in today's presentation we'll be discussing how to safely and effectively implement a naloxone distribution program in rural communities um i'd like to start us out with a poll um we would like to know what are you hoping to accomplish on today's webinar the poll options will pop up for you just a second all right are you hoping to learn how to implement a naloxone distribution program in your community discuss concerns about naloxone distribution that have been raised in your community connect with others in your field to discuss best practices successes and challenges learn about how to obtain naloxone at no cost or inexpensively learn about efficient approaches to naloxone training including online options identify distribution methods that offer privacy and or reduce travel for community members consider ways to manage distribution during the covid19 crisis and if you have any others feel free to list those in the chat as well in the poll at the bottom there there's an option for you it says if other please specify you can type your answer right in there and feel free to vote as many for as many of these options as possible i'm seeing that many folks are indicating that they are interested in identifying distribution methods that offer privacy and or reduce travel for community members and considering ways to manage distribution during the covet 19 crisis i'll give folks just another minute or so to continue to vote right and those two continue to be in the lead it looks like books are really interested in distribution methods they're interested in distribution methods that offer privacy reduced to travel and in ways that they can manage that distribution of naloxone during the covenant crisis thanks to everyone for participating in the poll i'm going to close it out now and i'm going to turn things over to christine lasher who will walk us who's the director of the ur medicine recovery center of excellence i'm going to turn things over to her so she can introduce the center and so she can introduce to today's speakers thank you kristen and thanks everyone for taking time out to join us this morning so i wanted to start by answering the question that we often get which is what does your center of excellence do primarily we aim to reduce morbidity and mortality related to substance use disorder particularly as related to synthetic opioids first and foremost we are disseminating evidence-based practices throughout identified communities in new york kentucky ohio and west virginia these practices are first identified through research and carefully adapted to rural communities such as the practice we will review today around targeted naloxone delivery other elements of this ecosystem of recovery include topics like medication assisted treatment via telemedicine behavioral health assessment officers and initiating buprenorphine in the emergency department which are all subjects of future webinars these these efforts combined with some of the other key areas of focus noted above fit together to create a robust system allowing for long-term support through this work and partnership with our service area partners we are synthesizing the wisdom across our entire service area to create a robust robust set of resources and provide technical assistance to communities across the united states today's webinar and associated toolkits will further add to this storehouse of materials our work around the ecosystem of recovery is being done today in allegheny and northern steuben counties in new york's southern tier as you see pictured to the right of the slide the remaining 21 of our target counties are spread across ohio kentucky and west virginia as you see pictured to the left our identification adaptation and dissemination work are specifically targeted toward these 23 counties but we are willing to make materials available to rural communities across the united states and will also tell you how to get connected to our center of excellence at the end of this presentation i would like to introduce our speakers today starting with dr gloria bachevitz since 1986 dr bachevitz has specialized in the treatment of addiction in her current role as medical director of strong recovery in the university of rochester's department of psychiatry she works in education administration and clinical care she is certified in addiction medicine by the american board of preventive medicine and board certified in psychiatry with added qualifications in addiction psychiatry dr bichevitz is co-principal investigator for the ur medicine recovery center of excellence patrick such is the senior director of addiction services and a senior associate faculty member in the university of rochester medical center's department of psychiatry and currently oversees three clinics at strong recovery which is a part of strong memorial hospital on the steering committee for the ur medicine recovery center of excellence patrick focuses on substance use disorder methadone treatment and community relations
Naloxone Overview
dr pachevitz let's start today by understanding more about naloxone itself is it safe and how is it used naloxone is a very critical tool for reducing death from opioid overdose it is so safe that its use by the general public is approved in all 50 states and puerto rico naloxone can be used as either an injection or a nasal spray the vast majority of naloxone distribution programs give naloxone in nasal spray and that is easier to use and very well accepted by the people who will need to administer it naloxone itself carries no risk of abuse and it has no effect on individuals who do not already have opioids in their system so what does research show about giving out naloxone and naloxone distribution kits a couple of things a systematic review of naloxone distribution programs found that when naloxone is introduced into a community these communities have reduced opioid overdose mortality also from 96 to 2014 over 26 000 opioid overdose reversals were reported from naloxone kits provided to laypersons and this is certainly an under reporting of the actual number of overdose reversals that were done next slide dr bochevitz perhaps you can review this chart as well with us and briefly share your experience relative to naloxone as related to reversal of potentially fatal overdose particularly when synthetic opioids are involved so the types of opioids most people think of when they hear of someone dying from an opioid overdose are medications like oxycodone or hydrocodone or street drugs like heroin but instead of the opioids the general public is familiar with there has been a dramatic shift involving increased availability of synthetic opioids especially fentanyl 67 percent of the opioid related deaths in 2018 involved these synthetic opioids fentanyl is a very powerful synthetic opioid and it has a very quick onset of action we are clearly in an era of synthetic opioid use and we will need more availability of naloxone and higher total doses of naloxone as well to reverse opioid overdose related to synthetic opioid use next slide thank you dr pichevitz so what we wanted to do next then was to spend some time talking about the challenges to naloxone availability and distribution in rural communities specifically in rural communities privacy is a concern there are fewer residents and therefore a greater likelihood of encountering someone you may know at an in-person naloxone training or pickup location additionally with limited transportation abilities and options it's hard for some to even get to a training or to a pickup point these concerns are additionally heightened in today's environment with the need for social distancing ems may be overwhelmed during the pandemic making it all the more important for naloxone to be available through other means our center of excellence is also currently developing tools to help organizations identify patients who may be at risk for suicide as was shared on our introductory slide so we'd like to talk today about how to launch a naloxone distribution program in rural communities that is focused on touchless training and touchless delivery of naloxone but before we get into those elements let's first talk about the steps to getting ready there are five basic steps steps four and five now being offered in a way that is touchless so that we all have the same foundation and the steps to be taken let's review them step one involves becoming trained in order to become a registered program after that step two involves going through the relevant steps in your particular state to become registered and we will review both of those today step three involves a supply of naloxone to provide to your communities there are many options here as well and now it would be time to actually train your community members in step 4 we will talk about touchless options and finally getting naloxone into the hands of those who need it most in a convenient and touchless fashion will be covered in step five patrick would you please take a moment about getting to talk about getting started as a community-based organization absolutely thank you christine before we go into a little bit more details about these steps it's very important for to understand that any for any community based organization who's looking to have a naloxone distribution program um this is um it shows an overview of the process that it generally involves selecting and training naloxone program lead or leads acquiring and completing registration paperwork and coordinating some train to trainer sessions for for your staff and working with regulatory authorities and naloxone suppliers to obtain the naloxone that will allow for community-based organization to train community members um and other organizations as well as being able to get the naloxone out um to people there are some nuances in the process depending on your state or or or region but in general that's that's the overview for any community-based organization see your next slide please now as christine mentioned earlier um the steps in the process of of becoming a naloxone distribution
How Can We Get Trained Ourselves?
program so the first step is getting trained yourself in every state the the the good thing is uh gloria dr beshavitz mentioned the need for naloxone um it's really an increased need now as we are starting to well as we're seeing an increase in overdoses and especially involving fentanyl that there is a sense of urgency to ensure that as we are in the middle of this pandemic that distribution of naloxone to everyone in the community is of the uh continues to be of the utmost importance as you could see um on on this slide for step one that the the states that are in the ur medicine recovery center of excellent service areas we've identified the the state the lead state organization to contact to to begin that process to to identify where the train the trainer sessions are available because that is the first thing for any organization that is looking to start this process to do if you are in a different state the harm reduction coalition is a great organization to contact and they will they will point you in the right direction they are connected to every state organization that is involved in naloxone distribution and the registration of distribution programs and they could guide anyone through that process and if for some reason you are unsure you can always contact our technical assistance center and they will provide some some guidance this is the process that we went through as a program is um through our state agency four of us um attended a train the trainer session and we then turned around and trained everyone else in our organization some we trained as trainers and some we just provided the training to so that they have the ability to carry naloxone and understanding when to use it next slide please
How Can We Become a Registered Program in Our State?
so as we move on to step two once you've gone through that train the trainer process the next step will be to go through the registration process and as you could see on this slide there are several organizations that um depending on your state that you could go through um to to begin this process and again if unsure or not aware of which organization that process would need to happen in your state the harm reduction coalition is again a great resource to contact and they will they will help to point you in the right direction for this process by going to the through the registration process once you're connected to the lead organization in your state there is generally a point person that will guide you through that process through the paperwork now when we did that as an organization there was actual paperwork that we have to complete but i would imagine at this point it's it's pretty much an online you know process where documents can be sent electronically in order for a program to to become uh registered this guide through your your state's lead organization will outline the process of becoming a registered program including the policies and procedures that are necessary for regis registered programs which will outline how to get naloxone how to how to handle the naloxone in the process of training people and the responsibilities of a registered program um there's you know some reporting involved in distributing um the naloxone and when it is used which is also all tied into um being able to continue to receive the supply of naloxone so once we before we actually go to step three for good next slide please christine before we go to step three um i wanted to just outline um the laws uh that are involved in distributing naloxone because those are generally very important for um anyone whether it's a train the trainer process um programs that are interested in in distributing naloxone as well as when training individuals in the community so if we look at so in new york the the public health law provides um that ability for individuals to to carry naloxone and and administer it to another person who is in need of help the law provides that ability that you do you do not have to be a medical professional once you are trained and have naloxone and come across a situation where you think it could be an overdose that you are you can administer the naloxone and there is liability protection the 911 good samaritan law in new york provides protection for anyone in a situation where they are calling for help whether that person might have some illegal substances on them whether they were using with the person that is now in need of help as well as the person that's overdosed um will not be arrested there will not be criminal charges brought to that to that person the person calling for help and the person who is in need of help and that is real that is really to encourage people to call 9-1-1 because that is a critical step in the process is calling 9-1-1 and ensuring that someone will have medical attention when um they they have an opioid overdose there are very similar laws um as you could see listed the new york good samaritan law is very similar to in kentucky the the statute to 18.133
in ohio the orc 2925.11 and in west virginia the 16-46-4 those laws are all um pretty similar that they provide you know that protection to encourage people to call 9-1-1 and call for help because that is critical medical attention in an overdose situation is critical and is always needed next slide please
How Can We Get Naloxone?
so patrick now that we understand the basic laws behind this how does the program even get naloxone in order to distribute it yes so once once a program has gone through that that step two where they've completed the the process of becoming a registered program so once registered and again there there are some you know it might vary a little bit by state so for example in new york state we actually go through the state department of health and receive a registration certificate that wants a registered program and usually that will also be identified in the registration process is how to order naloxone so the setup the the the paperwork to set up that process of ordering naloxone will generally be part of that registration process as in uh opioid overdose prevention program as they are called in new york and there may be third-party vendors involved for the actual ordering the naloxone so that setup might happen as part of the registration or once a registered program excuse me an organization would then have that ability to go through that third-party vendor in order to obtain naloxone and as a registered program the naloxone shipped directly to you including any materials that would be included as part of the kit and again this might vary by state but to take new york as an example um our you know through our vendor for naloxone we usually are getting a bag that the naloxone will go into um alcohol pads gloves breathing shields and again those items might vary based on how the state overdose prevention programs are set up um let's see yes so we can go to the next slide actually to step four
What Should the Training Cover?
so naloxone training can be done in groups or one-on-one and at a range settings but today we'd like to emphasize the simplicity of the training and encourage remote delivery such as online or by phone so dr bachchevitz now that an organization knows how to obtain naloxone what are the basic components of the training that they should provide oh basically it's easier than you think training and also converting your existing training to a touchless sort of training is very flexible in most states there's a lot of flexibility about how training can be conducted and as christine mentioned it can be done one-on-one or in groups and training can be tailored to the group itself because everyone starts with a different sort of a knowledge base training can be done online or over the phone even people can set up booths in a shopping mall or one of the local groups that we have recently set up a group to do curbside pickup of naloxone and curbside naloxone training so there are just a few key topics to cover evaluate for signs of overdose call 911 for help this is a very important one because people often think that once the person who uses opiates wakes up their work is done but the person may need more naloxone in the ed or they may need evaluation for other medical problems so it's it's real important to communicate that they should call 9-1-1 for help and that is listed on the pocket card that we have in the the toolkit as well understand the laws patrick uh just went over that topic um how to administer naloxone naloxone is administered very easily with the intranasal kits that are available uh people it's very intuitive it has a a little plunger that you just depress and most people understand it very very well how to support the person's breathing if needed how to monitor the person and stay with the person until help arrives and the fact also that addiction additional doses may be needed especially in the case of synthetic opioid overdose so as patrick mentioned before the kits that are given out have two doses and we encourage use of the second dose usually people will wait two to three minutes and then give the second dose if the person does not seem to have sufficiently recovered the next step of course is linkage to treatment which we'll also be talking uh more about but this this can happen or can begin at least in the emergency department if there are sufficient uh resources there and we're working to try and get sufficient resources in emergency departments as well next slide thank you dr pichevitz and so as we've mentioned we've actually created some tools to help with that training including a succinct format so that you can have that in a mobile version as well as other training to help you with the steps that dr bachevitz just reviewed so now that we know what needs to be trained as far as topics patrick perhaps you could talk about how that training could be delivered yes absolutely and actually before i do that i would like to emphasize in you know earlier steps of of becoming a registered program and actually getting naloxone the most critical and probably the hardest part of the whole process is connecting with the lead organization in your state that can assist with this because once you've made that contact and have a point person within that organization it really is fairly easy to go through this process so i would like for you know any organization listening to know that making that contact and also especially you know connection with the harm reduction coalition you know between those two things it's really a fairly easy process to go through to eventually becoming a registered program and having naloxone ship directly to you that you can then be in a position to train your community and distribute naloxone to them now the training can
How to Make Training Touchless
be done in in groups of you know sort of you know classroom style or or one-on-one and um of course now um the setting that we're providing training in is remote so it's either online through some sort of internet platform such as zoom or or something similar to what we're using for this webinar or or telephonically by phone we've also been able to provide some training to people especially one-on-one can be very effective by phone you know when and if an organization is able to provide in-person training those can really happen in a variety of settings um whether it's a clinic community center schools um you know any place that where there is a room that people can gather the the training can um happen and it it really is um as dr bushevitz mentioned earlier naloxone can really be used by anyone so um the audience can really vary you know a wide range of audiences um in some instances it might require a little bit of you know just being flexible to adapt your training depending on the audience you know for example as a treatment program we provide training to our patients and it's it's fairly quick and brief because um there there's some information that's either irrelevant for them or they're already aware of um in most instances they already know how narcan works so we provide the training around the responsibility as someone who has narcan and ensuring that they know how to use it and when they do use it to report back to to the registered program so that we have the information for all reporting as well as have the opportunity to provide them with more narcan um we are able to provide this training in ways that you know offers you know privacy social distancing uh not involving any travel for for the the program staff as well as the individuals um being trained and naloxone is um also able to be made available to people once they are trained in these remote formats next slide please so once
Touchless Naloxone Distribution
people are trained and again whether it's in person or through some sort of remote format um we've been with the covet 19 pandemic be able to basically switch to completely um touchless and and remote ways of of doing this that once trained naloxone can be mailed to people it can be provided you know curbside um depending on your setting where people can you don't even have to get off their cars and they and they can just um receive the naloxone um it can be home delivered or dropped off for people um we've even found i think it's only one where there's naloxone available to a vending machine i think that's in vegas so so there are ways to to do this that can still you know adhere to some of the precautions that we have to take with the current pandemic but as i mentioned in the beginning it's important that naloxone distribution continues um and there is that ability to to do that um i think so i wanted to yeah i wanted to highlight one program that was shared us in our service area and that is project dawn in ohio as an example so sierra dansler who's the program manager at ohio department of health manages the project on program and she provided the following summary project dawn which stands for deaths avoided with naloxone is a network of community-based drug overdose education and naloxone distribution programs in ohio the ohio department of health coordinates the programs which provide take-home intranasal naloxone kits and training to the public free of charge as of june 2020 there are 181 project on sites across 63 ohio counties and a statewide mail order program a variety of organizations have established project on programs many programs are headquartered at local health departments which also serve as the main training and distribution site some are managed by local health departments which partner with local agencies such as pharmacies or substance use disorder treatment centers excuse me where staff dispense the kids and provide the training excuse me some programs have multiple naloxone distribution sites at locations such as syringe access programs fire departments county jails and court systems even churches and community centers so we're very happy to highlight that program in ohio as one that's working quite well so how important is it in your experience dr bachevitz to engage with community groups and where do you suggest that people start well i think it's extremely important the more the community understands about opioid use disorder substance use disorder in general and opioid overdose the more lives can be saved and the more people can be brought into treatment and regain their functioning so it's also possible that by increased awareness of these things the the general stigma about opioid use and opioid use disorder treatment may be lessened among various parts of the community so it's very important to listen to the community and to make sure that the community voice is being heard we need to get familiar with the different options available in the community treatment options various community groups support groups of various types and also become familiar with the various issues that any community struggles with so we need to engage these community partners and local champions and also connect with others who are engaged in naloxone education and distribution in in the state or region and to share ideas and best practices and we need to incorporate input to ensure that the method of distribution we have chosen is appropriate and useful for the community we also need to address privacy and liability concerns especially when naloxone distribution programs are new to a given community or group there are often a lot of concerns about what laws cover this will i get in trouble for doing doing this and and that kind of thing so people need to understand about the laws in the given state next slide great thank you dr bachevitz i would like to just recap then the steps that we've covered today step one how can we get trained ourselves we've talked about the options there and train the trainer step two how can we become a registered program in our state through the state regulatory authorities that were highlighted step three how can we get naloxone this is typically through the state agency once you're a registered program step four what training for community what should training for the community members cover we've covered those topics for you and will make training available it should be readily available concise and can be done touchless meaning not in person but over the phone or online and finally step five how can we distribute naloxone to people who have been trained there are touchless options that would be made available through assorted community engagement so saving lives really is the first step where should people go next dr bachebits to continue with the recovery journey people should go to treatment to continue their recovery journey a treatment and recovery is an ongoing process and not a quick fix and that's often why self-help groups focus on the idea that uh take take things one day at a time uh it's a very important thing to live by when you're in recovery from substance use disorder so during recovery from substance use disorder the person who uses drugs acknowledges their problem and begins to accept help often that's that's a very difficult part engaging someone in treatment who may or may not be real interested in treatment and there are folks who are are very good at this chemical dependency counselors and nowadays we have peer peer support for people appears employed by programs to help people engage in treatment and continue in treatment so during recovery people have a lot of work to do and their treatment providers also have a lot of work to do they will have to accomplish things like dealing with urges and cravings finding sober supports letting go of people places and things that are associated with drug use and repairing family relationships and other relationships and that's just a just a beginning list so once the person's life has been saved with naloxone the person can be referred to treatment and there are numerous ways to get into treatment hopefully a lot of this can begin in the emergency department there are many state hotlines most states have them and the ones in the the four states kentucky new york ohio and west virginia are listed here on the slide there is also a coordination with the primary care provider and the primary care provider may in fact be a buprenorphine provider that's a medication assisted treatment provider and there also may be a behavioral health assessment or officer in the emergency department who can refer people to further treatment and figure out which programs will offer medication-assisted treatment which is uh often what is necessary for opioid use disorder and treatment facilities um will do what's called a chemical dependency evaluation to determine the level of care that is needed and what type of medication assisted treatment is needed next slide i think before we move forward patrick was there anything that you wanted to mention regarding interfacing with family members or the samhsa treatment locator yes i i think the uh being a naloxone distribution program provides a tremendous opportunity and interface with a lot of family members you know through our own experience of providing training a lot of times it's their parents or spouses or grandparents or other family members that are attending these trainings because they have a family member that they're concerned with or that's actively using so you know being aware of the the statewide number that can provide some information about treatment programs that are available in your state or sometimes you know there may be some you know some some local numbers that are available but for anyone that is unsure samsa if you can go to samsa.gov
will has a treatment locator off of their website and you could put in any town city or zip code and it will list all of the treatment programs and the levels of treatment that they're they they provide in your area so if unsure and if someone does not have the their local information that is a place you can go that you can start with that will provide you some information of treatment programs that are available so it's important to pass that information along to the family members that are attending naloxone training because as dr bashevis mentioned um it's important that we follow up the the overdose reversal with treatment for people great thank you very much patrick and before we move on to the next poll i just want to thank both of our presenters today for sharing their insights and experience so i'd like to turn it over to kristin for a poll before we start with our question and answer session all right great thank you so much christine i appreciate that and thank you gloria and patrick as well um so our next poll is uh recording the issues that you see in your community which of the following would you classify as an issue for your community opioid-related overdose including from synthetics concerns about naloxone's safety or effectiveness resources to start a naloxone distribution program obtaining supply of naloxone kits identifying distribution methods that offer privacy and or reduced travel challenges of distributing naloxone during the cova 19 crisis technology challenges in considering online training or other feel free to specify those in the chat and i'll give folks a minute or two to uh to you know fill in their responses here on the poll kristen could you just verify that the poll is available to folks i'm seeing the list of questions but not the poll itself okay uh we may be experiencing some technical difficulties with our polling um so if we do um i'd actually encourage you to fill in your responses and put them in the chat because we are very interested in seeing uh your responses here i'll give folks a minute or so to do that in the meantime hopefully we can get that poll up and running i apologize for that all right thank you all for participating in our poll today i'm going to turn things back to christine lasher who's going to walk us through some of the questions that were generated during today's discussion great thank you very much so there are some questions that we've received that i wanted to share with the team so we'll start with a question that came through on chat which has to do with verification of training before naloxone distribution by mail i'm not sure if there are any recommendations about how we would verify that someone has been properly trained perhaps patrick you could answer that question sure yeah yes absolutely and i and i can tell you the way we do it so um we have a process where um individuals register for the training so um even when we're doing um trainings in advance um you know we would announce our training and there would be a number for them to call so that they they provide um the registration information that would you know normally it's a name name date of birth um i'm not recalling um gender what other information we have on that register it's not extensive but we do have um the registration so for the remote trainings it still follows the same process individuals call and and they register so we know exactly who to expect so then once they attend the the zoom session for you know for example the the online training so then we confirm the person that registered attended training and then we're able to then get them locked some tool oh the registration information now also includes their address so for mailing the naloxone we ensure that we also obtain their address thank you patrick and another question that's come through says i find that telling people they must call 9-1-1 can be difficult for people in active substance use do we have any recommendations if they're hesitant about calling 9-1-1 i i can take that and that's um that's why we we emphasize the the the laws so the so the 9-1-1 good samaritan law and and you know whichever the corresponding law is for for your state or area that you're in it's important to really emphasize that for people because there is that fear you know some people have fear of i call 911 the police will show up and i'll be in trouble so we we we emphasized that and we also um in our training you know throughout the training repeated um numerous times that calling 9-1-1 is critical medical attention after an overdose is is necessary and it's critical to call 911 so emphasizing those two things um but but the law is very important for people to to understand especially those um who may be actively using to inch to to ensure them that there is that protection from any kind of criminal charges great thank you and the next question is for you dr bachevitz how do you make people feel more comfortable with the idea of naloxone in their community if they're worried that it will lead to more opioid use well so basically um we we talk about the fact that naloxone is something which can save a life and people who are not living cannot enter into treatment and get better so what we're doing is keeping people alive so that they can fight another day so that they can try again to get in treatment and repair the things that need to be repaired and the other way the other important piece is to listen to the community and just listen to their concerns about it people have all sorts of fears about it a lot of people think naloxone is is itself addictive for example and it's not they have many they've heard many uh sort of um untrue myths about uh naloxone that we need to dispel in our trainings and when we answer community questions about it so the important thing is to to listen and help them process uh whatever it is that they're they're feeling about this great thank you dr bachevitz another question that also came in patrick i think is for you which is can you explain how samhsa's block grants work for naloxone distribution centers sure absolutely um the the block grants from samsa are awarded to um state agencies and then those funds are dispersed through the naloxone distribution program so however those are set up in the state um the the state authority whether it's the department of health or the the behavioral health governing authority or substance use disorder specific governing authority disburse those funds um through the naloxone distribution program so registered programs um are then you know able to access naloxone um through those funds great thank you and the next one dr pichevitz is for you so what do you think about giving people who are trained more than one kit to distribute to others so i think that um the trainer should uh be very sure of what uh what what exactly the local uh and state laws about that say and should rely on uh point people wherever they're getting the naloxone from uh to um understand uh whether it can be given um they can give kids to give to others so i would i would guess that many uh states uh state agencies uh do not allow that because uh they're they have the um expectation that people will be trained even though the training could be brief but we want uh you know we want to know who we trained and we want to ask them to report that they did an over uh overdose reversal etc so um so that's an important thing but i'd i'd also like to say that this is something that that's already happening now a person told me the other day that uh yes he needs a naloxone kit because he just gave his away to a friend and we we do this all the time as well when we give a naloxone kit to a person who actively uses drugs because the expectation is not that they are going to rescue themselves with naloxone but that someone in their household is going to rescue them with naloxone so that person in their household could come into our training or the person who uses drugs could sort of train the the person who they live with about this so i i think it is already happening great thank you and those were all the questions that i had today unless there's anyone else who would like to put something into the q a we'd be happy to take those now and if not i will pass this back over to kristen for a final poll and to close today's session thank you great thank you so much christine i just want to take a minute to do a final poll uh where do rural communities need the most support and again we may not be having polling options at this at the moment the polls are acting a little bit funky so i'd like to encourage you to put your uh poll answers uh in the chats uh so the answers are where do rural communities need the most support starting a naloxone distribution program navigating state guidance about naloxone partnering with organizations that distribute naloxone implementing distribution with social distancing providing training on naloxone administration obtaining naloxone kits at low or no cost addressing privacy and anonymity around training and distribution providing evidence-based information about naloxone to community members or other again we're very interested in your answer to this question it'll help us understand where rural communities need support so please if you can't put it into the poll if the poll is not working please put that into the chat for us all right i'll give you one more minute to do that please all right thank you so much for participating in our poll today uh christine can you move me to the next slide please we would like to encourage you to visit the recovery center of excellence.org
for details about our upcoming events and publications we're going to be posting a recording of today's event to the website within the next week you can check back to the website for a recording and for tool kits related to today's presentation if you have suggestions on what you'd like to see covered in our next sessions you can email us at ur medicine underscore recovery at urmc raj and as we close out today's webinar i'd like to encourage you to fill out our evaluation form please stay connected in adobe connect and you'll be automatically routed to our evaluation forum your input's very
important to us because it helps us improve the quality and content of our webinars again please do not close out adobe connect you will be automatically routed to our evaluation form next slide please we've provided a slide with references for today's webinar as was noted early in the webinar as well you can download a pdf of today's slides from the pod that is located right below the chat window next slide please and we'd like to thank you for viewing our webinar we look forward to connecting with you again in a future webinar again please stay connected to the room and you'll be
automatically routed to our evaluation thank you so much
