Naloxone: Impacts of Community Distribution Programs

by | Nov 18, 2015 | H-STAT General Blog

Drug overdoses were the leading cause of injury death in 2013 in the United States. Drug overdoses claim tens of thousands of American lives every year, and in Georgia specifically, overdose deaths have tripled between 1999 and 2013 (Georgia State Report, 2013). Opioids are a prominent cause of overdose deaths and include range of pharmaceutical and illicit drugs such as morphine and heroin. Around 2 million Americans, aged 12 and older, either abused or were dependent on opioid painkillers in 2013 (CDC, 2015). Opioid overdose leads to decreased respiration and unconsciousness, putting overdose victims at risk of death (CDC, 2015). Enter Naloxone (also known by the brand name Narcan), a non-addictive medication that can reverse the effects of an opioid drug overdose. Naloxone is an opioid antagonist that competitively blocks opioid receptors in the brain, reversing overdose symptoms in the process. Within two to eight minutes of administering naloxone, breathing and consciousness can be restored to the overdose victim (WHO, 2015).

Medical amnesty (911 Good Samaritan Policies) is a statewide law in Georgia, which grants intoxicated minors a limited legal immunity for possession of certain drugs when they seek help for themselves or another individual who is in need of immediate medical attention (Medical Amnesty Initiative, 2012). Basically, medical amnesty allows people to make responsible decisions by removing the threat of punishment when they reach out for medical assistance during an emergency related to alcohol or drugs. For example If someone is at a scene of an overdose (either alcohol or drug) and the person calls 911 for assistance, the person cannot be arrested, tried, or convicted if law enforcement arrives and finds small amounts of drugs at the scene or alcohol possession or consumption for minors. Also it provides immunity for doctors and pharmacists for prescribing certain medications (Medical Amnesty Initiative, 2012). Without these measures in place, people often hesitate when stressful, life-threatening situations arise (SSDP, 2015). During a drug overdose occurrence, a person can stop breathing and lose consciousness. Brain damage due to a lack of oxygen can occur in as little as 4 minutes (Medline Plus, 2015). Once naloxone is administered, within a few minutes drug overdose symptoms can be reversed. Minutes can be the difference between brain damage and full recovery (Stop Overdose Illinois, 2015).

As of April 24, 2014, Georgia practitioners were authorized to begin issuing prescriptions for opioid antagonists (naloxone). That day, Georgia became the 15th state in the union to enact the 911 Medical Amnesty/Naloxone law, which grants limited prosecutorial immunity to people who seek help during a drug or alcohol overdose. Georgia also became the 19th state of the union to extend legal protections to people who administer nalox1naloxone-kit-2one to someone experiencing a drug overdose (Castillo, 2014). Unlike traditional prescriptions, practitioners may prescribe naloxone in the name of an organization, clinic, or law enforcement agency. The practitioner is authorized to issue these prescriptions to a person who is at risk of experiencing an opioid related overdose. The practitioner may also prescribe naloxone to someone who is in a position to help others who are at risk for an opioid related overdose. For example, naloxone can be prescribed to a pain management clinic, first responder, harm reduction organization, family member, or friend (Georgia Drug and Narcotics Agency, 2014). Giving naloxone to family members and friends of at-risk individuals can be an especially important measure, because these people are often the first responders during an overdose.

Medical amnesty laws go a long way towards increasing the availability of naloxone and making it safe for people to use naloxone without legal repercussions for drug use; however, many of the people most at risk of an overdose do not have access to naloxone or know how to use it properly. An overdose education and naloxone distribution program or (OEND) program has the potential to put the antidote directly in the hands of those people most likely to overdose themselves or be around someone who is likely to overdose. Programs such as needle exchanges and prison release programs are good examples of contact points in which OEND programs can educate people at risk for overdose and bystanders in how to prevent, recognize, and respond to an overdose (Walley et al., 2013). A study based in Massachusetts, between September 2006 and December 2009, followed over 2900 individuals enrolled in an OEND program. Of these individuals, 327 rescue attempts were made. Most rescue attempts occurred in a private setting, and the rescuer and person who overdosed were friends. Naloxone was successful in reviving the person who overdosed in 98% of the rescue attempts (Walley et al., 2013).

In another instance, this time involving Drug Overdose Prevention Education (DOPE), the program provides a short 10-minute long training on naloxone kits. DOPE trained and prescribed naloxone to 2500 participants between 2010 and 2013 in San Francisco, CA. Over 700 revival attempts were reported. Again, the majority of revival attempts took place in a private residence (40.5%) while another large percentage took place in a single room occupancy area or hotel room (29.6%). Of the over 700-reported revival attempts over 90% of them were overdoses related to heroin and 95.7% of the recipients were known to have survived (Rowe et al., 2015).

These two studies alone exhibit that many lives can be saved by educating people through local programs. Drug overdose education and training programs can mean saving thousands of lives if not ten of thousands of lives nationwide. It can also mean saving medical dollars otherwise spent on extended hospitalization (Sisk, 2015). With increased access, education, and minimal training someone who is at risk, knows someone at risk, or both can safely and effectively administer naloxone and give someone another chance at life.

On November 12, 2015 Health Students Taking Action Together, Inc. collaborated with Georgia Overdos8dac26_20c4088a51534ec59fdad6c3f74d4e8ee Prevention to provide members with the education and training regarding Georgia’s 9-1-1 Medical Amnesty Law and Naloxone access. Georgia Overdose Prevention is a volunteer organization in partnership with the non-profit organization Atlanta Harm Reduction. Since 2014, 300 overdoses have been reversed in Georgia using naloxone. However, gaps still exist in first responders and laypersons access to naloxone. Specifically, the rise in naloxone price as more and more people are in need of the antidote. As an element of the event, attendees were invited to receive a naloxone prescription and additional education for practicing harm reduction method, such as never mixing drugs, never using drugs alone, and never sharing needles. If you are interested in obtaining a naloxone kit, please contact Georgia Overdose Prevention or ask your doctor to write a prescription.

References

About Naloxone. (n.d.). Retrieved November 10, 2015, from http://www.naloxoneinfo.org/get-started/about-naloxone

Call 911 Good Samaritan Policies. (n.d.). Retrieved November 11, 2015, from http://ssdp.org/campaigns/call-911-good-samaritan-policies/

CPR – adult: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved November 11, 2015, from https://www.nlm.nih.gov/medlineplus/ency/article/000013.htm

Georgia Governor Signs 911 Medical Amnesty/ Naloxone Law. (n.d.). Retrieved November 10, 2015, from http://www.huffingtonpost.com/tessie-castillo/911-medical-amnesty_b_5213563.html

Rowe, C., Santos, G.-M., Vittinghoff, E., Wheeler, E., Davidson, P., & Coffin, P. O. (2015). Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program. Addiction, 110(8), 1301–1310. http://doi.org/10.1111/add.12961

Rural Recovery Center Gets Federal Dollars to Save Heroin Users in WNC | North Carolina Health News. (n.d.). Retrieved from

“Naloxone (Opioid Antagonist) Law Now In Effect.” Georgia Narcotics and Agency. GEORGIAGOV, 23 June 2014. Web. 10 Nov. 2015. <http://gdna.georgia.gov/press-releases/2014-06-23/naloxone-opioid-antagonist-law-now-effect>.

“Narcan | Naloxone | The Opiate Antidote to Save a Life.” Narcan | Naloxone | The Opiate Antidote to Save a Life. N.p., 2015. Web. 10 Nov. 2015. <http://stopoverdoseil.org/narcan.html>.

“Narcan | Naloxone | The Opiate Antidote to Save a Life.” Narcan | Naloxone | The Opiate Antidote to Save a Life. N.p., n.d. Web. 10 Nov. 2015. <http://stopoverdoseil.org/narcan.html>.

“Prescription Drug Overdose Data.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Oct. 2015. Web. 10 Nov. 2015. <http://www.cdc.gov/drugoverdose/data/overdose.html>.

“Training Tools: NaloxoneInfo.org.” Training Tools | NaloxoneInfo.org. N.p., 2013. Web. 10 Nov. 2015. <http://www.naloxoneinfo.org/run-program/training-tools>.

Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., … Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ, 346(jan30 5), f174–f174. http://doi.org/10.1136/bmj.f174

Wheeler, E., Davidson, P. J., Jones, T. S., & Irwin, K. S. (2012). Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010. MMWR. Morbidity and Mortality Weekly Report, 61(6), 101.

Wheeler, E., Jones, T. S., Gilbert, M. K., Davidson, P. J., & Centers for Disease Control and Prevention (CDC). (2015). Opioid Overdose Prevention Programs Providing Naloxone to Laypersons – United States, 2014. MMWR. Morbidity and Mortality Weekly Report, 64(23), 631–635.

WHO | World Health Organization. (n.d.). Retrieved November 10, 2015, from http://www.who.int/en/

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