“I am only one, but still I am one. I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do.” Helen Keller
The opioid crisis has affected me both personally and professionally. If you are reading this article, chances are the crisis has had an impact, great or small, on you as well. Many of us wonder what part we can play to help. “It’s such a large and looming problem,” we think. “What impact can I possible have and where would I even start?” Lately, Helen Keller’s quote above, sums up how I’ve come to view my involvement regarding the opioid crisis.
The opioid crisis is a multi-dimensional and systemic problem that requires a multi-pronged solution. Efforts have been made to reform legislation, increase funding, change prescribing guidelines, provide education and advocacy, and support treatment and recovery services for those who are addicted as well as their support network. These efforts are a step in the right direction, which is important to remember as we wade through how to address this public health emergency.
What are opioids?
Opioids are a class of drugs that includes prescription medications used to treat pain, as well as illicit drugs such as heroin and other synthetic opioids. Opioids work on several receptor sites in the body to reduce the perception of pain. There are many risks involved with using opioids including increased tolerance leading to addiction, and death. Death can occur when breathing becomes shallow and results in decreased oxygenation of the blood, which leads to brain and heart damage, and eventually cardiac arrest.
Based on data from 2016-2017, The U.S. Department of Health and Human Services reports over 130 people die every day from an opioid overdose. The National Institute on Drug Abuse reports that in 2017 there were more than 72,000 deaths related to drug overdose. Roughly 68 percent, or over 49,000 of these fatal overdoses involved opioids such as heroin, pain relievers, and fentanyl.
The Minnesota Department of Health reports that of the total drug overdose deaths in 2016, nearly 60 percent of them involved opioids. From 2015-2016, there was an 83 percent increase in the number related to synthetic opioids such as fentanyl, carfentanil, and tramadol. During this same time frame, fatal overdoses from heroin rose 32 percent, and prescription opioids and methadone related deaths had an increase of 18 percent.
Overdose Good Samaritan Immunity Law
The Substance Abuse and Mental Health Services Administration (SAMHSA) states that as of July 2017, 40 states and the District of Columbia have enacted some form of a “Good Samaritan” or 9-1-1 drug immunity law. These laws are put in place to provide protection for bystanders that call for emergency assistance in the event of an overdose, and also for those that administer naloxone.
In 2014, Steve’s Law was passed (Minnesota Statutes: 151.37 Subdivision 12, Section 3 [604A.04], Section 4 [604A.05]). This law allows laypeople to carry and administer naloxone, and releases them from liability when they’re acting in good faith to save a life. It also provides additional allowances for first responders to administer, as well as for prescribers to be allowed to prescribe to a third party. Another important note within the statute is that it provides limited immunity from criminal prosecution for the person experiencing the overdose, and also the person that is calling 9-1-1 and seeking medical assistance.
What is naloxone?
Naloxone is an opioid antagonist that can help reverse a potentially fatal overdose. Opioid related deaths can be avoided when naloxone is delivered in a timely manner (SAMHSA). It works by displacing the opioids from the brain receptors for a short time, allowing the person to breathe and temporarily reverse the effects of the overdose. Naloxone is administered by intramuscular injection or by nasal spray (Narcan).
Naloxone reverses an overdose caused by opioids such as heroin, morphine, oxycodone, codeine, methadone, hydrocodone, fentanyl, carfentanil, buprenorphine, and hyrdromorphone. Naloxone will not work if the overdose is due to alcohol, anti-depressants, or benzodiazepines.
Overdose prevention involves multiple strategies in a system wide effort to reduce the amount of opioid related overdoses and deaths. It includes educating families, individuals at risk, first responders, law enforcement, healthcare professionals, and the community about prevention, and what to do in the event of an overdose. Access to naloxone, and support for accessing treatment services is another key strategy, as well as encouraging the public to call 9-1-1 and seek immediate medical attention during a crisis.
The Steve Rummler Hope Network (SRHN) has an overdose prevention program that provides training on how to administer naloxone included in their overdose prevention rescue kits. The training is offered to multiple groups including retail locations, home health agencies, first responders, law enforcement, schools, hospitals, and other community agencies. They also provide naloxone training and overdose prevention kits to the general public so that society as a whole is better equipped to save lives.
It was at one of these events that I met Heather who is a trainer for SRHN. She shared the power and value of naloxone from a place of first-hand knowledge. As a person in recovery, she has been revived from multiple overdoses by the medication. She has also had the experience of being able to administer it to others several times, and save the lives of others.
If you want to save a life, you need to carry a kit
Heather talked about the various situations that would warrant naloxone. Children are at risk for having access to prescription medications. Sometimes people accidentally take too many pain pills, such as in the case with elderly people who have cognitive impairment, or someone who just had major surgery and may not be thinking clearly. Additional situations that support administering naloxone include when working with others in recovery, having loved ones who take chronic pain medication and/or struggle with the disease of addiction, walking into a public restroom, or when traveling. Overdose can happen anywhere, and at any time, and according to Heather, “If you want to save a life, you need to carry a kit.”
Other key considerations regarding naloxone:
- Know the signs of opioid overdose – some of them include blue lips and nails, shallow or absent breathing, not moving, can’t be woken up.
- Call 9-1-1 immediately and start rescue breaths.
- When in doubt, just administer – benefits outweigh the risks and side effects are rare.
- How to administer the naloxone.
- Don’t assume the person is safe after administration of naloxone, they can still continue to overdose.
- Pharmacies also carry naloxone – you can get it without a prescription. If you have a prescription, most insurances will cover it.
- Using the naloxone overdose prevention kit is an easy and effective way to save someone’s life.
In 2017, there were over 2,000 overdose reversals that were reported back to SRHN by first responders. Another organization that SRHN collaborates with that also distributes naloxone kits has had over 1,700 reversals reported to them so far in 2018. That means at least 3,700 lives have been saved just in the two years that they have been handing out kits. Between January 1, 2018 and October 29, 2018, SRHN has provided 8,886 Overdose Prevention Kits, they have provided training to a total of 3,649 individuals, and 184 training events.
Barriers to overdose prevention
One of the barriers to overdose prevention is the lack of awareness around the importance of education and training on how to use naloxone. I have experienced several of the situations that Heather described, and not once did I think that naloxone may be a tool that I could use if I needed to save a life.
Another barrier is the fear of liability. Whether you are a layperson, healthcare professional, an individual at risk, family member, or business owner, the fear of being liable for something going wrong, or criminally prosecuted, is very real. More education needs to be done regarding the Good Samaritan and drug immunity laws, and in Minnesota, specifically Steve’s Law.
The stigma that surrounds addiction can be a deterrent. Not only the stigma within society, and the myth that providing naloxone and overdose prevention will increase risk behaviors, but also the stigma in family systems. Once family members become aware of their loved ones’ struggles, people may feel shame. Sometimes people have concerns about having additional medication in the house.
As society continues to navigate the opioid crisis, you may find yourself led to becoming involved on some level. Involvement can be as simple as having an open dialogue with others about topics like chronic pain, addiction, overdose, and alternative supports. You can get trained to administer naloxone, or volunteer to help make or distribute overdose prevention kits. There are also opportunities to get involved on a larger scale such as with fundraising, or advocacy for reform.
Whatever your involvement, large or small, remember that when you share your own personal story of experience, strength, and hope, you are making a difference.
Jen Shepherd, MSW, LICSW, CCA, is a clinical social worker, clinical aromatherapist and co-publisher of The Phoenix Spirit.
U.S. Dept of Health and Human Services https://www.hhs.gov/opioids/about-the-epidemic/index.html
MN Dept of Health http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2016DrugOverdoseDeathReport_Final.pdf