naloxone pricing to law enforcement and
government agencies.
32
33
5. Opioid overdose abuse victims often take the opioid with at least one other person(s). [2] Often by the time
law enforcement or emergency services personnel arrive, the other person(s) have left the scene, afraid of the
repercussions of being arrested or involved with an overdose victim, especially if they die. What if these other
person(s) had a Naloxone kit with them, could administer the drug, and then leave the scene after calling 911?
And what is really, well, disturbing is, we began a Naloxone program in 2001 in New Mexico, from a recent
presentation made by University of New Mexico Project Echo:
To respond to the highest per capita heroin- related death rate in the nation, NM passed the 1st law which funded
statewide OD prevention and Naloxone distribution (administered by the NM Dept. of Health). The law directs the NM
Dept. of Health to: Develop a program to train lay persons to administer Naloxone to another person in case of opiate
overdose. {20}
And this article from 2001, when the program began under Governor Gary Johnson: {21}
a controversial package of drug-policy reform legislation introduced by New Mexico Gov. Gary Johnson in January, one
law that passed without much of a struggle was aimed at increasing use of naloxoneFear of infection also plays a role
in the aversion to naloxone use, according to speakers at the recent Lindesmith Center-Drug Policy Foundation annual
conference, held in Albuquerque, N.M. For example, overdose victims who receive naloxone require rescue breathing
immediately after the shot is administered a dicey prospect for police or even emergency medical personnel, who may
fear infection with HIV or hepatitis via blood, saliva, or other bodily fluids. But experts at the conference said that
using a protective mask equipped with a one-way breathing tube and a plastic shield can minimize these risks. I
think the cops will use it if given reassurance by Emergency Medical Services, said Dr. Steve Jenison of the New
Mexico Department of Health. It gets the job done. Harder to overcome may be simple prejudice against addicts.
What I hear in conversation is that those lives are not necessarily valuable, according to Maureen Rule, clinical
advisor to Albuquerque's Health Care for the Homeless. The response I hear is, 'So what if they die? But New
Mexico Secretary of Health J. Alex Valdez asserted, [Naloxone is] used for one reason and one reason alone, and
that's to save lives. You can debate the use of naloxone, but if you value the life of a person regardless of his
addiction to heroin if saving a life has value then it's worth $1.50.
The New Mexico legislation also protects individuals from civil liability or criminal prosecution for using an opioid
antagonist, as long as they act in good faith and with reasonable care. Rule noted that prior to the legislation,
Doctors were reticent about anything that was outside the standard care, but now the law provides legal protection. New
Mexico officials said they want to see naloxone distributed via police to injection-drug users and their family members and
friends throughout the state. And speakers at the drug-policy reform conference said that making naloxone more
readily available nationally would help fight an explosion in opioid overdose deaths. The New Mexico legislation was
sparked by the state's alarming overdose death rate, centered in Albuquerque and in Rio Arriba, the huge rural country
stretching north from Santa Fe to the Colorado border. Jenison reported that between 1996 and 1998, the statewide
incidence of fatal overdose from illicit drugs, primarily heroin, was 7.8 deaths per 100,000, nearly four times the national
average. Populated largely by Native Americans and Mexican-Americans, Rio Arriba experienced a catastrophic 35 deaths
per 100,000 population in 1998, and had at least sixteen overdose deaths in 2000. Bigg added with deliberate
ambiguity that his program has been distributing naloxone for a while in Chicago to about 300 drug users, doctors
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34
and others. Some doctors were involved who didn't want to be known, but now we have an 'out' physician, he said.
Among his clients, he reports there are forty-three people who were blue and unresponsive who are alive today.
Jenison reported that since discussion about naloxone heated up in January, a dozen or so private physicians in New
Mexico have been prescribing it to users and their families in and around Espanola, Rio Arriba County's biggest city.
But physician involvement in prescribing the drug remains scant in Albuquerque, Jenison said. In rural settings,
such as Rio Arriba, experts noted, users are more likely to have a home to store the drug and access to a doctor.
They're also more likely to have an intact family structure to watch over them and administer the drug, since, as
Wayne A. Salazar, Espanola's chief of police, stated, Heroin use is somewhat socially acceptable in the Hispanic
community in Rio Arriba. With 24 overdoses including 8 fatalities in his jurisdiction in the prior four months,
Salazar would like to see his officers carrying naloxone by mid-July. He says he's already gotten positive feedback.
There's nothing more frustrating during an OD then waiting that eight to 13 minutes for the EMTs to show up and
not being able to do a lot, all the family and friends crying all around you, said Salazar. Of course, police are as
helpless as ever if no one calls 911. Fearful of arrest, some users will actually let a companion die rather than call for
help. Harm-reduction specialists counsel users on techniques for safely calling 911, but even so, getting naloxone into
users' hands remains a huge stumbling block.
Heather Meschery, executive director of the Santa Cruz Needle Exchange, noted that 11 percent of her clients have been
arrested in conjunction with an overdose. And Salazar said his is one of only two police departments in New Mexico
that doesn't arrest overdose victims. Salazar's do officers confiscate personal-use amounts of heroin found on the scene,
and will investigate anything that looks like potential distribution. To counter this problem, advocates want to make
naloxone widely available in the user community. The New Mexico law currently applies to licensed professionals with
prescription-writing authority, but Cliff Rees, a lawyer for the state health department, said the regulations could be
broadened by mid-September to permit any person to administer the drug without fear of liability. Its a goal to
have it in users' homes, Rees said. Bigg stated that users have to discuss, plan and prepare for use of naloxone.
And you have to have it around you can't be hunting it down, he noted. One couple, for instance, keeps an 'OD
box' with a red cross on it. Of course, Bigg said, all bets are off for users who persist in using alone. Asked if naloxone
might give users a false sense of security and thus encourage reckless drug use, Rule said, Absolutely not it's really
unpleasant. It initiates withdrawal with such symptoms as cramping, sweats, vomiting, chills, loose bowels, aching bones
and joints. It's like turning a switch.
Wait a minute, we have had this program since 2001? With Good Samaritan protections? We were giving it to law
enforcement departments? There was a belief that it was important to get Naloxone in the hands of the users and
the individual homes? And Naloxone was only $1.50? What, When, Where? What have been the results, how many
lives have been saved? How many have been distributed and what has been the cost? And how many lay persons
have been trained to administer Naloxone? For the life of me, I cannot find one comprehensive study, date, public
comment, or promotion of this program (?) I submit that everything in this article about Naloxone getting into the
hands of the opioid users remains true today, the only thing that have changed is that the overdose death rate has
34
35
skyrocketed, Naloxone distribution in New Mexico, and in America, has lagged behind or been non-existent, and that
there have been millions and millions of dollars poured into research, education, prevention, etc. that has not produced the
results intended.
Approximately 3,000 opioid overdose reversals were reported to the New Mexico Department of Health Harm
Reduction Program through 2013 In the United States from 1996 through July 2010 opioid overdose prevention
programs in 15 states (including NM) and the District of Columbia reported training and providing naloxone to 53,032
persons, resulting in 10,171 drug overdose reversals using naloxone: {22}
Really? 3,000 lives saved with Naloxone in New Mexico, where are the press conferences? Where are the pats on the
back, much deserved? Oh, wait, read the small print, the key word is through 2013. Ok, so that is still an average
of 250 lives saved every year of the program. And this also indicates, that for every 19 people trained to administer
Naloxone, and assuming they had Naloxone available, they saved 1 life. And for every 5 doses of Naloxone
distributed a life was saved. Why didnt we, as New Mexicans, or in the United States, expand this exponentially in
any of the last 15 years of this program? I cannot find this answer in New Mexico or in the United States. And
remember much of this time was before pharmaceutical companies jacked the price up, before millions and millions of
dollars, spent each and every year on often meaningless research as it relates to opioid overdose death reduction, and, still
today, without a meaningful injecting of funding for this important and proven program. Alright, now I am just
downright mad, frustrated, ashamed of us as Americans, that this has continued to epidemic proportions right
through today. And I think of my fellow New Mexico citizens, Native Americans dying each and every one of these years
at rates 2 or 3 times over the rest of us, innocent high school and college students with their whole life ahead of them gone,
the citizens of Rio Arriba County and the fallout of death in those communities, and in every other crack and crevice of
New Mexico and the United States.
And the use of real stories of people who survived an overdose, prominently told, has a power much needed now at the
community level, regional, state, and national levels. We can use the media to sell increasingly new and questionably
effective pharmaceuticals and we do not have a campaign that is killing us every year at over 50,000 people?: {20}
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36
I am reminded of HIV/AIDS, which remains a serious issue right through today. I remember, in Indiana, when the
HIV/AIDS crisis hit, and the stigmas that were associated with it: drug users, homosexuals, etc. I remember a brave boy
stood up with his family, right there in Indiana, his name was Ryan White. He became, at least for a while, the face of the
AIDS crisis. I also remember as a kid when Walter Cronkite would, every day, list the soldiers who died in Vietnam. Who
are the faces of the opioid overdose death epidemic? The users themselves who have avoided an overdose death. And
what if, every day, we listed on National and New Mexico news, everybody we lost that day to opioid overdose abuse? We
need these faces for they educate the world that opioid overdose death can happen to anyone.
And our own New Mexico Department of Healths State Health Improvement Plan 2014-2016, states:
A public health, pain medication overdose prevention model based upon
Evidence Based
multi-sector partnership (hospital EDs, County law enforcement, managed
69% reduction in poisoning mortality
care organizations, county health department, public insurance brokers,
rate from 2009 to 2011; 15% reduction in
boards of medicine and pharmacy) with following components: (1)
substance abuse and overdose-related ED
community coalition building, (2) monitoring and epidemiologic
visits from 2008 to 2010 in Wilkes
surveillance, (3) provider education, (4) naloxone (5) project evaluation
County, NC
Increase access to overdose prevention education and naloxone for persons at-risk of misuse or overdose of their
prescribed pain medication (Co-prescription Pilots). {23}
More recently (and finally at least some data on Naloxone distribution in New Mexico):
Were encouraged, but we need more naloxone than this, said State Epidemiologist Dr.
Michael Landen. Our goal is to get all pharmacies to stock naloxone. Prescription opioids accounted
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37
for about half of overdose deaths. Another 154 died of heroin overdoses. Thirty-five pharmacies
submitted 285 Medicaid claims for naloxone from Jan. 1 to March 31, up from just 59 claims in the
first quarter last year. Landen noted that the 35 pharmacies that submitted Medicaid claims account for
only a fraction of the states approximately 300 pharmacies. Those totals also pale in comparison with
the 1.75 million prescriptions New Mexico clinicians wrote for opioid drugs in 2015, according to
the Department of Health data. The state is encouraging the states 300 pharmacies to dispense
naloxone to anyone with a prescription for narcotic painkillers. Pharmacy chains Walgreens and CVS
recently announced plans to stock and dispense naloxone in New Mexico. Some Albertsons
and Smiths Food and Drug stores stock naloxone, and the state is in negotiations with
Walmart to encourage the company to follow suit, Landen said. The state also encourages
clinicians to co-prescribe naloxone to anyone with a prescription for a narcotic painkiller. For
heroin users, the Department of Health last year distributed 7,186 doses of naloxone to people
enrolled in the agencys syringe-exchange and harm-reduction programs. {24}
That number shows the state needs to step up efforts to curb addiction, including better monitoring of
prescription painkillers, according to state Epidemiologist Dr. Michael Landen. He said New Mexico also
needs to expand the use of naloxone, a prescription drug that can counteract a drug overdose,
by making it more widely available to law enforcement officers and the public. Far more New
Mexicans could have died last year without Naloxone, which was used successfully in over 900
cases Prescription opioids narcotic painkillers such as hydrocodone and oxycodone
remained the leading cause of overdose deaths in 2014, accounting for nearly half the total. Back-to-back
declines in overdose deaths in 2012 and 2013 may have led to complacency about the problem,
Landen said. There was a lot of focus for a couple of years, and I just think some of the focus has
waned, he said. We now need to redouble our efforts. {25}
And the New Mexico Department of Human Services launches a public service campaign in 2016:
Those huge ads on Albuquerque buses soon will include a pitch for a drug that can save lives by reversing the effects of
an overdose. Advertisements for the drug naloxone, also known by the brand-name Narcan, also will appear at other cityowned properties, including bus shelters and community centers. The purpose of the public awareness campaign is to
encourage anyone who keeps narcotic painkillers around the house, or has a family member who uses heroin, to keep an
emergency dose of Narcan on hand. The lifesaving potential of naloxone has not been well publicized until just
recently, Albuquerque City Councilor Diane Gibson said at a news conference Tuesday to announce the effort. Narcan
is available in many drug stores right now here in Bernalillo County, Gibson said. One of my goals is that every
pharmacy in Albuquerque will carry it very soon. Narcan is available at 22 pharmacies in Bernalillo County, including
eight Walgreens stores, five Smiths Food and Drug Centers, and a several independent drug stores. The city effort is
part of a statewide public awareness campaign developed by the New Mexico Department of Human Services.
Narcan is very safe, said Jennifer Weiss-Burke, who lost her son to a heroin overdose in 2011. You dont have to
worry about administering it the wrong way. You get a few minutes training on how to use it and you are good to
go. State officials Tuesday said they dont know how many pharmacies stock naloxone statewide. Gov. Susana
Martinez signed a bill into law last month that expands access to naloxone by making it readily available to opioid
users as well as to their families, friends, community groups and programs. The law also shields people who
administer naloxone from civil liability or criminal prosecution. If you have an extra glass of wine one night with your
pain meds, you might overdose, Weiss-Burke said. Your family needs to understand that and know what the signs
are. {26}
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Well said and well done, Ms. Weiss-Burke, and Human Services Division, a substantial forward step, almost there to
the solution Alarming is that our state government does not know how many naloxone kits are in pharmacies in
New Mexico? Why not, are you not the distributor? Only 22 pharmacies participating in Bernalillo County, and only
35 pharmacies out of 300 in New Mexico, filing Medicaid claims for Naloxone. Thats only 10%, perhaps this should
not be optional. Perhaps it should be mandatory, Governor Martinez and the legislature, it is time to step in again.
All of this effort towards the management of opioid prescriptions but not much participation and even worst results:
Percent C hange in Filled Prescriptions, 2015 vs 2014
Opioid Products
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
State
S outh D akota
N ew M exico
N ew Y ork
N evada
N ew Jersey
A rizona
C olorado
W ashington
G eorgia
Florida
U tah
Tennessee
N ew H am pshire
Iowa
N orth C arolina
D elaware
W yom ing
W isconsin
M ississippi
M aryland
P ennsylvania
N orth D akota
A rkansas
Illinois
N ebraska
Idaho
%
Change
-0.7%
-1.9%
-2.7%
-3.0%
-3.2%
-4.5%
-4.6%
-4.7%
-5.1%
-5.3%
-5.3%
-5.3%
-5.4%
-5.6%
-5.6%
-5.6%
-5.6%
-5.7%
-5.7%
-5.8%
-5.8%
-5.9%
-6.0%
-6.0%
-6.2%
-6.3%
Rank
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
State
O klahom a
South C arolina
K ansas
Verm ont
M issouri
M ontana
H aw aii
M aine
O regon
C onnecticut
V irginia
Indiana
M ichigan
O hio
Alaska
Louisiana
M assachusetts
M innesota
Alabam a
Kentucky
C alifornia
R hode Island
D istrict of C olum bia
Texas
W est V irginia
Puerto R ico
{27}
%
Change
-6.4%
-6.4%
-6.4%
-6.6%
-6.9%
-7.0%
-7.1%
-7.1%
-7.2%
-7.2%
-7.3%
-7.5%
-7.6%
-7.8%
-8.1%
-8.2%
-8.2%
-8.5%
-8.6%
-8.8%
-9.2%
-11.0%
-11.1%
-11.5%
-13.1%
N /A
38
39
It appears to me that until all pharmacies are required to participate they are not going to participate. Well, so the
past is the past, Im sure now there is better participation, now right? So, I thought I would find out in my own backyard,
Santa Fe, New Mexico. On January 3, 2017, I went to 4 pharmacies with the following results;
Walgreens Cerrillos Road
I approached the pharmacy technician and said I needed some Naloxone. The technician and two others
did not know what this was or what it was for. I educated them about opioid overdose and what this lifesaving drug was for. The pharmacist on duty stepped in and stated that there was a standing order for the
drug correctly and showed the technician how to write a prescription for it. I was next asked for my
insurance coverage and I asked if I had to have insurance to get the drug. They said it could be sold to
me without insurance so I presented my Presbyterian insurance card and was told that I could have 10
units for $10 or 1 unit for $10 (?) I indicated that I might as well take 10! (I will be donating the Naloxone
to the best local distribution, in my judgement, to get it in the hands of users themselves.) I talked with
the pharmacist and asked, So if I had a guy overdosing in the car outside, would I have to go through this
process before I could get the Naloxone. The pharmacist stated that he could administer it in an
emergency. I then asked how many people have come in and requested it, either in an emergency,
or for their family, friend, or as a concerned citizen, or for themselves. The answer was never and
obviously there had not been even one case of an overdosed citizen being saved by coming to Walgreens.
The pharmacist commented that he thought that the stigma of drug use prevents those who
need it to come and ask for it. The pharmacist indicated that the only time it is distributed is when the
referring physician who prescribes Naloxone along with an opioid prescription. He said that sometimes
the customer will not take the Naloxone because they do not want to pay the co-pay from their
insurance. I was given 10 one-dose vials of Naloxone and 9 nasal attachments form Amphastar
Pharmaceuticals. I told the pharmacist that the new synthetic opioids are on the streets now and that it
often required 2 doses of Naloxone to save the overdosed citizen. I asked if they were given any
information to give the person requesting the Naloxone and he said there was none. I note the Amphastar
box has some directions on usage but it does not say to call 911 and get an ambulance there before or
after the overdose citizen has revived. I asked what the cost would be for the 10 vials without insurance
and was told it would be $370.00 which indicates that one vial would be $37.00.
39
40
CVS Cerrillos Road
I went in to this CVS and asked the same questions at this pharmacy. They indicated that they had some
and produced a box containing two vials with nose attachments within it, by Adapt Pharma (I note they
only had one more box in the stock in the back of the pharmacy desk. The pharmacy technician looked up
the directions on how to do the Narcan purchase. She indicated if I had insurance the cost of the Naloxone
would be $37.50 but if not, $116.00. I asked if they had anybody asked for Naloxone for a family member
friend, or as concerned citizen and they said they did not. I asked what would happen if I had an overdose
victim outside in the car, could they just give me a vial to save his life? The pharmacist indicated that he
would be able to administer the Naloxone in an emergency but I either had to buy it with or without
insurance. The pharmacy technician said they had just started the program and were not familiar with it.
I asked if they were given any information to provide with the Naloxone and they said they did
not. I note the Amphastar box had much better instructions, including calling 911. I again educated them
about opioid abuse and the new more powerful synthetic opioids that are hitting the streets. They
indicated that their CVS instructions sell the two-vial set at $109.00 without insurance and that they had a
coupon for $35.00 if I had insurance (?). When I tried to use my Presbyterian Hospital in their system, she
indicated that the Naloxone was not an approved medication under my plan (?).
Highland Pharmacy (Across from Saint Vincents Hospital)
I went to this pharmacy and they said they had Naloxone. The technician indicated that they did not have
any in stock but she could get it the next day. She indicated that they used the Alpha Pharma naloxone
two-pack. She indicated that she has never had anyone request Naloxone for themselves or others and
that if there was someone needing it overdosing outside, that the St. Vincents Emergency Room was
across the street.
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41
Del Norte Pharmacy Galisteo Street
The pharmacy staff here know the most about Naloxone and the pharmacist indicated that they did not
have any in stock because the pharmaceutical provider, Amphastar, had defective sprayers, and the
company removed all of them from the market. She stated that their order has been back ordered for
months and they have none. Again, I educated them about the need for two vials per kit and they
indicated that the Amphastar box has two vials, showing me a box. Unfortunately, they are incorrect,
there is only a single vial in the Amphastar boxes. They gave me instructions for the Naloxone, a one
page copied sheet of paper, which they said they received from the Southwest Care Center in Santa Fe.
They have no idea when they will be getting any more Naloxone.
Smiths Pharmacy Pacheco Street
I talked with the pharmacy technician here who indicated that they had Naloxone samples which were
provided by the Southwest Care Center in the summer of 2016 but they had to destroy these samples
because they expired in January 2017. They have not received any more naloxone, have none available,
and had not ordered any from any source. She indicated that they have nobody asking for it and
have had nobody approach them with an overdose emergency either. {28}
Southwest Care Center is funded by the Behavioral Health Division of the Department of Human Services
to:
The Behavioral Health Services Division (BHSD) contracts with SW CARE to provide technical assistance to pharmacies related to
naloxone. The goal is to increase access to naloxone by increasing the number of pharmacists credentialed to dispense naloxone,
increase patient outreach and education about naloxone, and reduce pharmacy barriers to dispensing and billing for naloxone.
Increasing access to naloxone is a strategy recommended by the Centers for Disease Control and Prevention
(http://www.cdc.gov/vitalsigns/heroin/).
In addition to other community prevention efforts BHSD Office of Substance Abuse and Prevention (OSAP) also oversees two public
awareness campaigns:
Increasing public awareness of, and access to naloxone through a media campaign consisting of radio public service
announcements, newsprint ads, billboards, and a resource website (http://doseofrealitynm.com/2015/08/31/more-infoaboutnaloxone/)
Increasing public awareness of the dangers of prescription drug abuse through A Dose of Reality media campaign consisting of
radio public service announcements, TV ads, newsprint ads, billboards, social media, movie theater ads, and resource website (
http://www.nmprevention.org/Dose-of-Reality/Home.html).
And they are award-winning for their Dose of Reality campaign, an award, really?
The New Mexico Human Services Departments (HSD) campaign to raise awareness of prescription drug abuse, called, A Dose of
Reality, has been awarded the 2015 Silver Cumbre Award for public service campaigns from the New Mexico chapter of the Public
Relations Society of America.
As part of the campaign, three commercials designed to capture teens attention appear on youth-oriented programming on
Comcast, YouTube, movie theaters, malls, billboards and gas pumps. Additionally, weekly posts are aimed directly at teens on
Instagram with combinations of common hashtags kids use to research and share information about getting high. Advertisements
on pharmaceutical drug bags promote safe storage and proper disposal, as well as a parent resource toolkit. All materials are
available for download at Susana Martinez, Governor Brent Earnest, Secretary at http://www.adoseofrealitynm.com for use by
parents and community members working on prevention. The campaign will also be featured in an upcoming Better Call Saul
episode. The campaign is being funded by a grant from the federal Substance Abuse and Mental Health Administration (SAMHSA)
Center for Substance Abuse Prevention (CSAP). The Cumbre Awards recognize outstanding strategic public relations campaigns
and tactics by New Mexicos communications professionals. {29}
41
42
While I understand the need to educate our youth about prescription overdoses, and their rate, especially among
females is rising, the mass amount of prescription overdoses is not with youth. Why wasnt this campaign aimed at
the 75%+ of the New Mexico population who are overdosing? And again, has it been effective, have the overdose
death rates gone down? And how many Naloxone units did they actually distribute? Are they ever planning on
distributing some more? For Santa Fe pharmacies, and perhaps all 300 New Mexico pharmacies, certainly need
some along with education about what Naloxone is even for.
Southwest Cares main thrust appears to be HIV/AIDS/Hepatitis, prevention and treatment. While, of course, related to
opioid abusers who contract these conditions as well, their website has no information on Naloxone, anywhere, yet they
are funded by the New Mexico Human Services Division for this purpose. {30}
I found they offered a training session in 2016:
Southwest CARE Center, with funding from the Behavior Health Services Division in New Mexico:
Invite you and your Staff
A Dose of Rxeality - You Can Be Part of the Solution! Campaign
Presented by:
Karen Clark, PharmD, Staff Pharmacist, Southwest CARE Center, Albuquerque, NM
Carly Cloud Floyd, PharmD, PhC, CACP, AAHIVP, Pharmacy Manager, Clinical Pharmacist, Southwest CARE Center, Albuquerque, NM
Kate Morton, PharmD, Director of Pharmacy, Southwest CARE Center, Santa Fe, NM
Craig Schaefer, CPhT, Pharmacy Specialist, Southwest CARE Center, Santa Fe, NM
Date:
Monday, May 2, 2016
Place:
Southwest CARE Center 649 Harkle Rd. NE, Santa Fe
Times: Call or email to confirm times or to schedule future training dates.
RSVP:
Contact Kate Morton @ 505-989-8154 or kmorton@southwestcare.org
* Pre-Registration is required to guarantee your seat.
RPh Objectives # 0104-9999-16-028-L01-P
By the end of this presentation, pharmacists will be able
to: Review the 2016 updated law regarding pharmacist
naloxone prescriptive authority and Department of Health
standing order
Describe the different groups of people that come into

the pharmacy who should receive naloxone
CPhT Objectives # 0104-9999-16-028-L01-T

By the end of this presentation, pharmacy technicians will be
able to:
Review the 2016 updated law regarding pharmacist naloxone
prescriptive authority and Department of Health standing order
and how this affects technicians in an outpatient pharmacy
setting
Identify good candidates for naloxone at the drop-off and

pick-up windows, or by reviewing prescription profiles
42
Properly and efficiently adjudicate a claim for naloxone
Effectively and efficiently counsel a patient and family

members on harm reduction strategies and naloxone use
by using the demo kit(s) provided
43
Properly and efficiently adjudicate a Medicaid claim for

naloxone
Identify appropriate vendors for naloxone and mucosal nasal
adaptors
The New Mexico Pharmacists Association is accredited by the Accreditation Council for Pharmacy
Education (ACPE) as a provider of continuing pharmacy education. This program provides 2.0 contact
hours (0.2 CEUs) of continuing pharmacy education credit. The knowledge-based program is designed for
pharmacists & pharmacy technicians. Participants are required to turn in a completed program evaluation form
to receive the designated CEUs. Your CPE credits will be submitted into the CPE Monitor Database within 60 days
based on the information provided.
ACPE Program # 0104-9999-16-028-L01-P/T / Initial Release Date: 5/02/16
And they are recognized as innovative in Naloxone distribution expansion:

The increase in naloxone access can be attributed in large part to a novel pharmacist-initiated naloxone program. Since April, a group of pharmacists who are part
of a nonprofit HIV/Hepatitis C clinic in New Mexico has been traveling to pharmacies in the state to train pharmacists to operate a naloxone program. Even though
we have this law in New Mexico, we didnt see claims increase for naloxone, so we felt we needed hands-on training for pharmacists and technicians, said Kate
Morton, PharmD, director of Pharmacy Services of Southwest CARE Center, the nonprofit that provides the onsite training. She said many pharmacists intended to
take advantage of the law but didnt know how to develop a program or were too strapped for time to get one started. Providing hands-on, peer-to-peer training
seemed like the most effective tactic, according to Morton. People are really appreciative that weve come to them and taken the time, especially in the more rural
towns, Morton told Pharmacy Today. {31}
And Ms. Morton writes, in her own editorial:

Since April, nearly 200 outpatient pharmacists and their staff, representing more than 43 pharmacies in 20 communities throughout the state, have been trained on
how to use patient demonstration kits and how to prescribe lifesaving naloxone to patients with an opioid painkiller prescription or their family members. New laws
allowing for easier distribution of naloxone, including the naloxone prescription order from New Mexicos Department of Health, have seen an increase in
the number of Medicaid claims for naloxone. More than 77 pharmacies and 160,000 patients received their prescriptions in pharmacy bags with the Dose
of Reality campaign message to promote the lifesaving benefit of naloxone. Collaboration must continue at the local and state level. The New Mexico
Behavioral Health Services Division and the state Department of Health have received four federal grants to raise awareness about the dangers of sharing
prescription drugs and reducing opioid overdose deaths, and expanding naloxone distribution and training first responders in high-need communities. This is
the right direction for all of us. Accidental opioid overdose can happen to anyone. Protect your family by asking your pharmacist today about naloxone.
{32}
It is apparent that the Naloxone distribution strategy providing it in pharmacies, is an utter failure and always has been, I
note the following problems and considerations with this strategy:
1. There appears to be no continuous source to even get Naloxone stocked in 3 out of the 5 pharmacies in Santa Fe,
with another pharmacy only having two boxes available. One pharmacy could get in 24 hours; another had been
given samples that expired 6 months later with no replenishment of their inventory. And no pharmacy had any
examples of anyone coming and wanting it as an emergency with someone overdosing nearby. If that did happen,
the pharmacists agreed that they could administer the Naloxone themselves.
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2. The fact that a person must have insurance to get Naloxone meant a copay anywhere from a $1 a single dose vial
up to $37.00 for a single use vial. For a double-vial pack, one pharmacy had it for $37.00 with insurance and
$116.00 without insurance. So, the cost per 2 does vial ranges from $2 to $37.00 if you have insurance. They only
apparent time that it has been distributed was as a separate prescription by a prescribing doctor who was giving the
patient an opioid prescription in tandem. And it appears that at least some of these customers have refused to pay
the copay for the Naloxone, taking only the opioid prescription.
3. There has been little to no education of the pharmacy staff on the problem of overdose death in New Mexico nor
about the synthetic opioids requiring two vials to revive the overdosing citizen.
4. There is no marketing of Naloxone with any signs or indication that Naloxone is even available. So, nothing
like a poster that might say Have a friend with an opioid problem? and a description of the various opioids
including heroin and fentanyl, and the need for two vials. And some information about the cost of it with Medicaid
and conventional insurance coverage would also be important.
5. Nobody is coming in and asking for Naloxone, for those that have it prescribed and have insurance, at least some
wont even pay a copay for Naloxone. Few claims for Medicaid for Naloxone are being filled. There is a stigma
with asking for Naloxone in a pharmacy setting.
6. There is no tracking and distribution management of the Naloxone. For example, if some of the Naloxone was
expiring in 6 months, that should be pulled from the shelves, and immediately distributed at the street level, where
it could be used the fastest, and before it expired.
7. There is some conflicting information about the storage of the Naloxone. None of the pharmacies had the drug in
any special temperature controlled container. The Amphastar box indicates it must be protected from light, stored
at 77 degrees Fahrenheit, that in transporting it, the range can be between 59 degrees and 86 degrees Fahrenheit. It
appears, however that, studies show that it is fine at room temperature and has been proven to be effective in high
heat and in very cold, Norway.
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I cannot find how much Southwest Care receives annually for their Naloxone distribution and education program, as well
as their Dose of Reality campaign. It appears that there is grant for over $300,000 per year (see below, under New
Mexico Funding).
Law Enforcement Agency Distribution. And expanding law enforcement agency availability of Naloxone, surprisingly
does not show a lot of push back from police personnel:
The drug will even be distributed free at a health fair in Espaola on Saturday. Police agencies
are getting on board, equipping officers with Narcan. Our goal is to ensure that all persons at high
risk from prescription opioid overdose have access to naloxone and this can occur in many
different ways, said state epidemiologist Dr. Michael Landen of the state Department of
Health. But if your mental picture of New Mexicos overdose problem is that of a junkie
shooting up in an alley, youre only partly right. Landen stresses that heroin overdoses are
just the tip of the iceberg. Heroin overdose deaths are a part, but not the largest part, of
overdose deaths in New Mexico, he said. Prescription opioids are the major cause of our
drug overdose epidemic in New Mexico at this time, he said. The prescription drugs that most
often are the cause of overdose deaths are painkillers like morphine, oxycodone and
hydrocodone We need to reduce the misuse of prescription opioids and assure that naloxone
is available to persons at risk of overdosing, said Landen. Prescription drug users are a
different population than heroin users, said Landen, but an overdose is an overdose...
A health fair Saturday sponsored by the Rio Arriba County Health Department will focus on gun violence
prevention and include several classes on how to recognize and intervene in a drug overdose,
said county health and human services director Lauren Reichelt. The classes are for anybody
concerned about a loved one in their environment at risk of overdose, said Reichelt. The antioverdose drug Narcan will be distributed free to attendees. They just need to come and no
affidavit or application is required, said Reichelt. {33}
First, I have to say, that I would not like the job of Dr. Landen or Ms. Reichelt at ground zero of the problem in Rio
Arriba County, having to address and respond to this issue. Kudos to him and to Ms. Reichelt for also moving in the right
direction, yet you are not quite there
State Police Chief Pete Kassetas has been studying the issue and sees no downside. A dozen or
more years ago, some of the agencys officers carried the drug but then there was a problem with
temperature stabilization that has now been solved. We are getting funding in place, training, then
deployment, said Kassetas. So I foresee within the next three to six months well be live in at least the
first two counties and I want to make it a statewide initiative. There is a cost to all of this stuff,
but I think it is well worth it to give us the ability, because usually we are the first ones on
scene.
Kassetas agrees that administering Narcan appears to be a change in the law-enforcement mind-set.
Years ago, I think at least the State Police and law enforcements vision was thats really not our job we
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are law enforcement, we are not medical responders and we are not into treatment, Kassetas
said. But I dont believe that. We are there to employ life-saving measures, no matter what
the situation is, and if we can be provided a tool, be it Narcan or the defibrillators we carry. A
month ago or so, Kassetas met with Health Department and community outreach folks from Taos and Rio
Arriba counties. They came to us and said we would like the State Police to carry this in Taos
and Rio Arriba counties, he said.
The Santa Fe County Sheriffs Office has never used Narcan before but, for the past couple of
months, Capt. Adan Mendoza has been looking into it. Its a life-saving measure, its a lifesaving tool, he said. Under very emergency type situations, extreme situations, Narcan can
be a tool to save someones life that is possibly overdosing The pilot program would involve
State Police officers carrying Narcan in Taos, Rio Arriba and Santa Fe counties, which is the state
Department of Public Safetys Region 7, said DOHs Landen. But Kassetas doesnt want half a solution. I
said, look, I think what is good for one county is good for all 33. After any liability and training
issues are worked out, Capt. Mendoza of the sheriffs office would like to see its widespread use in his
jurisdiction. I think our goal is to get it in the hands of every deputy thats out on the streets, said
Mendoza. At the minimum, we would want to start with maybe a pilot program with getting some kits out
to part of our patrol teams, so a certain amount of individuals would have it. But our goal is to have every
deputy have a kit while on duty. The Santa Fe Police Department is also looking into whether its officers
should have Narcan, and the associated cost and training issues, said an SFPD spokeswoman. {33}
And within 24 hours of the kits being handed out to the sheriffs deputies, a life is saved:
This incident is a real-life example of a situation that our deputies will be handling with this new program, Santa Fe
County Sheriff Robert A. Garcia said, The overdose victim received the nasal spray dosage and within four minutes he
became alert and communicated with Deputy Lopez, advising her that he had used heroin. On Friday, the sheriffs office
announced deputies would start using Narcan when responding to drug overdoses. {34}
Kudos to State Police Chief Kassetas, he sees the whole picture. The Santa Fe Sheriffs Department and the Santa Fe
Police Department had never used Naloxone in the capital city, in a program that has been around since 2001? It took them
2 more additional years to get the program going at the Santa Fe Sheriffs Department, not until 2016? And within 24
hours of implementation, a live is saved. Well, it is never too late, I guess.
Recently, in Lincoln County, where they suddenly had a rash of synthetic overdose deaths, the following statement
came from State Epidemiologist, Dr. Landen:
the standing order for pharmacists that was signed by Dr. Michael Landen, the State Epidemiologist on March 18,
2016, authorized pharmacists to dispense naloxone to any person who uses an opioid, regardless of how the opioid is
used or obtained and any person in a position to assist a person at risk of experiencing an opioid overdose. Sheriff
Robert Sheppard, who was in attendance, noted that the legislation was an unfunded mandate. Nevertheless, his
department was looking into funding sources so that deputies and narcotics officers will be able to carry the drug in the
field. In addition to the expense, there are other concerns including response time, shelf life and the fact that naloxone only
works on opioid overdoses. Narcan is only good for three to four minutes after the overdose, so the timeframe is
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important, Shepperd said. We arent close enough to be right there. There are two or three agencies that have gone out
and purchased this but they are in bigger populated areas, so their response time to these calls are a lot shorter than
ours. They also have more people to cover [smaller] areas. {35}
Sheriff Sheppard, while misinformed about the amount of time one can recover from an overdose using Naloxone (not
his fault), still gets it. Its about response time, availability of Naloxone and who is going to pay for it (it is not an
unfunded mandate in my estimation), and the issue of large rural territories that must be covered. And why are
police agencies seeking out funding sources for Naloxone when it is available from the State Department of Health
and supposedly at some corporation and other pharmacies in New Mexico?
And, in our second largest city, Las Cruces, well, not so much:
Las Cruces Police Department spokesman Dan Trujillo said LCPD currently doesnt carry naloxone. We patrol within city limits, so its not
necessarily something that would be a huge benefit for our officers to carry it, and the reason why is the (Las Cruces Fire Department) responds to
nearly all medical calls as it is and are well-trained in the usage of it, Trujillo said. Doa Ana County sheriff's deputies also do not carry the
medication. Unlike paramedics and emergency medical technicians, deputies are not trained to administer medications, such as naloxone,
department spokeswoman Kelly Jameson said. Aside from that, we are usually the last to respond to a situation where Narcan (naloxone) would
be necessary fire and EMS are the first to arrive," Jameson said. Harrand said the majority of the states emergency medical services carry
naloxone. They are usually the ones that reverse an overdose in the field and then transfer patients over to emergency rooms, which are equipped
with naloxone, she said. Our emergency departments are no strangers to treating opioid overdose. {36}
It appears that Las Cruces Police and Sheriff departments are not definitely not on board. Dr. Herrand, from The New
Mexico Department of Mental Health, indicates here that a majority of emergency medical services agencies carry
naloxone, that can be anywhere from 51% - 99%, what is the percentage? It should be 100% (P.S. click the link for
this article and read the human-interest story {36})
Police budgets are already strapped and there is a shortage of police officers even on the job in New Mexico. Police
budgets are for law enforcement, not health issues. We need them for interdiction of these dangerous drugs, getting these
drugs off the street, and not responding to overdoses all over the territory when they could be responding to law
enforcement challenges in the community. I am not saying they should not have naloxone in their squad cars if they come
on to a scene with an overdosing victim. Im saying we New Mexicans, at the community level, should be the ones
responding. We are first responders.
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Other Organizations Naloxone Distribution. It appears that New Mexico PMP program participation appears to be
minimal. And over 7,000 Naloxone doses distributed to program only participants. Im not saying these participants are
not higher risk for overdose and they should not have Naloxone, they absolutely should. But if it has been being
distributed for years, and the death rate continues at the same rate, why? Because we are not addressing the ones
who are not in any programs and are not going into a pharmacy to ask for naloxone, ever. In our largest city,
Albuquerque, with a population of over 900,000, almost half or our states population, and we only have 22 participating
pharmacies? Perhaps it is time that participation by pharmacies is no longer optional. Naloxone was distributed to
heroin users who are enrolled in the Department of Health programs for syringe exchange and heroin reduction programs.
We dont know how many of these doses went to heroin users who have overdosed previously? By definition, these users
have to be already enrolled in the programs so these doses were given post, any overdoses or not, as a preventive measure
to stop a future overdose. A good start, but no indication how many Naloxone units were distributed in total in New
Mexico, with opioid prescriptions, or illicit opioids, where more than half of the opioid overdose deaths occur. And
Naloxone saved 900 lives in 2014, which lives we dont know: where? what age, race, sex, what drug was used in the
overdose, were there any repeaters using Naloxone more than once, etc. Overdoses went down in 2012 and 2013 but we
dont know why? And they went up in 2014 and 2015 and we dont know why? The only answer we are given was
complacency. Im not sure who Dr. Landen is referring to and I would like some research on that please, I am afraid he
might be right. And the health fair in Rio Arriba County, the ground zero of opioid overdose in New Mexico, where
Naloxone is, after a training class, distributed without any registration of who is receiving it is on the right track.
And even bigger step: Just hand them out to adults and teenagers who will take it with the instructions on how to
administer it in the kit including noting the cell phone application that has all the education and training on how to
administer it. You see, those abusing opioids, including heroin, are probably not going to sit through a class from a
government agency, just hand it out, no questions asked. And those whose family members, neighbors, partners,
etc. may not either because they are being seen sitting at health fair and taking a class on opioid overdose. Stigma is
stigma.
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And it continues, now in Chaves County, part of the strategy, excellent, including a community consortium of individuals
and naloxone distribution, part of it very frustrating-why is the group having to find sources to procure Naloxone?, it
should be delivered by the New Mexico Department of Health in crates to these groups at that meeting, part of it is back to
what has not worked to meaningfully to reduce opioid overdose deaths, research, education and prevention, and finally
most of the grant funds will be used for youth prevention. Yes, dont get me wrong, youth prevention of overdoses is
critical, but by far are not the age groups that are overdosing as delineated in this paper.
While the grant funds will focus on youth, health care professionals recognize that the problem of opioid deaths knows no
age boundaries, and it has plagued the nation, state and county for decades. Opioids cause the majority of overdose
deaths, said Landen, and in New Mexico, most overdose deaths are due to prescription drugs. {37}
One of the strategies shared with health care officials at the recent meeting was encouraging law enforcement,
health organizations and detention centers to obtain naloxone and distribute it or administer it to people they think are
either likely to overdose or in the midst of overdosing. The third strategy involves treatment and prevention, which has
many different aspects. Some efforts involve educating people about the risks of opioids and especially how dangerous
they can be when used in combination with alcohol or other substances.
{20}
Taos Holy Cross Hospital has been distributing kits in the community:
John Hutchinson, PharmD, BCPS, is Director of Health Outreach for Holy Cross Hospital in Taos, NM. The 29-bed acute care rural hospital is the
sole community provider and owns some physician practices. In 2008, New Mexico was the state with the highest overdose death rate, dropping to
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50
second highest in 2010 and third highest in 2012. North-central New Mexico, where Hutchinson lives, is the epicenter of drug overdose deaths
in the statemost unintentional, and most from prescription opioids.
The whole community response, he explained, begins with limiting the volume of opioids in circulation through elements such as safe
opioid prescribing (e.g., not concomitantly prescribing benzodiazepines and muscle relaxants, running a prescription drug monitoring
report, urine testing for drugs); drop boxes and disposals strategically placed throughout the community; and prescribing guidelines in the
emergency department. It continues with treatment and recovery, behavioral health, the courts, a strong 12-step community, and schoolbased drug prevention talks. The solution has to extend beyond the walls of our institution, and so were trying to engage the community
at large, Hutchinson said.
In that big picture, naloxone can keep people alive and get them referred to treatments, and get them help, he continued. For more than a
decade, the New Mexico Department of Health has dispensed intranasal naloxone as part of its needle exchange program. But in January 2013,
Holy Cross Hospital started a community-based intranasal naloxone program that is funded by the state department of health. Led by Hutchinson,
the program aims to reduce prescription drug overdose deaths and to use the prescriptive authority for naloxone that New Mexico was
first in the nation to grant to pharmacists.
In a collaboration among community pharmacy, hospital pharmacy, local physician practices, and clinics, intranasal naloxone kits are
assembled by a pharmacist and dispensed to high-risk patients at the point of care. As Today went to press, approximately 130 kits had been
dispensed since the program began, and four successful reversals had been reportedwith none of the kits used on the person the kit was
dispensed to. When were dispensing these kits, these people are being educated, Hutchinson emphasized. The education piece is
critical. {38}
Kudos Mr. Hutchinson well said, he gets it. But even with this distribution, has the overdose deaths reduced in Taos
County? It does not appear so. The Colorado Consortium has a great program and they are currently raising funds to
provide Naloxone to law enforcement and first responders. Further research indicates they want to obtain $2,500 kits at
the cost of $187,500 which equals $75 per unit. {39}
The Harm Reduction Coalition is a consortium of agencies and individuals whose role is:
The Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and
dignity of individuals and communities impacted by drug use. Our efforts advance harm reduction policies, practices and
programs that address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration.
Recognizing that social inequality and injustice magnify drug-related harm and limit the voice of our most vulnerable
communities, we work to uphold every individuals right to health and well-being and their competence to participate in
the public policy dialogue. {40}
This appears to be a very worthy organization and mission, and I am impressed with attendees at their International
Convention, these people are on the front lines of many issues which include opioid abuse, overdose, and overdose deaths
(see Appendix). They have devoted their lives to reducing these and many other issues and the stigma that comes with
substance abuse citizens. Says Ms. Tula:
in spite of all weve accomplished, we are seeing unprecedented rates of people dying from fatal opioid
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overdoses and people being ripped from their communities and incarcerated for drug-related crimes.
Monique Tula, Executive Director {40}

As I read through the conference agenda and the workshops and panels at their recent national conference held in San
Diego, CA, I saw the following:
New Mexico Naloxone Access: New Statutes to Increase Distribution by Non-Clinicians
Dominick Zurlo, New Mexico Department of Health, Santa Fe, NM
in November 2016, included New Mexico presentations on a panel entitled Expanding Naloxone:
The Naloxone Buffet

Phillip Fiuty, Santa Fe Mountain Center, Tesuque, New Mexico
Dave Koppa, Santa Fe Mountain Center, Tesuque, New Mexico {40}
The Santa Fe Mountain Center delivers over 3,000 units of Naloxone a year through a state grant at Ground Zero and on
the streets of Rio Arriba County communities. For them to speak about their experiences and effectiveness is without
question, and there has been death reduction there recently. And the Department of Health, with Mr. Zurlo, was speaking
about the new legislation which is innovative, but legislation with Naloxone distribution has no effect. I must say I am
troubled by our government presenting at national conferences as if we are leading the way on the issue of opioid abuse
and overdose death by how we have reduced its impacts but the previous year was the highest in New Mexico for opioid
overdose death. In 2015, the New Mexico Department of Health, presenting a Webinar where Naloxone is mentioned. It is
less than sterling about the Naloxone program itself, but the observations are very important opioid abusers, when you
can even actually get them in a room somewhere, cannot and will not sit through education classes. {41}
Program started in 2001
Originally a 3-hour training Some problems:

Participants falling asleep
Participants needing to use
Too much information cognitive overload!
In 2005-2006 the program started implementing a short 15-20 minute on the street curriculum to meet people where
they are!
Basic information
It is not overwhelming
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Handouts re-designed
More easily integrated into outreaches and clinics
And after that, in 2006, I find nothing in New Mexico about Naloxone as a strategy for years.
From The Council of State and Territorial Epidemiologists 2016 Conference in Anchorage, Alaska:
Monday, June 20, 2016: 11:15 AM
Tubughnenq' 5, Dena'ina Convention Center
Samuel L Swift, New Mexico Department of Health, Santa Fe, NM
Luigi F Garcia Saavedra, New Mexico Department of Health, Santa Fe, NM

BACKGROUND: From 2008 to 2012, American Indians and Alaskan Natives (AIANs) had the highest drug overdose mortality rate of any
racial/ethnic group within the United States. However, there are counties in the United States where the AIAN drug overdose mortality rate is the
lowest of any racial/ethnic group. We investigated the relationship between county-level demographics and drug overdose among AIAN peoples.
County demographics may provide insight into potential protective or risk factors that are present in certain types of AIAN communities.
METHODS: We used an ecological study design linking county level demographics from the United States Census American Community Survey
and the 2008-2012 national mortality file obtained from the National Center for Health Statistics (NCHS). Using four multivariable logistic
regression models, we analyzed the impact of three county-level demographic variables on the drug overdose death rate among American Indians in
the county: 1) the percent of AIAN persons living in a county, 2) the percent of persons living on tribal lands, 3) and classification as an Indian
Health Service Area, and 4) all three variables together.
RESULTS: After adjustment for social and economic factors including poverty, educational attainment and Gini index, we found that percent of
self-identified AIANs living within the county, percent of county population living on tribal lands were both associated with a reduction in the log
transformed county level AIAN drug overdose death rates.
CONCLUSIONS: The three measures we used to describe the types of counties that AIAN individuals live in are likely proxy measures for
conditions in these communities. We believe that these measures may be proxies for community resilience, or community cohesiveness, which are
things we are unable to measure with this type of study design. These proxies of social structure In AIAN communities (percent of AIAN living in a
county and percent of county population living on tribal lands) were shown to be protective against drug overdose death. These results suggest that
there may be factors in American Indian communities that may be protective from drug overdose. Further research is needed into the identification
and bolstering of the protective factors intrinsic in AIAN communities. {42}
Wait, what? Protective factors from drug overdose in AIAN communities? And they are dying all through these
years at a rate of 2 or 3 to 1? And in 2016, one could argue convincingly that whatever protective factors they
have found in their study, are not working, period. Mr. Swift and Mr. Saavedra are using data that ends in 2012 (I tried
to find this presentation on the conference website and at the Department of Health, it is not available)? Have we even
studied what is happening NOW or even the last 2 years with Native Americans? Why didnt you use the most
recent New Mexico Substance Abuse Epidemiology Profile? I think we know why, because the overdose rate
skyrocketed, including Native Americans, and they could not show that. The New Mexico Epidemiology Profile, Dated
January 2016, all the data is there through 2014,? Found at: https://nmhealth.org/data/view/substance/1862/ .
Death
s
Rates
*
52
Bernalillo
Asian/
America
Pacific
n
Island
Indian
19
9
23
456
Catron
Chaves
Cibola
Colfax
Curry
De Baca
53
396
All
Race
s
918
Asian/
America
Pacific
n
Island
Indian
14.0
9.2
23.0
29.1
26.4
All
Race
s
26.9
0.0
0.0
83.3
49.4
56.3
25
32
62
41.7
33.2
46.8
17.0
23.0
20.5
17
4.2
0.0
0.0
11.7
27.9
11.8
10
17
0.0
0.0
0.0
35.3
22.7
28.3
16
24
0.0
0.0
13.3
6.9
13.0
10.0
0.0
0.0
0.0
40.4
0.0
18.6
Dona Ana
84
87
178
0.0
0.0
21.4
13.5
30.1
18.6
Eddy
19
37
56
0.0
0.0
0.0
17.0
27.1
22.1
Grant
16
17
33
0.0
0.0
0.0
27.0
28.3
26.7
Guadalupe 0
0.0
0.0
0.0
26.3
0.0
20.9
Harding
0.0
0.0
0.0
0.0
0.0
0.0
Hidalgo
10
0.0
1,344.0
17.1
71.4
46.1
Lea
13
39
58
0.0
57.3
37.2
8.8
28.6
18.7
Lincoln
20
30
27.9
0.0
0.0
33.4
31.3
31.8
Los Alamos 0
11
13
0.0
0.0
0.0
21.2
19.1
17.1
Luna
16
20
0.0
0.0
0.0
3.9
47.4
19.0
McKinley
29
45
12.5
0.0
45.1
19.2
16.4
14.0
Mora
13
13
0.0
0.0
0.0
80.0
0.0
67.9
Otero
19
39
66
17.6
0.0
28.1
19.5
21.5
20.7
Quay
13
0.0
0.0
0.0
45.9
23.1
32.0
Rio Arriba
10
126
10
147
35.5
0.0
116.3
95.2
35.2
78.4
Roosevelt
10
15
0.0
0.0
21.0
11.9
18.6
16.3
Sandoval
13
46
62
127
18.5
0.0
7.6
20.2
19.7
19.4
San Juan
29
17
63
111
14.1
0.0
53.4
16.4
21.1
18.2
San Miguel 0
46
53
0.0
0.0
0.0
41.5
24.7
37.1
Santa Fe
131
71
208
9.4
0.0
16.1
36.6
22.3
29.4
Sierra
20
26
96.0
0.0
0.0
31.0
53.6
44.6
Socorro
11
20
18.9
0.0
0.0
27.3
16.8
22.5
0
0
0
0
11
0
0
0
1
49
26
11
1
46
1,177
20
11
0
50
1,080
47
23
1
100
2,464
9.5
45.8
0.0
21.6
14.1
0.0
0.0
0.0
0.0
6.2
0.0
0.0
0.0
25.6
22.7
30.6
39.9
9.4
21.3
26.0
24.8
21.2
0.0
33.1
24.7
27.7
27.7
3.9
26.2
24.3
County
Taos
1
Torrance
1
Union
0
Valencia
2
New Mexico 117
Blac
k
Hispani
c
White
Blac
k
Hispani
c
White
I am all for collaboration around the country and finding out what others are doing to address this important subject. And
yes, New Mexico was the first to have a Naloxone program and had lead the way on other statutes which allow for more
Naloxone distribution. But thats where it ends, there is no effective Naloxone distribution. And, lets face it, if we
were #2 in the country in opioid overdose deaths in 2014, we should not be presenting at international conferences and in
an online Webinar, as if we had been successful in its distribution or the reduction of overdose deaths in New Mexico. It
analogous to NFL football coaches, the same coaches are moved around to different teams, paid astronomical salaries, and
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54
they consistently have a losing record. I would much prefer our tax dollars be spent on Naloxone at the street level
instead of conference, airfare, and hotel costs.
The New Mexico HOPE Initiative

Kudos to this community agency gathering of agencies in this effort:
Increased Coordination among Law Enforcement Agencies, Improved Access to, and Onsite Delivery of Life-Saving Medication to be Announced-- First Event of
National Heroin and Opioid Awareness Week to be held September 19
ALBUQUERQUE U.S. Attorney General Loretta E. Lynch has designated the week of September 18, 2016, as National Heroin and Opioid Awareness Week, and
U.S. Attorneys throughout the country are sponsoring events geared towards increasing awareness and developing solutions to the growing epidemic of heroin and
opioid abuse in our country during the awareness week.
In New Mexico, the New Mexico Heroin and Opioid Prevention and Education (HOPE) Initiative, a partnership between the UNM Health Sciences Center and the
U.S. Attorneys Office, will host a series of education events during National Heroin and Opioid Awareness Week. Bruce G. Ohr, Associate Deputy Attorney
General and Director of DOJs Organized Crime Drug Enforcement Task Force (OCDETF) Program, will participate in the HOPE Initiatives events.
One key component in the fight against addiction and overdose death is the availability of life-saving medications like Naloxone. Naloxone is a prescription drug
that reverses the effects of an opioid overdose; it is easy to administer and safe to use. U.S. Attorney Damon P. Martinez and Dr. Joanna G. Katzman, Director of
the UNM Pain Clinic, will launch the HOPE Initiatives Naloxone Project during a press conference at 10:00 a.m. on Monday, September 19, 2016 at the Hotel
Andaluz in Albuquerque, N.M. The goal of the Naloxone Project is to enlist law enforcement agencies throughout New Mexico to join HOPEs life-saving efforts
by implementing Naloxone protocols and carrying Naloxone. U.S. Attorney Martinez and Dr. Katzman will be joined by Bernalillo County Commissioner Maggie
Hart Stebbins, Albuquerque City Council President Dan Lewis, Albuquerque City Councilor Diane Gibson, and representatives of law enforcement agencies that
are carrying Naloxone, or are seeking to do so. Discussion details from this event will be posted to the NM HOPE Initiative website and available to the public
at www.hopeinitiativenm.org[external link]. {43}
While I also support all law enforcement agencies having Naloxone available in their cars, I still submit that they should
not be the ones on the front lines of its administration. It is us at the grass roots level.
The cost of Naloxone ranges from free to approximately $75 for a 2-nasal administration kit. There are also an
injectable Naloxone but it currently is at a far greater cost. It is not a controlled substance and cannot be used to get
high and is not poisonous. Safe administration applications, videos, pamphlets, and other advertisements abound.
And we have the Good Samaritan law to protect those who administer the drug to an overdose citizen.
New Mexico Funding. I guess, in the end, it always comes down to human and financial resources. In a time of shrinking
federal, state and local government budgets, there has been a great deal of funding for the opioid abuse and overdose death
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epidemic to the State of New Mexico citizens. I know it must be someplace, but I cannot find in federal or state agency
online information on how these monies are spent in detail, nor any performance analysis of the use of these monies (?).
And I remind you, this is our tax dollars at work:
Federal dollars earmarked specifically for opioid overdose in New Mexico $2,232,607. And this is supplementing funds from previous federal grants
also in New Mexico to the Department of Human Services, through the Behavioral Health Collaborative of $1M per year.
Federal dollars, the Center for Disease Control, 2015, earmarked specifically for opioid overdose in New
Mexico - $850,000 a year, for four years = $3,4000,000.
This funding allows the New Mexico Department of Health to develop new partnerships with the Board of
Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities
with a high overdose burden. [44]
For the life of me, I cannot understand what opioid overdose death prevention has to do with the Workers Compensation
Administration, other than lost work time and productivity, but wait a minute, if they are already deceased, who cares
about lost work time and productivity? Perhaps, its more educationI need to be educated on this one.
Additional 2017 funding specifically for New Mexico, $2,500,000 +? President Obamas $1.8B package of additional
funding to address Prescription Opioid Abuse and Heroin Abuse Epidemic, New Mexico, [45], $5,000,000 +?
The State of New Mexico Funding:
While I have tried valiantly, I cannot find how much New Mexico tax dollars are spent each year on opioid abuse
and overdose death prevention, I tried the sunshine portal, I tried the Department of Finance Administration, etc.
but to no avail (if, and when, I find this information I will update this paper). However, with federal funding, I found
the following and I note I cannot find anywhere analysis of the effectiveness in the use of some this funding on the
TAGGS website {46}, Congressional Budget Office, etc. (not easy to find, wonder why?):
New Mexico Human Services Department Funding:
Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO)
Organization: CENTER FOR SUBSTANCE ABUSE PREVENTION (Substance Abuse and Mental Health Services Administration)
Type: Discretionary Grant
Amount: $1,000,000
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The New Mexico will implement the PDO program in high need communities in New Mexico. The project aims to prevent overdose death through the:
1) purchase and distribution of naloxone for overdose reversal, and; 2) training to a wide variety of first responders to administer naloxone. In this
initiative, training of first responders will include not only law enforcement and EMT officials, but also family members, friends and social networks,
and organizations that work with people with addiction and who may be a first responder in the event of an overdose, such as treatment providers
and shelters. Strategies that integrate overdose prevention and naloxone as a harm reduction strategy into state and local treatment program
strategies and settings, including the state's Medicaid managed care programs, will be used.
Great, earmarked for Naloxone! You know what? Lets skip, the strategies that integrate. for that implies to
me more studies, data with no analysis, etc. The funding is discretionary. The harm reduction strategy is simple spend the money buying and distributing Naloxone and then studying the rate of overdose deaths over time given a
continuous supply of Naloxone in New Mexico. The education on how to administer the naloxone is already
available to every New Mexican who has a cell phone. Not sure what the PDO Program is, but that is what it should
look like.
State of New Mexico SPF Rx
Organization: CENTER FOR SUBSTANCE ABUSE PREVENTION (Substance Abuse and Mental Health Services Administration)
Type: Cooperative Agreement
Amount: $371,616
The New Mexico Human Services Department, will implement SPF Rx with the goal of increasing awareness of the dangers of sharing prescription
opioids and of overprescribing prescription opioids. The purpose of this project is to significantly increase the awareness of the dangers of sharing
prescription opioids and demonstrate how readily available they are in Bernalillo County. It aims to reduce the high volume of high-risk prescriptions
dispensed in New Mexico, and work with a broad range of partners to develop recommendations about how to address the roughly 30,000
individuals in New Mexico who have a prescription for opioids for half of a year or more, putting themselves at high risk of addiction and increased
risk of overdose. The state will expand its "A Dose of Reality" campaign, SAMHSA's Opioid Overdose Prevention Toolkit and the CDC Guidelines for
Prescribing Opioids for Chronic Pain to further educate the public.
How many New Mexicans dont already know about the opioid epidemic? How many do not know they can overdose on
prescription medication? What was the effectiveness of the Dose For Reality campaign we have already done on the
opioid overdose death rate (minimal to none)? It reminds me of all the billboards telling us that DWI is wrong. I often
say, Thanks for that billboard. It has reminded me that it is wrong to drink and drive, I had forgotten that. And The
Opioid Overdose Prevention Toolkit is available online, downloadable to any computer or cell phone
http://store.samhsa.gov/shin/ .
New Mexico Department of Health and Environment (Department of Health) Funding:
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NEW MEXICO PRESCRIPTION DRUG OVERDOSE PREVENTION

Organization: NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL (Centers For Disease Control)
Type: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)
Funding: Administrative Supplement Discretionary or Block Grant - $953,074, 2016
Non-Competing Continuation - $856,313, 2016
Total: $1,809,387 (so far)
I could not find any abstract for the intention of this finding other than the title. The Knowledge, Development,
Application type implies to me more studies, research, with no analysis. Again, we have all the data we need, we know
who, when, where, and how they are dying of prescription opioids. If we want to stop overdoses, distribute
Naloxone.
New Mexico Project LAUNCH
Organization: CENTER FOR MENTAL HEALTH SERVICES (Substance Abuse and Mental Health Services Administration)
Type: Substance Abuse & Mental Health Services: Projects of Regional and National Significance (Discretionary)
Funding: $4,580,000 - 2009-2014
The State of New Mexico's Department of Health's Family Health Bureau proposes to develop and implement a demonstration project in the County
of Santa Fe to promote wellness of children ages zero to eight years by coordinating key child-serving systems and integrating behavioral
and physical health services. The project expects to significantly improve the outcomes of children from Santa Fe County's lowest-income highestrisk neighborhoods and advance the seven strategic goals of New Mexico's Early Childhood Action Network (ECAN): 1. FAMILY ENGAGEMENT:
Strengthen the leadership of families with young children in policy development and implementation 2. HEALTH: All children, their parents, and all
pregnant women have access to continuous preventative, acute, and chronic health care, including behavioral and oral health. 3. DEVELOPMENT:
All developmental concerns of young children and their families are addressed prior to kindergarten. 4. EARLY LEARNING: High quality
early learning and care meets the needs of all families and promotes optimum development and school readiness for children.5. INVESTMENT:
Invest in young children and their families to promote healthy development and school readiness to improve the quality of life for all New Mexicans. 6.
FAMILY FRIENDLY COMMUNITIES AND SERVICES: Family friendly policies and practices are implemented in communities, in business, in
service, and in education systems. 7. PUBLIC ENGAGEMENT: The public actively embraces the importance of early childhood development and
is engaged in supporting policies and programs at all levels that support children and families to thrive.
What? While the opioid abuse and overdose death rates skyrocketed in New Mexico, we spent $5.5M on one county
in New Mexico to implement family friendly policies and practices. Couldnt find any effectiveness studies of the
project, but funding stopped in 2014, I wonder why?
The University of New Mexico Funding:
Lets look at what the University of New Mexico receives in federal funding related to this issue:
Department of Psychiatry:
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Comparing Interventions for Opioid Dependent Patients Presenting in Medical EDs

Organization: NATIONAL INSTITUTE ON DRUG ABUSE
TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
FUNDING: $612,048 2013
$632,425 2014
$633,973 2015
$1,878, 446 TOTAL (So far)
DESCRIPTION (provided by applicant): As addiction treatment becomes increasingly integrated into the medical care system, two models have
rightly received a great deal of attention. The first is the use of SBIRT models to identify cases, provide therapeutic contact, and refer the more
severe cases to longer-term care. The second is the treatment of addictions using medical models of treatment, including those that can be
implemented in primary care settings. Much less attention has been paid to optimizing strategies for bridging the gap between SBIRT and more
intensive/longer-term treatment for those on the severe end of the spectrum. This factor is of critical importance for opioid dependent patients, whose
needs are not met by brief interventions or brief treatment. Emergency room interventions for substance use disorders have been largely
limited to brief interventions/SBIRT models, and these have focused primarily on alcohol. Although there is a substantial literature
documenting the value of case management in linking drug users to treatment, this approach has not been applied to drug users in the ED setting. In
a sample of opioid dependent patients seen in a medical ED who are not currently engaged in treatment, this study will compare the effects of brief
strengths-based case management (SBCM) and those of a brief intervention with booster sessions (BIB), based on Motivational
Enhancement Therapy (MET), to the effects of screening, assessment and referral alone (SAR). These treatment models were selected
because of their evidence base and because they are feasible to implement in the ED. Participants meeting DSM-IV criteria for opioid dependence
will be randomly assigned (150 per group) to receive 1) the BIB intervention including a 30-minute motivational interviewing session in the
ED, followed by two 20-minute booster phone sessions; 2) up to 6 sessions of SBCM based on the model previously implemented by Rapp
and colleagues in prior studies; or 3) SAR. Staffs that are blinded to treatment condition will complete follow-up assessments at 3 and 6 months.
Aims of the study are to identify the main effects of SBCM and BIB on substance abuse treatment initiation and engagement, use of opioids and
other drugs, and broader measures of health and life functioning; to examine the interactions between treatment assignment and selected participant
attributes in predicting treatment initiation, engagement, and substance use outcomes; and to examine effects of treatment involvement on substance
use outcomes in the three treatment groups. The proposed study will be the first trial using a case management approach to link drug
dependent patients presenting in EDs to longer-term addiction treatment. It will be one of the first trials focusing specifically on opioid
dependent patients in medical EDs. A further innovative feature is that the case management approach will emphasize linkage to
pharmacotherapy, and in particular will facilitate linkage to office-based buprenorphine for patients who desire this treatment.
Dont we already know this in many other studies? The answer is yes. And were going to study 30-minute motivational
interviewing session and following up with 2 phone booster sessions for opioid dependent patients? Please, these
are opioid dependent patients! And we do not have even any preliminary data to work with to see what has been effective
for this overdose death epidemic after 3 years? Wait a minute, we have no substance abuse treatment facility in Rio Arriba
County, and we have spent $1.9M on this study already? I dont think so
Division of Health Sciences:
Epidemiology, Prevention and Treatment of HCV in Young Adult Persons who Inject Drugs in non-urban New Mexico
Organization: NATIONAL CENTER FOR PREVENTION SERVICES (Center For Disease Control)
Type: Cooperative Agreement
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Funding: $899,906 (2014-2016)

DESCRIPTION (provided by applicant): The hepatitis C virus (HCV) epidemic in the U.S. is concentrated in people who inject drugs (PWID). Increasing reports of HCV
including outbreaks of HCV in young adult PWID in non-urban locales have prompted concerns about an expanding epidemic. Several investigations suggest that that
these spikes in HCV infection are linked to sharp increases in prescription opiate use that has been trending in the U.S, and which have resulted in young adults
transitioning from prescription opiates to injection use, particularly heroin. Young adult PWID in non-urban areas may be at increased risk of infection,
from the combination of high viral infectivity and high prevalence of HCV in injecting groups, together with a lack of knowledge regarding infection routes
and effective prevention. New Mexico is one of the states leading recorded increases in HCV in young adults, ranking 2nd in the CDC's Emerging Infections
Program (EIP), Hepatitis Surveillance Demonstration Sites project, in 2011 for the number and rate of HCV cases reported. Heroin, prescription opioids, and
other drugs are also accounting for this state having one of the highest overdose rates in the country. Between October 2013 and March 2014, the New
Mexico Department of Health recorded 211 cases of HCV among young adults in a pilot surveillance study, demonstrating the gravity of the problem. To
address the need for prevention, care and treatment services against HCV in this population, we propose epidemiological and service uptake research in
two regions of New Mexico where young adult PWID have been impacted by drug use and HCV. We will initiate a prospective cohort study of young adult
non-urban PWID who will be recruited and followed in two health regions of New Mexico (the South West and North East) to: (1) gather epidemiologic data
on risk behaviors, drug use patterns, injection networks, prevention needs, and health service utilization; (2) to refer young adult PWID to HCV care
services, as well as other prevention and treatment opportunities including harm reduction and drug treatment, and assess rates of successful linkage,
including the cascade of care; (3) to examine factors that may contribute to non-treatment, poor adherence, and failure to achieve SVR among young adult
PWID with chronic HCV infection; and (4) assess reinfection events among young adult PWID who are treated for HCV and achieve SVR. Our proposal, which
we refer to in this application as New Mexico H-TIPS, will also include testing and referrals for HIV and HBV co-infections as well. A collaborative group of public health
and clinical specialists linked with a strong prevention and clinical service infrastructure in New Mexico will ensure successful implementation of this research. Results
from this proposed research will impact a diverse young population disproportionately at risk for HCV and reduce health disparities in a region highly impacted by drug
use and HCV.
Ok, by itself, without the opioid overdose deaths epidemic, this study would be somewhat worthwhile. But dont we
already know this information from other studies? And there were 211 cases of HCV in six months, or 422 annually in
rural areas, wouldnt this study garner more information to gather youths injecting opioids in their own backyard,
Albuquerque, where half the population resides?
Pilot Study of Combined Treatment for Veterans with Chronic Pain & Opiate Misuse
Organization: CENTER FOR DRUG EVALUATION AND RESEARCH (National Institutes of Health)
Type: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
Funding: $228,333 2014
$209,114 2015
$209,354 - 2016
$627,822 TOTAL (So far)
DESCRIPTION (provided by applicant): Opioid prescription in the treatment of chronic pain is frequent and carries a consequent risk of poor
treatment outcome, as well as higher morbidity and mortality in a clinically significant number of patients, particularly those who meet criteria or
opioid dependence. Despite the alarming increases (140% increase from 1992 to 2003) in prescription opiate misuse, abuse, and dependence
nationally in the United States, there are few treatment options available that target both pain-related interference and opioid dependence among
patients with chronic pain. In military veterans, this issue is of particular importance as numerous reports indicate increasing use of opioids
in the treatment of chronic pain, as well as increasing opioid-related problems, specifically in those who served in the Iraq and
Afghanistan theatres [Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)]. To date, there
are no evidenced-based treatment options which aim to both maximize effective functioning in Veterans with chronic pain while simultaneously
addressing problematic opioid use. The overall aim of the present study will be to determine the feasibility of an integrated psychosocial
treatment in veterans with chronic pain, who also have evidence of opioid-related misuse. To examine this aim, we will utilize a randomized
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design to assess the feasibility of integrating two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and
Mindfulness Based Relapse Prevention for substance use and misuse. Feasibility will be assessed by examining rates of recruitment and
retention of participants through a six month follow-up. In addition, we will evaluate progress within-treatment on specific therapy targets to aid in the
identification of potential treatment mechanisms. The results of this study will directly inform treatment of chronic pain patients and represents a
significant advance in the growing and understudied problem of opiate misuse among chronic pain patients. In addition to addressing the
question of whether the treatment is feasible, it will further examine issues of treatment mechanisms to better inform the design of a randomized
and controlled trial assessing treatment efficacy.
If there is ever a population that deserves the best when they are struggling with opioids are Veterans with, and without,
chronic pain. These men and women risked their life for our country. However, ACT therapy and Mindfulness relapse
prevention has also been around for years. Does it work for this population, or doesnt it? And how much does it cost,
really, to determine if it works? If the overdose death epidemic in Veterans is the same, or higher, then lets spend
some money on saving them first, and then on unfunded community treatment programs where they live.
ORGANIZATION: CENTER FOR NATIVE AMERICAN ENVIRONMENTAL HEALTH EQUITY RESEARCH (NATIONAL INSTITUTES OF HEALTH)
RESEARCH STUDY:
FUNDING: $700,00 2016 (So far)
DESCRIPTION (as provided by applicant): The integrated approach described in the UNM Center for Native Environmental Health Equity (Native EH
Equity) will for the first time address, across multiple tribes, disparities in social determinants of health, and tribal cultural and traditional
practices with the potential to provide resilience to reduce the effects of environmental disparities on the health of Native Americans. The
Native EH Equity approach, also for the first time, provides an integrative understanding of the generalizability of risk and resilience factors across
multiple tribes - Navajo Nation, Crow Nation, and the Cheyenne River Sioux Tribe (CRST) - to improve both our understanding of these relationships,
and our ability to develop and prioritize evidence-based risk reduction and prevention strategies. The focus of Native EH Equity will be to
develop common data sets that for the first time will standardize our approach to assessing these variables across multiple tribes. Achieving these
goals requires a strong administrative structure to ensure consistency across all components of the Center, to ensure parallel data are collected from
each of the partner tribes, and that data are managed in a structure that ensures integration and allows comparative analyses. The Administrative
Core (AC) for Native EH Equity brings decades of experience working with Tribal communities, leadership, and agencies; of managing and
analyzing large and complex datasets; of oversight of career development programs; of integrative analyses allowing replication of
findings with multiple levels of data; and of successful translation of results to enhance understanding in communities, among
researchers, to federal agencies, and to health care providers. The goal of the Administrative Core (AC) is to facilitate responsible management,
resource allocation, integration and communication within the team; to foster successful career development for new investigators; to provide and
manage pilot funding; and long-term to develop sustainable partnerships integrated within the institutional and tribal structures to ensure
sustainability of research on Native Environmental Health Equity.
FAMILY LISTENING PROGRAM: MULTI-TRIBAL IMPLEMENTATION AND EVALUATION
NATIONAL INSTITUTE ON DRUG ABUSE

RESEARCH STUDY
FUNDING: $677,496 2014
$584,115 2015
$591,687 - 2016
$1,853,298 (So far)
DESCRIPTION (provided by applicant): With substance abuse concerns plaguing tribal communities, health preventive approaches for American
Indian (AI) children need urgent attention. Mainstream programs fall short by failing to speak to AI children on their own terms. Not so with the
Family Listening/Circle Program (FL/CP) which integrates an evidence-based family-strengthening core, with cultural values and practices for 4th
graders, their parents and elders? Through previous Native American Research Centers for Health funding (Indian Health Service & National
Institutes of Health partnership) the FL/CP was created and piloted by community-based participatory research (CBPR) partnerships between the
University of New Mexico Center for Participatory Research and three tribal communities: Pueblo of Jemez, Ramah Band of Navajo and
Mescalero Apache Nation. FL/CP fills a gap in substance abuse prevention by recapturing historic traditions of cultural transmission, such
as family dinner story telling where elders connect with children, supporting enhanced child-family communication and psycho-social
coping through traditional dialogue, indigenous languages and empowerment where children and families create community action
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projects addressing community substance abuse. With initial FL/CP pilot and feasibility research completed, Tribal Research Teams (TRTs) from
the Pueblo of Jemez, Ramah Band of Navajo and Mescalero Apache Nation are now in place for full program implementation and effectiveness
testing through a longitudinal quasi-experimental design involving a long-term, multi-tribal/academic research partnership. Under this five-year R01
effectiveness trial, tribal partners are committed to assessing the program's effectiveness and disseminating the approach and intervention within
Indian Country as a best practice in reducing substance abuse health disparities, with TRTs collaborating on all research activities,
implementation, interpretation/analysis, and dissemination plans. Three specific aims are 1) To rigorously test effectiveness of FLCP; with a
comparative longitudinal design within and across the tribes, with 4th graders to prevent substance initiation/use and strengthen families; 2) Through
CBPR, support TRTs to transform their research capacities into local prevention research infrastructures and partnering; 3) To assess
additional program effects on other health/education programs and leadership within the tribes. In sum, this multi-tribal/academic partnership builds
on accomplishments to test the effectiveness of an innovative intervention. This grant provides an unparalleled opportunity to reduce
substance abuse in three tribal communities, strengthen tribal research capacities, and impact substance abuse prevention research
designs nationally, by illustrating how CBPR processes can integrate evidence-based and cultural-centered practices to create effective
programs that generate community ownership and sustainability.
Again, Native American communities, if not more than others, deserve our consideration and concern for the
environmental disparities on their health. And we have countless studies on their environmental disparities of
poverty, substance abuse, unemployment, effect of their incarceration in U.S. jails and prisons, threats to their
culture, etc. And now we are going to study Native American children communications on substance abuse This
assumes that first, that Native Americans, arent already discussing substance abuse with their children and
grandchildren at the dinner table and in many other settings. And it assumes, I guess, that there is a better way to
communicate substance abuse issues to the children of Native Americans? I doubt it, and I find it insulting and
condescending that the University of New Mexico thinks they do. If Native Americans had real support on the myriad
of issues which cause endemic substance abuse and overdose deaths, then perhaps these conversations with their children
wouldnt be needed. Oh, and its a five-year study, so expect to add at least $1M more. How about we do a study on
why they are dying 2 or 3 times the rate of other New Mexicans from opioid overdoses? How about funding
Naloxone distribution specifically on the tribal reservations and studying its effects? There will be more Native
Americans to listen to if they are alive! How about we provide funding to build treatment centers on the
reservation, run by Native Americans, using proven therapies, where they are taking care of their own people?
New Funding:
In addition, the Department of Health and the Human Services Department announced in September that it had secured more than $11 million in
grants to reduce opioid-related deaths, strengthen prevention efforts, and improve opioid surveillance data. DOHs Epidemiology and Response
Division also received two grants from the US Centers for Disease Control and Prevention, totaling $3.7 million over three years to aid in
preventing prescription drug overdoses and to enhance tracking and reporting of overdoses; this is in addition to $3.4 million received in
September 2015 over four years for preventing prescription drug overdoses {47}
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THE PRESCRIPTION DRUG OPIOID OVERDOSE PREVENTION GRANTS WILL PROVIDE UP TO $11 MILLION TO 12
STATES to reduce opioid overdose-related deaths. Funding will support training on prevention of opioid overdose-related deaths as well as the
purchase and distribution of naloxone to first responders. Awardees are Alaska, Arkansas, Illinois, Missouri, New Jersey, New Mexico, Oklahoma,
South Carolina, Washington, West Virginia, Wisconsin, and Wyoming. (SAMHSA) {12}
If my math is right, that is over $35M over the next four years, or almost $9M a year, and at least a part of that is
earmarked specifically for reducing opioid related deaths
Naloxone Distribution Support. I am not alone in this recommendation to increase Naloxone distribution, and in many
cases, it has been recommended for years:
Our own New Mexico Department of Human Services promotional information states:
INCREASE ACCESS TO NALOXONE:
Naloxone (also known as Narcan) is a medication used to reverse an opioid overdose.
Naloxone Facts:
Naloxone is FDA approved, since 1971.
Naloxone is not a controlled substance.
Naloxone is non-addictive.
Naloxone can be administered repeatedly without harm.
Naloxone has no potential for abuse.
Naloxone could meet over the counter specifications [22]
The New Mexico Department of Public Health also has a link to YouTube for a Narcan video, apparently from a Chicago
program. I wonder why we do not have our own video with the incredible amount of resources for opioid overdose
prevention already funded? [48]
National Naloxone Programming. Lets look are national research on Naloxone distribution studies and programs, and
perhaps, if we just did this, we would not have to spend any more resources on studies and research, it has already
been done and paid for by all American tax payers:
Our own New Mexico Department of Health in 2016:
Increasing Naloxone Availability Helps Prevent Opioid Overdose Deaths In 2016, legislation passed that
eases restrictions on possession, storage, distribution, and prescribing and administration of Naloxone,
[49]
The National Institutes for Health in 2015:
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Existing research suggests that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent
overdoses and administer naloxone. Counseling patients about the risks of opioid overdose and prescribing naloxone is an emerging
clinical practice that may reduce fatalities from overdose while enhancing the safe prescribing of opioids. [50]
Findings indicate a positive association between injection of prescription opioids and public health indicators suggesting a need for
prescription opioid formulations that may inhibit injection of these medications. [51]
The Journal for Substance Abuse
The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care
providers, and physicians. In contrast, individuals who self-identified as naloxone-trained had the highest optimism and the lowest
amount of burnout and stigma. Conclusions: Provider training and refinement of naloxone administration procedures are needed to
improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering
psychoeducation to health care providers. [52]
So, lay people who administer Naloxone have high optimism and low burnout rates. Wow, it is
actually an optimism inducing act!
Confidence improved significantly from pre- to post-training across both routes of administration (ps < .
001). However, confidence was higher among those who were trained using the intranasal naloxone
compared to those who were trained using the intramuscular injection naloxone at pre- (p = .011) and
post-training (p < .001). Confidence increased from pre- to post-training in each of the participant types
(ps < .001). Post-hoc tests revealed that confidence was higher among providers and friends/family
members compared to other participants, such as first responders, only at post-training (p < .
05). Conclusions: Opioid overdose trainings are effective in increasing knowledge and confidence related
to opioid overdose situations. Findings suggest that trainees are more confident administering
naloxone via intranasal spray compared to injection. Future research should attempt to
identify other factors that may increase the likelihood of trainees' effectively intervening in
opioid overdose situations. [53]
And there are many, many, more, just do a Google Search.

And in Baltimore, another opioid war zone:
BALTIMORE After two decades of sending a needle exchange van around this city, officials here last
year started doing something new. They wouldnt just hand out clean syringes; they would distribute the
antidote to the opioid overdoses ravaging local communities. When the van rolls through Baltimore these
days, a member of the citys health department teaches newcomers how to deliver naloxone, the life-saving
medication that can reverse the effects of an opioid overdose, and gives them a free kit containing two doses.
Similar scenes are playing out at recovery centers, school orientations, and town meetings around the
country as communities try to prevent fatal opioid overdoses, which quadrupled in the past decade and a half.
Once a tool found mainly in ambulance and emergency departments, naloxone is increasingly being
offered to the masses without prescriptions. Some advocates liken knowing how to use naloxone to
knowing how to perform CPR, granting someone the opportunity to save anothers life. For at least two
decades, advocates have pushed to get naloxone to people with drug addictions and their
families, and in recent years, campaigns have focused on equipping police forces with the antidote. Those
groups remain the main audiences for the efforts. But some initiatives are also trying to reach
people regardless of whether they use opioids or know someone who does, just in case they
find an overdose victim passed out in a car, unconscious in a restaurant bathroom, or dying on
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their own front lawn. Training sessions now include security guards, parking enforcement, and
ordinary community members.
Here in Maryland, a change in state law allowed municipalities to issue their own standing orders, and Dr.
Leana Wen, Baltimores health commissioner, signed one last year. Since the order took effect last
October, the city has conducted about 15,000 training sessions for lay people, Wen said. The
city also has an online training program. I have Narcan in my bag right now, because you
never know, Wen said in an interview, using one of the drugs brand names.In 2001, New
Mexico changed its laws to make naloxone easier to get, and since then, every state except
for Kansas, Montana, and Wyoming has altered policies to improve access to naloxoneIt
might not be a friend or family member, but it might just be a person passed out at the bus
stop, said Evan Hoessel of Albuquerque Health Care for the Homeless, who has done
trainings for church groups.
Shirley Buntain, a mother of four in Louisville, Ky., got trained to use naloxone last
summer because she has a son who uses illegal substances. But she said she may
have to save others as well and carries naloxone in a backpack wherever she goes. I
trained for him, but I also trained for the people who didnt want to admit that their child had
a problem, said Buntain, 54, an office manager at a machine shop. I went from being a mom who
carried an EpiPen for a bee allergy to being a mom who carries an antidote. Its not a place I ever imagined
being in. That shit works wonders, 30-year-old Andrew Chamberlain said one day last month
as he left the needle exchange van here with clean syringes. By the time you put in the
second [dose], theyre jumping up.
Chamberlain said he had used naloxone several times in the past year on fellow drug users and
got refills of the drug at methadone clinics, among other places. Ive used it three times in the past
week, chimed in a woman standing on the sidewalk, which was littered with needle caps. Once in that
alley, once in that alley over there, she said, pointing to alleys into which some people vanished after
they stepped off the van. The woman, combing her soaking wet hair, added: Ive had it used on
me.
People who are trained to use naloxone receive a card so they can get refills at local pharmacies.
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.
A man leaves the needle exchange van after getting clean syringes and learning how to use naloxone
{ {54}
Kudos to Dr. Wen, Evan Hoessel training church groups, Ms. Buntain, Mr. Chamberlain saving 3 people in one
week, and the unidentified woman who actually saved herself, they get it, and yet we are not distributing Naloxone
in New Mexico near enough as this article might be inferred.
And from University of New Mexico, Health Services Division, Project Echo, presentation in 2016:
Expanding access to naloxone has been supported by:
U.S. Conference of Mayors (2008 Resolution) sponsored by Santa Fe Mayor David Coss
American Society of Addiction Medicine (Policy Statement 2010) American Medical Association (2012
Resolution)
American Public Health Association (2012 Resolution)
National Alliance of State and Territorial AIDS Directors (Testimony to FDA, April 2012) {20}
The New Mexico Medical Board Support. Minutes of the New Mexico Medical Board in November 2015 indicate the
following:
Mr. Frank apprised the Board of Department of Healths Naloxone Regulations. DOH has been working on
increasing access to Naloxone, one issue is the storage and distribution of Naloxone. It is still considered a
dangerous drug, not over the counter, but it appears to be relatively safe. One of the barriers is that the
Pharmacy Board controls the storage and distribution of the drug. One option is to allow third party
entities to store and distribute Naloxone. This would directly affect Board of Pharmacy regulations. The
DOH has proposed that they will allow the third party to distribute Naloxone by DOH
regulation. After discussion, the Board decided that this is a Board of Pharmacy issue, however the
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Board generally supports the proposed regulation. {55}
It appears, first, that there needs to be some training of doctors from the Department of Health about the incorrect
perception that Naloxone is dangerous and cannot be given over the counter. Second, it appears that the Department of
Health allows third party entities to distribute Naloxone. Finally, the Medical Board supports this option.
And then we have a step backwards from politicians like the Governor of Maine, not looking at the data, and making a
kneejerk reaction and a deadly decision, although thankfully his veto was overrode by the Maine Legislature:
Naloxone does not truly save lives; it merely extends them until the next overdose, Maine
Governor Paul LePage, wrote in April, when he vetoed a bill that would have made it easier to get naloxone
(the legislature overrode the veto). {54}
I am afraid that Governor LePage is touching on what is the background of this issue, drug abuse stigma and the
resulting implication-they are not worth saving, they are going to die anyway. Its real this perception, it cant be
underestimated, and yet I hope I have shown that even if you believe this, it is more cost effective to keep them alive.
So, Governor LePage, educate thyself:
Public health advocates say such views reflect the stigma against people struggling with addiction; they
also note that overdoes are often caused when users inadvertently take heroin laced with more potent
opioids like fentanyl or carfentanil. But even if naloxone did encourage riskier behavior, experts
say that it saves far more people than it could ever endanger. Cities and states report
hundreds of lives saved each year. A A recent survey of 140 organizations found that lay people had
reversed more than 26,000 overdoses from 1996 to 2014; more than 80 percent of the people who saved
someone with naloxone were fellow drug users. {54}
And, while I am thinking of it, lets dispel some wrong information about Naloxone:
Myth #1: If you give an overdose antidote to drug users, they will abuse more drugs.
Fact: Studies report that naloxone does not encourage drug use, and in fact, has been shown
to decrease it in some circumstances. By blocking the effects of opiates, naloxone can produce unpleasant
withdrawal symptoms, which nobody wants, especially not an active drug user.
Myth #2: We cant trust a person who is high to respond appropriately in a life-threatening situation.
Fact: Since 1996, over 10,000 overdose reversals have taken place using naloxone. The vast majority of
these were done by active drug users. Many of them were probably high.
Myth #3: Naloxone will keep drug users from seeking treatment.
Fact: Death keeps people from seeking treatment. Naloxone gives people another chance to get help if
they choose, and often, the near-death experience of drug overdose and being saved with naloxone acts
as a catalyst to encourage people to get into treatment.
Myth #4: Naloxone makes people violent.
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Fact: There is some truth to this - but not much. While naloxone can cause confusion and fight or flight
response when administered at high doses, in smaller amounts, naloxone rarely causes overdose victims
to become combative.
Myth #5: Naloxone Can Give People Heart Attacks
Fact: According to research in the American Journal of Public Health, Complications such as seizures and
arrhythmia have been reported after naloxone administration on very rare occasions. However, their links
to naloxone have been questioned in the medical literature, and, even if there is a connection, it
constitutes a risk only for patients with pre-existing heart disease... Similarly, in a study of 1192 episodes
in Norway in which paramedics administered naloxone out of hospital, just 3 adverse events or 0.25% of
caseswere considered serious enough to require hospitalization. Pulmonary edema has also occurred in
overdose patients, but that is a result of respiratory depression, not naloxone administration.
Myth #6: Intramuscular naloxone isnt safe.
Fact: Many people avoid intramuscular naloxone because it involves the use of a syringe, however, it is
just as safe and effective as naloxone administered through other measures, such as intranasally. With
intranasal naloxone, less is absorbed into the body which means it can be slower to take effect and is also
less likely to cause withdrawal symptoms or induce combativeness. However, intramuscular naloxone has
been shown to have a slightly quicker effect, which means that life-saving breathing function is restored
sooner.
Myth #7: Naloxone Loses Effectiveness Under High Temperatures
Fact: Even after exposure to extreme temperature change, naloxone still works. In clinical studies,
naloxone maintained a concentration 89.62 +- 1.33% even when subjected to ~21 and ~129 degrees
Fahrenheit temperatures every twelve hours for 28 days. Nevertheless, it is recommended that naloxone
be kept at room temperature and/or stored in UV ray resistant materials. {72}
And back in New Mexico, people are standing up. From Rio Rancho, a school board member stands up and demands
Naloxone and she states that the Albuquerque High Schools have no Naloxone program, I wonder if they know they can
get it for free (to be explained below)?
If EpiPens can be used by bee-sting victims and others, including non-professionals, to
combat allergic reactions, maybe the next step in treating drug overdoses from opioids is the
use of naloxone. Its not that Cullen has heard any high school in Rio Rancho has a plethora of opiate
abusers. But if one life can be saved, how can that be wrong? Rio Rancho Public Schools should
lead by example, she said. Albuquerque Public Schools doesnt have a naloxone program. Finding
funds could be problematic. Gov. Susana Martinez signed House Bill 277 into law on Feb. 9. It provides
for the authorized possession, storage, distribution, prescribing and administration of opioid antagonists;
providing for immunity from civil and criminal liability; declaring an emergency. Those last three words
are the key. Rio Rancho Fire Rescue carries the drug and, according to RRFD Dep. Chief Paul Bearce, Naloxone has been part
of the scope of practice for EMTs and paramedics for at least two decades. We have used naloxone 48 times in 2016. {56}
Well done Ms. Cullen, standing up, and Chief Bearce, for using Naloxone for over 20 years, saving 48 people in
2016. And Ms. Cullen, we will get free units in your high schools, very soon.
And in Santa Fe County:
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Today Santa Fe County announces a new partnership with the Santa Fe Public Schools and its Santa Fe
Prevention Alliance for the purchase and distribution of Narcan to first responders, the Santa Fe
Public schools and community laypersons in Santa Fe County. The contract also includes provisions
for opioid overdose prevention training and Narcan administration for first responders, people who use
opioids, and family members who may be in position to witness and respond quickly to a drug overdose.
The total amount of the contract is $100,000. {56}
I am not sure how much of those resources are going to purchasing Naloxone for the high schools, but, again, they can get
it free and they will have it for free very soon.
From the New Mexico Department of Human Services Division minutes in 2016, I note a very important observation
by Mr. Tom Starke of Recovery Santa Fe.:
They worked very hard this year on trauma:
Most of these individuals they are trying to get out of the criminal justice system carry trauma
from past experience and when they get into interacting with your agencies they are
frequently re-traumatized by interactions with people and also because the systems are
unaware they are carrying trauma. These systems can re-traumatize them and greatly reduce
their ability to function and take advantage of the resources you are trying to provide them
because, without realizing it, they are pulling these people's abilities to function way down
(through these interactions).
Furthermore, people working in your organizations can be traumatized by dealing with these
clients, and not realize it. A big source of burnout, people exposed constantly to trauma can
catch it, it's almost like a virus, the frontline staff. They tried to get a SAMSHA training for all
Santa Fe front-line workers, to train twenty trainers and have them fan out and train more. He
asks you to consider all of your staff, not just those in Santa Fe but all over NM, whether to
train that staff would be helpful. Thank you. {58}
Kudos to Mr. Starke, he gets it. This is very important when we consider the Naloxone distribution strategy to law
enforcement officers, probation departments, courts, etc. And most important, they mention the burnout rate having to
deal with citizens in trauma all the time. These overdose citizens, who have had any contact with these agencies
may be traumatized and not reach out to them for Naloxone. Once again, the need for the general public providing
access to Naloxone.
Naloxone Cost: As it is often with these difficult issues, the argument eventually comes down to resources. Naloxone, an
antagonist agent that has been around since 1971, and at least some type of Naloxone program has existed since 2001 in
New Mexico at the Department of Health, I cannot find anywhere a cost benefit analysis study of any kind (?). On January
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4, 2017, I talked with Dominick Zurlo from the New Mexico Department of Health, who was kind enough to immediately
provide me additional data about the Naloxone program, (I note that he adroitly suggested that I go to the New Mexico
Sunshine portal for budgetary and spending histories, however The Department of Health and The Human Services
Division are not participating agencies, I guess transparency is optional for New Mexico State government agencies), he
indicated:
Naloxone itself is purchased through the Public Health Division Pharmacy (because it is a medication) and the
Atomizers are purchased through the Hepatitis and Harm Reduction Program. The Pharmacy retains these
purchase records for a longer period, Of course, The Public Health Division, is a division of Mr. Zurlos agency.
Surely you talk to each other, dont you? Do you do effectiveness and efficiency studies together?
Naloxone
Atomizers
FY09
$29,932.30
N/A
FY10
$74,882.50
N/A
FY11
$34,261.50
$5,040.00
FY12
$29,881.60
$5,300.00
FY13
$139,467.68
$16,166.72
FY14
$8,677.36
$27,318.09
FY15
$262,513.49
$8,132.00
FY16
$126,775.74
$23,431.50
TOTA
$706,392.17
L
Narcan nasal
FY17
$85,388.31
$110,791.68
All of these purchases were made with state general funds, or with revenue generated by Medicaid billing
for naloxone distribution (in FY15 and FY16), except in FY15, $80,000 of the purchases were made with
funding provided by BHSD (Behavioral Health Services Department). This was the first year federal SAPT
(Substance Abuse Prevention and Treatment) Block Grant funding from SAMSHA (Substance Abuse and
Mental Health Services Administration) could be used to help purchase naloxone. The years listed here are
all using the naloxone device which requires assembly of the medication into a syringe barrel and the
attachment of an atomizer for it to be administered nasally. The purchase in FY17 is a new device from
Adapt Pharma which requires no assembly. Ive also attached the education sheet which contains the
curriculum for both devices. It is titled: Overdose Prevention 20 Min 11-15-16. (See Appendix)
While the cost of naloxone has increased over the years, the cost of the current device through a
Government Interest Price is $75.00 for two doses, although this price can vary some at times.
So, for example, in FY17, the NMDOH has purchased 3,000 doses so far. The NMDOH does not
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currently have any federal funding to purchase naloxone itself; however, BHSD does have a
grant to do so over the next 4 years (they are a separate Department, so I do not have access
to their fiscal information directly regarding how much they are planning on spending in
future years).
Ive also included our program Legislative Fact sheet which shows the overdose prevention work through
the Harm Reduction Program. In addition, working with community partners the Epidemiology and
response Division of NMDOH also began some programs to help increase distribution of naloxone
through providers and other non-harm reduction type programs. So, the total amounts of
naloxone dispensed/distributed from 2010-2015 breaks down like this for the two different
divisions. You may notice a slight discrepancy in 2015 between this and the Legislative fact sheet graph.
This is due to additional forms being submitted after the Legislative Fact sheet was produced (in October
2016). The following data is current as of today (however, may be changed based on additional
submissions):
2010: 1335
2011: 1580
2012: 3011
2013: 3813 (172 from ERD, which started that year)
2014: 5879 (718 from ERD)
2015: 7211 (414 from ERD)
Ok, lets take this this data, critically thinnk about it, crunch it, and see if it is effective and efficient. Please forgive me for
the rudimentary spreadsheet below but I frankly do not have any more time to make it pretty (use your zoom function in
MS Word to see more clearly), however it is critical that we understand what the data is telling us:
NALOXONE DISTRIBUTION
IN NEW MEXICO
An Analysis - Jan 2017
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NM NAX
NM NAX
NM
NM
NM
NM
X
NAX UNITS DISPENSED BY REPLACED BY NAX DEATH NAX UNITS ATOMIZERS
EES: DISPENSED: ENROLLEES: ENROLLEES: REVERSALS: PURCHASED: PURCHASED:
2
7
8
8
9
0
?
894
1179
1779
1706
2474
4365
7205
0.97
1.17
1.38
1.63
1.81
1.78
1.45
441
401
1232
1935
2687
2474
4365
(est)
19602
?
204
128
455
709
844
769
672
NM
NAX $
TOTALS:
NM NAX $
PER
ENROLLEE:
TOTAL NAX
UNITS BY
REVERSALS:
$81.04
$38.84
$27.34
$148.51
$26.31
$110.06
$30.28
4.38
9.21
3.91
2.41
2.93
5.68
10.72
$593,420,618
$660,593,699
$699,537,568
$614,823,866
$734,448,255
$672,447,105
?
$0.0002
$0.00016
$0.00004
$0.00012
$0.00002
$0.00019
$0.00012
$144.17
$90.46
$321.55
$501.06
$596.46
$543.46
$35,820
$19,107
$14,242
$68,016
$14,393
$55,142
$0.02
$0.01
$0.01
$0.04
$0.01
$0.03
$593,384,797
$660,574,591
$699,523,326
$614,755,850
$734,433,862
$672,391,963
$69.20
5.18
$3,975,271,109
$0.00012
$366
$206,720
$0.02
$3,975,064,389
$29,932
$74,883
$34,262
$29,882
$139,468
$8,677
$262,513
$126,776
$0
$0
$5,040
$5,300
$16,167
$27,318
$8,132
$23,432
$29,932
$74,883
$39,302
$35,182
$155,634
$35,995
$270,645
$150,207
$110,792
$0
$110,792
787252
$85,388
$872,640
TOTAL NM
ECONONIC $
SAVED:
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NM REVRSALS NM REVERSALS TOTAL NAX $

TOTAL NAX $ TO
NAX $ COST PER $ SAVED PER TO PREVENT PREVENT ALLN NM OD'S
NM CITIZEN:
NM CITIZEN: ALL NM OD'S:
PER NM CITIZEN:
TOTAL $ SAVED
PREVENT ALL
NM OD's:
(est)
1.50
13535
3781
Data Received: 1/4/2017, NM Department of Health website, Various Divisions.

Cost of Overdose death: The U.S. National Institute on Drug Abuse, Medical Care, News Release, Sept. 14, 2016
This data is for naloxone distribution to enrollees in the Department of Health program only. This means that the enrollee must sign
up for the program which includes needle exchanges for opioid abusers. Therefore, Naloxone is distributed to an enrollee who is
currently not overdosing, is an IV drug user, and perhaps, a higher risk for overdose and multiple overdose.
The costs of Naloxone distribution, staffing, travel costs, education, etc. is not included in this analysis, although negligible, when you
consider the benefits and savings.
Reversals are only reported reversals by the enrollees themselves. Therefore, this number could be exactly accurate or even higher
than what was reported by the enrollees. Given they are IV drug users, there is a higher chance that these users may have multiple
reversals than opioid abusers only.
The calculations are based on this population and applied to this population only, IV drug users. The total cost of Naloxone, the number of
units distributed, and the units replaced, and the resulting number of reversals may be higher or lower for the general opioid abuser
population. We just simply do not know because we have no data on the total population of opioid abusers who use Naloxone for all
prescription and illicit opioid abuse.
Some data I could not find after exhaustive research.
General Data Analysis:

1. We can see the number of Enrollees in the program is expanding, almost doubling in CY 2016, thats good.
Why we are getting more enrollees I do not know? And if the Enrollees doubled, why didnt the opioid
overdose death rate only decrease by 7.5%? Because, while distributing to these users is important,
Naloxone is not reaching the majority of opioid abusers and addicts.
2. The amount of Naloxone distributed is also growing in the last few years, thats good as well. The average was
1.5 Naloxone kits per enrollee. About 66% of the distributions, were replacements, meaning that these Naloxone
distributions were for a second kit or more. This means that, given by the number enrollees, many enrollees were
getting more than one kit. Therefore, there were many who were taking more than one kit, and others who
did not take any.
3. The amount of Reversals (those who were saved by Naloxone) also has increased, thats great. However, in
CY2016, when the amount of Naloxone distributed doubled, the number of Reversals went down, Why? This
could mean that, in this population, there is point where the amount of Naloxone distributed has a
diminishing return rate on Reversals in this population.
4. In CY 2014, one of the worst years ever for opioid overdose deaths, Naloxone funding fell 80% why?
5. IN CY2011, CY2015, CY2016, the Reversals rate was substantially higher, what was the reason for this? This is
good. We need to know what was different in those years which saved many more overdose deaths.
6. The Naloxone cost per enrollee was about $67.00. There was one reversal for every 5 Naloxone units
distributed. If New Mexico citizens paid themselves for the Naloxone (and they didnt completely, but partially in
their taxes), each New Mexico citizen would contribute $.00012 cents each. Thats right, that is a fraction of
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one cent per year. Im willing to give one cent, how about you?
7. The New Mexico economic savings was also $4B in eight years with a total of 13,058 enrollees. The savings
to each New Mexico citizen would be about $350 every year if the savings were distributed to them. Really,
you mean distributing Naloxone would actually save me $350 per year, every year, if the savings were given
to New Mexico citizens?
8. If we used this formula and sought to save all New Mexican overdose deaths, it would cost an additional
$207,000, over eight years. If New Mexican citizens paid to save the overdoses themselves (and they dont,
except in their taxes), it would cost us each .02 cents each year. And if we saved all overdose deaths over the
8 years, it would have saved us $4B in economic costs. Ok, so your saying that if every New Mexican would
have contributed $.02 a year during all this time, we could have purchased enough Naloxone if given to these
opioid overdose abusers who died to (2961 deaths)? Yes, that is what I am saying.
9. If this model was expanded to include all deaths in the United States, would the results be similar? Yes, I am
saying that, given the costs of an overdose death and the total population would be different, but it would
still be a negligible cost to each American.
Why? Because there are relatively few deaths every year in comparison to the total population, Naloxone
distribution is relatively cheap, if the Naloxone gets in the hands of the user and they use it in time-they live,
every time. A high rate of return for a low cost.
By all accounts, Naloxone is a worthy, small investment.
Naloxone Distribution Partners. The providers for Naloxone, of which Mr. Zurlo directed me to the New Mexico
HIV/Hepatitis/STD online site, http://www.nmhivguide.org/. (See Appendix) While I am not understanding why this
distributor information is not prominently available at the New Mexico Department of Health site, for those who need it
(opioid users and abusers) to find (and do, or do not have HIV/Hepatitis/STD), I am glad it is listed somewhere. At the
Harm Reduction site: https://nmhealth.org/about/, there are the various statutes and standing orders as it relates to
Naloxone as well as the three hour training required to be a Harm Reduction certified, https://nmhealth.org/publication/.
(See Appendix) While I applaud each and every distributor of Naloxone in New Mexico, and without them, certainly
the opioid overdose rate would be higher, it is still not enough to significantly change the opioid overdose death
rates in New Mexico.
Pharmaceutical Naloxone Providers. Certainly, the cost of Naloxone has skyrocketed in the last few years as it is
being used more and more to prevent overdose death in the United States. It is no different in New Mexico, and, at
least some pharmaceutical companies should have their feet held to the fire for doing this to the American people.
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Naloxone is cheap to produce and it could be provided as a public service to stop death from opioid overdose. And, of
course, a great deal of opioid abuse problem is overprescribing of prescriptions sold by the pharmaceutical
industry:
Used to reverse the effect of opioid overdose, police and first responders have carried injectable versions
of the drug for years. Demand has surged as the federal government and some states including New
Mexico are adopting policies to combat the opioid addiction crisis through tactics such as
dispensing naloxone with every opioid prescription. The 2014 development of a nasal spray form
has further driven demand. However, the drugs price has also risen steeply in the last couple of years: the
most costly version, the auto-injectorThe other side of rising drug costs: prices are rising faster than
utilization... Increased demand and rising prices resulted in an over 250 percent increase in spending
on naloxone from 2011 to 2015. Health Notes: Prescription Drug Costs Page 7 Evzio, was introduced
in 2014 at $287, increased to $375 by late 2015, and has a current price of $2,250. Increased
demand and rising prices resulted in an over 250 percent increase in spending on naloxone
from 2011 to 2015. {59}
Some pharmaceutical companies do have community grants and programs which can be used to help reduce the cost of
naloxone and educate the public. I have begun discussions already with several of them. Already, there is good news on
that front from one pharmaceutical company: They are willing to greatly reduce the price and provide free naloxone
kits to all high schools in New Mexico. I will be working very closely with this company. Kudos to this company,
they get it. They will make a profit for sure, but its a reasonable profit and at $37.50 a unit, well worth it. 24,000 deaths
a year (2013) divided by $25M = $1042.00 a life. And, of course. this $25M is for the whole industry with their highpriced injectors for several hundred dollars. If we purchased them all from this company, I predict a price lower than
$37.50 from them with the increased volume, it could be much, much less. By making relationships with other state
programs distributing Naloxone, we could make regional or national purchase volumes. And maybe, just maybe, some of
the other companies might come down on their prices too. In Cleveland, injectable naloxone is at $12 a unit:
Naloxone manufacturers have donated thousands of doses to communities and offer discounts to first
responders, but the rising cost of the drug combined with the rising need has forced some
programs to cut back on what they can buy. Emily Metz, who coordinates a naloxone training program in
the Cleveland area, said the price of the nasal spray the program purchased has gone from $12 to $30 per
dose in recent years. The program is switching to an injectable version it can buy for about $12. {54}
Way to go Ms. Metz! I will be talking with her soon to find out who she is buying her Naloxone from! The Colorado
Consortium has a great program and they are currently raising funds to provide Naloxone to law enforcement and first
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responders. Further research indicates they want to obtain $2,500 kits at the cost of $187,500 which equals $75 per unit
(with perhaps two doses) which appears to be a common price. {39} And some companies have not gotten it yet. Kaleo
Pharma and I will be in future discussions regarding their short-sighted response and the market they are actually missing:
Whether naloxone manufacturers want to apply to make naloxone available over the counter is a
different story. One of them, Kaleo Pharma, told STAT it has no plans to get its naloxone auto-injector
approved for over-the-counter use. {54}
What Should We Research and Study? I am suggesting we look at the following possible studies and see if they help
with our mission of reducing opioid overdose deaths (And forgive me if this has already been done, I no longer have
time for any more research, I have got to get funded and immediately to the streets of New Mexico.)
1.
Why have Americans needed to take increasingly more pain medication without any real change in reported
pain? What is happening within the collective and individual psyches of Americans? {20}
2. What possible reasons would there be for different opioid prescribing levels by state, and specifically, in New
Mexico? {20}
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3.
75
So, if we control the heroin addiction problem better we also address prescription opioids and cocaine addiction at
the same time? And our heroin overdose death rate continues to climb in New Mexico. {20}
17
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76
4. What
are
endemic
factors that are causing

this in America, and in
New Mexico? Women,
18
youth, white, middle and

higher incomes,
those
with private insurance

are growing, why? {20}
5. What are the psycho-social factors that are causing this specifically with Americans? We are creating the
market that is killing us. {20}
Americans use 80% of the global supply of opioids and 99% of

hydrocodone, but make up only 4.6% of the worlds population
Institute of
Addiction
Inc.Inc.
Institute ofMedicine,
Addiction Medicine,
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Critical Thinking & Analysis. This is the hardest part of writing this paper for we as New Mexicans must take
responsibility for are actions, good decisions, inactions, and poor decisions in regards to the opioid overdose death
epidemic in New Mexico. We must all take our lumps for failed policy, strategy, and perhaps view when it comes
to opioid overdose deaths. I will start with an apology myself, as a New Mexico citizen and as an American, for
looking the other way for a long while (6 months) and not stepping up earlier to write this paper and to offer
solutions that could have been implemented earlier. New Mexico citizens died while I looked away and they
continue to die right now. As a former chief probation officer, and as a businessman, I have devoted most of my adult life
making a difference in addressing the ravages of substance abuse. This epidemic is unprecedented, and even in bringing
all of my experience with substance abuse to bear, while helpful, is still not enough for this is a new problem in America
never before seen.
So, I am standing up now, having educated myself, and Im saying, no more will this epidemic
continue to plague New Mexico. But I need the help of many New Mexicans, many other Americans, it cannot be done
by me alone. Wait, maybe I am overreacting, maybe overdose deaths are not that concerning to New Mexicans?
{22}
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1 in 5 New Mexicans know someone who has died of a drug overdose and 1 out of 2 New Mexicans know someone
struggling with a substance abuse problem and 80% are concerned about drug abuse? Nope we are informed and
concerned about substance abuse in New Mexico
The Hard Truth: I am sorry to say it but we have been sold the proverbial bill of goods and we have paid for it
with our tax dollars when it comes to opioid overdose death prevention. For all New Mexico organizations and
individuals on the front lines of this epidemic, I am genuinely sorry, and thank you for the lives you have saved, and will
save, with your efforts. But unfortunately, you can only do so much with funds and staffing you have, the Naloxone you
have, or dont have, and the myriad rules and regulations you are up against in trying to stem this epidemic overdose death
emergency tide.
1. We have not made opioid overdose deaths a real priority in this state and never have. We have had
millions of dollars thrown at it, duplicative research, poor strategies, no policy evaluation, innovative
legislation and laws, declared it a state emergency, and the death rate has remained essentially the samewith the solution in our back pocket since at least 2001. And again, until recently with the Obama
Administration, Representative Ben Lujan, Senators Martin Heinrich and Tom Udalls efforts, it is the
same in America. If this is the real policy of the Martinez administration, then it is time to stand up, hold
a press conference, state the true policy, and accept the consequences. If these lives are expendable,
somehow worth less than any other deaths of our citizens in New Mexico, then we need to say it.
2. We have two state agencies, and subdivisions within, and the Governors office, who have been funded and
charged with addressing this issue. Yet I could not find one interagency joint press conference, with or without
the Governor, nor have I even seen one inter-agency press conference within the Department of Health where
there are at least 3 divisions involved in this issue, that shows me there is any joint effort to maximize the
pool of resources we have, focus it, and direct it to the problem strategically and efficiently. Dr. Landen is
right, there has been little to no study of the policies and responses to this issue. Our government doesnt
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know what to do, knows what we are doing is not working, and have not made a real effort to find out
why. And the answer is in their own data, they have control of the Naloxone, control of the funding, and
thus control of the death rate as it has stood and stands in New Mexico.
3. The federal government has poured millions and millions of dollars into New Mexico for this issue and I cannot
find where they did any accountability of how these funds were used and what effectiveness these funds have
produced. These are our tax dollars and, in the end, we have the say of how they are to be spent.
4. As far the Health Sciences Division at the University of New Mexico, ditto. Get out of your analytical
ivory tower, see the real issues, and use your multi-million-dollar annual grant funding to study what I
have suggested in this paper if you really want to address the overdose deaths. Redirect some of the
research funds you are using every year towards this issue specifically, purchase some Naloxone, find out
the barriers that are preventing them from using it, study the citizens who actually overdose and the
reasons behind the overdose, provide 2000 beds where they can be treated, and then study those results.
Why do family members and friends pass along opioid prescriptions to those who do are then abusing it?
Why are Native Americans dying at a rate 2 or 3 times the rate of other New Mexico citizens? And the
big one: Why is Naloxone not effectively getting into the hands of the people who most need it, the
overdosing opioid abusing citizen? What is about Americans, and New Mexicans, where we are creating
the opioid market for prescription drugs that is killing our fellow citizens?
5. We have researched this issue to death studying demographics, locations, etc. and spent millions gathering it, in
triplicate, duplicating our efforts in government agencies, and with government funding. and then applying it to
no meaningful strategy or policy that will reduce these deaths. People are dying in New Mexico at an epidemic
rate and we are not responding to it well or, if, at all. The studies that really need to be done are not being done.
6. The strategy of providing Naloxone at pharmacies, where it is even actually there behind the counters,
has been a sham we have no data that shows that it is even effective and I have shown many barriers
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that make it ineffective. The fact that in the capitol of our State, not 15 miles from the seat of our
gubernatorial, legislative, and governmental agency power and funding, 3 out of 5 pharmacies have no
Naloxone, are uneducated about its ability to prevent deaths, and it is not promoted or marketed to the public
who needs it, is indicative of the true policy of this administration. You would think, at least in Santa Fe, for
appearance purposes at least, we would have Naloxone flowing into the community. And the Pharmacy
Prescription Management Program is important, in its current optional participation state, is also near
worthless. Until we order these pharmacies, all 300 of them, to participate fully in reporting opioid
prescriptions data, and providing Naloxone with every suspect or refill opioid prescription, we are
kidding ourselves. Until these pharmacies take an active role in educating the public about the problem,
telling them where they can have excess opioid prescriptions taken back and destroyed, and fully
reporting multiple opioid prescriptions by prescriptions physicians and by the customers receiving them,
their effect is negligible. If this is truly a proclaimed emergency, then they need to be ordered to do this,
by law or executive order, Governor Martinez and/or the New Mexico Legislature.
7. You have got to ask yourself: How did this Hallford guy get all this information, crunch the data, come
up with an action plan, and write this paper in 2 weeks? Why arent our agencies doing this already and
why havent they done this in the past?
So, we must look at our governmental agencies, the University of New Mexico, and what we can do with the federal
funding we have.
New Mexico Governors Office. I will begin by starting at the top, fellow New Mexico citizen and our Governor, the
Honorable Susana Martinez. And some of this also applies to our former Governors Richardson and Johnson, since
Naloxone existed, and we knew about it, and never used it meaningfully to address the continually rising opioid overdose
death rate in New Mexico. Governor Martinez stated, just a few days ago, the following:
This is an issue that weve been focused on since day one of my administration. While weve made
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important strides, we still have a lot of work to do, said Governor Susana Martinez. One overdose
death is one too many, which is why were going to continue doing everything in our power to
end this epidemic. {5}
I believe Governor Martinez when she says that this is an important issue and she recognizes it as an epidemic. She has
publicly declared is an emergency. As a former district attorney, she has also seen the ravages of substance abuse and
prosecuted drug dealers, and other substance abuse addicts, who were also criminals. And while there are certainly some
of these overdose deaths that are drug dealers and criminal/addicts, she knows that there is also a very significant
portion of these deaths who are not those people. Her administrations own research, ad infinitum, has shown that.
There are many innocent victims who, had they not abused opioids or become addicted, had not, or would have not, ever
committed a crime. They are high school football players, a teenager on the swim team, college students, people
successful in their careers, people with chronic pain, the elderly, too many Native Americans, Hispanic, Black, and
White-they are just like us they are us -New Mexican citizens.
However, either she has been horribly misinformed by her staff and/or cabinet secretaries or perhaps she does not know
where significant, necessary, and just a part, of millions of dollars, that have not been directed strategically towards
stopping these deaths have been spent. Part of it has been spent on endless research, education and public service programs
which have not effectively produced significant results, and at least no visible analysis of what is, or is not, working. And
with our budget woes in New Mexico, every dollar counts. And I am sure she believes that she is ultimately responsible
in her position as Governor, the leader of all New Mexico citizens and our government, some who are no longer with us
due to this epidemic. But I am sorry to say, Governor Martinez, you were and are not doing everything in your
power to combat this epidemic.
We can look at Governor Martinezs Executive Budget Recommendations:
Her 2015 EXECUTIVE BUDGET RECOMMENDATION Fiscal Year 2015 (July 1, 2014 - June 30, 2015) indicates:
Table 5
Performance Measures Summary and Evaluation

FY14
Target
FY14 FY15 FY16

Actual
Target
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Output Number of naloxone prescriptions provided in conjunction with

opioid prescriptions.
1,000
154
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500
Her 2016 EXECUTIVE BUDGET RECOMMENDATION Fiscal Year 2016 (July 1, 2015 - June 30, 2016) and in Fiscal Year 2017 (July 1, 2016,
June 30, 2017) indicates:
FY17
Target:
Output Number of naloxone prescriptions provided in conjunction with
1000
opioid prescriptions.
{60}
Apparently, the Governor reached only15% of her target for 2014 and then decided to not increase that target in
2015 (after the highest opioid overdose death rate in 2014) and then to increase its distribution to only 50% of her original
goal from 2014 in 2016 (?) She doubles it for 2017, 1000 Naloxone units to be provided with opioid prescriptions of
which there are almost 2 million opioid prescriptions in New Mexico every year? Im sorry Governor Martinez,
1000 units is not going to do it, not even close
In my estimation, Governor Martinez needs to convene her cabinet secretaries in the Department of Health, Department of
Human Services, and the Department of Finance and Administration and their best analysts to gather the data that is
already there, strategically analyze it, and see what is possible, as I have done. This is not my data, it is our data, with
the answers right here from the citizens of New Mexico. She needs to find out why, in 2015, the death rate was the
worst after spending millions of dollars trying to address it. Next, she needs to convene bipartisan legislature leadership,
the University of New Mexico Health Sciences Division leadership, bipartisan state Senators and House Representatives,
federal agencies, public and community interest groups, and maybe even a few willing opioid-addicted New Mexico
citizens from Rio Arriba County, to learn one thing why is Naloxone not getting in the hands of those overdosing
citizens who desperately need it and they, then die? That is, really, the only question. Or, save us all some time, and
maybe even some deaths and all the other cost savings that are possible, and implement the plan that I am proposing in this
paper immediately. We need the Governor, and the relevant state and federal agencies to work with us, providing us
funding and support, and working with the community level agencies also wanting to address this epidemic. We need to
join together, we can do this, now.
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For some reason, there is a pervasive resistance, in the face of all the research that supports it, a refusal to get Naloxone,
en masse, out in the communities and tribal lands of New Mexico and most importantly, in the hands of the opioid
abuser themselves. She needs to use the power of her office to inform New Mexicans that this strategy is going to
save many lives, is very cost efficient, civilly responsible, and will build community in the communities of New
Mexico, New Mexicans taking care of New Mexicans.
The New Mexico Department of Health:
State Epidemiologist, Dr. Landen, has, while not, with perhaps epidemic haste in my judgment, been moving in the right
direction over the last 2 years. I believe he sees the issue with overdose deaths and has begun to call for changes. In May
2016, at the Prevention for States Awardee Meeting, he concludes and recommends:
Conclusions:
Multiple overdose prevention bills may assure that something passes

PMP bill probably would not have passed without naloxone bill
Starting with strongest language might be best
Compromising later helped PMP bill
Overdose prevention community support essential
Abuse deterrent opioid bill failed this session
Policy evaluation has been an afterthought
Recommendations:
If major issues with naloxone access exist, consider naloxone standing order legislation or equivalent.
Any PMP mandate legislation may be helpful if subsequent board rules are required and a minimum standard
for checks is set.
The overdose death epidemic is evolving and policy must constantly evolve too
Begin planning for policy evaluation as early as possible.
{ 61}
Kudos Dr. Landen, well said. We havent studied what works or doesnt work, we need statewide and community
level support, and he is speaking specifically about overdose death prevention. But then we have this, in June 2016,
where we are, once again, promoting distributing Naloxone to only 10% of the pharmacies in New Mexico, and as if
increasing distribution here, will be effective as the ideal setting for both patients and families to access Naloxone, with
no data to prove it, and actually, plenty of data that disproves it:
There were only 59 naloxone claims provided via Medicaid from pharmacies in the first quarter of 2015. Overdose death
impacts every community in New Mexico and requires community-wide efforts and collaboration to
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combat this epidemic, said Department of Health Secretary Designate Lynn

Gallagher. Pharmacies provide an ideal setting for both patients and families to access
naloxone and overdose prevention education and this is a great example of how multiple
community partners can participate in reducing overdose deaths.
While this recent increase in pharmacy-based naloxone is encouraging, the naloxone Medicaid claims
came from 35 pharmacies across the state. This represents only 10% of all pharmacies in the state. In
order to continue to increase the availability of naloxone and increase the number of pharmacies
dispensing naloxone, the Department of Health and the Human Services Department are working
with pharmacies across the state to implement the statewide standing order for naloxone.
{62}
Sorry, Secretary Gallagher, you are very, very mistaken. If you are speaking about Southwest Care Centers effort
through the Department of Human Services, I dont think so. And really, that does not matter - It is not getting in the
hands of the end user efficiently and effectively, NOW.
My Recommendations:
Convene a statewide overdose death prevention policy task force. Have it staffed with the people on the front
lines of this issue, Rio Arriba County, tribal authorities, legislators, emergency services personnel, ER
doctors, UNM Project Echo physicians, opioid overdose citizens who are still alive. Ill be happy to chair it
and lead it.
Redirect and use your funding for massive Naloxone distribution, placed strategically in the hands of the
opioid abusers.
Redirect dollars into opioid addiction treatment, providing inpatient beds in areas like Rio Arriba County,
outpatient therapist, invoke the national guard to augment law enforcement interdiction efforts, and go after
the distribution level dealers of this poison
The New Mexico Department of Human Services:

This department is managing at least a $1.3M annual package to be utilized for Naloxone distribution and
marketing. Your efforts in this capacity have been less than acceptable. Naloxone is not in pharmacies, your
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marketing efforts have had little to no effects, and your partner, Southwest Care is not doing what you contracted
them to do. You have done studies already done by the Department of Health and you have done no analysis
worthwhile to figure out what does work to stop this death epidemic. And I do not see you working with the
Department of Health in tandem on this issue. You need to do what is necessary to get Naloxone in the hands of as
many opioid users, and abusers, period. Marketing is about educating the public at the grass roots level on this
issue, pharmacies are not the ideal place for distribution or education, and you can educate the whole state quickly
through effective computer and cellular phone mediums. You, and others, must get your hands a little dirty and
get on the streets, in communities, in small towns, and the farms of New Mexico. If you will work with Stop OD,
Inc., we can get this done efficiently and effectively.
FINDINGS:
Hopefully, I have shown the following with the data and research on opioid overdose deaths in New Mexico:
1. Almost all that we have done, and are doing, on this specific issue, have not effectively reduced the death from
opioid overdoses. We are also up against an epidemic never before seen, and we must do our best to respond. We
are losing over 50,000 lives each year.
2. All of our research and data generation has not been effectively analyzed and a comprehensive policy developed.
We know who, what, when, where, and how of the opioid abuser who overdoses and dies. But we do not know
what to do that is most effective.
3. While we have had multi-million-dollar funding to address the issue, we have not used it wisely or well. We have a
university that is out of touch on this issue, and using millions of dollars that could be used to address the opioid
abuse crises directly.
4. We have known about Naloxone since 2001, and, while the use of it is now finally increasing, we have not used it
enough to reduce the deaths.
5. We have a belief that distribution on Naloxone is best done through pharmacies and through law enforcement
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agencies and first responders. This is not the best solution. It is to get it directly into the hands of the opioid
abuser themselves and to those who are with them: fellow abusers, family members, friends, roommates, neighbors,
strangers. It must be distributed for free, anonymous, and without barriers to finding it in the community.
6. We can maximize the benefit and use of Naloxone through strategic marketing, inventory control, distribution
strategies, and reduce the cost per unit.
7. We must ask for the help of our fellow New Mexicans to address this issue at the community level. And studies are
showing that those who save the life of another brings them optimism.
8. Saving each and every one of these deaths will not happen but, in saving as many as we can, we are actually saving
money ourselves, in our economy, in America itself.
9. Until we address the special challenges of Native American opioid overdose deaths, we will not reduce the deaths
near as quickly as we could. We need to provide resources directly to the Native American communities which
address directly opioid abuse and overdose deaths.
10.
After overdose reversals, if we do not have effective inpatient and outpatient treatment safety nets, we will
be seeing these citizens again and again, and will lose some of them to overdose death.
11.
If we do not actually declare war against the illicit opioid distributors, within and outside our borders, we
will not stem the tide of illegal, and increasingly more dangerous, drugs flowing into our country. If we do not
figure out, as Americans, why we are creating our own market of overflowing prescription drugs, misused and
overused, we will not effectively stop the rampant overdose rates. We must track the prescriptions, the prescribers,
and the users along with the pharmaceutical manufacturers to reduce the epidemic of unneeded prescriptions. And
if we do not figure why one family member or friend would give unused and unneeded opioids to another family
member or friend, or sell it on the street.
When I ran two public agencies, I believed they could be run like a business and I was right. We figured out, as a criminal
justice agency, who are customers were, what programs were needed, how to efficiently and effectively market our
products with limited resources, and how to promote our agency in the community. So, I formed another one, a not for
profit, Stop OD, Inc. Stop OD, Inc. is poised and ready to address this problem-which is really, a problem of marketing,
placing financial resources where they most impact this issue, and distribution. Getting Naloxone into the hands of
those who need it, the overdosing citizens of New Mexico. They are our customers.
Conclusions. Lets start with what we can all now, hopefully agree about:
We are, and have been in a long, painful, life-losing opioid drug war and overdose deaths that have reached
epidemic proportions.
Our enemies are in many countries, and all over, and within the borders of our own country. Until we realize that
we are dealing with a large group of some very dark souls, true terrorists, who have no problem with knowingly
killing over 50,000 Americans, addicting millions more, costing us over $50B annually in economic costs, and
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breaking millions of American hearts in our communities, families, friends, and even in total strangers. And they
do it every year. These individuals make ISIS look like amateurs. Nothing short of declared war will
change this.
For those of us who have been battling this problem for years have not been able to meaningfully react with any
real results in the opioid overdose death rates. It is beyond any one of our governments, agencies, community
groups, religious communities, schools, neighborhoods, even often beyond preventing it in our own homes. We
are tired, overwhelmed, frustrated, and some of have given up hope, making those that die every year somehow
expendable. We are the wealthiest country in the history of the world and we cannot take care of our own.
And even with this wealth, we are the main abusers by far of opioids, we, by far, are the consumers driving
the opioid world market. There is something collectively endemic in our culture that we have to address for
it affecting all of us, everywhere, no matter where we live.
We must critically assess our meaningful, intentional, genuine, efforts that have not worked to address this issue.
We must, individually and collectively, take our lumps where we are wrong, point ourselves in another direction,
and respond together in a united front, non-partisan, non-racial, strategic way. Looking at the history of this
country, we have done this with far more ominous threats, often with much less resources than we have for
this issue.
And, here is the good news, we have the solution for this issue right in front of us and the means to initiate
it. And the solution will build community without judgement, those who help out are proven in studies to
become more optimistic and feel good about themselves, and they do not have to risk sacrificing their lives, or
even a particularly large amount of time, to save one life, or even, perhaps many, lives.
We can stand up individually and, in doing this, collectively save thousands of lives every year. And perhaps,
one day, like polio, stop these deaths.
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Finally, I am not suggesting anything unachievable and I am also not saying this will magically save us from the
epidemic facing us that is the ravages of rampant substance abuse. To address this endemic cancer, completely,
we have a very hard battle in front of us. We have to look at ourselves, as Americans collectively and
individually, and ask our ourselves: What is driving us to put into our bodies these highly and increasingly
more addictive poisons that most of us know is either going to ruin our and others lives, and in some cases,
kill us? What pain are these fellow Americans, who abuse, are addicted, and in some cases, overdose, and
die from opioids and other substances, really, trying to medicate? There is a voice, collectively and
individually, in this country and in their heads, that is very painful that we, and they, dont want to hear,
and we are trying to silence that voice by turning away and/or using these substances in epidemic
proportions. And until we allow, and truly hear these voices expressed, without judgment, these desperate voices
of pain that I submit come from loss of hope, poverty, hunger, racism, sexism, the raped, the abused, those
subjected to daily to violence and overwhelming fear, those with no economic hope or future, those who have lost
faith in our leaders, in our country in their God, the Native Americans, those in real physical and psychological
pain, those with chronic pain and incurable diseases, our veterans horribly wounded physically and
psychologically, the abhorrently lonely and disconnected, and the many lost and disconnected youth who have no
idea what they are putting into their bodies, we will not overcome this huge and multi-faceted epidemic of
collective and individual substance abuse. But what I am saying is that one very important and significant
issue, opioid overdose deaths, can be reduced significantly, immediately, and in the future.
Naloxone needs to be in medicine cabinets, cars, buses, public parks, airports government agencies and private
businesses throughout New Mexico. Every location it is available should be also promoting and educating the free
cellular phone application. And the drug should be provided, without judgment, to anyone who requests it
anonymously. Who better to get into the hands of those who need it it is us, the citizens of New Mexico . It
wont cost us anything, only educating ourselves for an hour or two in the privacy of our homes (who doesnt have
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a cellular phone these days?), and if it crosses our path, helping another New Mexican not die from an overdose. I
believe most New Mexicans are willing and able to do that. We just have to ask them and provide that
Naloxone.
What We Might Not Agree Upon:
1.
Perhaps the biggest issue in the background, and sometimes the foreground, is the idea that opioid abusers
are all drug addicts, street-level, homeless, lifelong addicts that, through their bad choices, deserve their fate.
I hope first I have shown that the opioid overdose death citizens are not all that, not even the majority. They
are us. I also hope that I have shown that keeping these citizens alive is cost effective, a community building
effort, and can be reduced greatly in a short period of time.
2. We may not agree that we are at war in this epidemic. I hope I have shown you with this paper and the
Editorial I have written within it, below, that we are and our casualty rate is over 50,000 lives a year. We are
being attacked by real terrorists who also make billions of dollars and cost us billions of dollars, every year.
This plan is cost-effective, reasonable, ethical, fiscally, and civilly responsible, because no New Mexican or American
should not have the opportunity to save another citizens life, or their own. It must be done in the streets, backyards,
neighborhoods, rural farms, towns, cities, businesses, governments, and community organizations of New
Mexico and America, by the people who live there. And what could be a better community building effort than
one community member saving another community member? We are at war, we have part of the army, right
here in New Mexico, it is ourselves.
Lets think of ourselves as The Red Cross on this drug war battlefield, saving as many as we can, no questions
asked. And we do not have to do triage because everyone we give Naloxone to in time, lives. There is little to no
danger to be on this battlefield, the enemy is not shooting at us. The Red Cross army is the citizens of New Mexico,
Good Samaritans, led by our Governor, backed by our government, fighting back, removing our wounded from the
battlefield-fully alive. Thats fighting back against these terrorists, with compassion, civic duty, empathy, and dare I
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say it, unconditional Love. This is a power that cannot be denied, and once again we become a model state, as we
lead the rest of the country on another front of the substance abuse, needless overdose death-rate battlefield, with a
huge reduction in overdose deaths.
STRATEGIC ACTION PLAN:

Like most research papers, this paper does the research, looks at the policies, has conclusions, and makes
recommendations. Unlike most research papers, this paper includes what we are going to do about it in New Mexico,
how, and immediately. Stop OD, Inc. is standing up now and we will address this issue, one way or the other.
Either stand with us, beside us, or behind us, but do not stand in front of us.
Stop OD, Inc. will enact the following plan for New Mexico as soon as it is funded by a combination of our own
federal grants, donations, agency grant funding, and support from governments, activists and community organizations,
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businesses, and individuals. We will be applying for federal grants for funding our program., soliciting medical and
pharmacy organizations, universities, pharmaceutical companies, opioid overdose prevention organizations, churches,
companies and small businesses, local community groups, and private individuals to help us in any way they can. We also
will accept public and private donations through various channels. We also will be soliciting existing New Mexico state
government agencies, specifically managing the federal and state resources provided to our citizens. for this important
strategic, emergency epidemic response we are proposing in this paper, from their existing and future funding. With
government help, our even without it, we will reduce the deaths from opioid deaths significantly and very soon.
1. We will partner with the New Mexico Department of Healths Naloxone distribution program as well as free and
discounted Naloxone sources for our supply of Naloxone. We will immediately request free Naloxone to all New
Mexico high schools from our pharmaceutical source and work with the New Mexico Public Education Department
for its immediate distribution.
2. We will distribute Naloxone kits first, to targeted areas where the opioid abuse is the highest. We already know this
information from the New Mexico Department of Health, emergency medical services (EMS) data
https://nmhealthEMSData, hospitals, community organizations, pharmacies, and law enforcement data. We will
plot this information and make heat maps telling us where to go first. The Naloxone kits will include two
injections due to the increase of synthetic opioids which often can take two doses to revive the overdosed citizen.
We will strategically place Naloxone in radiuses within communities where it is available quickly and easily, no
questions asked. We will analyze data from rural counties, where Naloxone has never existed at all, determine
historic overdose death rates, and make sure there is enough Naloxone, strategically placed, to make sure it is
available in remote parts of New Mexico. And we will provide Naloxone to anyone who asks for it, free.
3. We will go into to targeted neighborhoods and provide Naloxone in strategically placed locations which could
cover a section of streets, a neighborhood, or small town. We will load this information into a cellular phone
application, one that we create ourselves or approve from existing cell phone applications for this purpose. In these
kits, will be the information necessary to administer the Naloxone safely, a copy of the Good Samaritan law,
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treatment center information, and an online and by mailing reporting format to report the use of the Naloxone that
has saved a life. We will provide a weather-resistant sticker and/or placard which can be displayed in the windows
and/or on the mailboxes of agencies, community organizations, businesses, and homes were Naloxone kits are
available.
4. We will track the distributors of the Naloxone when possible and award and honor those who have saved lives with
their efforts. We will track the overdose citizens with an identifier that will allow them to remain anonymous and
yet provide us with data about location, age, race, sex, education, income level, and whether they have used
Naloxone before and how many times. We will promote any overdose citizens saved by Naloxone who are willing
to come forward and tell their story. We will provide Naloxone to those who ask for it, no questions asked. It is
not a controlled substance, cannot be used to get high, is safe, and the person is protected by the Good
Samaritan Law. If we are so worried about losing the antidote, what else can, or are they going to do with
it? We will never provide identifiable information about any opioid user without their permission, or in the case of
a minor, their parents and their parents permission.
5. We will replenish Naloxone kits to agencies, organizations, and individuals when requested and have toll-free
number and online communications formats. We will safely and securely store the Naloxone inventory, track its
shelf life, and provide accounting of the use of the Naloxone and other expenses. We will collect Naloxone that is
months away from its expiration date, redistribute these units to the street, so that they can be used immediately and
before the expiration date.
6. We will design a strategic advertising campaign using the media, billboards, posters, other advertising
formats (shirts, mugs, etc.) and community presentations which will include the cellular phone application
information about Naloxone and where to get it, our telephone number, and recognize supporting partner
agencies, organizations, businesses, and pharmaceutical company(s) who provide us financial and other
support for our mission.
7. We will negotiate with the pharmaceutical industry, and pharmaceutical companies individually, to obtain very
discounted, or free, Naloxone for New Mexico. We will honor those companies who will step forward and help
stop this epidemic, it is their corporate responsibility, and a relatively small cost in comparison to the volume
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and revenue they are receiving from the sale of opioids in New Mexico and in America. For those that do not
participate, we will pursue a class action suit, by the People of New Mexico, for the many and significant costs of
opioid overdose deaths as evidenced in this paper, and the ripple effect of harm that affects thousands of New
Mexicans every year in New Mexico.
8. We will work with individuals and communities to safely take back unused opioids, illicit drugs, and assure their
immediate destruction through proper law enforcement channels. We will also take back any used syringes safely
for their immediate and safe destruction. We will hand out clean syringes, if they are provided to us by any
community or governmental agency, to anybody who asks for them.
9. We will provide law enforcement officials with any information we may gain about illicit opioid manufacturers,
illicit doctors, or pharmacists prescribing opioids illicitly, street dealers, and what opioids and other drugs we may
find being distributed in all the areas of New Mexico, while protecting the informations source.
EDITIORIAL:
I have designed this paper as a research paper but I cannot resist the need to editorialize now.
We are at a critical juncture of the opioid overdose abuse death epidemic in New Mexico. We have the resources, even
with shrinking governmental budgets, which are earmarked for this expressed purpose and we have even more available at
the federal level. We are asking federal agencies, New Mexico governments, tribal authorities, treatment agencies,
hospitals, businesses, pharmaceutical companies, community groups, law enforcement and emergency service personnel to
partner with us because we can reduce greatly opioid overdose very soon. When I came to New Mexico in 2003, we were
#1 in death and injury from Driving While Intoxicated (DWI) offenses. We moved to 25th in a few short years, we can do
the same with opioid overdose deaths, in a much shorter period.
We are in an epidemic here, opioid abuse, overdoses, and overdoses causing death. If this were asthma,
tuberculosis, malaria, or Ebola, we would, and do, respond in kind. We marshalled are available resources and we
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went out in metropolitan and rural communities and provided inoculations. I guess the difference here is an unconscious
or, sometimes conscious, view that these citizens are causalities of the drug war and perhaps we should use our tax
dollars in other efforts. My mother taught me as a kid that you have to stand for something or you will fall for
anything, so I stand and declare we are at war, and we need to address this problem with a multi-faceted strategic
approach; find and eradicate the drug mills that are making these synthetic, highly addictive, killers of the innocent, in our
country and in foreign countries (Heroin-Afghanistan, Pakistan, Tajikistan, Albania, Turkey, The Netherlands, Iran, India,
Thailand, Kyrgyzstan) and (synthetic opioids China, Mexico, Ukraine, The Netherlands) {63} Are any of these countries,
except perhaps China, Pakistan, and India, really, any kind of threat to the full force and weight of the United States of
America? And we know where the money is being laundered as well (see Central Intelligence Agency Report). {64}
Go after those who are bringing the drugs into New Mexico at the distributor level (Im not sure why those who are
convicted are not given life imprisonment-this is a war crime now and there is plenty of room now at Guantanamo
and other prisons filled with opioid addicts, for them), the illicit drug prescribing doctors and pharmacists who are
knowingly prescribing for monetary gain after swearing an oath to protect and care for their patients (ditto on the life
imprisonment), sweep up the dealers on the street (and remember that many of these are opioid addicts themselves
forced to deal drugs to support their own habit), reduce overprescribing of opioid prescriptions by doctors, and learn
other ways to deal with pain, limit refills of these prescriptions when they are not needed, provide treatment and social
services to opioid abusers and addicts, and of course, Naloxone distribution. These people are the real terrorists,
knowing, genocidal, killers making billions of dollars from us and causing billions of dollars in cost to us. And this is
every year I am seriously suggesting that we use our armed forces and our state national guards to augment the
law enforcement efforts to address this drug war, after all we declared it a state emergency, and maybe we could start in
El Paso, just south of our border, a hub for the drug distribution from Mexico. {65}
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We are obsessed with the terrorist threat within, and outside, our borders and if we added up all of the people
killed in the United States by terrorist s attacks in the last 13 years, including 9/11, (3412 deaths), they would be
less than just 40 days of opioid overdose deaths (3640 deaths), if we want to add the Pearl Harbor attack (2403
deaths), add one more month of opioid overdose death (2700 deaths). The current opioid overdose death rate in one
year is almost the same to all deaths from the Korean War or in two years, the death rates would be almost the same
as the combination of all deaths from the Korean War and Vietnam. At this annual death rate, for 10 years, these
deaths would exceed the total deaths from World War II by over 100,000 deaths. {66} Looking at the terrorism
innocent loss of lives from a strictly economic point of view (3412 deaths over 13 years) we spend $100B a year {67},
equating to over $1.2T in the last 13 years, to prevent the present and future risk of losing how many lives (dont get me
wrong, these were horrible innocent lives lost)? Yes, I know that many of the opioid deaths are Americans who have drug
dependency (a disease, proven, a chemical imbalance) but now these internal and external terrorists are making
increasingly more addictive synthetic opioids specifically designed to create a whole population of new addicts and more
and more American deaths that are not currently drug dependent. And they are laughing all the way to the bank. And now
overdose deaths are increasing around the world:
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{71}
Wait, we are only 4.3% of the world population and we have almost 33% of all overdose deaths in the world?
For a local example, in Taos:

Wilma Romero, 66, pleaded guilty to trafficking heroin and conspiring to launder the proceeds and under her plea agreement will face no more
than two years in prison followed by a term of supervised release. Elena Carabajal,26, pleaded guilty to one charge of possessing heroin with intent
to distribute and will be sentenced to no more than 1 1/2 years in prison and supervised probation. Wilma Romeros sons Ivan Romero, 40, and
Ricco Romero, 29 were responsible for purchasing large quantities of heroin from suppliers in Albuquerque and Los Lunas. Other members of
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the organization, like Jason Jurassic Duran, would act as couriers and transport the drugs to Ivan and Ricco in Taos County. Upon getting the
heroin, Ivan and Ricco prepared it for distribution by mixing it or cutting it with other substances and packaged it into smaller portion for sale
either directly or through a network of dealers. Ivan and Ricco pleaded guilty to drug trafficking and money laundering in December and agreed to
forfeit over $400,000 to the U.S. government. If those pleas are accepted, Ivan will received a sentence between 10 and 12 years in prison while
Ricco will get a 10-year sentence. Melissa Romero also pleaded guilty to participating in a drug laundering scheme in December while Tyler ZigZag Baker pleaded guilty to his role in the organization in October. After Ivan was arrested in 2015, members of the ring made separate deposits
of $90,000 and $150,000 at the same Taos bank in order to get bank or cashiers checks to make his bail. {68}
How many heroin overdoses and overdose deaths were there in Taos County during the Romero familys terrorist reign
where they knowingly dealt heroin, and made great money at the profession? Sorry life imprisonment, they are serial
murderers, Wilma too, its the cost of doing business.
Why arent we after these real terrorists within our borders and in other countries? The distributors, those who
finance drug distributors, illicit prescribing doctors, and the clandestine laboratorys making even more addictive
opioids to our citizens? We are at condition red on the real national terrorist meter right now in America. The
media brings into our living rooms daily, from every angle, terrorists attacks, shootings, and the like. Hollywood glorifies
drug dealers like Pablo Escobar, an absolutely genocidal maniac (who has at least 3 movies and series), Breaking Bad, and
countless others. And for those who think of what we have lost in the American culture (ironically in Hollywood) due to
opioid accidental overdose deaths, I remind us of the following:
George Michael Singer, Heroin, age 53

Prince Singer, Fentanyl, age 57
Phillip Seymour Hoffman Actor, Heroin and drug cocktail, age 46
Michael Jackson = Demerol withdrawal, propofol to medicate withdrawal, age 50
Heath Ledger Actor, several prescription opioids, age 29
Howie Epstein Bassist, Tom Petty & Heartbreakers, Heroin, age 47
Dee Dee Ramone Heroin, age 50
Chris Farley Actor, age Heroin and other opioids, Age 33
Kurt Colbain Singer, Heroin (possible suicide), age 27
River Phoenix - Actor, Heroin, Age 23
David Kennedy Son of Robert Kennedy, Demerol, Age 28
John Belushi Actor/Musician, Heroin, Age 33
Howard Arkley - Painter, Heroin, age 48
Jean-Michel Basquiat Artist, Heroin, Age 28
Robert Bingham Author, Heroin, Age 33
Derek Boogaard Hockey Player, Oxycodone, Age 29
Tim Buckley Musician, Heroin, Morphine, Age 28
Gram Parsons = Musician, Morphine, Age 27
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Elvis Presley Entertainer, Codeine, Age 47

Cory Monteith Actor, Heroin, Age 31
Jim Morrison Singer, Heroin, Age 28
Paula Courson Jim Morrisons partner, Heroin, age 33
Nick Drake Musician, Heroin Age 28
Peter Fandom Musician The Pretenders, Heroin, age 31
Hillel Slovak Musician, Red Hot Chili Peppers, Heroin, age 26
Brad Renfro Actor, Heroin, age 26
Bradley Nowell Musician, Band-Sublime, Heroin, age 28
Peaches Geldof Daughter of Bob Geldof, Musician/Humanitarian, Heroin, Age 25
Paula Yates British Television Presenter and mother of Peaches Geldof, Heroin, Age 41
Bridgette Anderson - Child Actress, Heroin, Age 21
Robbin Crosby Musician, Band-RATT, Heroin, Age 43
Lucy Grealy Irish Writer, survivor of cancer of the face in childhood, Codeine, Heroin, OxyContin,
Age 39
Max Cantor Journalist/Actor, Heroin, age 32
Jimmy McCulloch Musician, Band-Paul McCartney & Wings, Morphine, age 26
(Source: Google Searches, Famous Opioid Accidental Deaths, accessed January 6, 2017)
And thousands and thousands more, less well known, but just as loved, Americans and New Mexicans, who should be
here today. All these who died accidentally, after Naloxone was introduced in 1971
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REFERENCES:
(Note: All the links listed below should be operational and take you directly to the report. I have shortened the address name for brevity. If I
missed any, Im sorry, contact me at timothy.hallford@roadsafetytechnologies.com and I will get you the information.)
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https://www.abqjournal.com/864542/China disputes US claim its top source of synthetic drugs, , Erika Kinetz
and Gillian Wong, Associated Press, December 19, 2016, https://www.abqjournal.com/911835/ .
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Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths United States, 20102015. December 30,
2016, MMWR Morb Mortal Wkly Rep 2016;65:14451452 DOI, http://dx.doi.org/.
17. Heath Care Costs for Opioid Abuse: A State-by-State Analysis, Matrix Global Advisors, LLC, April 2015,
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18. Wolters Kluwer Health: Lippincott Williams and Wilkins. (2016, September 14). Costs of US prescription opioid
epidemic estimated at $78. 5 billion. ScienceDaily. Retrieved December 30, 2016 from:
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19. Training: New Mexico Pharmacist Prescriptive Authority for Naloxone Protocol, New Mexico Pharmacists
Association & Project ECHO, 1\26\16, https://nmpa30.wildapricot.org/ .

20. New Mexico Law Permits Widespread Naloxone Use, Partnership For Drug-Free Kids, June 28, 2001,
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21. New Mexicos Drug Overdose Death Epidemic: Understanding the Problem and Finding a Way Out of the Crisis,
Pamphlet: Collaboration of The Drug Policy Alliance, Healing Addiction in our Community, The Drug Policy
Alliance, Revised May 2016, http://www.drugpolicy.org/.
22. New Mexico State Health Improvement Plan,, New Mexico Department of Health, 2013.
23. More NM residents get naloxone, Albuquerque Journal, Olivier Uyttebrouck / Journal Staff Writer, June 8th,
2016, https://www.abqjournal.com/787112.
24. New Mexicos drug deaths highest ever, Olivier Uyttebrouck / Journal Staff Writer, Albuquerque, Journal, July
24, 2015, https://www.abqjournal.com/617556/ .
25. Albuquerque promotes overdose drug to save lives, Olivier Uyttebrouck / Journal Staff Writer, Albuquerque,
Journal, April 6, 2016, https://www.abqjournal.com/752167.
26. Tennessee Chronic Pain Guidelines and Controlled Substance Efforts Symposia, Michael Mutter, M.D., October
6, 2016, http://www.mc.vanderbilt.edu/.
27. Fiscal Impact Report, New Mexico Legislature, February 11, 2016, https://www.nmlegis.gov/.
28. New Mexico Recognized for Raising Awareness of Prescription Drug Abuse, Press Release, New Mexico
Department of Human Services, November 18, 2015, http://www.hsd.state.nm.us/
29. Southwest Care Center Website, accessed, January 5, 2017, https://southwestcare.org/.
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30. Pharmacists increase access to naloxone in communities, Loren Bonner, Pharmacy Today, December 2016,
http://www.pharmacytoday.org/
31. Reader View: Protect family by asking opioid questions, Kate Morgan, Editorial, The Santa Fe New Mexican,
November 5, 2016, http://www.santafenewmexican.com.
32. Back from the brink: Life-saving Narcan can revive a patient who has overdosed on heroin or other opioid, Andy
Stiny / Journal Staff Writer, Albuquerque Journal, September 19, 2014.
33. Deputy revives OD victim as Santa Fe Sheriffs office begins Narcan program, Edmundo Carrillo/Journal Staff
Writer, Albuquerque Journal, June 15, 2016, https://www.abqjournal.com/599195\ .
34. Lincoln County Board of Commissioners address use of Narcan, Lisa Maue, Guest Contributor, Ruidoso
News, December 29, 2016, http://www.ruidosonews.com/story
35. Yearly overdose deaths number in hundreds in New Mexico, Alexis Severson, Las Cruces Sun-News, November
8, 2016, http://www.marionstar.com/story.
36. Local alliance seeks to combat opioid deaths; Physician: In New Mexico, most overdose deaths are due to
prescription drugs, Roswell Daily Record, December 16, 2016, http://rdrnews.com/wordpress/.
37. Old drug, new life: Naloxone access expands to community pharmacies, Engage Magazine, American
Pharmacists Association, April 1, 2015, http://www.pharmacist.com/
38. Naloxone for Life, Colorado Consortium pamphlet, http://www.uscommunities.org/.
Harm Reduction Coalition Website, accessed January 4, 2017, http://harmreduction.org/.
39. Harm Reduction Coalition Conference 2016, San Diego, California, Nov. 3-6, 2016,
http://harmreduction.org/our-work.
40. High Impact Prevention for People Who Inject Drugs, National Alliance of State And Regional AIDS Directors,
Dominick V. Zurlo, M.A. Educational Psychology Hepatitis and Harm Reduction Program Manager New Mexico
Department of Health Public Health Division Infectious Disease Bureau, June 30, 2015,
https://www.nastad.org/sites/
41. The Council of State and Territorial Epidemiologists June 20, 2016, http://www.csteconference.org/2016/
42. MEDIA ADVISORY-- New Mexico Hope Initiative to Launch Naloxone Project, The United States Attorneys
Office, District of New Mexico, September 16, 2016, https://www.justice.gov/usao-nm/ .
43. New Mexico Receives Federal Funding to Combat Prescription Drug Overdoses, New Mexico Department of
Health Press Release, September 1, 2015, https://nmhealth.org/news/information/2015/9/?view=302 .
44. Udall, Heinrich Welcome Over $2.6 Million in Funding to Help NM Communities Treat and Prevent Prescription
Drug Addiction, September 7 2016, http://www.heinrich.senate.gov .
45. TAGGS Website, Department of Human Services, accessed Jan 4, 2017, https://taggs.hhs.gov/SearchRecip.
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46. Substantial Improvement in National Ranking for Overdose Deaths, New Mexico Department of Health Press
Release, December 29, 2016, https://nmhealth.org/news/information/.
47. New Mexico Department of Health, Harm Reduction Program, https://nmhealth.org/about/phd/idb/hrp/ ,
YouTube video: https://youtu.be/5SCCpgOhJjk.
48. Naloxone in New Mexico, New Mexico Department of Health, March 2016, https://nmhealth.org/.
49. A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community
Programming Into Clinical Practice, Shane R. Mueller MSW, Alexander Y. Walley MD MSc, Susan L.
Calcaterra MD MPH, Jason M. Glanz PhD & Ingrid A. Binswanger MD MPH MS, March 16, 2015,
/https://www.ncbi.nlm.nih.gov/pubmed/25774771
50. Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders, Ryan A.
Black, PhD; Kimberlee J. Trudeau, PhD; Theresa A. Cassidy, MPH; Simon H. Budman, PhD; Stephen F. Butler,
PhD, Journal of Opioid Management, January/February 2013, Volume 9, Number 1, http://pnpcsw.pnpco.com/
51. Assessment of provider attitudes toward #naloxone on Twitter, Nancy A. Haug, PhD, Jennifer
Bielenberg, MS, Steven H. Linder , MD & Anna Lembke, Journal of Substance Abuse ,Volume 37, 2016 Issue 1:
Includes Special Section: From Education to Implementation: Addressing the Opioid Misuse Epidemic" pp. 35-41.
Substance Abuse Journal, Volume 36, 2015 - Issue 2: Expanding Treatment for Opioid Use Disorder: The Role of
Pharmacotherapies, http://www.tandfonline.com/ .
52. Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution Program in the US
Department of Veterans Affairs,, Elizabeth M. Oliva Ph.D., Andrea Nevedal Ph.D., Eleanor T. Lewis Ph.D.,
Matthew D. McCaa B.A., Michael F. Cochran M.D., P. Eric Konicki M.D., Corey S. Davis J.D., M.S.P.H &
Christine Wilder M.D. (2015): Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution
Program in the US Department of Veterans Affairs, Substance Abuse, DOI: http://dx.doi.org/.
53. Not just for medics: Drugs that reverse opioid overdoses are being pushed to the masses, Andrew Joseph,
Statnews.com, October 3, 2016, https://www.statnews.com/2016/.
54. New Mexico Medical Board Regular Board Meeting Minutes, November 5-6, 2015,
http://www.nmmb.state.nm.us/.
55. RRPS considers having naloxone on hand to treat overdoses, Gary Herron, Rio Rancho Observer, December 18,
2016, http://www.rrobserver.com/news/.
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56. Santa Fe County Releases Funds to Reduce Drug Overdose, Santa Fe County Government, Rachel OConnor,
10/3/2016, https://www.santafecountynm.
57. Human Services Division Meeting, July 24, 2016, http://www.newmexico.networkofcare.
58. Prescription Drug Costs: Maximizing State Agency Purchasing Power, Health Notes, Program Education Unit,
New Mexico Legislative Finance Committee, September 20, 2016, https://www.nmlegis.gov/.
59. Executive Budget Recommendations,, New Mexico Governor Susana Martinez, 2015,
http://www.governor.state.nm.us.
60. Prevention for States Awardee Meeting, New Mexico Department of Health, Dr. Michael Landen,
May 4, 2016, https://www.cdc.gov/drugoverdose/
61. Increase in Pharmacies Dispensing Naloxone, New Mexico Department of Health, June 6, 2016,
https://nmhealth.org/news/i.
62. United States military casualties of war, World Drug Report, United Nations Office on Drugs & Crime,
October 2, 2014, https://www.unodc.org/doc/
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64. DEA 2016 Report: Alarming rise in opioid, drug overdoses; product passing through El Paso, KFOX TV, El Paso,
TX, http://kfoxtv.com/news/local/.
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66. The cost of fighting terrorism, CNN Money, Jeanne Sahadi, November 16, 2015, http://money.cnn.com/2015/ .
67. More members of Taos drug ring enter guilty pleas,, By Edmundo Carrillio, Albuquerque Journal North, January
6, 2017, https://www.abqjournal.com/922778/.
68. Opioid overdoses straining hospital ERs, Drug Topics: Voice of the Pharmacist, November 4, 2014,
http://drugtopics.
69. Heroin deaths surpass gun homicides for the first time, CDC data shows. Christopher Ingraham, The Washington
Post, September 8, 2016, https://www.washingtonpost.com/news/ .
70. Facts and Stats, Overdose Awareness Day, http://www.overdoseday.com/.
71. Top Seven Crazy Myths About Drug Overdose Antidote, Naloxone, Huffington Post, Tessie Castillo, North
Carolina Harm Reduction Coalition, March 31, 2014, 7 Crazy Myths about Naloxone .
72. New effort targets drug overdoses in Indian Country: Provision of life-saving medication will help reduce rate of
opioid overdoses in American Indian and Alaska Native communities, Indian Health Service, press release,
12/16/2015, https://www.ihs.gov/
73. Epidemic and emergency, or why Ohio must do more in response to its opioid overdose deaths,
by the Beacon Journal editorial board, January 2, 2017, http://www.ohio.com/.
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74. Consequences of Substance Abuse in New Mexico and Rio Arriba County, Presentation to Behavioral Health
Subcommittee of Legislative Health and Human Services Committee, New Mexico Legislature, New Mexico
Department of Health, Dr. Michael Landen MD, MPH, July 24, 2014, https://www.nmlegis.gov/.
About Timothy L. Hallford

Timothy Hallford is President & CEO of Stop OD, Inc. and President and CEO of Road Safety Technologies, LLC, a
company using technology to reduce needless death and injuries on our highways. He is working associate of the Joseph
Campbell Foundation and participant and presenter at the Parliament of World Religions. He has a Masters Degree in
Public Affairs form Indiana University and has studied psychology at the PhD level at Pacifica Graduate Institute. He
completed the Academy for the Love of Learning, Leading by Being program in Santa Fe, NM in 2013. He is the proud
father of Ashley Seidner, D.O. and Devin Hallford. He resides with his rescue dogs, Puck and Cormac, in Santa Fe, New
Mexico. He can be reached at 505-469-5319 or timothy.hallford@roadsafetytechnologies.com.
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APPENDIX
105
106
CURRENT NALOXONE PROVIDERS IN

NEW MEXICO
106
1217 1st St. NW,
505-266-
Albuquerque
Albuquerque, NM
4188
REDUCING
OPIOID OVERDOsE
DEATHS IN The
United
Healthcare for the
87102
Homeless
HIV Testing & Prevention

STD Testing & Services
Albuquerque
States
& NEW MEXICO
107
Hepatitis Services
Metro
Harm reduction/syringe
services
Overdose
prevention/Naloxone
3-
Anthony Public
865 N. Main,
575-882-
5-
Health Office
Anthony, NM 88021
5858
Southwest
Artesia Public
1001 Memorial
575-746-
4-
Health Office
Drive, Artesia, NM
9819
Southeast
88210
Carlsbad Public
1306 W. Stevens,
575-885-
4-
Health Office
Carlsbad, NM
4191
Southeast
88220
Casa De Salud
1608 Isleta Blvd
505-907-
3-
(Just Healthcare)
NW, Albuquerque,
8311
Albuquerque
NM 87501
Metro
Chaparral Public
317 McCombs,
575-824-
5-
Health Office
Chaparral, NM
4734
Southwest
88081
Cibola Public
700 E. Roosevelt
505-285-
1-
Health Office
Ave., Suite 100,
4601
Northwest
Grants, NM 87020

Hepatitis Services
services
Overdose
prevention/Naloxone
Hepatitis Services
services
Overdose
prevention/Naloxone
Hepatitis Services
services
Overdose
prevention/Naloxone
services
Overdose
prevention/Naloxone
Hepatitis Services
services
Overdose
prevention/Naloxone
Hepatitis Services
services
Overdose
prevention/Naloxone
107
108
NEW MEXICO STATUTES/ STANDING ORDERS

TITLE 7
CHAPTER 32
PART 7
HEALTH
ALCOHOL AND DRUG ABUSE
OVERDOSE PREVENTION AND EDUCATION PROGRAM AUTHORIZATION FOR
OPIOID ANTAGONISTS
7.32.7.1
ISSUING AGENCY: Department of Health; Public Health Division; Infectious Disease Prevention and
Control Bureau.
[7.32.7.1 NMAC - Rp, 7.32.7.1 NMAC, 7/15/2016]
7.32.7.2
SCOPE: This rule applies to all New Mexico department of health registered overdose prevention and
education programs that obtain, prescribe, dispense, distribute, or administer an opioid antagonist.
[7.32.7.2 NMAC - Rp 7.32.7.2 NMAC, 7/15/2016]
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109
7.32.7.3
STATUTORY AUTHORITY: The statutory authority for adopting these rules is found in Subsection E
of Section 9-7-6 NMSA 1978 (Department of Health Act) and Subsection J of Section 24-23-1 NMSA 1978 which requires
the secretary of health to promulgate rules relating to overdose prevention and education programs.
[7.32.7.3 NMAC - Rp 7.32.7.3 NMAC, 7/15/2016]
7.32.7.4
DURATION: Permanent.
[7.32.7.4 NMAC - Rp, 7.32.7.4 NMAC, 7/15/2016]
7.32.7.5
EFFECTIVE DATE: July 15, 2016, unless a later date is cited at the end of a section.
[7.32.7.5 NMAC - Rp, 7.32.7.5 NMAC, 7/15/2016]
7.32.7.6
OBJECTIVE: The objective of these regulations is to reduce mortality due to opioid overdose by
increasing the administration, distribution, prescription and dispensation of opioid antagonists to individuals who are at
risk of opioid overdose and to individuals, such as family members, friends or other persons, who may be in a position to
assist individuals who are experiencing an overdose. These regulations shall set standards for the establishment of
standing orders to obtain, store, distribute and administer an opioid antagonist; the establishment of overdose prevention
and education programs and standards for them to register, obtain, store, and distribute naloxone; the establishment of
standards for overdose prevention curricula, training and the certification of individuals to store and distribute opioid
antagonists for the overdose prevention and education programs.
[7.32.7.6 NMAC - Rp, 7.32.7.6 NMAC, 7/15/2016]
7.32.7.7
DEFINITIONS:
A.
Administration of opioid antagonist means the direct application of an opioid antagonist to the body
of an individual by injection, inhalation, ingestion or any other means.
B.
Department means the New Mexico department of health.
C.
Dispense means to evaluate and implement a prescription for an opioid antagonist, including the
preparation and the delivery of a drug or device to a patient or patients agent;
D.
Distribute means to deliver an opioid antagonist drug or opioid antagonist device by means other
than by administering or dispensing;
E.
Enrollment form means the form approved by the department to register an individual as a trained
targeted responder.
F.
Licensed prescriber means any individual who is authorized by law to prescribe an opioid antagonist
in the state.
G.
Medication log means the form used to track the storage and distribution of the opioid antagonist.
H.
Opioid means any substance containing or derived from opium including, but not limited to
morphine and heroin, and any morphine-like synthetic narcotic that produces the same effects as substances derived from
the opium poppy.
I.
Opioid antagonist means a drug approved by the federal food and drug administration that, when
administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body. "Opioid
antagonist" shall be limited to naloxone or other like medications that are indicated for use in reversing an opioid overdose
and are approved by the department for such purpose.
J.
Overdose prevention and education program (OPE) means any community-based organization, law
enforcement agency, detention facility or school that has registered with the department in accordance with department
rules and uses an approved department curriculum to teach overdose prevention and opioid antagonist administration.
K.
Overdose response educator means any staff or volunteer who is registered with an overdose
prevention and education program who are trained and certified by the department in the overdose response education
curriculum.
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L.
Overdose response educator curriculum means a department approved curriculum to train and certify
overdose response educators, which must be repeated every two years.
M.
Possess means to have physical control or custody of an opioid antagonist.
N.
Record of use form means the department designated report for the use or loss of an opioid
antagonist, the response to a suspected opioid overdose or the re-issuance of an opioid antagonist to a trained targeted
responder.
O.
Standing order means a licensed prescribers instruction or prescribed procedure that is either patient
specific or non-patient specific that can be exercised by other persons until changed or canceled by a licensed prescriber.
P.
Storage means possession of an opioid antagonist with the intent to dispense or distribute it.
Q.
Trained targeted responder means a person who is trained by overdose response educators to possess
and administer an opioid antagonist to a person who is experiencing an opioid overdose, and has completed the trained
targeted responder curriculum.
R.
Trained targeted responder curriculum means a department approved curriculum for trained targeted
responders.
[7.32.7.7 NMAC - Rp, 7.32.7.7 NMAC, 7/15/2016]
7.32.7.7 REQUIREMENTS FOR OVERDOSE PREVENTION AND EDUCATION PROGRAMS,

7.32.7.8 OVERDOSE RESPONSE EDUCATORS AND TRAINED TARGETED RESPONDERS:
A.
Overdose prevention and education program requirements: An overdose prevention and education program
is a program which facilitates the distribution of opioid antagonists and provides education related to
overdoses, overdose prevention and the administration of opioid antagonists. An overdose prevention and
education program shall:
(1)
register with the department using the form approved by the department which shall include at
a minimum:
(a)
date of registration;
(b)
overdose prevention and education program name; and
(c)
name, address, e-mail and telephone number of overdose prevention and education
program contact;
(2)
identify who will be overdose response educator
(3)
train or verify overdose response educators have successfully completed and maintained a
current certification in the overdose response educator curriculum;
(4)
enroll trained targeted responders using the enrollment form;
(5)
train or verify trained targeted responders have completed the trained targeted responder
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curriculum;
(6)
identify and maintain a secure location for the storage of the opioid antagonists designated
for distribution in accordance with these regulations;
(7)
label the opioid antagonist in accordance with these regulations;
(8)
utilize the record of use form to report all known uses or losses of an opioid antagonist,
responses to a suspected opioid overdose, or the re-issuance of an opioid antagonist to a
trained targeted responder;
(9)
maintain personal protective equipment and response equipment at training locations;
(10)
provide trained targeted responders with necessary response equipment; and
(11)
be prepared for scheduled and unscheduled site visits by the department where the
department may review the maintenance of enrollment forms, record of use forms,
medication logs and any other information required to be maintained pursuant to these rules.
B.
Overdoes response educators shall:
(1)
successfully complete the overdose response educator curriculum and maintain this
certification;
(2)
comply with the terms of a standing order issued by a licensed prescriber, which may include
possession of opioid antagonists and distribution of the opioid antagonist to trained targeted
responders;
(3)
teach trained targeted responders the trained targeted responder curriculum; and
(4)
complete medication log, enrollment forms and record of use forms for trained targeted
responders.
C.
Trained targeted responders:
(1)
are trained in the trained targeted responder curriculum; and
(2)
shall report all known responses to suspected opioid overdoses to an overdose prevention
and education program using the record of use form.
[7.32.7.8 NMAC - Rp, 7.32.7.9 & 10 NMAC, 7/15/2016]
7.32.7.8
REQUIREMENTS FOR DISTRIBUTION OF OPIOID ANTAGONIST:

A.
The New Mexico department of health public health division pharmacy warehouse can distribute
the opioid antagonist to any registered overdose prevention and education program.
B.
Standing orders from a department licensed prescriber for the distribution of an opioid antagonist
shall include at a minimum:
(1)
authorization to maintain supplies of opioid antagonists for the purposes of distributing the as
part
of the departments overdose prevention efforts;
(2) authorization for overdose response educators to possess and distribute the opioid antagonist to
trained targeted responders;
(3) instructions for overdose response educators to educate and advise clients of overdose prevention
methods, recognizing an overdose, and potential contraindications and precautions.
C.
Medication log, enrollment forms and record of use forms shall be utilized by an overdose
prevention and education program in order to document the distribution and administration of
opioid antagonists.
[7.32.7.9 NMAC - Rp, 7.32.7.10 NMAC, 7/15/2016]
7.32.7.10
REQUIREMENTS FOR STORAGE OF THE OPIOID ANTAGONIST:

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A.
Any opioid antagonist designated for distribution by an overdose prevention and education
program must be stored in a secure designated location.
(1) The location must be locked with entry limited to overdose response educators and other
individuals as designated by the overdose prevention and education program.
(2) A medication log of the opioid antagonist must be maintained, and include the following
information, at minimum:
(a)
lot numbers of the opioid antagonist;
(b)
expiration dates of the opioid antagonist;
(c)
date, quantity of opioid antagonist doses and the name of the individual who is
removing the opioid antagonist from the secured location for distribution;
(d)
date, quantity of opioid antagonist doses and the name of the individual who is
returning doses of the opioid antagonist to the secured location if they have not
been distributed; and
(e)
for doses of the opioid antagonist distributed, the medication log must also include
the name and date of birth of the trained targeted responder, the date of
distribution, lot number of each opioid antagonist dose and the expiration date of
each opioid antagonist dose.
B.
Any registered overdose prevention and education program, may make an opioid antagonist
available for use in response to a possible overdose incident. The opioid antagonist
designated for use at an overdose prevention and education program for a possible overdose
response shall be stored in a secure but accessible location.
[7.32.7.10 NMAC - Rp, 7.32.7.10 NMAC, 7/15/2016]
7.32.7.11
LABELING OF THE OPIOID ANTAGONIST:
A.
The overdose prevention and education program shall label the opioid antagonist prior to it leaving the
designated secure storage location which shall include:
(1)
the name and address of the overdose prevention and education program distributing the
opioid antagonist; and
(2)
the text use as directed.
B.
At the time of distribution of an opioid antagonist to a trained targeted responder, the overdose
response educator shall complete the following information on the label:
(1)
name of the trained targeted responder;
(2)
date of distribution of the opioid antagonist; and
C.
At the time of distribution of an opioid antagonist to a trained targeted responder, the overdose
response educator will provide directions for use of the opioid antagonist.
[7.32.7.11 NMAC - N, 7/15/2016]
7.32.7.12
MINIMUM REQUIREMENTS FOR ENROLLMENT AND RECORD OF USE FORMS:

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A.
The enrollment form shall include at a minimum:

(1)
name of the overdose prevention and education program;
(2)
department designated code of the trained targeted responder; and
(3)
the quantity of the opioid antagonist distributed.
B.
The record of use form shall contain at a minimum:
(1)
the name of the overdose prevention and education program recording the report;
(2)
the department designated code of the reporting trained targeted responder;
(3)
the quantity of the opioid antagonist administered, lost, or expired;
(4)
the date or approximate date of the overdose incident, if there is one being reported;
(5)
the disposition of the person who was administered the opioid antagonist; and
(6)
the quantity of the opioid antagonist distributed.
[7.32.7.12 NMAC-N, 7/15/2016]
7.32.7.13 APPLICABILITY OF REGULATIONS: In the event an approved opioid antagonist is classified as an over
the counter (OTC) medication the following portions of these regulations shall no longer be applicable: 7.32.7.9,
7.32.7.10, 7.32.7.11 NMAC. Department protocols will remain in effect.
[7.32.7.13 NMAC-N, 7/15/2016]
History of 7.32.7 NMAC:
Pre - NMAC History: None.
History of Repealed Material:
7.32.7 NMAC, Authorization to Administer Opioid Antagonists, filed 6/1/2001.
7.32.7 NMAC, Authorization to Administer Opioid Antagonists, filed 8/30/2001 - Repealed effective 7/15/2016.
Part name changed to Overdose Prevention and Education Program Authorization for Opioid Antagonists.
NMSA24231Authoritytopossess,store,distribute,dispense,prescribeandadministeropioidantagonists;release
fromliability;rulemaking.
A.personmaypossessanopioidantagonist,regardlessofwhetherthepersonholdsaprescriptionfortheopioid antagonist.
B.Anypersonactingunderastandingorderissuedbyalicensedprescribermaystoreordistributeanopioidantagonist.
C.Pursuanttoavalidprescription,apharmacistmaydispenseanopioidantagonisttoaperson:
(1)atriskofexperiencinganopioidrelateddrugoverdose;or
(2)inapositiontoassistanotherpersonatriskofexperiencinganopioidrelateddrugoverdose.
D.Apharmacistmaydistributeanopioidantagonisttoaregisteredoverdosepreventionandeducationprogram.
E.Apersonmayadministeranopioidantagonisttoanotherpersoniftheperson:
(1)ingoodfaith,believestheotherpersonisexperiencingadrugoverdose;and
(2)actswithreasonablecareinadministeringthedrugtotheotherperson.
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F.Alicensedprescribermaydirectlyorbystandingorderprescribe,dispenseordistributeanopioidantagonistto:
(1)apersonatriskofexperiencinganopioidrelateddrugoverdose;
(2)afamilymember,friendorotherpersoninapositiontoassistapersonatriskofexperiencinganopioidrelated
drugoverdose;
(3)anemployee,volunteerorrepresentativeofacommunitybasedentityprovidingoverdosepreventionand
educationservicesthatisregisteredwiththedepartment;or
(4)afirstresponder.
G.Aregisteredoverdosepreventionandeducationprogramthatpossesses,stores,distributesoradministersanopioid
antagonistinaccordancewithdepartmentrulesandonstandingordersfromalicensedprescriberpursuanttothissection
shallnotbesubjecttocivilliability,criminalprosecutionorprofessionaldisciplinaryactionarisingfromthepossession,
storage,distributionoradministrationoftheopioidantagonist;providedthatactionsaretakenwithreasonablecareand
withoutwillful,wantonorrecklessbehavior.
H.Apersonwhopossessesorwhoadministers,dispensesordistributesanopioidantagonisttoanotherpersonpursuantto
thissectionshallnotbesubjecttocivilliability,criminalprosecutionorprofessionaldisciplinaryactionasaresultofthe
possession,administration,distributionordispensingoftheopioidantagonist;providedthatactionsaretakenwith
reasonablecareandwithoutwillful,wantonorrecklessbehavior.
I.Thedepartmentshallcreate,collectandmaintainanyindividuallyidentifiableinformationpursuanttothissectionina
mannerconsistentwithstateandfederalprivacylaws.
J.Thesecretaryshallpromulgaterulesrelatingtooverdosepreventionandeducationprograms:
(1)establishingrequirementsandprotocolsfortheregistrationofoverdosepreventionandeducationprogramsthatarenot
licensedpharmacies;
(2)monitoringregisteredoverdosepreventionandeducationprograms'storageanddistributionofopioidantagonists;
(3)gatheringdatafromoverdosepreventionandeducationprogramstoinformpublichealtheffortstoaddressoverdose
preventionefforts;and
(4)authorizingstandardsforoverdosepreventioneducationcurricula,trainingandthecertificationofindividualstostore
anddistributeopioidantagonistsfortheoverdosepreventionandeducationprogram.
K.Asusedinthissection:
(1)"administer"meansthedirectapplicationofadrugtothebodyofanindividualbyinjection,inhalation,ingestionor
anyothermeans;
(2)"department"meansthedepartmentofhealth;
(3)"dispense"meanstoevaluateandimplementaprescriptionforanopioidantagonist,includingthepreparationand
deliveryofadrugordevicetoapatientorpatient'sagent;
(4)"distribute"meanstodeliveranopioidantagonistdrugoropioidantagonistdevicebymeansotherthanby
administeringordispensing;
(5)"firstresponder"meansanypublicsafetyemployeeorvolunteerwhosedutiesincluderespondingrapidlytoan
emergency,including:
(a)alawenforcementofficer;
(b)afirefighterorcertifiedvolunteerfirefighter;or
(c)emergencymedicalservicespersonnel;
(6)"licensedprescriber"meansanyindividualwhoisauthorizedbylawtoprescribeanopioidantagonistinthestate;
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115
(7)"opioidantagonist"meansadrugapprovedbythefederalfoodanddrugadministrationthat,whenadministered,
negatesorneutralizesinwholeorinpartthepharmacologicaleffectsofanopioidinthebody."Opioidantagonist"shallbe
limitedtonaloxoneorotherlikemedicationsthatareindicatedforuseinreversinganopioidoverdoseandareapprovedby
thedepartmentforsuchpurpose;
(8)"possess"meanstohavephysicalcontrolorcustodyofanopioidantagonist;
(9)"registeredoverdosepreventionandeducationprogram"meansanycommunitybasedorganization,lawenforcement
agency,detentionfacilityorschoolthathasregisteredwiththedepartmentinaccordancewithdepartmentrulesanduses
anapproveddepartmentcurriculumtoteachoverdosepreventionandopioidantagonistadministration;
(10)"standingorder"meansalicensedprescriber'sinstructionorprescribedprocedurethatiseitherpatientspecificornon
patientspecificthatcanbeexercisedbyotherpersonsuntilchangedorcanceledbyalicensedprescriber;and
(11)"storage"meanspossessionofanopioidantagonistwiththeintenttodispenseordistributeit.
History:Laws2001,ch.228,1;2016,ch.45,1;2016,ch.47,1.
NewMexicoDepartmentofHealthPublicHealthDivisionRegisteredOverdosePreventionandEducation
ProgramsNALOXONESTANDINGORDER
Authority:NMSA1978,24231.B:Anypersonactingunderastandingorderissuedbyalicensedprescribermaystoreor
distributeanopioidantagonist;and
NMSA1978,24231.FAlicensedprescribermaydirectlyorbystandingorderprescribe,dispenseordistributeanopioid
antagonistto:
1)apersonatriskofexperiencinganopioidrelateddrugoverdose;
(2)afamilymember,friendorotherpersoninapositiontoassistapersonatriskofexperiencinganopioidrelated
drugoverdose;
3)anemployee,volunteerorrepresentativeofacommunitybasedentityprovidingoverdosepreventionand
educationservicesthatisregisteredwiththedepartment;or
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4)afirstresponder.
Purpose:Tocontributetodecreasingmorbidityandmortalityrelatedtoopioidoverdose,thisstandingorderpermits:
Clinicalstaffofregisteredoverdosepreventionandeducationprograms(OPE)toobtain,store,anddispense/distribute
naloxonetoeligibleclients;and
NonclinicalstaffandvolunteersofOPEswhohavecompletedtheNMDOHHepatitisandHarmReduction
Certificationtrainingtoobtain,storeanddistributenaloxonetoeligibleclients.NaloxonestorageforOPEs:naloxonemay
bestoredatanyOPEsolongasthestoragelocationiskeptsecure,withentrylimitedtoHepatitisandHarmReduction
CertifiedstaffandindividualsdesignatedbytheOPEtohaveaccess.
Assessment:
1.Clientspresentingforopioidoverdosepreventionservicesareeligibleformanagementunderthisstandingorder.Clients
areeligibleiftheyhavereceivedtrainingthroughanapprovedoverdosepreventionandeducationcurriculum.Eligible
clientsinclude:Apersonatriskofexperiencinganopioidrelateddrugoverdose;Afamilymember,friendorother
personinapositiontoassistapersonatriskofexperiencinganopioidrelateddrugoverdose;Anemployee,volunteeror
representativeofacommunitybasedentityprovidingoverdosepreventionandeducationservicesthatisregisteredwith
thedepartment;and,Afirstresponder.
2.Ifanyoftheaboveconditionsarenotmet,contactalicensedhealthcareproviderforanorder.
3.Ifaclienthasinsuranceorothermeanstoaccessorobtainnaloxonethroughtheirprimaryhealthcareprovideror
throughapharmacy,theyshouldbeencouragedtoobtainnaloxonethroughthosesources.However,thisshouldnotRev:
JS/DVZ/CN92616beabarriertoprovidingthemwiththeeducationormedicationiftheyareunabletoreasonably
accessnaloxonethroughothermeans.
4.Assesstheclientwhopresentsforcontraindicationsandprecautions,including:Contraindications:hypersensitivityor
allergytonaloxone.
Precautions:
oAnaphylacticshockmayoccurinthoseallergictonaloxoneoranycomponentofthemedication.
oAcutewithdrawalsymptomsmayoccurinindividualscurrentlyusingopioidsincluding:bodyaches,fever,sweating,
runnynose,sneezing,yawning,weakness,shiveringortrembling,nervousness,restlessnessorirritability,diarrhea,nausea,
abdominalcramps,increasedbloodpressureandtachycardia.
oRespiratorydepressionmayoccurduetoothersubstancesnaloxoneisnoteffectiveagainstrespiratorydepressiondue
tononopioidsubstances.
oReversalofrespiratorydepressionbypartialagonistsormixedagonist/antagonists,suchasbuprenorphine,maybe
incompleteorrequirehigherdosesofnaloxone.
Order1.Atinitialenrollment:DocumentasanInitialEnrollmentusingtheNaloxoneEnrollmentandRecordofUse
Form.Dispenseasavailable:Two(2)Naloxone2mg/2mlinprefilledsyringeforintranasaluseANDTwo(2)Mucosal
AtomizationDevices(MAD)ORTwo(2)Naloxone4mg/0.1mlinFDAapprovedintranasaladministrationdevicesMore
thantwoprefilledsyringesofnaloxoneandMADs,orFDAapprovedintranasalnaloxonedevices,maybeprovidedifthe
clientindicatesoneofthefollowing:
a)Lengthytraveltoreachtheprogramlocation;
b)Limitedhoursoftheprogramlocation;or
c)Potentialtousemultipledosespriortoabilitytoreturntotheprogramlocation.
2.Forclientspresentingforarefill:DocumentasaRecordofUseusingtheNaloxoneEnrollmentandRecordofUse
Form.Dispenseasavailable:Two(2)Naloxone2mg/2mlinprefilledsyringeforintranasaluseRev:JS/DVZ/CN926
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16ANDTwo(2)MucosalAtomizationDevices(MAD)ORTwo(2)Naloxone4mg/0.1mlinFDAapprovedintranasal
administrationdevicesMorethantwoprefilledsyringesofnaloxoneandMADs,orFDAapprovedintranasalnaloxone
devices,maybeprovidediftheclientindicatesoneofthefollowing:
a)Lengthytraveltoreachtheprogramlocation;
b)Limitedhoursoftheprogramlocation;or
c)Potentialtousemultipledosespriortoabilitytoreturntotheprogramlocation.
3.Adviseclientsthattheuseofnaloxoneinindividualswithcontraindicationsorprecautionsmaycauseadverseeffects.
4.Offerallclientsacopyofthedruginformationsheetlocatedathttp://nmhealth.org/about/phd/idb/hrp/
5.OfferallclientsacopyoftheOverdosePreventionandRescueBreathingin20MinutesorLesseducationalhandout,
locatedathttp://nmhealth.org/about/phd/idb/hrp/
AdministrationForanyindividualwhopresentswithapossibleoverdose:
1.ActivateEMS/call911.
2.Administerintranasalnaloxonebyinsertingtheatomizerendintothenostrilandpushingtheplungeratthebaseofthe
device.Eitherofthesedevicesmaybeutilized:a.Naloxone2mg/2mlinprefilledsyringeforintranasaluseusinga
MucosalAtomizationDevice(MAD).Administerofthemedicationineachnostril.ORb.Naloxone4mg/0.1mlin
FDAapprovedintranasaladministrationdevices.Administerallofthemedicationinonenostril.Warning:Naloxone
reversalofanopioidoverdosecanberapidfollowingadministration,thepatientmayregainconsciousnessquickly,but
maybeconfused,agitated,irritable,and/orcombative(duetoprecipitatedwithdrawalandpossiblyduetohypoxia).Safely
restrainthepatientandfindaquietplacefortheclienttorest.
3.Providerescuebreathingasneeded.Ifrescuebreathingisnotnecessary,placethepatientontheirside(toprevent
aspiration).Rev:JS/DVZ/CN92616
4.Ifacomatosepatientwithsuspectedoverdosefailstoawakenwithnaloxonewithin5minutes,administeraseconddose
ofnaloxone(prefilledsyringeorspray)viaoneofthetwointranasalformsasabove.Consideralternatecausesforthe
condition(e.g.,MI,hypoglycemia).
5.StaywiththeindividualuntilEMSorothermedicalservicesarrive.Naloxonemayrarelycauseadverseeffectsin
individualswithcontraindications,sothepersonmustbeobservedduringthistime,eitherbythepersonwhoadministered
naloxone,anothertrainedindividual,EMSpersonnel,oraclinicallylicensedindividual.
6.Naloxonewearsoffafter3090minutesrespiratorydepressionmayreoccurwithlongactingopioids.Additional
dosesofnaloxonemayberequireduntilemergencymedicalassistancebecomesavailable.7.Reporttheincidenttothe
HepatitisandHarmReductionProgramutilizingtheNaloxoneEnrollmentandRecordofUseFormlocatedat:
http://nmhealth.org/about/phd/idb/hrp/Thisstandingordershallremainineffectuntilrescinded.LicensedPrescriberNPI
SignatureDateChristopherNovakPHDMedicalDirector150883411010/4/2016
A. What causes an overdose (OD)

Toxic amount: too much of the substance; reduce amount and do tester shot
Mixing: effects are amplified; reduce amounts, inject first if mixing with alcohol
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118
Tolerance: lowers during periods of non-use (i.e.: detox/jail/no money); reduce and do tester shot
Quality: varies in strength and purity; try to use known source and do tester shot
Using Alone: if something goes wrong nobody to help; fix w/friend, unlocked door, and call someone trusted
B. How to recognize an OD
Over-amp: Stimulants (cocaine/speed) make the body speed up
Overdose: Heroin and other downers (alcohol/benzos) make the body slow o Signs of OD: Unresponsive, unconscious, breathing
slow/shallow (<12 breaths/min); pale, clammy, loss of color, blue/gray (esp. lips/nails); loud/uneven snoring/gurgling; not breathing;
faint/no pulse
o High vs OD: the line= UNRESPONSIVE
C. What to do if OD occurs
Stimulation: Call name, sternum rub
Call 911 - Good Samaritan 911 Law: protects against citation or arrest, except if another law is being broken o Quiet the scene (or go to
a quiet area), be calm and speak clearly, and do not argue
o Give exact address/location, person not breathing or turning blue
o There is no need to say: it is an overdose, give a name, or if drugs were involved
o Tell the paramedics everything known about the situation when they arrive
Use Naloxone
Perform Rescue Breathing = If they do not start breathing in 3 minutes, use a second dose of naloxone
D. Naloxone Administration
(using device with separate atomizer)
1. Remove the colored caps on medicine vial and syringe barrel
2. Insert vial into barrel & gently turn until it stops
3. Twist nasal atomizer onto tip of barrel. It is ready to use
4. Place assembled naloxone atomizer into one nostril
5. Press firmly on base of vial, spraying half into nostril
6. Repeat in other nostril
If an atomizer is not available (lost, missing, etc.), slowly drip the naloxone under the tongue
(using all-in-one intranasal device) * *
1. Remove device from blister pack
2. Place nozzle end into nostril
3. Press firmly on base of device, spraying medication into nostril
*Stay with the person as naloxone loses effect 30-90 minutes after administration.
E. Rescue Breathing
Stimulation and Airway 1. Check responsiveness. Ask, Are you okay?, shake foot, use sternum rub
2. Are they breathing? Look, listen and feel
3. If no response, call 911
4. Check for clear airway. If blocked, roll on side and use finger sweep to clear 1. Roll onto back, tilt head back and pinch nose
2. Give 2 regular breaths
3. Look, listen and feel
4. If still not breathing give 1 breath every 5 seconds
5. Continue until person revives or help arrives
6. Once they start breathing, put them in the recovery position
Rescue Breathing
*Remember to keep breathing for them. Brain damage starts occurring 4 minutes after loss of oxygen.
Recovery Position
F. OD Myths These do not work:
Slap or punch: may bruise or break nose/jaw
Put in cold water or use ice: makes the body cold, slow even more, and can lead to hypothermia
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Use a lamp cord like a home-made defibrillator: can cause electric burns, irregular heartbeat, or death
Inject with milk/saline/other substances: can cause the body to go into shock
***How to demonstrate assembling the Naloxone if a training device is not available to Dispense Naloxone to participant
o Have participant attach atomizer themselves
o Show participant how the vial is assembled but do not actually remove the plastic caps or twist the vial into the barrel as this will cause the
Naloxone to spoil before use.
HARM REDUCTION COALTION INTERNATIONAL CONFERENCE

2016 APPLICABLE SESSIONS:
PANEL: Expanding Naloxone Moderator:
Mark Kinzly, TX Opioid Narcan Initiative, Austin, TX
Issues in Initiating or Expanding Effective Opioid Overdose Prevention Work
Dan Bigg, Chicago Recovery Alliance, Chicago, IL
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120
Maya Doe-Simkins, MDSC/Harm Reduction Michigan, Maple City, MI

Eliza Wheeler, Harm Reduction Coalition, Oakland, CA
Naloxone at the Crossroads of North and South: Advocating for Access and Piloting Programs in North Carolina,
Washington, D.C., Rural Maryland, and D.C.s Maryland Suburbs
Andrew Bell, HIPS, Washington D.C
New Mexico Naloxone Access: New Statutes to Increase Distribution by Non-Clinicians
Dominick Zurlo, New Mexico Department of Health, Santa Fe, NM
Enhanced Naloxone Distribution in Six New York City Target Neighborhoods
Monique Wright, NYC Department of Health and Mental Hygiene, New York, NY
The Naloxone Buffet
Phillip Fiuty, Santa Fe Mountain Center, Tesuque, New Mexico
Dave Koppa, Santa Fe Mountain Center, Tesuque, New Mexico
How Overdose Prevention Training Media Can Save Lives AND Create Change
Gretchen Hildebran, Independent Acxel Barboza, New York Harm Reduction Educators, New York, NY
Narelle Ellendon, NYSDOH/AIDS Institute, New York, NY
WORKSHOP: Opioid Overdose Prevention Initiatives on the College Campus: Partnerships with Academics and
Community Experts
Mark Kinzly, TX Opioid Narcan Initiative & Austin Harm Reduction Coalition, Austin, TX
Lori Holleran Steiker, The University of Texas at Austin School of Social Work, Austin, TX
Mitchell Hinrichs, Student at University of Texas at Austin, Austin, TX
Lucas Hill, University of Texas at Austin, School of Pharmacy, Austin, TX
Stephanie Danielle Hamborsky, University of Texas at Austin Students for Sensible Drug Policy, Austin, TX
Chris Brownson, University of Texas at Austin Office of Student Affairs and Health Services, Austin, TX
WORKSHOP: Practicing Harm Reduction with Ourselves: The Beautiful Grit of Cultivating a Culture of
Community Wellness in the Grip of Chronic Collective Grief/Trauma
Kristin Doneski, AAC/Cambridge Needle Exchange and Overdose Prevention Program, Cambridge, MA
Hilary Eslinger, Preble Street, Portland, ME
WORKSHOP: Community Engaged Research to Advance Naloxone Distribution in Treatment Settings
Mary Hawk, University of Pittsburgh, Pittsburgh, PA
James Egan, University of Pittsburgh, Pittsburgh, PA
Sarah Danforth, Prevention Point Pittsburgh, Pittsburgh, PA
PANEL: Overdose in the Criminal Justice System
Moderator: Demetrius McCord, Deputy Director, Harm Reduction Coalition, New York, NY
Overdose Education and Naloxone Delivery in Local Detention Centers in Maryland
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121
Kirsten Forseth, Maryland Department of Health and Mental Hygiene, Baltimore, MD

Erin Haas, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Training Incarcerated Individuals Prior to Release and Equipping them with Naloxone Upon Release
Valerie White, AIDS Institute, New York, NY Sharon Stancliff, Harm Reduction Coalition, New York, NY
Overdose Prevention and Naloxone Distribution in Criminal Justice Settings: The NEXT Study
Lynn Wenger, RTI International, San Francisco, CA
Witnessed Overdoses and Naloxone Use Among Visitors to Rikers Island Trained in Overdose Prevention
Lara Maldjian, NYC Department of Health and Mental Hygiene, New York, NY
Overdose Prevention within Law Enforcement and Incarceration Systems
Emilie Junge, Chicago Recovery Alliance, Chicago, IL
Geoff Bathje, Adler University, Chicago, IL
PANEL: First Responder Moderator: Adam Butler, Harm Reduction Coalition
The Nevada Rural Opioid Overdose Reversal (NROOR) Project: Successes and Challenges in Implementing a
HRSA-funded Naloxone Program
Karla Wagner, University of Nevada, Reno, NV
Christopher Marchand, University of Nevada, Reno, NV Widespread Distribution of Intranasal Naloxone: Findings
from a Multi-Site Overdose Prevention Project in Norway
Desiree Madah-Amiri, Norwegian Centre for Addiction Research, Oslo, Norway
O.D. Be Gone! a.k.a. Naloxone and the Inner City Youth Experience in Vancouver, BC
Keren Mitchell, Inner City Youth Program, Providence Health Care, Vancouver, Canada
Elise Durante, Inner City Youth Program, Providence Health Care, Vancouver, Canada
Katrina Pellatt, Inner City Youth Program, Providence Health Care, Vancouver, Canada Jane Buxton, Inner City Youth
Program, Providence Health Care, Vancouver, Canada
ROUNDTABLE: Red State Harm Reduction: Naloxone, Medical Amnesty, and Drug Policy in the Bible Belt Jeremy
Galloway, Families for Sensible Drug Policy and Southeast Harm Reduction Project, Dahlonega, GA
Mona Bennett, Atlanta Harm Reduction Coalition, Atlanta, GA
Jeremy Sharp, Students for Sensible Drug Policy, Washington D.C.
PANEL: Ask Mom How to Save a Life: Parents Taking a Lead Position to Prevent Overdose Deaths
Gretchen Burns Bergman, Moms United to End War on Drugs/A New PATH, Spring Valley, CA
Denise Cullen, Broken No More, Orange, CA
April Ella, A New PATH, Spring Valley, CA
Elon Burns, San Diego Coastal Sober Living, San Diego, CA
Caroline Stewart, Caroline Stewart and Associates, San Diego, CA
Peter Davidson, University of California at San Diego, San Diego, CA
PANEL: Fentanyl: A More Dangerous Heroin: Emerging Patterns in the Heroin Overdose Epidemic
Dan Ciccarone, University of San Francisco, San Francisco, CA
Jeff Ondocsin, University of California at San Francisco, San Francisco, CA
Sarah Mars, University of California at San Francisco, San Francisco, CA
PANEL: The Participant Experience
Moderator: T Steve Jones
Peer Delivery Model for Naloxone Distribution and Increasing Opioid Safety Knowledge among Veterans:
Preliminary Results of a Longitudinal Cohort Study in New York City
121
122
Alex Bennett, National Development and Research Institutes (NDRI), New York, NY Take Home Naloxone Program
Participants Perspectives and Program Evaluation Regarding Contacting Emergency Services During an Overdose
Event
Jane Buxton, British Columbia Centre for Disease Control, Vancouver, Canada Experiences of Opiate Overdose in
Puerto Rico: PWIDs Readiness to Intervene and the Need for Overdose Prevention Training and Naloxone
Distribution
Debora Upegui-Hernandez, Intercambios Puerto Rico, Fajardo, Puerto Rico
Harnessing the Expertise of Peer Educators in Health Promotion and Disease Prevention Megan Stapleton, New
South Wales Users and AIDS Association, Sydney, Australia
PANEL: Curbing Overdose
Moderator: William Matthews, Harm Reduction Coalition, New York, NY
Curbing Opioid Overdose using Programmatic and Geo-spatial Data
Kate Lena, AHOPE Needle Exchange Program Boston Public Health Commission, Boston, MA
Expanded Overdose Prevention Services with Naloxone in Michigan as an Instigator for Improved Access to Harm
Reduction Services
Steve Alsum, The Grand Rapids Red Project, Grand Rapids, MI Overdose Fatality Review Program Development and
Results Erin Haas, Maryland Department of Health and Mental Hygiene, Baltimore, MD
PANEL: Overdose Moderator:
Allan Clear, NYSDOH/AIDS Institute, New York, NY
Overdose and Naloxone Use Among Opioid Overdose Prevention Trainees in New York City: Results from a
Longitudinal Cohort Study of Community-based Overdose Prevention
Laura Maldjian, NYC Department of Health and Mental Hygiene, New York, NY
Opioid Overdose and Naloxone Distribution in San Francisco: From Epidemiology to Intervention Development to
Implementation
Alex Kral, RTI International, San Francisco, CA
Perceptions and Behaviors Related to Overdose and Naloxone Among Opioid Users at Risk for Overdose
Janelle Silvis, San Francisco Department of Public Health, San Francisco, CA
PANEL: Working with Young People
Moderator: Demetrius McCord, Harm Reduction Coalition
Access to Substance Use Treatment Among Young Adults Who Use Prescription Opioids Non-Medically
Elliot Liebling, Brown University, Providence, RI
Brandon Marshall, Brown University School of Public Health, Providence, RI Above/Below:
Trauma, Transience, and Survival
Kacey Byczek, Lower East Side Harm Reduction Center, New York, NY Harm Reduction and Mental Health:
Approaches to Working with Transition Age Youth
Joseph Bonnell, Outside In, Portland, OR
PANEL: Syringe Exchanges and the New Heroin Epidemic
Kiefer Paterson, AIDS United, Washington, D.C.
Magalie Lerman, NASTAD, Washington, D.C.
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Empowering the People. Empowering The People shows how drug users are often marginalized from formal health care
delivery institutions and from making their own health decisions. But, with community-based organizations at the forefront
of providing naloxone, drug users can access it; a miracle drug, that does more than save people's lives.
This video features Carl Hart, Louise Vincent, Robert Childs and Helen, a mother whose son is addicted to heroin.
LENGTH: 4 MINUTES
LANGUAGE: ENGLISH DIRECTOR: HYUN NAMKOONG
WEB PAGE: nchrc.org
LEADing a new direction This video features the work of Santa Fe, New Mexico's Law Enforcement Assisted Diversion
program. Santa Fe's LEAD program has improved relationships between law enforcement and drug users. LEAD programs
challenge police to consider multidisciplinary and comprehensive approaches to providing assistance and stability rather
than incarceration to communities of people who use drugs.
LENGTH: 5 MINUTES
LANGUAGE: ENGLISH
DIRECTOR: HYUN NAMKOONG
WEB PAGE: nchrc.org
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Reducing Opioid Overdose Deaths in The United States and in New Mexico

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Reducing Opioid Overdose Deaths in The United States and in New Mexico

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Running head: REDUCING OPIOID OVERDOsE DEATHS IN The United States & NEW MEXICO

DEFINITIONS AND RELATED STATE AGENCIES:

Conducting surveillance of relevant, prioritized health outcome

NEW MEXICO DEPARTMENT OF HUMAN SERVICES

Project Echo Program:

Total Opioid Prescribing in New Mexico:

Opioid Overdose Citizens Data Conclusions:

What is the opioid overdose rate for 2015?

The drug overdose rate declined by 7.5%, not 9%.

overdosed citizens, etc.)

Rio Arriba County, Ground Zero:

Beautiful Land, Ugly Addictions

Sex/Age group (yrs.)

Natural and semisynthetic

70 (6.7) 29 (1.0) 95 (8.3) 44 (1.5)

230 (3.8) 357 (12.7)

949 (14.4) 108.7

151 (12.4) 261 (3.5)

102 (1.9)110 (2.3) 125 (2.2)

618 (5.4) 21 (3.6) 690 (6.1)33 (5.6)

554 (8.6)176 (2.1) 643 (9.7)

States with good reporting (n = 7)

217 (12.7) 76.4

284 (2.8) 64.7

183 (3.1) 63.2

TABLE 2. Number and age-adjusted rate of drug overdose

Illinois than methadone and

251 (4.0) 90.5

Walgreens Cerrillos Road

CVS Cerrillos Road

Highland Pharmacy (Across from Saint Vincents Hospital)

Del Norte Pharmacy Galisteo Street

Smiths Pharmacy Pacheco Street

Describe the different groups of people that come into

CPhT Objectives # 0104-9999-16-028-L01-T

Identify good candidates for naloxone at the drop-off and

Properly and efficiently adjudicate a claim for naloxone

Effectively and efficiently counsel a patient and family

Properly and efficiently adjudicate a Medicaid claim for

And they are recognized as innovative in Naloxone distribution expansion:

And Ms. Morton writes, in her own editorial:

Monique Tula, Executive Director {40}

The Naloxone Buffet

Program started in 2001

Originally a 3-hour training Some problems:

Luigi F Garcia Saavedra, New Mexico Department of Health, Santa Fe, NM

The New Mexico HOPE Initiative

NEW MEXICO PRESCRIPTION DRUG OVERDOSE PREVENTION

Comparing Interventions for Opioid Dependent Patients Presenting in Medical EDs

Funding: $899,906 (2014-2016)

NATIONAL INSTITUTE ON DRUG ABUSE

And there are many, many, more, just do a Google Search.

Board generally supports the proposed regulation. {55}

NM REVRSALS NM REVERSALS TOTAL NAX $

Data Received: 1/4/2017, NM Department of Health website, Various Divisions.

General Data Analysis:

factors that are causing

youth, white, middle and

with private insurance

Americans use 80% of the global supply of opioids and 99% of

Performance Measures Summary and Evaluation

FY14 FY15 FY16

Output Number of naloxone prescriptions provided in conjunction with

Multiple overdose prevention bills may assure that something passes