Overdose drug saves lives, if you know how to use it

August 5, 2018
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“Narcan reverses the effects of the opiate’s response,” says Kate Arms, a local Gold Cross assistant supervisor and paramedic. “The goal is to increase the patient respirations but not necessarily to wake them up.” Arms said each paramedic emergency response unit carries 4 milligrams of naloxone, which is the generic drug for Narcan.

In Quentin Tarantino’s 1994 cult classic movie “Pulp Fiction,” John Travolta’s character dramatically revives Uma Thurman’s character from a heroin overdose.

In a panic, he plunges a nearly four-inch syringe filled with adrenaline straight into her heart, and she immediately comes to — flamboyantly gasping for breath.

That iconic illustration of an opioid overdose got a few things right:

• Lack of any responsiveness.

• Decreased-to-no breathing.

• Pinpoint pupils.

• Potential for aspiration.

But it also got (more than) a few things wrong:

• Heavily delayed reaction time.

• Use of adrenaline.

• Location and force of injection.

• Exaggerated return to consciousness.

The list goes on …

Christian Clements, who recently became the Rochester Harm Reduction Services coordinator, is working to address this type of misinformation when it comes to recognizing and responding to opioid overdoses. The newly established community-based organization will work to provide naloxone, clean-use supplies and education to those who use opioids in Rochester.

Narcan, generically referred to as naloxone, is a competitive antagonist medication. At the most basic level, it interrupts and reverses the opioid’s effects by competing for the same receptor sites in the brain and spinal cord.

Both Narcan and naloxone are becoming more widely known as the nation begins to address its opioid crisis.

“The fact that we’re having a conversation about Narcan is one thing, but addressing the actual use is a completely different conversation,” Clements said. “I don’t like the popular “Pulp Fiction” idea, but the reality is that you literally stick someone in the arm or leg, and there you go.”

According to the Minnesota Department of Health, there were 2,074 non-fatal, hospital-treated opioid overdoses in Minnesota from January to September of 2016. The MDH also reported that in 2016, there were 395 opioid-involved deaths (including prescription opioids, heroin, fentanyl, and fentanyl analogues).

The numbers for both fatal and non-fatal opioid overdoses in Olmsted County specifically are not known due to patient privacy laws.

Due in part to those statistics, Clements has started working to make naloxone, clean needles and testing strips more readily accessible to anyone in or around Rochester.

He works with other addiction and mental health community organizations such as Recovery is Happening in Rochester, Valhalla Place in Brooklyn Park and the Rural Aids Awareness Network in Mankato to acquire and distribute those supplies.

But while news headlines — and even that sensationalized movie scene — bring some awareness of opioid overdoses and the existence of an overdose-reversing drug, Clements said there are still many misconceptions and stigmas surrounding naloxone’s use, purpose and importance.

“I’m not enabling anyone,” he said. “People are going to use this stuff whether or not they know what I have in my bag. Having the tools to help isn’t acceptance of the issue — it’s actually being proactive of the issue.”

During a harm reduction educational training at Café Steam on July 7, 100 naloxone kits were distributed to local residents and businesses. The next training is at Recovery is Happening on Tuesday, August 7.

“None of these things are necessarily going to get people to stop using,” Clements said. “However, knowledge is power, and it can change the way that people use. These are all tools that, when used together, make for a stronger community.”

‘We had a gap that should’ve been fulfilled a while back’

Stephanie Devich has seen the numbers skyrocket.

A few years ago, her organization, Valhalla Place in Brooklyn Park, distributed 7,000 naloxone kits to opioid users and the people who know them.

“As of last month, I’m almost at 15,000 kits distributed so far this year,” said Devich, a licensed alcohol and drug counselor, certified prevention professional and harm reduction specialist.

Valhalla Place has historically been one of the largest distributors of naloxone in the state, and it’s where Christian Clements gets his supplies.

Connected through other harm reduction program professionals in the state, his services, supplies and knowledge have come from working with Recovery is Happening in Rochester, Mankato’s Rural AIDS Awareness Network and Valhalla Place.

In 2018, Valhalla Place received $399,860 as part of the State Targeted Response to the Opioid Crisis Grant, according to the Minnesota Department of Human Services.`

Devich said about 66,000 kits can be given out with that grant funding alone, but they could possibly distribute up to 100,000 naloxone kits by paying for the difference out-of-pocket.

“We were able to get the largest state-targeted response grant in the state of Minnesota — nearly $400,000 — through July of next year,” Devich said. “We have those huge numbers so that I can distribute as much naloxone as possible.”

With that money, Valhalla Place targets high-risk opioid users, as well as their family and friends, and provides education, training and access to naloxone.

Some of those resources have already found a home in Rochester.

“So far, we have put 200 kits in less than 30 days out into your community,” Devich said. “For me to go through 100 kits in that fast of time, that shows we had a gap that should’ve been fulfilled a while back.”

She said that when she had previously reached out to the Rochester area, no one was interested in her organization’s services.

“(Rochester’s) been an option, but no one would listen,” Devich said. “There’s a discord; You have the overdoses, but people might just not be willing to talk about it.”

‘There is no harm, and there is a need.’

The Minnesota Department of Health has data demonstrating the need.

In 2016, there were 395 opioid-involved deaths, including prescription opioids, heroin, fentanyl, and fentanyl analogues – an 18% increase from 2015.

There were 67 opioid-involved overdose deaths (non-exclusive) in Olmsted County through 2000 to 2016; 8 were in 2016 alone, which is tied for the seventh-highest in the state that year.

Emergency first responders have felt that need, too.

Kate Arms, a Gold Cross Ambulance paramedic and assistant supervisor, said the 14 Gold Cross sites across Minnesota and Wisconsin have administered naloxone a few hundred times so far in 2018; Rochester and the surrounding area have had a 25 percent increase since last year.

“I would say (we respond to) at least five a week,” Arms said regarding overdose emergency calls, “but depending on the week and time, it can be more than that.”

She said that although Narcan is something of a “buzz word” in the news, the drug is nothing new for the medical community.

“This is as old school as they come,” Arms said. “I don’t think it has affected the epidemic one way or the other, but you have more of a chance to intervene and hopefully get patients help.”

With increased public access, Arms stressed the importance of calling 911 if anyone is ever unsure in an overdose situation. Although naloxone only works to interrupt an opioid’s effects and eventually wears off, she said overdoses can be dangerous and fatal if the user isn’t thoroughly monitored.

Dr. Matthew Sztajnkrycer agreed. The professor of emergency medicine at Mayo Clinic stressed that naloxone alone isn’t always a life-saving resource.

“It’s kind of a sexy drug because it works really well at saving people’s lives, but one thing that is important to remember is that no one has ever died from a lack of naloxone,” Sztajnkrycer said. “People have died because no one has given them rescue breaths, supported their airway or basic life support.”

‘It’s an action step they can take’

In addition to the grants that have helped community-based organizations such as Valhalla Place distribute naloxone and other supplies, pharmacies have been allowed to distribute the drug without a prescription since 2014.

Minnesota Department of Health opioid overdose prevention director Kate Erickson said that state legislation allows pharmacies to opt in to distribute naloxone to someone at risk or who knows someone at risk of an opiate overdose.

“That third-party prescribing piece is unique for family members and friends who are concerned about a loved one,” Erickson said. “It’s an action step they can take to be prepared in an emergency.”

While the legislation has been in effect since Jan. 1, 2017, not all pharmacies have joined the protocol.

Close to 30 Rochester pharmacies are listed on the Narcan website saying they carry the drug. However, only 14 were able to confirm that they had the medication available and on hand by Friday morning.

Rochester Pharmacies That Stock Narcan

This map shows the pharmacies in Rochester that confirmed that they sell Narcan/Naloxone in a spray or injection. Doseage sizes vary by location. To add a location to this map, email ahalliwell@rochestermagazine.com.

That’s not the only legislation that has been passed in recent years to address the opioid crisis with naloxone.

Erickson also said the reason organizations such as Rochester Harm Reduction Services and Valhalla Place can independently distribute the drug legally is because of what’s known as “Steve’s Law.”

“’Steve’s Law’ allows laypeople to administer naloxone to respond to an emergency, the same type of response as those who perform CPR or carry an EpiPen,” she said. “As a public health approach, that is something that the general population can do to be involved in responding to the opioid epidemic.”

‘They are using so they don’t die’

There are some who believe that increased access to a drug like Narcan might increase opiate use.

“We have certainly heard that belief before, but we have not seen any data to support that increased access might increase use,” Erickson said. “If people are using a substance, it’s because their body is addicted to the substance. It wants and needs that substance, so they’re not going to want to block that, right?”

Erickson said obtaining Narcan for an opioid addiction is no different than carrying an EpiPen for a shellfish allergy.

“Somebody has naloxone with them when they are using so they don’t die,” she said. “This is a substance use disorder, and this is a condition (where) people have a medication that can save their life.”

‘It’s based in love and kindness’

As Clements continues his work distributing naloxone kits to family, friends and users in Rochester, he said that the stigma attached to drug use is one of the most essential challenges he has yet to tackle.

“To me, the principles are very simple behind harm reduction: it’s based in love and kindness,” he said. “A huge portion of this work is about changing the stigma of drug use. If anyone thinks that the war on drugs is still a thing, they don’t realize that the drugs have won.”

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