Natick Doctor Takes Part in Demo of Overdose-Reversing Drug

From Fiorente Healthdesk:

The number of people using opioids, including prescription pain medications and heroin, is growing exponentially. As of 2014, there were 435,000 heroin users in the US, and this number may have increased dramatically given the most recent overdose numbers.

All opioids are highly addictive. People who have a family history of substance use or who may have undiagnosed or untreated anxiety or depressive disorders are at high risk for opioid use and addiction.
Young people may be particularly susceptible to substance use disorders since their brains are still developing and substance use during this time may interfere with development of a healthy brain reward-system.

Like many other communities, Natick, Mass. has seen a dramatic increase in overdoses since the beginning of 2016. According to Natick Police Chief James Hicks, the community of 30,000 people has seen 15 overdoses in the first six months of 2016, one of which was fatal. In all of 2015, there were 24 overdoses in Natick of which two were fatal.

If you know someone who is using opioids, regardless of whether they are prescribed or illicit, then you should train yourself to intervene in case of an overdose.

In this article, you will learn how to administer naloxone in an attempt to reverse the effects of opioid overdose and potentially save someone’s life.

Natick Together for Youth, a non-profit focused on reducing youth substance use, convened a special seminar on overdose awareness at Leonard Morse Hospital in Natick. Katie Sugarman, executive director, invited a group of speakers including Jeffrey Zeizel, LICSW, an addiction specialist, Shelley Richmond Joseph, Esq., a legal expert on laws related to addiction treatment, Natick Police Lt. Cara Rossi-Cafarelli, and a team of pharmacists-in-training from the Massachusetts College of Pharmacy & Health Sciences.
Anthony Villanova, Ali Cronin and Pia Clive, all second-year pharmacy students in the accelerated PharmD program at the Massachusetts College of Pharmacy and Health Sciences, presented detailed instructions for using naloxone to reverse an opioid overdose to an audience of about 30 people at the Natick Together for Youth event.

Here is a summary of the information they shared.

Acquiring Naloxone

Under recent legislation passed by the Massachusetts State Legislature, pharmacies in Massachusetts have standing orders to make naloxone available to anyone who requests it. No prescription is needed. Insurances companies are required to cover payment for naloxone, aside from the usual co-pay for prescription medicines.

It helps to call the pharmacy ahead of time and make sure they have naloxone in stock (ask for the “orange box” configuration, which consists of a syringe-like applicator and two ampules of the medication). Confirm that the pharmacy can bill your insurance company for the balance of the payment (after the co-pay).

Make sure you request a nasal atomizer in addition to the naloxone kit. The atomizer, which costs about $5 and is sold separately, makes it easier to administer the naloxone.

Assemble your Naloxone Kit

Open the kit and confirm that it contains a syringe and two ampules filled with naloxone. Remove the yellow caps from each end of the syringe-like applicator. Place the nasal atomizer on the tip of the applicator. Store the assembled materials back in the box and keep in a place where you will find it quickly in an emergency.

Recognizing an Overdose

A person experiencing overdose will show symptoms of oxygen starvation, as their depressed central nervous system will cause their breathing to slow down and possibly stop altogether. Telltale signs include blue lips or finger tips, very shallow breathing or no breathing at all.

They make be making a choking or gurgling sound as their bodies struggle to get oxygen. Their pupils may be pinpoints and fixed.

You can confirm they are unresponsive by taking the knuckles of your fist and vigorously grinding your knuckles into their sternum, which is the bone in the middle of their chest. If they do not respond to this, you should take action immediately.

Emergency Aid for an Opioid Overdose

Call 911. This is very important. After administration of naloxone, the person must be under medical supervision to prevent a recurrence of the overdose. Even if you are currently under the influence of an illicit substance yourself, you will be protected by a Good Samaritan law . Just make the call.

Move the person onto the floor on their back.

If the person is not breathing, administer five to 10 rescue breaths. Make sure the person’s mouth is clear of obstructions. Tilt the person’s head back, and use your mouth to blow long, slow breaths into the person’s mouth. Make sure their chest rises as you blow into their mouth.

Remove the purple cap from one ampule of naloxone and gently twist the ampule into the syringe-like applicator. The ampule is fully inserted when a few drops of medication squirt out of the nasal atomizer.

Place the applicator into the left nostril of the person, and press on the ampule to squirt half of the naloxone into the left nostril. Place the applicator on the right nostril, and insert the remaining half of the naloxone into the right nostril.

Continue giving rescue breaths until the person begins breathing on their own. If the first ampule of naloxone doesn’t revive the person, wait three minutes, and repeat the process by administering the second ampule of naloxone in the same manner.

Once the person begins breathing on their own, place them in the recovery position.

Naloxone works by breaking the bond between the opioid drug and opioid receptors in the body. Naloxone will effectively break these bonds for a period of 45 to 60 minutes. However, it will not flush opioid drugs out of the body.

The opioids will remain in the person’s body, and it is possible that the person will experience another overdose once the naloxone dose wears off. Therefore, it is very important to place the person under medical supervision until they are out of danger. The person should be transported to a hospital for observation.

It is also possible that the revived person will begin immediately experiencing symptoms of withdrawal. These symptoms may include chills, sweating, nausea or agitation. Try to keep the person calm until emergency personnel arrive. Make sure the person knows they were just revived from an overdose and that they need immediate medical attention so that they don’t slip back into an overdose after the naloxone wears off.

If the person is not experiencing an opioid overdose and you administer naloxone, there are no negative consequences. The drug will have no effect on the person, and they will not be harmed.

There are other means of delivering naloxone through special kits that go by brand names ,such as NARCAN or EVZIO. These instructions don’t apply to those delivery systems. Follow the specific directions for those products.

It is important to understand that you are not “enabling” a substance user by acquiring naloxone and being prepared to deal with an overdose. You are saving his or her life.

Naloxone is an emergency medication designed to prevent accidental deaths. It is not a treatment method for substance use.

If you are in a position to assist a person in seek of treatment following overdose, look for an evidence-based treatment program.