Naloxone critical tool in fighting overdose deaths

It’s been called a ‘miracle drug,’ but there’s still a stigma surrounding the use of naloxone, a fast-acting medicine that can reverse the effects of an opioid overdose. The Adams County Opioid Awareness Task Force (OATF) is tackling the issue with its continued efforts to distribute the drug free of charge and educate people on its benefits and how to administer it.

History of the Drug

The Food and Drug Administration first approved the use of naloxone as an injectable intervention for treating opioid overdoses in 1971, according to an article in the medical journal Drugs. But it wasn’t until 1996 that recommendations for its use in the community appeared in medical circles, the article states.

In 2012, when patterns of the opioid epidemic began to emerge, several governmental agencies held a conference to discuss the use of a ‘take-home’ naloxone nasal spray “in response to rising overdose mortality rates,” the Drugs article explains.

It adds that progress toward providing naloxone to the community occurred when technical barriers to delivering the drug were removed by creating a method that could be delivered by laypersons instead.

The first brand name version of the nasal spray was Narcan, developed by Opiant Pharmaceuticals in 2013. It was approved by the FDA in 2015 as safe to use without a prescription, according to the Drugs article. Since then, the article says, naloxone has become a “well-established essential medicine” for reversing overdoses.

How It Works

“Naloxone essentially is a blocker of the opioid,” says Dr. Mitch Crawford, director of addiction services for WellSpan Health.

When someone overdoses on opioids, according to Crawford, the brain’s opioid receptors are overwhelmed and breathing begins to shut down.

“Naloxone moves those opioids off those receptors, and it starts having the opposite effect. Opioids are no longer telling the body to stop breathing.” As a result, “people have a reversal of the overdose.”

It can be surprising to a person experiencing an overdose to be revived, however. Moving from a state of intoxication caused by the drug to unconsciousness to sudden awareness again is often a jarring experience. Crawford compares it to being awoken from a bad dream.

“There's an element of fear and confusion that folks have. Sometimes that can be perceived by the folks who experience it to be very painful, very uncomfortable.”

That’s why providers and first responders encourage those who’ve been revived to seek emergency medical help right away. The effects of a naloxone reversal only last about two hours, according to Crawford. Once that happens, the amount of opioids left in the person’s system could potentially cause another overdose.

“It’s not safe to just say ‘Okay, you’re good.’ There’s no way for us to know that by just looking at someone,” Crawford emphasizes.

Community Efforts

The Adams County OATF began handing out naloxone nasal spray kits for free in 2017 as a result of federal grant funding, says Samiah Slusser, project director for strategic prevention at the Center for Youth and Community Development (CFYCD), one of the partners in the OATF.

Prior to that, CFYCD worked with the Pennsylvania Criminal Justice Advisory Board as a partner in that agency's similar effort.

Slusser feels the efforts have paid off. Last year there were 17 deaths due to opioid overdoses in Adams County, according to coroner Pat Felix. So far this year there have been none.

“We would like to say that that’s because we’ve spent this year really getting out there with the Narcan and educating people,” Slusser says. (Narcan is a brand name of naloxone and is often used to reference the drug.)

The task force makes sure to have kits on hand for distribution at many community events, like the Adams County Farmers Market and First Fridays. They also make sure to inform people that one doesn’t need medical training to administer the drug.

“The kits that we give out are really nice. They have a cheater card in them that tells you what to do. There’s a mouth guard and there are gloves,” Slusser explains. “It has two doses of Narcan because sometimes the first dose won’t work. They can use the second dose if needed.”

The task force wants to further the availability of the kits by making them available in bars, restaurants, public restrooms and anywhere else people gather. “Wherever you see an AED machine, there should be Narcan,” Slusser says.

“We want this tool in every first aid kit in the county. We want everyone to keep naloxone,” says Matt Moon, a Gettysburg city councilman and member of the Opioid Awareness Task Force.

He adds that the cost to citizens to obtain a naloxone kit is free. “The state is providing an immense amount of funding. This is the priority.”

Fentanyl

The urgency to increase the amount of kits available in the community stems from the increased rates of death due to fentanyl that the county and the country have seen over recent years. Fentanyl is a synthetic opioid 50 times more potent than heroin and 100 times more potent than morphine, says the Centers for Disease Control.

It’s responsible for the deaths of more than 150 people per day in the country, the CDC reports. In Adams County, the coroner reported that 14 of the 17 overdose deaths last year involved fentanyl.

Crawford confirms the rise of fentanyl’s presence in the region. “We know unfortunately that a majority supply of opioids is contaminated with, or is fully, fentanyl.”

Many fentanyl-related overdoses can be unintentional, Slusser says. “It’s odorless, colorless, tasteless. It can be mixed in and made to look like an aspirin.”

That’s why it’s important to seek out medical treatment immediately following the administration of naloxone, Crawford says. The effects of naloxone only last about two hours, he explains, and once it wears off, the body can potentially fall back into an overdose state.

“It’s really important to be under medical care to make sure the amount of opioid in the system is not going to cause another overdose. It’s not rare that we have to administer subsequent rounds of naloxone to people,” Crawford emphasizes.

Combating the Stigma

Despite evidence that the use of naloxone saves lives, there remains a social stigma, and some resistance, to its availability in the community.

“There are still just such different perceptions about it. That’s a big challenge for us to educate people,” Slusser says.

A negative perception of the drug, according to Slusser, stems from the perception some people have that, if given naloxone, people struggling with addiction could continue to use drugs and overdose again.

But both Crawford and Moon counter that argument. “The only thing we’re enabling is that person to breathe if they have an overdose,” Crawford says. “Hopefully they're going to get to a point … where they want to engage in treatment.”

“Naloxone allows people to continue to a recovery journey,” he adds.

Moon is more pointed. “We need to keep our citizens alive. At the end of day we’re only there for one reason, and that’s to keep people from dying.”

Slusser explains that some people are afraid to use the drug because of possible ramifications of their involvement in the overdose. But, she adds, administering naloxone in the event of an emergency is covered by the Commonwealth’s ‘Good Samaritan’ law.

Title 42 of the Commonwealth’s consolidated statutes, commonly known as the ‘Good Samaritan’ law, states that “any person … whether or not trained to practice medicine, who in good faith renders emergency care … shall not be liable for any civil damages as a result of rendering such care.”

The OATF’s educational mission isn’t just about teaching people how to use naloxone. It’s also about breaking the stereotypes of who struggles with drug addiction. “People have a perception of who and what an addict looks like, but it could be your child, your grandparent,” Slusser says.

Not everyone knows someone who has died from an overdose, but it takes a community to overcome the problem of so many deaths by overdose. The OATF hopes people understand as much. It will continue its fight to educate the public, erase stigma and equip Adams County communities with the tools they need.

The National Institue on Druge Abuse provides more information about naloxone. To obtain a free kit from the OATF, visit www.overdosefreeadams.org.