Tuesday, January 17, 2017

Air Quality Recess Guidance for Schools Now Available: Guidance helps principals know when to keep kids inside on bad air days

(Salt Lake City, UT) – With the first major inversion forecast to hit the Wasatch Front this week, parents may be wondering if it’s safe for their children to play outside during school recess. The Utah Departments of Health (UDOH) and Environmental Quality (DEQ) have released updated Recess Guidance for Schools to help principals and school administrators know when to move recess indoors on poor air quality days.

Inversions can be especially hard on children and anyone with certain chronic health conditions like asthma. During the winter, particulate matter (or PM2.5) is the main pollutant of concern as inversions trap cold air and pollution in the valleys. PM2.5 is made up of soot, dust, and vehicle emissions. It’s small enough to get past the body’s natural defense systems and when inhaled, can get deep into the lungs where it becomes trapped, aggravating current health problems. 

The Recess Guidance for Schools recommends that on days when the PM2.5 is:
  • Below 35.4 μg/m3 – All students stay outdoors for recess.
  • Between 35.5 μg/m3 and 55.4 μg/m3 – Students with respiratory symptoms and “sensitive” students stay indoors for recess. Sensitive students may include those with asthma, cystic fibrosis, chronic lung disease, congenital heart disease, compromised immune systems, or other respiratory problems.
  • Above 55.5 μg/m3 – All students stay indoors for recess.
First created in 2004, the Recess Guidance has undergone three major revisions as new research and air quality studies have been completed. Input about how to balance the need for physical activity and keeping children safe from unhealthy air outdoors was sought from school personnel, health scientists, health care professionals, advocacy groups, and parent groups. The guidance aligns with the EPA’s Air Quality Index (AQI) levels and recommendations, and is tailored for the elementary school recess setting.

School administrators are encouraged to check the PM2.5 levels throughout the winter months at least 30 minutes prior to recess. “The Recess Guidance has been critical in helping me know how to help our students stay healthy and safe,” said BJ Weller, principal at Canyon View Elementary.

“The school principal makes the final decision regarding when and where to hold recess. We encourage schools to consider active options for indoor recess should the need arise,” said Brittany Guerra with the UDOH Asthma Program. “Fortunately, data shows there were only a handful of days over the last five years that our guidance recommended all students be kept indoors for recess due to poor air quality.”

Parents, with the advice of their health care provider, should also inform the school if they believe their child is part of a sensitive group and should have limited outdoor physical activity when air quality is poor.

The UDOH also offers daily email alerts during the inversion season to help school administrators know when PM2.5 reaches unhealthful levels and the specific guidance on which students should be kept indoors. To receive the air quality email alerts, send a blank email to hl-recess-air-quality-subscribe@list.utah.gov.

“Using the Recess Guidance has been very helpful in determining whether the air quality is safe for our students to go out and play in. It is so easy to just open the email and have the air quality for our area available without searching and taking a lot of time,” said Trudy Messick, with Renaissance Academy.

To see current PM2.5 levels, download the UtahAir app or visit www.air.utah.gov. Copies of the Air Quality Recess Guidance for Schools and video tutorials about how to use the guidance are available at www.health.utah.gov/asthma.
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Media Contact:
Brittany Guerra
UDOH Asthma Program                                                                           
(o) 801-538-6894 (m) 678-773-3983 

Wednesday, January 11, 2017

Utah Adolescents with Potential Eating Disorders more likely to be Suicidal, Suffer from Bullying and Violence

(Salt Lake City, UT) – In 2011 and 2013, 4% of female students and 1.4% of male students in grades 9-12 in Utah public schools met a threshold for underweight combined with eating disordered behaviors, totaling more than 1,000 boys and nearly 3,000 girls in the state. These same students had higher rates of depression, suicide ideation and attempt, bullying, and physical and sexual violence, according to a new report released by the Utah Department of Health (UDOH).

"While we’ve monitored overweight and obesity among adolescents and the associated health risks for years, we haven't looked into the prevalence and health effects of anorexia and eating disorders before now. What we found is that nearly 4,000 adolescents in Utah may be at risk for an eating disorder and that these adolescents have significant physical and mental health risks,” said Michael Friedrichs, UDOH epidemiologist.

The increased risk for adverse physical and mental health problems for adolescents with and without potential eating disorders is startling. The data analysis showed that adolescents with potential eating disorders reported feeling so sad or hopeless for two weeks that they stopped doing their usual activities at a rate of 42.3%, compared to 25.9% of adolescents without a potential eating disorder. Similarly, students with potential eating disorders reported that they considered suicide, made a suicide plan, attempted suicide, and were injured as a result of a suicide attempt at much higher rates than students without an eating disorder.

In addition, adolescents with potential eating disorders reported feeling less safe and reported more experiences of violence, compared to adolescents without a potential disorder. Of those students who reported being bullied on school property, 33.2% had a potential eating disorder, compared to 21.5% of students without. Drastically higher rates of physical and sexual violence by a dating partner (32.2% and 38% respectively) were also found for students with potential eating disorders compared to those without (5.6% physical violence and 9.5% sexual violence).

The UDOH analyzed data from the 2011 and 2013 Youth Risk Behavior Survey (YRBS) to determine the rates of potential eating disorders among Utah adolescents and the associated adverse health experiences. Adolescents with potential eating disorders were defined as students with a Body Mass Index (BMI) below the 15th percentile and who reported they had one or more disordered eating behaviors. The most commonly reported disordered eating behaviors for underweight adolescents were trying to lose weight (12.1%), followed by fasting for 24 hours or more to lose weight (8.8%), vomiting or using laxatives to lose weight (4.2%), and taking diet pills (1.7%). All of these behaviors had higher rates for girls.

“Prevention and early intervention of these behaviors is critical to the long-term health and well-being of our young people,” said Megan Waters, violence prevention specialist with the UDOH. “We recommend that healthcare providers screen adolescents for eating disorders and associated risk behaviors and that trainings for school personnel and parents be made available to help them better understand the connections between eating disorders and other behaviors such as suicide ideation and dating violence.”

A copy of the report can be found at http://ow.ly/nTlI307U9LA. Information on risk behaviors such as suicide and dating violence can be found at http://health.utah.gov/vipp

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Media Contact:
Megan Waters
Violence & Injury Prevention Program
(o) 801-538-6626

Tuesday, January 10, 2017

New Plan Unveiled to Help Stop Suicides in Utah

(Salt Lake City, UT) – Suicide prevention experts from the Utah Department of Health (UDOH), Utah Division of Substance Abuse and Mental Health (DSAMH), and Utah Suicide Prevention Coalition unveiled a new plan to help stop suicides in Utah. The plan couldn’t be timelier; as suicide claimed 609 Utahns in 2015, for a rate of 24.5 per 100,000 population ages 10+. Every suicide death causes a ripple effect of immeasurable pain to individuals, families, and communities throughout the state.

“Everyone plays a role in suicide prevention and it is up to each one of us to help create communities which are strong in factors that protect people from suicide,” said Andrea Hood, suicide prevention expert with the UDOH. “The new plan outlines strategies to help communities accomplish this by describing ways to improve resiliency, crisis response, mental health treatment, and early identification of mental health conditions.”

Suicide is a complex issue influenced by individual, family, relational, community, and societal factors. Prevention strategies must address the factors that increase risk for suicide and the factors that protect from suicide risk. The new Utah Suicide Prevention Plan is structured around the following protective factors:
  • Increasing availability and access to quality physical and behavioral health care
  • Increasing social norms supportive of help-seeking and recovery
  • Reducing access to lethal means, such as firearms
  • Increasing connectedness to individuals, family, community, and social institutions by creating safe and supportive school and community environments
  • Increasing safe media portrayals of suicide and adoption of safe messaging principles
  • Increasing coping and problem solving skills
  • Increasing support to survivors of suicide loss
  • Increasing prevention and early intervention for mental health problems, suicide ideation and behaviors, and substance misuse
  • Increasing comprehensive data collection and analysis regarding risk and protective factors for suicide to guide prevention efforts
“Over the last few years our state has come a long way in understanding and addressing suicide. This plan represents the progress we have made and the foundation we have built for suicide prevention,” said Kim Myers, suicide prevention coordinator with the DSAMH.

The new plan highlights evidence-based strategies that are tried and true steps communities can take to build resiliency, create safety nets for those in crisis, and ultimately save lives in Utah. The plan also has a greater emphasis on social connectedness than previous statewide efforts.

The Utah Suicide Prevention Coalition will oversee implementation of the plan. The coalition is a partnership of community members, suicide survivors, service providers, researchers, and others dedicated to saving lives and advancing suicide prevention efforts in Utah. To learn how to get involved or for a copy of the plan, visit http://utahsuicideprevention.org.

“We have a more comprehensive, collaborative approach to suicide prevention in Utah than ever before,” said Hood. “Our hope is that the strategies we are all working so hard on will save lives and bring hope to those who are feeling alone or hopeless, because each life matters.”

All suicidal thoughts, behaviors, and attempts should be taken seriously. Get help 24/7 by calling the Statewide CrisisLine at 801-587-3000 or the National Suicide Prevention LifeLine at 1-800-273-TALK. Help is also available online at www.suicidepreventionlifeline.org. Trained consultants will provide free and confidential crisis counseling to anyone in need.

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Media Contacts:
Andrea Hood, UDOH
(o) 801-538-6599 (m) 801-913-6304
Kimberly Myers, DSAMH
(m) 801-633-2408

Thursday, December 29, 2016

Top 10 Public Health Stories in 2016

The votes are in! These are the top 10 public health stories in Utah for 2016: 

#1 Uninsured Rate at Lowest Point in a Decade
New data from the Utah Department of Health show 8.8% of Utahns (265,100 residents) did not have health insurance during 2015. The figure represents the lowest uninsured rate Utah has experienced in more than a decade.

“There are likely several factors that have lead Utah to this point,” said UDOH Executive Director Dr. Joseph Miner. “The state’s healthy economy and low unemployment rate certainly play a role. Changes in health insurance that allowed more young adults to remain on their parents’ health plan and that offered health insurance subsidies to some lower-income families appear to be having a positive effect on the uninsured rate as well.”

The 2015 data show a continued decrease in the number of uninsured Utahns between the ages of 19-26. In 2011, 23.6 percent of these residents did not have insurance, but last year that number had decreased to just 12 percent. The number of uninsured Utahns who fit into the population targeted for Medicaid expansion, those between the ages of 19-64 who earn between 0-138 percent of the federal poverty level, has also decreased over the past several years.

#2 Zika Virus Arrives in Utah
As of November 28th, 678 people had been tested for Zika virus in Utah; with a total of 21 Zika-positive test results. Nine of these positive test results were in women who were pregnant; five of which have delivered infants with normal outcomes so far, two resulted in pregnancy loss, one was lost to follow-up, and one has not delivered yet. However, it was two unique cases that brought international attention to state.

The Salt Lake County Health Department announced the death of a county resident infected with Zika virus on July 8th, the first confirmed Zika-related death in the continental U.S. The deceased individual had traveled to an area with Zika. Ten days later, Utah health officials confirmed a new case of Zika virus infection in a family contact who helped care for the individual who died. The person had not recently traveled to an area with Zika and had not had sex with someone who was infected with Zika or who had traveled to an area with Zika. A CDC team was dispatched to Utah to help with the investigation. Extensive mosquito trapping as well as a community survey shows there is no evidence at this time that mosquitoes that commonly spread Zika (aedes species) virus are in Utah.

The Bureaus of Epidemiology, Maternal and Child Health, and Children with Special Health Care Needs are keeping a close eye on the situation and developed a Zika virus plan that includes guidelines on monitoring, testing, and educational outreach to the public. The Utah Public Health Laboratory recently became certified to perform Zika virus blood testing and will be ready to perform a more specific type of Zika testing.

The CDC recommends that women who are pregnant not travel to areas with Zika. They should also use condoms or not have sex with partners who have traveled to or live in an area with Zika for the duration of their pregnancy. Tips on Zika prevention are available at https://www.cdc.gov/zika.

 #3 Syringe Exchange Programs Have Go-Ahead to Start in Utah
Syringe exchange programs (SEPs), also called syringe services programs (SSPs), needle exchange programs (NEPs), or needle-syringe programs (NSPs), are community-based programs that provide access to sterile needles and syringes free of charge. The programs also facilitate safe disposal of used needles and syringes. SEPs are an effective component of a comprehensive, integrated approach to HIV and hepatitis C prevention among people who inject drugs. Most SEPs offer other prevention materials (e.g., alcohol swabs, vials of sterile water, and condoms) and services, such as education on safer injection practices and wound care; overdose prevention, including Naloxone distribution; referral to substance abuse treatment programs; and counseling and testing for HIV and hepatitis C. Many SEPs also provide links to critical services and programs, such as HIV care, treatment, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) services; hepatitis C treatment; hepatitis A and B vaccinations; screening for other sexually transmitted diseases and tuberculosis; partner services; prevention of mother-to-child HIV transmission; and other medical, social, and mental health services.

Syringe exchange programs became legal in Utah on March 25, 2016, when Governor Herbert signed House Bill 308 into law. The bill went into effect May 10, 2016, and states that agencies in Utah “may operate a syringe exchange program in the state to prevent the transmission of disease and reduce morbidity and mortality among individuals who inject drugs and those individuals’ contacts.” Rule 386-900 Special Measures for the Operation of Syringe Exchange Programs, sets forth operating requirements for entities conducting syringe exchange. As of November 10, 2016, agencies throughout Utah may enroll their Syringe Exchange Programs with the UDOH. The rule requires agencies conducting SEP to register with the UDOH and provide quarterly reports of activities to be analyzed and then reported annually to the Utah State Legislature, showing effectiveness and sustainability of the program. The UDOH will provide support, technical assistance, training and guidance to all Utah SEPs and will apply for, and distribute, funding as available.

#4 Utah Pharmacists Can Now Dispense Naloxone without a Prescription
On December 8, 2016, Dr. Joseph Minder, executive director of the Utah Department of Health (UDOH), signed a statewide standing order allowing pharmacists to dispense naloxone, without a prior prescription, to anyone at increased risk of experiencing an opioid overdose. Naloxone is a safe and legal drug that can reverse heroin and prescription opioid overdoses by blocking the effects of opiates on the brain and restoring breathing in minutes. There is no potential for abuse and side effects are rare.

Six Utahns die every week from opioid overdoses. In 2015, 268 Utahns died from a prescription opioid overdose (such as oxycodone, hydrocodone, methadone, morphine, and fentanyl), 127 died from illicit opioids such as heroin, and 10 deaths involved both prescription and illicit opioids; an average of 33 each month (13.5 per 100,000 population). An estimated 80% of heroin users start with prescription drugs. Utah ranks 4th highest in the nation for drug overdose deaths.

#5 Updated Utah Air Quality Recess Guidance for Schools
The average adult breathes 20,000 liters of air a day. During inversion months, poor air quality can trigger asthma attacks. The primary pollutant of concern during the winter months is particulate matter (PM) 2.5. The elderly, immunocompromised, and children have been identified as sensitive groups to air pollution and special precautions should be taken during poor air quality days to reduce their exposure. 

On June 13, 2016 the Utah Department of Health Asthma Program hosted the "Air Quality and Health Summit." The purpose of the summit was to ensure the Utah Air Quality Recess Guidance was based on current evidence and supported by schools, health professionals, and community members. The event included a variety of expert led presentations, moderator led discussion, and was attended by 53 stakeholders representing 27 different organizations in the community.  The result of the Summit was an updated Utah Air Quality Recess Guidance that better aligns with Air Quality Index (AQI) recommendations and colors.  The Guidance now recommends the following:
  • When PM2.5 levels are below 35.4 (green and yellow zone), all students can go outdoors for recess.
  • When PM2.5 levels are between 35.5-55.4 (orange zone), sensitive high-risk students and students with respiratory symptoms should remain indoors for recess.
  • When PM2.5 levels are above 55.5 (red and purple zone), all students should be kept indoors for recess.

#6 Teen Birth Rate Reaches Historic Low 
The Utah teen birth rate continued to fall in 2015, reaching a historic low of 17.6 births per 1,000 girls ages 15-19.  Considered by the Centers for Disease Control and Prevention to be a “Winnable Battle”, a goal of reducing teen pregnancy by 20% between 2010 and 2015 was set. The rate of teen birth in Utah declined 37% in this period.  While no one factor can explain why teen pregnancy rates are declining, evidence supports that teen pregnancy prevention education efforts and increased access to contraceptives has led to teens using more reliable forms of contraception.  Another contributing factor may be teens mirroring the trends of delayed childbearing in women ages 20 and over.  

To address teen pregnancy in Utah, two education programs, abstinence only and personal responsibility, are conducted with adolescents. To find out more about these programs and where they are located, visit www.health.utah.gov/mihp.

#7 Electronic Cigarette Substance Rule Set in Place
Since 2011, Utah has seen a sharp increase in the use of electronic cigarettes and other vape products. Current use of electronic cigarettes and other vape products among Utah youth has grown five-fold, from 1.9% in 2011 to 10.5% in 2015. Among Utah adults, electronic cigarette and other vape products has remained unchanged, from 1.9% in 2012 to 4.8% in 2014.

Effective December 31, 2016, R 384-415, Electronic-Cigarette Substance Standards, seeks to regulate electronic-cigarette substances at the point of sale between the retailer and the consumer. The regulation takes the form of standards for: (1) labeling; (2) nicotine content; (3) packaging; and (4) product quality. As stated in Utah Code 26-57-103, the sale of electronic-cigarette substances that fail to meet these standards will be prohibited. The purpose of enacting regulatory standards for these products is to attempt to limit the increased number of nicotine related poisonings in the state. Labeling standards seek to better communicate nicotine toxicity to the consumers. Standards for nicotine content set a limit for the concentration of nicotine in an electronic-cigarette substance. Packaging standards are intended to make child entry to the product more difficult. Product quality standards prescribe requirements for eventual product approval by the FDA and a restriction on the sale of certain products.

#8 Harmful Algal Blooms Plague Utah Waterways
In July 2016, a large harmful algal bloom was discovered along the eastern shore of Utah Lake. Although algae are a natural part of many freshwater ecosystems, under the right conditions they can proliferate to create large algal blooms. High levels of nutrients in the water, combined with warm temperatures, abundant sunlight, and calm water, can promote rapid algal growth, resulting in the extensive, bright-green blooms. These blooms can contain harmful cyanobacteria, a type of bacteria (often referred to as blue-green algae) that produces toxins that can pose risks to humans, wildlife, domestic animals, and fish.

The Utah Department of Health and Utah County Health Department (UCHD) closed Utah Lake to the public on July 15, 2016 due to the harmful algal bloom. State and local health departments have the legal authority to close public places, such as a lake, to protect the health of the public. While the UCHD has previously issued advisories regarding algal blooms on Utah Lake due to public health concerns, this is the first time the entire lake has been closed. Additional warnings and closures of bodies of water – the Jordan River canal system, Scofield Reservoir, Mantua Reservoir, Big East Lake, Box Lake, and McClellan Lake – were closed in the weeks and months following. Coordination with the Utah Department of Environmental Quality and state and local agencies was essential for testing water samples and informing the public about the algal bloom.

#9 Statewide Health Assessment
UDOH collaborated with Intermountain Healthcare and the Local Health Departments to conduct a Statewide Health Assessment. Data on more than 100 health indicators, broken out, where possible, by geography, age, sex, race, ethnicity, income, and education as well as trends over time were reviewed. Twenty-seven community input meetings were held around the state to gather views on the health issues of greatest need and disparity for a particular area. Other needs assessments conducted by community or health agencies were reviewed. A prioritization methodology was decided upon and applied to the data and information gathered. The top priorities were then taken to a broader Utah Health Improvement Plan Coalition that consists of state and local health agencies, Tribes, partner agencies, and health systems for further review and prioritization. The Coalition also assisted in the public health system strengths, weaknesses, opportunities, and threats analysis. Three priority areas have been prioritized as a result of this process and the collaborating partners are developing a Utah Health Improvement Plan to work towards improvement in these areas.
  • Reducing obesity and obesity-related chronic conditions
  • Reducing prescription drug misuse, abuse and overdose
  • Improving mental health and reducing suicide
This is a new level of collaboration and it is hoped that collective efforts may contribute to greater levels of improvement.

#10 Medicaid Expansion Update
The Affordable Care Act (ACA) gives individual states the option to expand Medicaid to new adults earning up to 138% of Federal Poverty Level (FPL). Without expansion, there is a gap in coverage for adults who do not currently qualify for Medicaid and are ineligible to receive benefits and subsidies through the federally facilitated marketplace. After years of deliberation and research, state leaders have developed a plan for a Utah-specific approach to reduce the number of the uninsured adults in the state.

During the 2016 Legislative Session, House Bill 437 passed and directed the Utah Department of Health’s Medicaid agency to implement a health coverage improvement plan (known as the 115 waiver). Based on funding and approval from the Centers for Medicare and Medicaid Services (CMS) the program is designed to provide Medicaid coverage for the following adults:
  • Parents with dependent children earning up to 60% of the FPL
  • Adults without dependent children earning up to 5% of the FPL who are: chronically homeless;involved in the justice system through probation, parole, or court ordered treatment needing substance abuse or mental health treatment; or Needing substance abuse treatment or mental health treatment.
Public hearings on the health coverage improvement plan took place in April and May 2016. The final plan was submitted to CMS on July 1, 2016 and if approved, will begin enrolling new members on January 1, 2017.

Other public health stories that received honorable mentions:

Thursday, December 8, 2016

Utah Pharmacists Can Now Dispense Naloxone without a Prescription

(Salt Lake, UT) – Today, the executive director of the Utah Department of Health (UDOH) signed a statewide standing order allowing pharmacists to dispense naloxone, without a prior prescription, to anyone at increased risk of experiencing an opioid overdose. Naloxone is a safe and legal drug that can reverse heroin and prescription opioid overdoses by blocking the effects of opiates on the brain and restoring breathing in minutes. There is no potential for abuse and side effects are rare.

“Opioid overdose can be reversed and death prevented by timely administration of naloxone,” said Dr. Joseph Miner, executive director of the UDOH. “As authorized by state law, this standing order is intended to increase access to naloxone for those who might be at risk of an overdose or who might be in a position to assist somebody at risk of an overdose.” Naloxone can be administered via a nasal spray (commonly known as Narcan®) or intramuscular injection.

Six Utahns die every week from opioid overdoses. In 2015, 268 Utahns died from a prescription opioid overdose (such as oxycodone, hydrocodone, methadone, morphine, and fentanyl), 127 died from illicit opioids such as heroin, and 10 deaths involved both prescription and illicit opioids; an average of 33 each month (13.5 per 100,000 population). An estimated 80% of heroin users start with prescription drugs. Utah ranks 4th highest in the nation for drug overdose deaths.

Those at highest risk of an opioid overdose include individuals who:
  • Are taking high doses of opioids for long-term management of chronic pain
  • Have a history of substance abuse or a previous non-fatal overdose
  • Have lowered opioid tolerance as a result of completing a detoxification program or recently being released from incarceration
  • Are using a combination of opioids and other drugs such as benzodiazepines (Klonopin, Valium, Xanax) or alcohol
  • Are unfamiliar with the strength and dosage of prescription opioids and the purity of street drugs like heroin
  • Are alone when using drugs
  • Smoke cigarettes or have a respiratory illness, kidney or liver disease, cardiac illness, or HIV/AIDS
During the 2016 General Legislative Session, Rep. Steve Eliason sponsored House Bill 240, Opiate Overdose Response Act, passed authorizing the Utah Department of Commerce and UDOH to implement a standing prescription drug order to dispense naloxone. Additional laws passed in recent years expanding access to naloxone and providing protections for bystanders to report an overdose without fear of criminal prosecution for illegal possession of a controlled substance or illegal drug.

“This important policy will save lives and give people’s sons and daughters, mothers and fathers, a second chance at life and hopefully help them step out of substance abuse once and for all,” said Eliason.

While not mandatory for pharmacies to participate in the standing order, those that do are encouraged to voluntarily register with the UDOH. Additionally, Utah Administrative Rule 156-17b-625 requires pharmacists dispensing naloxone under the standing order to report annually to the UDOH the total number of single doses of naloxone dispensed and the name of each naloxone product dispensed along with the total number of single doses of that particular product.

"Providing naloxone more quickly to the Utah public may be the difference between life and death for those struggling with opioid use disorders. The Division of Occupational and Professional Licensing appreciates the strong support of Governor Gary Herbert, the Utah Legislature, the Department of Health, and others in making naloxone available to protect our citizens,” said Francine A. Giani, executive director of the Utah Department of Commerce.

To learn more about naloxone and the standing order visit https://naloxone.utah.gov. For information on opioids, visit http://opidemic.org.  

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Media Contact:
Tom Hudachko, UDOH
(o) 801-538-6232 (m) 801-560-4649
Jennifer Bolton, DOPL
(o) 801-530-6646 (m) 801-652-8322