GOSHEN — Putting naloxone into anyone’s hands can create an added layer of defense to help prevent opioid-related overdose deaths. But, wielding the overdose-reversal medication comes with a set of attached responsibilities and understandings, experts and emergency responders believe.
Paramedics, firefighters and police officers remain on the front line, carrying naloxone — also known by the popular brand name Narcan — as a tool in overdose situations. The medication is also available to the public, as is training on how to use it.
“I think it can be a good thing,” Chief Mickey Scott of the Syracuse Fire Department and Turkey Creek Fire Territory said of equipping and training people with nalaxone. “If it saves one life, it’s worth it.”
Local addictions treatment and drug prevention organizations host classes when needed to teach participants how to administer naloxone, its function, its limitations and the nature of addiction.
Those close to people with an opioid drug addiction are viewed as the next line of defense to thwart an overdose.
“The real huge need is getting (naloxone) into the hands of patients who are using opioids, and family members and friends who would probably more likely come upon somebody who is overdosing,” said John Horsley, director of addiction services at Oaklawn.
Horsley, who keeps Narcan on hand due to his position, added teachers and staff from other agencies also undergo naloxone training to be ready in case an overdose situation arises.
A STOPGAP, NOT A CURE
The main lesson about naloxone is it’s not a safety net, it’s not fun and it will not cure addictions.
“It is not a substitute for medical care,” said Brooke Marshall, an addiction therapist at Oaklawn. “This is to buy us time.”
Nalaxone only works on opioid substances, including heroin and pain medications like oxycontin, oxycodone and morphine, said Marshall, who also volunteers at Gweedo’s Purple Shamrocks, an opioid addiction resource center in Elkhart.
When a person overdoses and stops breathing, naloxone can reverse the effects, in a king-of-the-mountain-like situation, by kicking opiates off the user’s brain receptors and then attaching to the receptors to block the opiates, she described.
The result can revive an overdosing person as a temporary solution while waiting for emergency responders to arrive and begin administering medical treatment. The effects are harsh. When naloxone uproots the opiates, the brain undergoes immediate withdrawal symptoms, which can be painful and uncomfortable, she said.
Patients can sometimes become combative when revived, as if rudely awakened from a deep sleep, Scott added as a caveat.
“If you’re going to administer (Narcan), you’ve got to be aware that something like that could happen,” Scott said.
He and other public safety leaders worry the availability of naloxone to the public will give some addicts the false hope they can get high while the medication, like a video game’s extra life, is nearby to pull them out of an overdose.
Marshall disagrees. She believes the consequences are unpleasant to a level where opioid users wouldn’t want to tempt them.
Indiana legalized naloxone for public use with the enactment of Senate Enrolled Act 406, also called “Aaron’s Law,” in 2015. The law opened access to the medication from emergency responders to residents if they believe someone they know is at risk of an opioid overdose, the Indiana General Assembly’s website shows.
The move came amid climbing rates of opioid-related deaths statewide.
Opioids accounted for 274, or nearly a quarter, of the 1,236 overdose deaths in Indiana in 2015. And of the drug overdose deaths that year, 85 percent were unintentional, according to a 2017 report by the Indiana State Department of Health.
Suspected opioid overdose deaths in Indiana grew by 35 percent between July 2016 and September 2017, according to Centers for Disease Control and Prevention report in March.
Elkhart County saw a rate of about 22 non-fatal opioid overdose-related emergency room cases per 100,000 people in 2015, while the rate of deaths from the drugs was 2.8 per 100,000 people from 2011–2015, state health department data shows.
“Opioids, in general, in Elkhart County have been slower to become a problem. We lagged. And that could be because of our law enforcement efforts,” said Jessica Kosher, director of the Elkhart County Drug-Free Partnership. “We’re starting to see it trickle in in treatment, and law enforcement’s seeing more and more of it. … It’s bubbling up more and more.”
Naloxone comes in multiple forms. There are generic injectable versions, the Narcan brand is a nasal spray, while another brand, Evzio, is a prescription auto-injector.
Naloxone is available at numerous local pharmacies. Walgreen’s and CVS can both dispense Narcan and generic naloxone without prescriptions. The medication is covered by most insurance plans, and out-of-pocket costs vary, representatives from both companies said.
For the uninsured, the out-of-pocket price for Narcan is about $95, while generic naloxone is about $38 at CVS, said spokeswoman Erin Britt.
Marshall led a Narcan training session during a mental health breakfast at Oaklawn’s Elkhart campus April 24. That same day, the Council for a Drug Free LaGrange County sponsored a training event at the First Church of God in LaGrange.
Marshall has conducted Narcan trainings about once a month over the past year at different locations.
The events are also opportunities for her to scrub away myths about addiction and opioids, saying addiction can affect anyone, and addicts don’t fit certain stereotypes.
“There’s a lot of stigma and false information about addiction,” Marshall said. “We need to start viewing addiction for what it is, and it is a disease. That’s a community thing.”
To her, naloxone should be part of any home first-aid kit.
“In the middle of an opiate epidemic, it should definitely be part of that,” she said.
Training sessions are scheduled at Oaklawn and Gweedo’s Purple Shamrocks based on demand. But as requests for them grow, Oaklawn is looking into how to expand the schedule, Horsley said.