WEBVTT 1 "Frank, Jordon" (239741696) 00:00:00.000 --> 00:00:20.000 Afternoon. My name is Jordan Frank. Thank you. My name is Jordan Franken. I'm a project coordinator at the hearing County Office of harm Reduction within the Department of Health. We're so lucky today to have some of our partners from the U belder School pharmacy. 2 "Frank, Jordon" (239741696) 00:00:20.000 --> 00:00:38.250 Presenting so I would like to introduce Julia Vickeraddi. She is a farm B and MPA and a clinical assistant professor at the Uville University School Pharmacy and a pharmacist at vital pharmacy. Her work focuses on utilizing community pharmacists to improve public health and access to preventative care. 3 "Frank, Jordon" (239741696) 00:00:38.250 --> 00:00:58.250 Alyssa Wells Erick is the pharmacy board certified pharmacy specialist and serves as an assistant team for clinical affairs and outreach at the Uville University School of Pharmacy where she leads community based clinical services, public health and outreach initiatives, and pharmacy provider collaborations across Western New York. 4 "Frank, Jordon" (239741696) 00:00:58.250 --> 00:01:12.226 So they're on campus pharmacy vital pharmacy. So please give a warm welcome to our lovely presenters today who are going to share some informa going to share about one of the recent studies. 5 "Alyssa Wozniak" (1229755648) 00:01:12.226 --> 00:01:43.162 Right. Hello, everyone. Thank you for that introduction. So I'm gonna just introduce where we're going today and then I'll pass it off to my colleague to kick us off in the presentation. So my name's Alyssa, and what we're gonna be presenting on today is a study that we did, so we looked at a lockdone access in area county, specifically in the pharmacies in the county. And we like to present those findings from our secret shopper study today. And then with that said, I'm gonna pass it over to Julia to kick us off, start the presentation. 6 "Julia Vicaretti" (3055158016) 00:01:43.162 --> 00:01:58.440 Perfect. All right, good morning. My name is Julia. I just kind of want us to start today by considering some situations. So imagine a community member might go into their local pharmacy to pick up NO lock zone for a loved one. So maybe it's their parent, a child. 7 "Julia Vicaretti" (3055158016) 00:01:58.440 --> 00:02:17.280 Even a friend or a sibling, who they are concerned might overdose. This person looks all over the pharmacy and can't find any on the shelf anywhere. They decide to ask a front end staff member if they know where it's kept. Unfortunately, that staff member isn't aware that this particular pharmacy. 8 "Julia Vicaretti" (3055158016) 00:02:17.280 --> 00:02:34.920 Keeps their pharmacy or sorry, keeps there in the lock zone behind the counter in the pharmacy where it's available for over the counter purchase. So the community member leaves the pharmacy feeling a little frustrated and defeated without the lock zone, not because it wasn't available, but because the workflow within the pharmacy failed. 9 "Julia Vicaretti" (3055158016) 00:02:34.920 --> 00:02:54.920 Now, imagine a different pharmacy, maybe it's down the street from the 1st one. A different community member is looking for something to help with their colds. They have some some sniffles, but they noticed nolaxone on the shop next to it and they decide to purchase them because they have a family member who is at risk of overdose, who's gonna be visiting for the holidays, and they want to be prepared just to. 10 "Julia Vicaretti" (3055158016) 00:02:54.920 --> 00:03:15.740 In case. They bring that up to the register only to find that the Noxtone would cost $50, which is more than they can afford to spend right now. There was NO signage, and the cash here didn't mention that they could have taken that back to the pharmacy and had it paid through for their insurance or that the end CAP program could reduce any copay that they may have based. 11 "Julia Vicaretti" (3055158016) 00:03:15.740 --> 00:03:35.870 So instead they just put it back and then they leave the pharmacy without the naloxone. So these types of situations which happen all too often are exactly why we decided to conduct the study. So as we know, nalaxone is now available over the counter in pharmacies, so people are able to buy it. 12 "Julia Vicaretti" (3055158016) 00:03:35.870 --> 00:03:59.010 Without a prescription, just like they would do with like thailand oil or coffe zero. But the retail cost for Analoxone is typically around 40 to $50, which can be just out of reach for people especially for something that they hope to never have to use. That being said, in New York State, New or Naloxone is also available through the pharmacy under a statewide standing order, so. 13 "Julia Vicaretti" (3055158016) 00:03:59.010 --> 00:04:14.340 Essentially all that means is that a patient can get in a lock zone through the pharmacy without having an individual specific prescription from their dr.. And that would allow them to bill their insurance for them in a lock zone instead of having to pay for it out of pocket. 14 "Julia Vicaretti" (3055158016) 00:04:14.340 --> 00:04:31.979 And then if they have a copay, the end CAP program, which is the Noxtone copay assistance program, can be used on top of their insurance to reduce that copay further. And then, of course, just like always, there is the option for prescribers to write individual prescriptions for patients billed through their insurance. 15 "Julia Vicaretti" (3055158016) 00:04:31.979 --> 00:04:48.749 Just like we saw. So there are kind of multiple different pathways for a person to get in a lockstone, but there's been quite a bit of research in this area in other states that show that there's still gaps in access. So, e.g. despite a standing order being in place, there were some pharmacies. 16 "Julia Vicaretti" (3055158016) 00:04:48.749 --> 00:05:06.509 That still didn't offer naloxone without a prescription as just the policy or if naloxone was provided patients weren't adequately counseled on when and how to use it. There was also some noted access differences between different pharmacy types and their geographic settings, so. 17 "Julia Vicaretti" (3055158016) 00:05:06.509 --> 00:05:25.769 Independent versus chain pharmacies, rural versus urban settings. We talked a little bit about this already, but there was often high out of pocket costs for those who didn't have insurance or who weren't using insurance. And there were multiple examples of individuals that faced stigma and just pharmacy staff having workflow barriers to. 18 "Julia Vicaretti" (3055158016) 00:05:25.769 --> 00:05:44.369 To properly addressing this. So there's been a lot of research done, but we specifically wanted to look at area County specific data where there's been kind of a gap in the research. We wanted to understand the real world pharmacy experience to help to guide those future improvements in overdose prevention practices. 19 "Julia Vicaretti" (3055158016) 00:05:44.369 --> 00:05:59.369 And countywide harm reduction efforts. So to do this, we conducted a study using secret shopper methodology, so we surveyed 65 different pharmacies here in Ary county, which is about 62 % of the pharmacies in the county. 20 "Julia Vicaretti" (3055158016) 00:05:59.369 --> 00:06:18.929 We visited all different types, so including chain pharmacies, so things like your Walgreens CVS, independence, which are like mom and pop type pharmacies, and then grocery pharmacies, so like those inside webmans and tops. These pharmacies were located across the Irie County in urban, suburban, rural communities. 21 "Julia Vicaretti" (3055158016) 00:06:18.929 --> 00:06:38.929 And at each pharmacy we assessed the availability of nolock zone, the cost, both what it would be over the counter and through their insurance, and then we looked at whether pharmacy staffed used the statewide standing order or end cap, where they kept the nolock zone. So, you know, was it behind the counter or was it over the counter? 22 "Julia Vicaretti" (3055158016) 00:06:38.929 --> 00:07:00.809 Or if the pharmacy would only dispense it with a prescription. We also evaluated staff knowledge and attitudes if medication was provided and if it was appropriate given the requirements of the standing order and just overall any staff behaviors that may have helped or hindered patients access to naloxone. And then last thing we analyzed was the differences that existed. 23 "Julia Vicaretti" (3055158016) 00:07:00.809 --> 00:07:16.649 Between pharmacy type, where they were located and their proximity to the overdose hotspots in Theory County. So what did we find that availability is high, but access is not so simple. 24 "Julia Vicaretti" (3055158016) 00:07:16.649 --> 00:07:33.359 So 89 % of the pharmacies we visited had NO lock zone available, and we found that availability actually did increase with the community needs. So pharmacies were more likely to have NO Locksone available if they were located in an overdose hotspot, which is great. Like that shows that there is an alignment. 25 "Julia Vicaretti" (3055158016) 00:07:33.359 --> 00:07:53.359 Between overdose burden and pharmacy stocking, but there were still barriers that might make accessing the lock zone even if it is available a little more tricky. So we found that a lot of pharmacy staff is misinformed on things like prescription requirements, the fact that NO longer requires the prescription, and NCAP. 26 "Julia Vicaretti" (3055158016) 00:07:53.359 --> 00:08:17.009 Eligibility and there were multiple instances where pharmacy staff insisted that they were unable to dispense noloxone without a prescription. We also noticed some inconsistencies in pharmacy workflows, which can just make it challenging for patients to navigate. There was a lot of variation in where nolaxone is kept and how a patient would need to request it, whether that be at the pharmacy at the front end and how they would go about it. 27 "Julia Vicaretti" (3055158016) 00:08:17.009 --> 00:08:34.349 And then lastly, a lot of pharmacies kept in the locksome behind the counter, so it is still available to purchase without a prescription. It's just kept in the pharmacy space. A patient would still need to ask pharmacy staff to get it for them, which just adds another layer of stigma and potential confusion. 28 "Julia Vicaretti" (3055158016) 00:08:34.349 --> 00:08:54.349 Just another barrier. So even with this high availability, people will often still leave the pharmacy without naloxone because the process to obtain it can be unclear and consistent or even com uncomfortable. Okay, so this kind of ties into our last point, but just because NO loxone is considered an over the counter medication. 29 "Julia Vicaretti" (3055158016) 00:08:54.349 --> 00:09:13.259 Doesn't necessarily mean that pharmacies are stocking it over the counter, so only about 31 % of the pharmacies we visited actually kept niloxone like on the shelf where patients could pick it up themselves. This was especially pronounced in independent pharmacies where only 7 % kept their naloxone over the counter, so. 30 "Julia Vicaretti" (3055158016) 00:09:13.259 --> 00:09:30.479 Also, even if it's kept there that doesn't necessarily equate to access. So when it's purchased as an over the counter medication, we can't bill it through their insurance, we can't use NCAP to reduce the cost, and patients would have to pay that full retail price, which as we said is typically between 40 to $50, which. 31 "Julia Vicaretti" (3055158016) 00:09:30.479 --> 00:09:46.529 Can be quite expensive and out of reach for a lot of patients. And just kind of all of this to say, we found that over the counter availability does exist like policy wise, but that doesn't necessarily translate to practice, let alone actual availability for patients. 32 "Julia Vicaretti" (3055158016) 00:09:46.529 --> 00:10:06.529 And the different ways that pharmacy stock in the lock zone creates various financial and operational barriers for patients. So speaking of those operational barriers, we found that our secret shoppers reported a greater level of difficulty navigating the process of obtaining the lock zone at those individ. 33 "Julia Vicaretti" (3055158016) 00:10:06.529 --> 00:10:27.149 Independent pharmacies compared to the chain or grocery pharmacies. So if you remember, the independent pharmacies were significantly more likely to keep noloxone behind the counter, which as we discussed just creates extra barriers, extra steps, and introduces the potential for more stigma. And just overall another barrier to accessing nooxone. 34 "Julia Vicaretti" (3055158016) 00:10:27.149 --> 00:10:47.149 Interestingly I thought independent pharmacies were also more often located in areas with a higher burden of overdose deaths, which further amplifies kind of those inequities. So all of this to say improving processes at these independent pharmacies really has the potential to meaningfully expand access to the lock zone where it's needed. 35 "Julia Vicaretti" (3055158016) 00:10:47.149 --> 00:11:05.879 Did most. And then we found that geography shapes access. So suburban pharmacies regardless of the type, offered more consistent noxtone availability compared to rural and urban areas who tended to have a little bit more variability in their stock. 36 "Julia Vicaretti" (3055158016) 00:11:05.879 --> 00:11:24.081 I think this just kind of goes to show, how the zip code a pharmacy is located in can have an impact on whether or not a person is able to obtain the lock zone or if they have to leave the pharmacy without it. Okay, I will now pass it over to Alyssa who will go through the rest of our findings. 37 "Alyssa Wozniak" (1229755648) 00:11:24.081 --> 00:11:40.409 Alright, thank you for that, Julia. So just to detail some additional findings and then we'll get into more of a discussion here. Our 5th finding was related to that in the lock zone assistance program or NCAP. So if you're unfamiliar with what NCAP is. 38 "Alyssa Wozniak" (1229755648) 00:11:40.409 --> 00:11:59.399 As a program run by New York state. Again, like Julia mentioned, it covers about 40 % or $40 excuse me, of a copay for somebody's NO longer Narkin provided it is billed to their insurance in the 1st place. So it kind of picks up the extra, e.g., if you had a coupon card for a medication in the pharmacy but they. 39 "Alyssa Wozniak" (1229755648) 00:11:59.399 --> 00:12:19.399 Ran it to your insurance 1st. It helps pick up some of that extra. Alright, so with that said, you know, that's a great thing, that's a great program for our patients. But when we secret shocked this, only 4 % of our pharmacies actually mentioned NCAP at the counter. So after the meeting that somebody showed up, they brought in our can there, asked for it. 40 "Alyssa Wozniak" (1229755648) 00:12:19.399 --> 00:12:37.679 The counter. And they were like, oh, you know, hey, I'll build this to your insurance, let me build it to them or to end cap excuse me, so that only happened 4 % of the time. Some other pharmacies were able to kind of talk about this with our secret shoppers once we prompted them, we gave them a flyer and said. 41 "Alyssa Wozniak" (1229755648) 00:12:37.679 --> 00:12:54.119 But if they don't mention it, show them this flyer, see if it rings the bell, if it's something that they're gonna use in the pharmacy. So once we did that, there was an additional 36 % that were able to give a little bit of information, talk about it. It doesn't necessarily mean they even build it. We only had a couple pharmacies where they tried to build at the end cap. 42 "Alyssa Wozniak" (1229755648) 00:12:54.119 --> 00:13:12.539 But regardless of that, 60 % still were unable to, I guess, give any information about NCAP or take it farther to the billing stage. This was a common source of confusion for our pharmacies that the shoppers noted. A lot of pharmacies told them the products they have on hand are not eligible for NCAP. 43 "Alyssa Wozniak" (1229755648) 00:13:12.539 --> 00:13:32.539 When we talked to New york State it's actually supposed to be that everything covered under the standing order that pharmacy is signed on to is covered, so there's a little bit of a mismatch there, and then also they didn't know is their pharmacy eligible to enroll? Is their pharmacy enrolled, so we investigated this a little bit further and cap enrollment does lapse for pharmacies after a year of an activity. 44 "Alyssa Wozniak" (1229755648) 00:13:32.539 --> 00:13:51.809 And so folks might not know they're not signed up and kind of contribute to that confusion. And that said, we went through the enrollment process as a test. The information that you need to re enroll, is not necessarily readily available to most of your pharmacists that are working a day to day shift. Some of it is. 45 "Alyssa Wozniak" (1229755648) 00:13:51.809 --> 00:14:11.809 But not always. So that said while you can kind of sign up on the spot, pharmacies may not be able to because they won't have all the numbers basically that are needed to do so. So the impact of this is of course that our eligible patients will either leave with a higher copay than they would have had if they were run through this program or pay out of pocket or just leave without NO. 46 "Alyssa Wozniak" (1229755648) 00:14:11.809 --> 00:14:28.439 So, and when really this is a program that's supposed to be, you know, in our pharmacy and helping our patients speaking to that a little bit more, I mentioned NCAP is something that we use when we bill it to insurance this lock zone. 47 "Alyssa Wozniak" (1229755648) 00:14:28.439 --> 00:14:48.439 In order to do that, of course we can have a prescription sent by the provider, we'll fill it just like anything else, your Maxicilin, e.g.. But also as long as your pharmacy is signed up or signed onto a standing order, which Julia mentioned, just allows you to dispense it without a prescription as part of a public health matter basically, not unlike we do with flu shots. 48 "Alyssa Wozniak" (1229755648) 00:14:48.439 --> 00:15:09.389 Your process, right? You can just show up to the pharmacy and get what you came for it. It's a flu shop. It's a similar process. So when we looked at that standing order a little bit further, we read some of the things that are required by for pharmacists to do when they're signed onto that standing order, and one of them has to do with counseling. So there are several things that. 49 "Alyssa Wozniak" (1229755648) 00:15:09.389 --> 00:15:29.389 Our pharmacists should be educating on what in the lock zone is, a little bit about how it works so that patient know it safe even if, you know, it doesn't happen to be in a lock zone and it's not an overdose that they're experiencing, so they know it's still safe to try those kinds of things. Risk factors for overdose signs of overdose, how to respond, calling 911, and then how to access for. 50 "Alyssa Wozniak" (1229755648) 00:15:29.389 --> 00:15:52.609 Other treatment and support. So those are things that our standing order does require us to counsel on, but that said, for the most part, our pharmacies were only giving a brief explanation. I can get into a whole host of reasons that this could be, you know, from being busy to all sorts of things, right? So of course there's several reasons this kind of occurred, but what we observed then in practice is our counseling really just looked at device use so now. 51 "Alyssa Wozniak" (1229755648) 00:15:52.609 --> 00:16:16.739 96 % of the time we did tell our patients how to use it, which is great. So we talked about how to insert the nasal spray, how to deploy it, all of that. So that's good. But really rarely did we cover recognizing an overdose the importance of calling 911, so that was 39 % and 21 % respectively. And then when we get into risk factors, response steps, information to connect them to treatment and support, that was really rarely addressed. 52 "Alyssa Wozniak" (1229755648) 00:16:16.739 --> 00:16:36.739 So while our secret shoppers did perceive our pharmacy staff, you know, whoever they talked to, whether it was technicians, front end staff or pharmacists as knowledgeable, we did have a good performance there and they were also perceived as professional or supportive. We did see kind of these gaps in consistency in counseling, which the standing order does require. 53 "Alyssa Wozniak" (1229755648) 00:16:36.739 --> 00:16:55.949 So that's something to, to note because our patients or clients, whoever they maybe, they maybe leaving without all of the knowledge that's needed to safely respond in an emergency and really use that in a lockstone to its best capability. And also to kind of go along with that, if somebody's purchasing this over the counter unless there is. 54 "Alyssa Wozniak" (1229755648) 00:16:55.949 --> 00:17:11.819 Flyers situated there, maybe a QR code, do a video about how to use it unless they read the packaging insert and that over the counter medication like you would for thailan all, e.g., the drug facts box unless they do those things or bring it back to the pharmacy and say, hey, how do I use this? 55 "Alyssa Wozniak" (1229755648) 00:17:11.819 --> 00:17:29.789 When you buy something over the counter, they're not gonna get that counseling, right? Just how like you can walk into Walgreens by thailan all and go on your way. So that OTC pathway while really good for access can remove some of that education opportunity as well. So we thought, you know, perhaps this means there is a need for some simple practical standardized counseling tools. 56 "Alyssa Wozniak" (1229755648) 00:17:29.789 --> 00:17:46.709 In pharmacies. Do we put them over the counter? Can we put them back in the pharmacy counter, hand them out with the lock though and things like that because whatever the reason is, the counseling isn't happening. And then kind of to wrap up the last couple of findings here. Another thing that we found which was interesting. 57 "Alyssa Wozniak" (1229755648) 00:17:46.709 --> 00:18:03.899 Is that different factors within our pharmacies is actually associated with some of our overdose outcomes in the neighborhood, which are really just gonna speak to like we all know, why it's important to have other access barriers. And I saw on the chat somebody mentioned, hey, in, in our county, we have this program, this program. 58 "Alyssa Wozniak" (1229755648) 00:18:03.899 --> 00:18:23.129 Great. So some of these pharmacy operation characteristics are are gonna just reinforce why those are important. So we did find things like hours of operation. So e.g., whether pharmacies are open on the weekend, whether they're open on Sundays, whether they sell in a lockdone online, we know chains probably sell in the lockstone online, right? Like I can go to Walgreens buy anything online. 59 "Alyssa Wozniak" (1229755648) 00:18:23.129 --> 00:18:43.129 If I go to my mom at pop, they probably don't even have a website so I can't do that, right? And then pharmacy types so independence versus chain versus grocery. We found that those characteristics were actually associated with the higher overdose death zip codes as well. So our communities with those limited pharmacy access points, whether it was online access by. 60 "Alyssa Wozniak" (1229755648) 00:18:43.129 --> 00:19:01.019 Where it was open on Sundays, things like that, they tended to have higher overdose burden, which just speaks to, we need these other alternate pathways as well since we can't mandate, you know, those operational things for all these. So all these other programs we have, you know, from the county or from these other programs in your community to access the lockdone. 61 "Alyssa Wozniak" (1229755648) 00:19:01.019 --> 00:19:18.509 Are obviously huge and, and a really big need. And then our last couple of findings here are related to just kind of that cost barrier. Just to speak to that a little bit more, we actually see cost barriers that affect both patients and the pharmacies. So like we kind of mentioned. 62 "Alyssa Wozniak" (1229755648) 00:19:18.509 --> 00:19:36.389 With our prescription where we run the lock zone, either through a standing order or through a prescription for a patient, we can then bill their insurance and we can bill end cap. When we have a prescription, we can do that, but if you don't have insurance, well then you're still subject to that full cash cost and cap. 63 "Alyssa Wozniak" (1229755648) 00:19:36.389 --> 00:19:53.849 Can't cover those folks because NCAP is only a secondary payer. If we try to run the full thing to endcap, it rejects, we can't cover anything for those patients. So basically they're left with over the counter in the lock zone costs or uninsured or maybe under insured patient. So that said, that's a big coverage gap in our community. 64 "Alyssa Wozniak" (1229755648) 00:19:53.849 --> 00:20:12.479 And then in addition, we did see some cost variations across our different pharmacies. So our grocery pharmacies tend to be a little bit more expensive, maybe closer to the $60 range. Independence did tend to have lower pricing that was significant across the pharmacy type. So that's something to consider if your patient's outsourcing. 65 "Alyssa Wozniak" (1229755648) 00:20:12.479 --> 00:20:30.359 The lock zone in the community and looking to keep that on hands when we're talking about that OTC cost, and it could help with those folks that are maybe uninsured. That said, looking at the pharmacy side of things and some of the cost barriers for pharmacy, pharmacies actually lose money on insurance reimbursement. 66 "Alyssa Wozniak" (1229755648) 00:20:30.359 --> 00:20:50.359 For the lockdone depending on the payers, so we tried to run some test claims to our pharmacy, we actually found that we lost about $15 when we tried to provide somebody with the lockdone, which, you know, when we have prescriptions for things, we're gonna get it to the patient NO matter what, whether we take a loss or not, right? But when you think about that, it's it's really a broader systemic problem. 67 "Alyssa Wozniak" (1229755648) 00:20:50.359 --> 00:21:16.079 But it could potentially discourage like this broad stocking, the proactive nox zone efforts, so you might think, hey, you know, dispense No zone with everybody on an opioid, right? If we're not seeing this, this could be a barrier to something like that because if you lose $15 a lot of times it could become a problem. So the implication of all this is that our uninsured folks may need some alternative access points, which, we do have some programming for that in the community, which is great. 68 "Alyssa Wozniak" (1229755648) 00:21:16.079 --> 00:21:36.079 And then pharmacies may need some of that financial operational support to kind of sustain access in lobby for some of that systemic fix that we need to see. But kind of wrapping this up just to think about, you know, how can we improve access together? I'm sure there's things we're already doing, so we're gonna get kind of through these points and then we'll open it up to just allow. 69 "Alyssa Wozniak" (1229755648) 00:21:36.079 --> 00:21:59.749 There's a little bit of discussion here where I'm sure we're gonna brainstorm some other good thing. But before we kind of get to that, these are just some thoughts that we had kind of looking at this. So we thought, you know, what could community facing providers do to maybe assist with some of this and we thought maybe one important thing would just be helping to improve our navigation for clients. So, we do a lot of. 70 "Alyssa Wozniak" (1229755648) 00:21:59.749 --> 00:22:26.369 Social need work in our pharmacy, where we figure out, you know, do people need access to food, do people need access to housing, whatever it is. So we kind of keep a resource notebook of like where to quickly refer people. We thought, well, maybe one thing we could do is, in your areas for the clients you're serving, for the patients that you're serving, just knowing, you know, where they can easily access the lockstone. You know, so and so always said they can get it at this pharmacy, NO problem. We can help provide some of that data, right? So. 71 "Alyssa Wozniak" (1229755648) 00:22:26.369 --> 00:22:46.369 If you kind of know that, it might be easy to help point somebody in the right direction or give options, of course cause we're talking about, you know, referring patients to different places and with pharmacies you have to give different options, just like you would with any care, but then also teaching clients and community members kind of what to expect with the pharmacy. So if you say, hey, you know, go pick up the Lockman with the pharmacy. 72 "Alyssa Wozniak" (1229755648) 00:22:46.369 --> 00:23:06.619 Not necessarily that easy. So where do they look? They can look over the counter, but if they do, they're gonna have to pay 40 to $60. So if they don't want to, bring it back to the pharmacy counter, ask to bill insurance, and also ask to bill end count. So these are just some quick things that we can teach patients or if they come back to you and they say, Yeah I tried to get in the lock zone I thought I needed a pharmacy to. 73 "Alyssa Wozniak" (1229755648) 00:23:06.619 --> 00:23:24.839 Don't have it. Well it's not that simple, so maybe we can just provide some quick counseling and we'll have some handouts that will be shared with you just to kind of go through that. So kind of helping clients overcome these real world barriers might be nice. So just coaching your clients, you know, ask the pharmacy to run the lockstone through the standing order if they can't find an OTC. 74 "Alyssa Wozniak" (1229755648) 00:23:24.839 --> 00:23:39.989 If they have a high copay asking to bill it through insurance, ask to build through, and then if you see access barriers and you see a trend, I'm not sure where we should report it, but we probably should so that we can coordinate solutions cause that's kind of what we found here is that there are barriers and need to work to fix them. 75 "Alyssa Wozniak" (1229755648) 00:23:39.989 --> 00:23:59.159 We'll also get a little bit into what we think we could do to assist, but, other than that, we also just thought of maybe strengthening our community pathways, so if you already keep resource lists for certain things, maybe social needs, e.g., yeah, keep a resource list maybe for nox zone, where can they easily get in a lock zone and you probably already do, right? You probably have. 76 "Alyssa Wozniak" (1229755648) 00:23:59.159 --> 00:24:19.159 Your program that gives the lockbone through the county or whatnot, but if there's a couple pharmacies in your area where they could get it easily, you know, toss those on as well. So kind of just supporting those awareness efforts to teach somebody, you know, where can I go to get the lockdone? And then as far as clinicians and prescribers, we thought, you know, what can we do to make pharmacy pick up? 77 "Alyssa Wozniak" (1229755648) 00:24:19.159 --> 00:24:47.309 Here for patients, we thought, I guess you could consider prescribing the lock zone even though it is OTC and even though we have the standing order, why? Well, sometimes pharmacies are not signed up for the standing order. Sometimes their standing order enrollment has lapsed. Sometimes they need to re enroll in other things but if you send a prescription every time, it removes all those barriers. Of course that's clicks on your end, but maybe your EMR has like a, a setup where you can send that. 78 "Alyssa Wozniak" (1229755648) 00:24:47.309 --> 00:25:03.029 As a bundle with an opioid I don't know. But those are just some ideas that we had because that then avoids issues with pharmacies not being under the standing order, not knowing what to do, and sometimes it just depends who you talk to at the pharmacy and whether they know how to direct you the right way, which is unfortunate, but. 79 "Alyssa Wozniak" (1229755648) 00:25:03.029 --> 00:25:19.079 And if you have the time when you're working with your patients, just a brief counseling moment, any little point that you can relay will help ensure that they get additional counseling on how to use it, whatever it is, on top of whatever the pharmacy can provide. So all that would support any pharmacy, workload. 80 "Alyssa Wozniak" (1229755648) 00:25:19.079 --> 00:25:39.079 You can always encourage your patients, like the pharmacists should tell you how to use this. If they don't ask. A lot of times their patients come to the counter, any questions? Nope. But encourage them, talk to the pharmacist, you know, make sure they tell you how to use it. This is why it's important so that they know that that's a resource for them, and then also telling them about the ENDCAP program. You know, if you have a flyer on hand about ncap. 81 "Alyssa Wozniak" (1229755648) 00:25:39.079 --> 00:26:00.899 Not give them that because the pharmacy may not know what they're talking about otherwise, it'll save them $40, which is great. And then also, same thing, if you have an issue, a prescriber with a certain pharmacy, every time you send a lock zone there, it's a problem. Patients met with stigma, whatever it is, they never fill it, it's ever in stock, somehow report on that, so we can, you know, address that at a system level. 82 "Alyssa Wozniak" (1229755648) 00:26:00.899 --> 00:26:17.039 And then lastly, I think at a county level or systems agency type level, just thinking about, well, how do we address those pharmacy level gaps? Obviously we need to reinforce our standing order requirements with our pharmacies and talk about those counseling things that need to be covered. 83 "Alyssa Wozniak" (1229755648) 00:26:17.039 --> 00:26:37.039 Maybe consider providing them some educational materials. New York State does have a birth control access program where pharmacists prescribe under our standing order. And one thing that's nice about that program is all the birth control counseling is like there. You just give it to your patients, so perhaps we could do something like that with NO Laxman can and some of that probably exists, it may just not have made it to every pharmacy, right? 84 "Alyssa Wozniak" (1229755648) 00:26:37.039 --> 00:26:53.639 Right. So that's all good things. And then also ncap. We maybe have a new ncap re enrollment strategy. Let's get all our pharmacies back re enrolled if it fell off and you didn't know, things like that. And then lastly encouraging our pharmacies to publicly display where is NO Oxfun available in your store. 85 "Alyssa Wozniak" (1229755648) 00:26:53.639 --> 00:27:10.499 Is it just over the counter? Is it just behind the counter? That way they don't leave, can't find it left, you know, so it can help that visibility can help with some of that navigation. And then also we found we need more support in our independent pharmacies and then our rural in urban hotspots where we found some pockets, so. 86 "Alyssa Wozniak" (1229755648) 00:27:10.499 --> 00:27:29.909 We have wall boxes, vending machines, all of that, so just making sure they're in those hotspots and I'm sure they are. So those are all great things. Maybe we could have a countywide in the lack zone access map. The state has one, but there's some holes in that one. Not everybody in your county was there, so maybe we could have something like that, which would be great. 87 "Alyssa Wozniak" (1229755648) 00:27:29.909 --> 00:27:45.719 And maybe we can advocate for NCAP, you know, increase or what do we do for those uninsured patients? Can we give them $40 even though they're uninsured too, right? Does it have to go through insurance 1st? So just some things to think about from an advocacy standpoint that could help. 88 "Alyssa Wozniak" (1229755648) 00:27:45.719 --> 00:28:02.669 I'm sure there's barriers to all of these things and people have tried, but just to mention. So kind of in conclusion, we did find that nolockstone varies widely by pharmacy type, zip code, and then major gaps in our independent rural and then some urban hotspot pocket areas. 89 "Alyssa Wozniak" (1229755648) 00:28:02.669 --> 00:28:22.669 And that was mostly related to standing order confusion and cap use. So Juana or Narque was available. These things actually made the process harder and and things like that for our patients. So we would love to partner with whether it's Irie county, new York state. We've talked to New org State a little bit about their end CAP program already to kind of strengthen these pharmacy workflows, put a big pushback. 90 "Alyssa Wozniak" (1229755648) 00:28:22.669 --> 00:28:46.219 Talking with the pharmacies to make this another focus again. So we would love to assist with some of that and we think it's important as well. But we'd love to know, you know, how can we help your organization? What are you seeing in the community? How do you think pharmacies could help, things like that. So we know that improving access in pharmacy, it's a pharmacy problem, but multi sector collaboration helps because while I know the pharmacy world, you might find. 91 "Alyssa Wozniak" (1229755648) 00:28:46.219 --> 00:29:11.601 Something all the time when your patient tries in a lock zone, and I don't I don't know about it, so if we could share that here today, I think that that's a good thing. So with that said, that's kind of where I was gonna conclude the presentation. So our contact information is here, but yeah, just, you know, what can we help with further or what are you seeing in the community if we have time for discussion? 92 "Ables, Lee" (433469440) 00:29:11.601 --> 00:29:45.219 I think we can give folks a couple minutes to see if there's any lingering questions or thoughts, there is someone who mentioned something about wondering how effective education or counseling coming from pharmacists who seem to be operating with a large negative bias might be, and if this would pose a larger deterrent, then it would be helpful, which I think is interesting to think about and if you guys have any thoughts on that, but if anyone else has additional thoughts or questions. 93 "Ables, Lee" (433469440) 00:29:45.219 --> 00:29:50.363 Please feel free to add them into the chat before we move on to Eri County data. Yeah. 94 "Alyssa Wozniak" (1229755648) 00:29:50.363 --> 00:30:05.500 Let me just make sure I understand the question. So the question is, I'm sure I could probably find it in the chat, but it's related to if somebody does have a negative bias perhaps, and they end up providing more counseling, would that help her hinder? Is that kind of the question? I'm just taking through. 95 "Ables, Lee" (433469440) 00:30:05.500 --> 00:30:20.186 Yeah, it's essentially saying like if the pharmacist is coming with a negative lens to counseling that, that individual, is that going to help or hurt the situation? 96 "Alyssa Wozniak" (1229755648) 00:30:20.186 --> 00:30:42.689 That's a good question. I'll offer my thoughts and i'll turn it over to Julia if you have any others. So I guess the good news is when we looked at our pharmacy, looking at the sort of attitude and behaviors of the pharmacy, like did you feel stigma? Things like that. I think it was like 80 %. Everybody kind of in that said NO, but we did still have a small percentage that. 97 "Alyssa Wozniak" (1229755648) 00:30:42.689 --> 00:31:01.589 Maybe they felt a little bit, you know, judged or like their mystigma or, you know, things like that. So there is still a little bit for that potential in our, our pharmacist population. It could also depend who they talk to. So I guess I shouldn't say just pharmacists that could be, you know, front end, but regardless it's happening in pharmacies. 98 "Alyssa Wozniak" (1229755648) 00:31:01.589 --> 00:31:16.739 So yeah, I think you raised a good question cause there is potential for that given we did see that percentage. There was NO differences across pharmacies or geography or anything like that. But I guess for that reason, that's why I'm thinking if we can provide some standardized information. 99 "Alyssa Wozniak" (1229755648) 00:31:16.739 --> 00:31:31.799 Kind of like we do with our birth control prescribing program, it could help with that because that one it's prescriptive. It's like you give them, you give the patient this and you tell them this, and here's all the information that they need about how to use. 100 "Alyssa Wozniak" (1229755648) 00:31:31.799 --> 00:32:00.503 On that particular birth control, e.g.. So I think that that kind of could help if it was included with that standing order. And then in addition, when people sign on to those standing orders, they usually are doing that because they want to improve access to the patient. So I think that's probably why we do see pretty much a good performance in that category, but yeah, there was a small percentage where we did see a little bit of potential for that. But I'll turn it over to Julia in case you have other thoughts on that matter. 101 "Julia Vicaretti" (3055158016) 00:32:00.503 --> 00:32:27.589 Yeah, so kind of building off of that, I do think what we saw was that most pharmacists were at least like supportive or neutral, which is a good thing. But I know just to kind of contri continue to, I guess bridge that gap in like knowledge and empathy and understanding. I know like with our flu shot standing order, we all have to attend like a continuing education before the standing order goes into effect, so I feasibly I don't know. 102 "Julia Vicaretti" (3055158016) 00:32:27.589 --> 00:32:46.784 Why we couldn't do something similar, but more focused on like coming at it from like the stigma, and like opioid use disorder as like a disease not as like a character flaw, like those types of interventions just as an education standpoint, just to make sure we're all on the same page. 103 "Alyssa Wozniak" (1229755648) 00:32:46.784 --> 00:32:51.585 That's great. Thank you. Let's see. 104 "Julia Vicaretti" (3055158016) 00:32:54.268 --> 00:33:18.103 Let's see Stacey said, as a care coordinator, it would be helpful to have seminars available to explain mental health medication especially and also symptoms to look out for such as flucinations that happened with a client med change recently. Oh via sitements that's all different worlds. Yes, it's there's, I love the concept of like, I don't even know, like a lunch and learn about meds. 105 "Alyssa Wozniak" (1229755648) 00:33:18.103 --> 00:33:39.959 Yeah, I think that could be great. And a lot of times those things go hand in hand even with a topic like this, so it all ties together. Yeah, we do see that frequently in pharmacy, certainly a high need population, so I agree there's a, there's a need. 106 "Alyssa Wozniak" (1229755648) 00:33:39.959 --> 00:33:59.959 Asthma and hailers and albuteral vials can have milk proteins. I'm curious about this as clients with dairy allergies who have asthma. Yeah, we can, I don't know if you wanna put your email in the chatter directly to us. We can kind of. 107 "Alyssa Wozniak" (1229755648) 00:33:59.959 --> 00:34:22.724 Look into that and provide you some information if you're interested Stacey and send it to me or Julia and we can follow up with you. We're we do know other pharmacy things, so we're happy to share if you do have other questions. Okay, I'll take that down. We'll connect with you. 108 "Frank, Jordon" (239741696) 00:34:23.421 --> 00:34:33.764 It looks like that's it. Did anyone else have any other additional questions or things that came up during the presentation? 109 "Alyssa Wozniak" (1229755648) 00:34:33.764 --> 00:34:54.319 And then I will note, we put together just like a quick, how to for that process of where people can find the lock zone over the counter or, whether it's behind the counter the questions to ask about their insurance. So we put together a version that is, I guess, more provider facing or community, worker facing that you could kind of take. 110 "Alyssa Wozniak" (1229755648) 00:34:54.319 --> 00:35:08.158 To look at to help your patients know what to ask and then we also put together one that you can hand out to your patients, so I saw somebody posted that those will be shared out to you so can look out for that as well if there's a need for that in your population. 111 "Frank, Jordon" (239741696) 00:35:08.158 --> 00:35:26.719 Thank you so much, Alyssa and Julia. This was incredibly helpful Local data in regards to access, I mean local data in general in public health is always superior, so I'm very excited and to learn. I was very excited to learn about this. Thank you so much for sharing. 112 "Frank, Jordon" (239741696) 00:35:26.719 --> 00:35:46.429 Feel free to reach out if you have any additional questions and we will definitely be sharing all of the information that Alyssa and Julia spoke about in the newsletter. Next up we have our data analysts Jason, to share some updates and data. 113 "Meurlin, Jason" (1216354304) 00:35:46.429 --> 00:35:51.549 Yes, 1st of all, can everybody hear me, ok? 114 "Frank, Jordon" (239741696) 00:35:51.549 --> 00:35:53.997 We can hear you Jason. 115 "Meurlin, Jason" (1216354304) 00:35:53.997 --> 00:35:57.144 Great, and are the slides coming up? 116 "Frank, Jordon" (239741696) 00:35:57.144 --> 00:35:59.647 They are. 117 "Meurlin, Jason" (1216354304) 00:35:59.647 --> 00:36:07.229 Okay, awesome, maybe just enter presentation mode. 118 "Meurlin, Jason" (1216354304) 00:36:07.229 --> 00:36:31.249 Alright, so welcome. That was an incredible presentation, a lot of great research there from the evil and hope to see lots more studies like that. So for this week or this month, we're gonna start with going over the overall overdose depth picture, then we're gonna compare to the statewide. 119 "Meurlin, Jason" (1216354304) 00:36:31.249 --> 00:36:54.229 We're gonna look at overdose death demographics, overdose death toxicology, and then new for this month we're gonna be doing a deep dive on opioid related death toxicology, looking at what else besides Sentinel is in the drug supply. Then we're going to be looking at overdose deaths by zip code, our non fatal overdose reporting frequency, non fatal overdose location, and then a. 120 "Meurlin, Jason" (1216354304) 00:36:54.229 --> 00:37:00.419 Parathon of the location of non fatal versus fatal overdoses. 121 "Meurlin, Jason" (1216354304) 00:37:00.419 --> 00:37:18.539 So in 2025 so far, with cases reported through 11 December, we have 224 overdose deaths in the area County for the year. A hundred and 55 are suspected to be overdo opioid related. A hundred and 33 are confirmed opioid related and 22 are still waiting for toxicology. 122 "Meurlin, Jason" (1216354304) 00:37:18.539 --> 00:37:35.189 And 69 are confirmed to be non opiate related. So once again we are still looking at most likely coming in at under 250 for the year with the year almost being over, so we're we're on par for another substantial decrease year over year, from 2024. 123 "Meurlin, Jason" (1216354304) 00:37:35.189 --> 00:37:58.189 Comparing to statewide trends, this is looking at the number of overdose deaths that have occurred in the past twelve months from the each respective month. So for the twelve month period from December 2020 4th through November 2025, we experienced 234 overdose deaths, which is a 36 % decrease to the twelve month period prior ending in. 124 "Meurlin, Jason" (1216354304) 00:37:58.189 --> 00:38:20.149 November 2024. We have not yet received new new New York State CDC data, but with the most recent data available, which was as of April, new york State was at a 37 % decrease, so our current decrease is right around that level. And it looks like we are approaching over levels of overdose deaths that we haven't seen pre pandemic, so. 125 "Meurlin, Jason" (1216354304) 00:38:20.149 --> 00:38:44.600 So on 2018 2019, we're at about those levels as of right now. So positive times looking at our overdose death in the graphics, you can see the black population is still disproportionately affected by overdose depth. Although the disparity is beginning to shrink. August 2023 July 2024, which is the orange bar, that was the. 126 "Meurlin, Jason" (1216354304) 00:38:44.600 --> 00:39:09.740 Of the disparity where we saw 35 % of our overdose death as part of the black community and in the most recent twelve months, which is the red bar, the death have been 23 % black. So there's still a significant disparity that exists, but it is happening closing each month. Now we're gonna look at the population adjusted demographics stuff. 127 "Meurlin, Jason" (1216354304) 00:39:09.740 --> 00:39:30.980 Population adjustments allowed us to see these distarities a little better and monitor them over time. And this is gonna show which groups are most disproportionately affected. The bigger the gap between these lines, the bigger the distarity is and as we mentioned, the distarity was largest in mid 2020 04:23 to 2024, but it has been. 128 "Meurlin, Jason" (1216354304) 00:39:30.980 --> 00:39:52.100 And in recent data, we see the Hispanic population is now the most disproportionately affected by overdose deaths. Although the rates of the Hispanic and black population are at the moment very similar. It looks like the decline in overdose deaths, the decline in the disparity has started to slow down a little bit. We're not seeing. 129 "Meurlin, Jason" (1216354304) 00:39:52.100 --> 00:40:13.290 Add of the decline in recent months that we were throughout most of 2025. So we will continue to monitor that and see how those rates evolve over time. Year over year from November from November of last year among the black population, we've seen a 54 % decrease in population adjusted deaths. 130 "Meurlin, Jason" (1216354304) 00:40:13.290 --> 00:40:33.290 A 23 % decrease among the Hispanic population and a 25 % decrease among the white population. So decreases across the board, although they might be showing kind of slowing if they need to monitor. Looking at non opioid deaths specifically, which are largely cocaine related. 131 "Meurlin, Jason" (1216354304) 00:40:33.290 --> 00:40:56.420 We see that the racial distarities remain large despite a recent decrease. So in mid 2024, we had seen a, very large large spike in non opioid deaths population adjusted among the black population. And since this is looking at a twelve month average, now that that those months have fallen out of that twelve. 132 "Meurlin, Jason" (1216354304) 00:40:56.420 --> 00:41:16.420 Twelve month window. We're starting to see that that that disparity started to come down. So we have not seen, you know, more opioid, more nonopioid deaths in recent months to to make up for that spike in mid 2024. We have now seen that rate of of racial disparity decreased to. 133 "Meurlin, Jason" (1216354304) 00:41:16.420 --> 00:41:38.180 Levels we saw in like 20 2021. So we have significantly come down in the peak in mid 2024, and we'll continue to answer but it looks like we might be approaching a a lower steady state of disparity. It'll be interesting to see if this continues a sharp decline or if we level out at around this. 134 "Meurlin, Jason" (1216354304) 00:41:38.180 --> 00:41:58.290 Current level, which is still a significant large disparity. Looking at age demographics, that's for overdose death, we can see that the 40 to 49 age groups is still the most disproportionately affected, and the declines and death rate across the board seem to be slowing a bit. 135 "Meurlin, Jason" (1216354304) 00:41:58.290 --> 00:42:18.290 Interestingly, we have, we do see somewhat of a convergence among the 50 to 59 age group and the 30 to 39 age group. The 50 to 59 age group, which is that dark gray line is has is continuing a sharp decline that it is has been when it has been declining rather sharply since mid 2020. 136 "Meurlin, Jason" (1216354304) 00:42:18.290 --> 00:42:36.900 Four, Whereas among the 30 demographic in their thirties, we're seeing that decline basically stopped and even uptake very slightly. So we're seeing that convergence among the 50 people in their fifties, people in their thirties, with people in their forties remaining the most disproportionately affected. 137 "Meurlin, Jason" (1216354304) 00:42:36.900 --> 00:42:52.140 People in their 2020s and younger have reached all time lows regarding population invested over those deaths and the 60 and older demographics so older adults is starting to flow as well. 138 "Meurlin, Jason" (1216354304) 00:42:52.140 --> 00:43:15.870 So looking at the overdose death demographics in a, by age in a slightly different way, here we're looking at each aged bracket and the percentage of each aged bracket that is confirmed non opioid related versus opioid related. So we can see that for the 50 to 59 and the 60 and older age groups. 139 "Meurlin, Jason" (1216354304) 00:43:15.870 --> 00:43:35.400 Upwards of 40 % of those aged demographics were non opioid related deaths. Whereas for 40 to 49 and younger, it's 25 % or less. So there is a pretty stark difference in the age profile rather in the substance profile when we look by age. 140 "Meurlin, Jason" (1216354304) 00:43:35.400 --> 00:43:50.820 So we can we can see, very strong difference there, which we'll look at in some more detail here. This is looking at those population adjusted depths over time by age, and this is specifically for non opioid deaths. 141 "Meurlin, Jason" (1216354304) 00:43:50.820 --> 00:44:09.840 And we can see that that 50 to 59 age group, this lines up with that previous slide that we're seeing a very high disproportionate impact among the 50 to 59 age group. It increased throughout 2024 and it has remained relatively flat in recent months, but still the largest age group by far. 142 "Meurlin, Jason" (1216354304) 00:44:09.840 --> 00:44:26.640 In contrast, we saw the 60 in older aged demographic significantly decreased beginning in late 2024 and continuing to decrease in in recent months. So, yeah, with the those with the the. 143 "Meurlin, Jason" (1216354304) 00:44:26.640 --> 00:44:46.640 16 older age group declining such so so sharply. It's really the 50 to 59 aged demographic that's being predominantly affected by non opioid related deaths. Looking at our overall toxicology in the past twelve months with data available through. 144 "Meurlin, Jason" (1216354304) 00:44:46.640 --> 00:45:05.910 For September 2025. We can see that opioids and cocaine be both being detected in conjunction have decreased significantly over time in at the peak of our overdose deaths in 2023 58 % of our deaths were related to both opioids and cocaine, and now that's down to 37 %. 145 "Meurlin, Jason" (1216354304) 00:45:05.910 --> 00:45:24.480 Another 30 % is opioids only, which is up from 25 % in 2023, and we have seen an increase in cocaine only, where it was cocaine only in the absence of opioid, it's where 13 % of our overdose deaths in 2023 compared to 21 % in the most recent data. 146 "Meurlin, Jason" (1216354304) 00:45:24.480 --> 00:45:48.050 Oh at this over time, so this is the the basically that same pie chart that's stretched over time. The pie charts like a snapshot, and these line charts show how each life of the pie would has changed over time. So this allows us to see recent trends more clearly, and each point is an average over the past. 147 "Meurlin, Jason" (1216354304) 00:45:48.050 --> 00:46:09.540 Last six months, so we can we can analyze these trends and see what has changed. So when the most recent month of data that we've incorporated here, which is September of 2025, we saw an increase in both opioids and cocaine deaths, but the blue line both opioids and cocaine being detected. That's now close to 40 % of our overdose death. 148 "Meurlin, Jason" (1216354304) 00:46:09.540 --> 00:46:29.540 In contrast, we saw a decrease in opioid without cocaine. So opioids without cocaine decrease to 27 % of our dose deaths and other categories of cocaine only and other substances are remaining fairly the same. 20 % of our dose deaths were cocaine only, only in the absence of opioids and. 149 "Meurlin, Jason" (1216354304) 00:46:29.540 --> 00:46:51.860 13 % were other substances such as methan vetamine, benzodazophines and various other things. So that's the trend we'll tinue to monitor to see if that opioid at both the lines of both opioids and cocaine continues to increase or if we're gonna see a drop back down again to where to follow the decline that we had seen through most of 20. 150 "Meurlin, Jason" (1216354304) 00:46:51.860 --> 00:47:04.290 24 and 2025. So we'll continue to monitor that, but it is rather concerning that we're seeing this uptick in opiate and cocaine depth. 151 "Meurlin, Jason" (1216354304) 00:47:04.290 --> 00:47:24.290 So now to keep things fresh, we're gonna do a deep dive into our opioid related toxicology. So this is specifically looking at opioid related death and their composition. So in 2025 data, we can see that as a percentage of opioid related deaths, sentinel decreased rather significantly and other opioids increas. 152 "Meurlin, Jason" (1216354304) 00:47:24.290 --> 00:47:44.610 Increased pretty significantly while heroin fell to an alzheim low. It's important to remember while we're looking at opioid these opioid related data that the majority of our opioid related deaths involve two or more substances, often fencinel, but even within that other opioid category, we'll often see multiple different opioids being detected. 153 "Meurlin, Jason" (1216354304) 00:47:44.610 --> 00:48:00.270 So it's important to keep in mind that these categories often overlaps. In 2024, we saw 238 ventinal related deaths compared to 101 in 2025 year to date, and just once again. 154 "Meurlin, Jason" (1216354304) 00:48:00.270 --> 00:48:20.270 Data for 2025 is not yet complete, but we are getting close. And when we're looking at that other opioid category, we saw 33 in 2024 and about 30 in 2025 year to date. So it's not so much that the other opioid debts are going up. This is more a product of the sentinel related debts going. 155 "Meurlin, Jason" (1216354304) 00:48:20.270 --> 00:48:37.140 Down. So as the fencinal related deaths go down, the other opioids are making up a bigger portion of the pie. So now we'll look at that in a little more detail. So looking at death opioid related depths excluding those that are related to fencinel. 156 "Meurlin, Jason" (1216354304) 00:48:37.140 --> 00:48:57.140 We see similar rates of beeper northin, methadone, oxycodone, and hydrocodone. Each one had about seven or eight detections among all the overdose deaths with a good degree of overlap, and excluding pentinel we see very, very little tramitol or heroin. We can see that orange line is is heroin detections. 157 "Meurlin, Jason" (1216354304) 00:48:57.140 --> 00:49:27.020 And since roughly 2022, Heroin's been almost non existent in our drug supply or among overdose deaths in the deaths that exclude ventinal. When we look at deaths that include ventinal that will go up slightly, but yes, we will we'll examine that. Looking at deaths including ventinals, we can see we see more deaths from all these other opioids indicating that a lot of these deaths that were related to other opioids also involve. 158 "Meurlin, Jason" (1216354304) 00:49:27.020 --> 00:49:46.320 Fencinel. And in particular, we still see an increased frequency of methadone and traumadol compared to the non fensinal death. So as we mentioned in the previous slide, traumadol was almost non existent among the opia related deaths excluding fencinel, but when we include fencinel, we see quite a few more traminal deaths. 159 "Meurlin, Jason" (1216354304) 00:49:46.320 --> 00:50:06.030 As well as metadone deaths. However, however, for the other substance opioid opioid substances of orphine oxycodone and hydrocodone, we don't see a lot of those related to ventinal. Those those figures are roughly the same whether we look at the deaths that include or exclude ventinal indicating that most of them do not include ventinal. 160 "Meurlin, Jason" (1216354304) 00:50:06.030 --> 00:50:23.970 I had to remove the heroin lines from this graph because when we include the vessel related deaths, it actually would, would go off the chart this particular chart, so we'll look at that on the following slide. But for, for quite a few years, the majority, the vast majority of our heroin depth also involve vessels. 161 "Meurlin, Jason" (1216354304) 00:50:23.970 --> 00:50:44.310 So now if we had in fencinel, we changed, I changed it to a bar chart to make it a little easier to visual visualize. Sentinel still accounts for the vast majority of opioid related deaths, but on a positive note, the fence our fencinel related deaths have decreased dramatically from 2023 to 2025. 162 "Meurlin, Jason" (1216354304) 00:50:44.310 --> 00:51:04.310 In 2023, we saw upward of 300 deaths related to confessional and in recent data it's looking at right around a hundred, little over a hundred. So very significant decrease in fencinel related deaths. We can see heroin related deaths have also become pract practically non existent. 163 "Meurlin, Jason" (1216354304) 00:51:04.310 --> 00:51:12.150 And all the other opioids are basically divorfed by, by Fencinel. 164 "Meurlin, Jason" (1216354304) 00:51:12.150 --> 00:51:29.520 Interestingly, if we exclude cocaine related deaths, because as you know, we mentioned in our toxicality slides, many depths are related to both opioids and cocaine. But if we exclude those cocaine related deaths, we can see fencinal related deaths have been decreasing continuously since 2021. 165 "Meurlin, Jason" (1216354304) 00:51:29.520 --> 00:51:49.520 And now we in the absence of cocaine, we only, we have less than 40 deaths that are related to Fentanal in total. So a lot of the pentanil related deaths that we're still seeing are also related to cocaine. So that was our deep dive on toxicology, I hope that you found that. 166 "Meurlin, Jason" (1216354304) 00:51:49.520 --> 00:52:06.480 Interesting. Now moving on to overdose depth by zip code in the past six months from June 2025 to November 2025. The most just unfortunately affected zip code was 14215 on the east side, which forwarded. There we saw ten depths. 167 "Meurlin, Jason" (1216354304) 00:52:06.480 --> 00:52:27.830 Next we saw 142 oh one which is on the lower west side, where we had seven deaths 14212, which is near Broadway on the east side, also seven death, and then 6th deaths in South Buffalo, six deaths in Hamburg, five deaths in lacowana, and five deaths in West Seneca. 168 "Meurlin, Jason" (1216354304) 00:52:27.830 --> 00:52:47.960 Lacowana is a new one. We had seen a lot of too many deaths there in quite a while. So this is the 1st time in, in a, in a good amount of time that we've seen lacouana cross that threshold of five deaths. So that's something we'll continue to monitor. But yes, as overdose deaths decrease, there's gonna be fewer. 169 "Meurlin, Jason" (1216354304) 00:52:47.960 --> 00:53:01.560 And fewer zip codes that are gonna meet that threshold of five deaths in this six month span, so it'll be easier to focus on individual individual locations for to reduce those depths further. 170 "Meurlin, Jason" (1216354304) 00:53:01.560 --> 00:53:21.560 Looking at comparisons over time, we're seeing so on the left we have the six month window from December 2024 to May 2025 on the right, the one we just looked at June 2025 to November 2025, areas where we're seeing increasing overdose deaths include 14215 on the east side, 14212 near. 171 "Meurlin, Jason" (1216354304) 00:53:21.560 --> 00:53:44.820 Broadway, 14218, which is lacouana, and Hamburg which is 14075. Areas where we're seeing decreasing overdose deaths include 14207. That's the blackrock riverside area, and that is particularly notable because the black rock area is where we see a very high concentration of our overall overdose reporting and usually our highest concentration of death. 172 "Meurlin, Jason" (1216354304) 00:53:44.820 --> 00:54:04.820 So the fact that we are we're seeing significantly fewer there and the really positive sign and is quite unexpected. 14211 is also on the east side of Buffalo near Genesis street. There we also saw a decrease in death, and 14203, which is a strange one because that's what other code we're. 173 "Meurlin, Jason" (1216354304) 00:54:04.820 --> 00:54:21.300 A lot of people actually live. It's, south of downtown Buffalo it's kind of in the outer Harbor area, and we saw a decrease in overdose deaths there. 174 "Meurlin, Jason" (1216354304) 00:54:21.300 --> 00:54:41.300 Now looking over at our non fatal overdose reporting, which is compiled for us by our local Heida office, and we thank them very much as always for the diligent work they do in collecting these reports and sending them over to us. They were they received these reports daily, they aggregate them from law enforcement reports and emergency service calls. 175 "Meurlin, Jason" (1216354304) 00:54:41.300 --> 00:55:01.300 And they send them to us for overdose response and planning of outreach. It's important to note that not all overdoses are reported. There's a significant degree of under reporting and often people will, you know, take care of a bystandard will handle the overdose or someone else will handle it, you know, a family member will handle handle it or something, and it doesn't end every. 176 "Meurlin, Jason" (1216354304) 00:55:01.300 --> 00:55:09.210 Or end up getting reported to law enforcement. So it's important to note that this is not the full picture of overdose of the New Year county. 177 "Meurlin, Jason" (1216354304) 00:55:09.210 --> 00:55:29.210 We typically typically see two to three reports per day, and even though overdose deaths are down, our non fatal reports are still in that range. In recent weeks we pushed towards the bottom of that range of about two reports per day. A few months ago we were pushing the top of that range towards near three reports per day. 178 "Meurlin, Jason" (1216354304) 00:55:29.210 --> 00:55:55.950 But we're still kind of in our normal range, which is interesting considering the the significantly decreased rate of overdose deaths. Looking at our shifts in nonfatal reporting over time by zip code, so we've got six months, six month windows of December 2024 to May 2025 on the left, June 2025 to November 2025 on the right, and we've seen a couple of significant shifts. 179 "Meurlin, Jason" (1216354304) 00:55:55.950 --> 00:56:15.950 Most notably I think the landfactor and the few areas, which is 14043 and 14086 suburbs bordering the east of the east of the city. That there we've seen an increase in our nonbatal reporting, where they didn't meet the threshold. 180 "Meurlin, Jason" (1216354304) 00:56:15.950 --> 00:56:48.080 Reporting in the previous six month window, but recently they have. We've also seen an increase in reporting in the Springviell area, 14141, kind of a more rural zip code. And then aside from that we saw increased reporting on the east side of Buckalow, particularly 14211 and 14215, and broadly on the west side and including blackrock. So that's that block of three that we often talk about, 142-071-4213 and 14201. So the. 181 "Meurlin, Jason" (1216354304) 00:56:48.080 --> 00:57:09.000 All the way up through BlackRock saw increased reporting. Also, the Aggretsville area within Ampherst 14226. We saw an increase in reporting there, and firstly we saw a decrease in reporting in another area of 1st 14212221, which is kind of the Williamsville area. 182 "Meurlin, Jason" (1216354304) 00:57:09.000 --> 00:57:27.720 So some shifting in reporting within December group of am 1st. We also see a decrease in reporting in Grand Island. Kenmore and Hamburg. Hamburg is notable because we saw an increase in overdose deaths, but a decrease in overdose non fatal overdose reporting. 183 "Meurlin, Jason" (1216354304) 00:57:27.720 --> 00:57:47.720 So that's a caused for concern that we might be seeing some underreporting going on in Hamburg. And we also saw a pretty significant decrease in 14209, which is kind of right in the center of the city of Buffalo along main Street. 184 "Meurlin, Jason" (1216354304) 00:57:47.720 --> 00:58:03.150 So, as I mentioned, we typically see more non fatal overdose reports than overdose deaths in each each zip code. And so if zip over zip code overdose deaths exceed non fatal reports, that's the cause of concern and a potential indicator of under reporting. 185 "Meurlin, Jason" (1216354304) 00:58:03.150 --> 00:58:23.150 So we'll look at some of those zip codes that are caused for concerns. And it's most of the zip codes that we discussed in our overdose deaths by zip code, 14215 and 14215212, which is the upper east side and near broadway. Both exhibited a disproportionate number of deaths relat. 186 "Meurlin, Jason" (1216354304) 00:58:23.150 --> 00:58:44.300 Same with West Seneca and 142-241-4224 has in general had a disproportionate level of overdose deaths this year, and that's something we'll be continuing to monitor. Lack of onea, as we mentioned is also an area of concern where we haven't really seen too much reporting, but we saw. 187 "Meurlin, Jason" (1216354304) 00:58:44.300 --> 00:59:01.140 A significant number of deaths and hamburgred pretty significantly, really not a lot of reporting but a significant number of deaths. So just to summarize overdose this continues to decline, but non fatal reports are holding steady. 188 "Meurlin, Jason" (1216354304) 00:59:01.140 --> 00:59:16.410 Dissarities by race and ethnicity are still significant but decreasing. They remain large for non opioid related death although we did see a significant recent decrease. The age profile of our overdose deaths differs by substance. 189 "Meurlin, Jason" (1216354304) 00:59:16.410 --> 00:59:35.820 Our non opioid debt for non opioid substances, we predominantly see deaths among the 50 to 59 age group for opioid related deaths and overall overdose death is predominantly 40 to 49. We see a high concentration of death in the east side of Buffalo, the lower west side and West Seneca. 190 "Meurlin, Jason" (1216354304) 00:59:35.820 --> 00:59:55.820 And we're seeing overdose deaths decrease in BlackRock Riverside, the east side, particularly in your Genesy street, and the Outer Harbor south of downtown. And we're seeing more depths than we expected in West Aneca, Hamburg and the east side with Lacowana emerging as an area of concern with a high number of deaths all the. 191 "Meurlin, Jason" (1216354304) 00:59:55.820 --> 00:59:58.320 The reporting. 192 "Meurlin, Jason" (1216354304) 00:59:58.320 --> 01:00:18.320 As always I'm gonna plug my data webinars for our heat maps. If you're interested in digging a little deeper into the locations where we're seeing overdoses congregate, please join us for our quarterly webinar and you can scan this QR code or I'll drop the link in the chat. Our next one is in February. You can ask questions. 193 "Meurlin, Jason" (1216354304) 01:00:18.320 --> 01:00:45.788 Request specific maps and sign up for monthly heat map updates once your organization signs and returns an MOU indicating that you intend to keep the data internal. We've been sending out reports for a couple of months now and we've gotten some people seem to really enjoy them. So we would love to get those out to some more people. And, thank you very much. 194 "Frank, Jordon" (239741696) 01:00:45.788 --> 01:01:17.770 Thank you so much Jason. I didn't see any questions regarding Jason's presentation in the chat. I'm just gonna reiterate what Lee posted. We do have a little survey now for the end of our bridge area presentations. We on how you got the presentation went and if you would be interested in maybe presenting a bridge area at some point in the future, so we would really appreciate if anyone could fill that out. I know we all. 195 "Frank, Jordon" (239741696) 01:01:17.770 --> 01:01:24.066 In this public health space. Oh, there is a question Jason. 196 "Meurlin, Jason" (1216354304) 01:01:24.066 --> 01:01:43.130 Let me see. What are the non non opioid deaths in the other population. So there is definitely some alcohol in there although I'm not I'm not really sure if yeah NO problem. I'm not really sure if, if alcohol is just. 197 "Meurlin, Jason" (1216354304) 01:01:43.130 --> 01:02:07.646 Proportionate among the older population. For non opioid deaths, it is mostly cocained across the board and particularly in the older population. Maybe next time instead of doing a deep dive on opioid related depths, we can do that deep dive on the non opioid related substances, but it is predominantly going to be cocaine. 198 "Frank, Jordon" (239741696) 01:02:07.646 --> 01:02:26.880 Awesome, that would be helpful. It looks like Jason, something to consider for next month, for sure. Thank you so much for everyone coming and joining this afternoon. Again, please feel please help us out and fill out the survey, and we look forward to seeing you next month.