COVID-19 Opioid Overdose Prevention Program Guidance
COVID-19 Guidance for Opioid Overdose Prevention Programs in New York State
(issued March 30, 2020)
This document provides COVID-19 guidance for opioid overdose prevention programs. It supplements other guidance provided by Federal, State and local authorities on handling the current state of emergency.
ESSENTIAL SERVICES
The following are essential services in New York State:
Training individuals in overdose recognition and response;
Furnishing naloxone to trained individuals; and
Administering naloxone on someone who is experiencing an opioid overdose.
Individuals providing these services are not mandated to remain home. They should, however, be vigilant in social distancing by keeping 6 feet apart from others.
ACCESS TO YOUR SITES
Staff, clients or other visitors with any of the following should not enter your premises:
- Unresolved COVID-19 infection; or
- Cough or fever, the primary symptoms of COVID-19 infection; or
- Exposure within the past 14 days of closer than 6 feet lasting for more than 2 minutes toanyone who has tested positive for COVID-19.
Symptomatic individuals should be instructed to self-isolate and seek medical guidance.
HYGIENE AND SITE MAINTENANCE
All individuals should be reminded about social distancing, refrain from touching their faces, and
avoid unnecessarily touching other surfaces.
Staff should routinely wash their hands with soap and water for at least 20 seconds, especially
before engaging clients, after going to the bathroom, before eating and handling food, and after
blowing the nose, coughing or sneezing.
Disposable gloves are an additional safety tool for reducing COVID-19 transmission.
Hand sanitizer dispensers should be available and prominently visible. Their use should be directed
for all individuals entering your premises.
Commonly touched surfaces should routinely be wiped down with an antiseptic product that has
at least 60% alcohol as those surfaces may harbor COVID-19. Examples include sinks, bathroom fixtures, tables, countertops, door knobs, light and appliance switches, cabinet handles, handrails, telephones (including cell phones), computers and tablets (with a focus on keyboards, mice and screens), keys, hand sanitizer containers, etc.
SCHEDULING AND CONDUCTING RESPONDER TRAINING
No in-person group trainings should be scheduled, and all currently scheduled group trainings
should be cancelled.
Remote one-on-one and group trainings are encouraged using either the telephone or with
distance technology such as ZoomTM or SkypeTM.
One-on-one, on-premises trainings may take place, but only if social distancing is maintained
among all individuals.
Avoid making trainings unnecessarily long. Training content can be delivered effectively in most
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COVID-19 Guidance for Opioid Overdose Prevention Programs in New York State
TRAINING CONTENT
As always, the emphasis in training should be on:
- Knowing the signs of an opioid overdose;
- Intervening appropriately by calling 911 and administering naloxone; and
- Providing post-overdose support.
These elements are addressed fully in Putting the Pieces Together: A Guide for New York State's Registered Opioid Overdose Prevention Programs.The bulk of training may be conducted by directing individuals to online training resources such as: - https://www.naloxoneforall.org/videos;
- https://prescribetoprevent.org/patient-education/videos/; and
- https://www.narcan.com/patients/how-to-use-narcan/.All responders should be given information about obtaining naloxone in pharmacies.
Individuals with prescription drug coverage as part of their health insurance should be told about the
Naloxone Co-payment Assistance Program (N-CAP).
A directory of pharmacies that have standing orders for naloxone and more information on N-CAP
may be found at
https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/directories.htm
ADMINISTERING NALOXONE
There must be no delay in administering naloxone for suspected opioid overdoses.
Administration of naloxone will entail a brief period of being less than 6 feet from another person.
This administration can be done safely, so long as care is taken in avoiding unnecessary contact.
If there is no response to naloxone in 2-3 minutes, a second dose should be administered.
RESCUE BREATHING AND CHEST COMPRESSIONS
Rescue breathing, even with a breathing mask, and chest compressions may carry a risk for COVID-19
transmission, however, these techniques when correctly done can save lives, particularly if
naloxone is not available.
There is no mandate that rescue breathing or any other form of resuscitation be taught by programs
or carried out by trained responders.
It is an individual responder’s decision, informed by the risks, whether to provide rescue breathing.
The most critical interventions remain administration of naloxone and calling 911.
FURNISHING NALOXONE
Overdose kits should be assembled prior to a training encounter on surfaces that have been
appropriately prepared, first by washing with soap and water, if dirty, and then by wiping with an
antiseptic agent.
When naloxone furnishing is conducted on premises, it should be done by first placing an assembled
kit on a clean surface. The staff should then back away from that surface keeping a minimum distance of 6 feet from the person obtaining the kit. The trained responder should then be directed to take the kit without touching any other surfaces.
When naloxone is furnished off-premises, such as outside or in a responder’s home, social distancing should be maintained. Staff in these settings should always have, and regularly use, a bottle of hand sanitizer.
Assembly of kits and furnishing of naloxone should be conducted with disposable gloves if these are available.
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COVID-19 Guidance for Opioid Overdose Prevention Programs in New York State
• All responders should be given written instructions with their kits on recognizing an opioid overdose and how to respond. These materials may be ordered through the New York State Opioid Overdose Prevention Program System. You may also download the following information sheets:
- Narcan nasal spray: https://www.health.ny.gov/publications/12028.pdf
- Injectable naloxone: https://www.health.ny.gov/publications/12028a.pdf
QUANTITY OF NALOXONE FURNISHED TO RESPONDERS
Two doses of naloxone must be included in every kit provided to responders.
There may be exceptional circumstances in light of COVID-19 in which some responders will benefit
from having one or two additional doses placed in their kits. Programs may address this need at their discretion.
MAILING NALOXONE
• Programs have the option of mailing naloxone to trained responders. Programs seeking to do this should contact the New York State Department of Health at overdose@health.ny.gov for additional guidance on carrying out this activity. Programs will need to cover the costs associated with mailing the naloxone.
TRAINING OF TRAINERS
New York State offers an on-line “training of trainers” (TOT) for opioid overdose prevention program staff through www.HIVTraining.org.
If the staff to be trained have not used this platform before, they will need to complete a simple registration on the site.
After registering, they can find the naloxone TOT by doing a search for “Opioid Overdose Prevention”.
ORDERING NALOXONE AND OTHER SUPPLIES
• Programs should continue to order supplies as they have done in the past.
MANDATED REPORTING AND RECORD KEEPING
The reporting and record keeping requirements in the regulations and summarized in Putting the Pieces Together: A Guide for New York State's Registered Opioid Overdose Prevention Programs remain in effect.
If COVID-19-related disruptions preclude adherence to these mandates, please make whatever temporary adjustments are necessary to allow for continued training and naloxone provision.
RESOURCES TO SUPPORT STAFF, CLIENTS AND YOURSELF
New York State’s COVID-19 resources:
o OnlineGuidanceandUpdates:https://coronavirus.health.ny.gov/ o InformationLine:1-888-364-3065
o EmotionalSupportHotline:1-844-863-9314Local government health resources: https://www.nysacho.org/directory/
CDC’s COVID-19 Guidance on How to Manage Anxiety & Stress:
https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
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COVID-19 Guidance for Opioid Overdose Prevention Programs in New York State
Finding substance use disorder treatment through the NYS Office of Addiction Services and
Supports (OASAS): https://oasas.ny.gov/; 1-877-8-HOPENY; or text 467369.
NOTE: Medications for treating opioid use disorder (OUD)—methadone and buprenorphine—treat the underlying OUD and help protect people from having an overdose. They also prevent withdrawal due to disruption of drug supply. SAMHSA and OASAS have responded to the pandemic by making it easier for persons to start OUD treatment and to stay on it. Helping bridge people to OUD treatment saves lives.
Harm reduction for people using drugs:
- Syringe exchange program site directory:
https://www.health.ny.gov/diseases/aids/consumers/prevention/needles_syringes/docs /sep_hours_sites.pdf
Note: Call first to verify locations and hours of operation.
- Build a Safety Plan from the NYS Department of Health:
https://www.health.ny.gov/publications/9895.pdf
- Safer Drug Use During the COVID-19 Outbreak from Vital Strategies, the Harm Reduction Coalition, Higher Ground Harm Reduction and Reynolds Health Strategies: https://www.vitalstrategies.org/wp-content/uploads/Safer-drug-use-during-the-COVID- outbreak.pdf
- Guidance for People Who Use Substances on COVID-19 (Novel Coronavirus) from Yale Program in Addiction Medicine: https://yale.app.box.com/v/COVID19HarmReductionGuidance
THANK YOU!!!
New Yorkers are coming together in amazing and inspirational ways during these challenging times. You, your staff and responders are on the frontline in saving lives. That was the case before COVID-19; that’s the case now; and that will be the case afterwards. THANK YOU!!!
If you have any questions or suggestions, please send them to overdose@health.ny.gov.
