First response to the opioid crisis

First Response published in the print issue of rotary magazine written by Elizabeth huitt music by Yu Kim of Chicago I'm Scott [Music] Thomas Matt fer was in his office at a public library in Middletown New York when a colleague in the second floor children's room called to tell him someone was sunbathing on the lawn outside this sounded odd to fer who suspected it might be a medical situation he headed outside bringing along a security officer in the grass they found the woman drifting in and out of Consciousness ants were crawling on her shirt they ran inside had someone call 911 and grabbed a Noone kit fer remembers his hands shaking as he got the medication ready and sprayed it into her nose about 30 seconds later she sat up the timing of this episode which took place in 2016 at the Middletown Thal library was fortuitous just 3 weeks earlier the social services provider had offered a community training in administering the lockone a drug that rapidly reverses opioid overdoses fiser an assistant and multiple security guards signed up in recent years as the Nationwide opioid crisis had hit their small community 50 Mi Northwest of New York City they had found themselves calling emergency responders several times to help overdosing patrons before the general news is out people in libraries know what's going on says fiser director of the Thal Public Library District they're on the street right they've got their ear to the ground the opioid crisis has tightened its grip on communities Across America more than 880,000 people in the US died of overdoses involving opioids in 2022 almost quadrupled the total in 2010 in response people like fiser are equipping themselves with the overdose reversing drug nxone with help from local governments and Community Based organizations including rotary clubs the approach is turning high school students Transit workers and music festival staff into deao First Responders efforts are building to tackle op addiction before it begins and tele medicine policies from the covid-19 pandemic make it easier for people to get treatment but experts say there's still a long way to go before the crisis subsides in the meantime Noone is becoming a key tool for reducing stigma and saving lives we all have loved ones family members friends who may be experiencing problems with drug use says magdalina SDA director of the center for opioid epidemiology and policy at New York University Grossman school of medicine she says that it's important to have nxone readily available to respond the opioid crisis has been mounting since the 1990s when millions of patients began receiving prescriptions for powerful painkillers like oxycotton that had just come onto the market over time some people developed substance use disorders and turned to street drugs particularly heroin which was often cheaper than pills then around the mid-2010s a synthetic opioid started to spread elicit fentanyl easier to produce than heroin and up to 50 times more potent making it much easier for people to accidentally take too much what's more because fentanyl is cheap to make it's often mixed into other drugs such as heroin or cocaine or pressed into counterfeit pills meant to look like prescription medications fake pills are especially dangerous for an increasing number of people self-medicating with drugs bought through social media from mid 2019 through 2021 84% of adolescent overdose deaths involved illicit fentel and 25% involved fake pills according to the US Centers for Disease Control and prevention people can overdose un fentanyl without even knowing they're taking it this has led to a particularly dangerous moment the main challenge is The lethality of the drug Supply that is leading to an unprecedented number of people dying from overdoses says SDA as overdose is Skyrocket nxone is becoming a critical tool to help stop these deaths known by the brand names Naran or clado the drug reverses overdoses by binding to opioid receptors in the brain blocking the opioids in the bloodstream from having an effect a study in Pennsylvania published in 2022 found that people who received at least one dose of nxone following an opioid overdose were 11 times more likely to survive and contrary to concerns that its availability would encourage people who use drugs to take more risks Studies have found that it does not lead to increased opioid use this is why over the last two decades state policies and Community level programs have worked to put none Within Reach of people who may need it Most states have some version of laws allowing pharmacists to provide no loxone on request without a doctor's prescription and in 2023 the US Food and Drug Administration approved Narcan to sell overthe counter a big GameChanger according to SDA nooon can now be found in US supermarkets convenience stores and gas stations on shelves like ibuprofen or aspirin people can even buy it online the change is in addition to wide- ranging efforts to make nooc Zone accessible across communities School nurses offices carry it service plazas across the turnpike in Ohio stock it many restaurants and bars keep no lockone on hand Music Festival goers at laap palooza in Chicago were handed doses this year and New Hampshire distributes overdose response kits to businesses some cities are even placing the lockone alongside defibrillators used for cardiac arrest in public places such as libraries and community centers fiser the librarian says every staff member who attended the first training with him in 2016 has administered the drug the library had about a 3 and a halfe stretch with no overdoses but last winter two people were revived he offers training to interested staff members once a year since the most common type of Noone is a nasal spray can also come in a syringe it doesn't take much time or expertise to learn how to administer it the more people that are prepared to deal with an event the safer everybody is going to be he says still there are barriers SDA notes that people don't always feel comfortable asking for an Al Lock Zone and many pharmacist choose not to stock it even if they're permitted to plus the cost of buying no loxone over the counter can be prohibitive for many people SDA says a two-d Doos kit retails for about $45 without health insurance still the efforts are part of a broader push that is Raising awareness and reducing stigma around the lock Zone which sarda sees as significant if we normalize it sarda says people are much more likely to a have it and B use it on a Wednesday evening in late June at the YMCA in Southgate Michigan Steve ALS instructed a group of 14 people on what to do if they come across someone who may have overdosed on opioids the retired firefighter and rotary member told trainees that once a person is unconscious lay them facing up insert the nooo nozzle into the nose and spray it then get the person into the recovery position lying on the side and be sure to call for emergency responders even if it turns out the person is not experiencing an opioid overdose no loxone is safe to give the training was the first public session ALS had led a member of the Rotary Club of Southgate he had learned how to teach others to use Noone through project smart a multifaceted initiative of the rotary Action Group for addiction prevention the project led by the action group's North American chapter mobilizes rotary clubs in the US to address opioid overuse from prevention to treatment project organizers have developed programs for schools including 30 minute age specific education presentations and drug free clubs for students another component involves Distributing medication disposal kits to households to destroy old prescriptions before they're misused the initiative also includes efforts to connect people with treatment options and tella health providers that prescribe medication for opioid use disorder one of project Smart's most active initiative so far is an effort to expand the lockone access by teaching rotary members and others to lead training sessions in their communities Larry kenamore a retired paramedic and a rotarian who helped launch the initiative estimates more than a thousand people in a dozen states have been trained in how to use Noone people who attend are given kits to take home and as to report in when they use one so that the Action Group can track the impact in one recent report a police officer in Arkansas whose Department was trained through the project says he use the medicine twice to revive a pregnant woman and a teenager kenamore says Al's first trainees in Southgate included several rotarians YMCA staff members and a few people who found the event on social media one woman told ALS that one of her family members uses drugs it was a concern of hers that maybe this should be kept around he says as the fire chief of Southgate alss was involved with an effort to distribute defibulators in the 1990s I don't see this as any different he he says it's just a tool that can help save lives that's readily available to the public doesn't really require any specialized knowledge you simply have to learn a couple of things researchers have estimated widespread distribution of nxone to emergency personnel and other people likely to encounter an overdose could reduce overdose death rates by more than 20% a study published in 2019 found that North Carolina counties where Noone kits were passed out had lower overdose death rates than counties without distributed kits while Advocates are working to make Noone more widely available research shows that it's particularly effective in the hands of people who use drugs or likely to be bystanders the idea is to make its public presence common so it's readily at hand whenever needed I think it's really important for everyone essentially to have access to the lock Zone SAS says in a parking lot tucked behind a building on a busy street in Cincinnati while letters glow on a vending machine 24 hours a day stay safe drivers can pull their cars alongside it roll down their window punch in a code collect their items and drive away the machine doesn't offer sodas and candy bars instead it's stock with the lockone strips the test substances for the presence of fentanyl safe for sex kits pregnancy tests and more the Cincinnati HIV prevention organization caracle placed the vending machine outside its office in 2021 as a mid pandemic effort to support vulnerable residents when in-person Services weren't possible the organization takes an approach known as harm reduction which tries to lessen negative outcomes for people who are not ready or able to completely stop engaging in Risky Behavior explains Direct ctor of prevention Suzanne bachmeier that idea is controversial with critics concerned that it could encourage drug use but some elements of the strategy are being more widely embraced fentol test strips for instance have been considered illegal drug paraphernalia in some states now they're increasingly recognized as life-saving tools and at least 20 states have decriminalized them since 2018 there're also o becoming more widely available on college campuses and elsewhere amid an increase in counterfeit pills meant to resemble popular medications for everything from anxiety to attention deficit hyperactivity disorder Carol's vending machine which almost 1,600 people had signed up for as of October 2023 was among the first in the country now the machines some stocked only with no lockone other others carrying a wider array of items are popping up on New York City street corners in rural health centers in bus terminals and in police stations based on carac CO's experience bachmeier believes the machine is a best practice for Distributing supplies to date clients report that testing strips they got from Caracol machines have detected fentol in drugs about 5,800 times and people use no loxone from the machine to reverse overdoses almost 3,500 times according to clinical pharmacist Daniel erant an assistant professor at the University of Cincinnati who partnered with carot Cole to track the machine's impact we found that the best bang for your buck in terms of just overall dollars spent in harm reduction is when the lock zone is given to the community who is at risk says erant anybody can register to get a code to access the free items in the vending machine a process that takes a couple of minutes by phone or in person the registration process helps track how the machine is used but those brief conversations are also starting points for new connections bachmeyer explains many people who first interacted with Caracol through the vending machine later came to use other services like HIV testing prenatal care or help for domestic violence she says multiple people have sought assistance connect to treatment for opioid addiction part of the intention of tracking Carol's vending machine was to learn from the experience to inform other communities according to erant now the organization has consulted with more than 50 Public Health officials and others interested in setting up similar programs the vending machine has turned out to be more successful than organizers expected erant says though it's no Silver Bullet this is a Band-Aid this is not something that's going to solve everything erant says it's something that we're hoping will help because this current system doesn't work well enough that these things aren't needed Carol Catz bear knows the opioid crisis well her oldest son Brian died in 2016 of a fentanyl related overdose 4 days after Brian's unveiling ceremony a Jewish custom traditionally held near the anniversary of burial his younger brother Alex also died of an overdose involving fentanyl The Empty Chairs the holidays the Ripple effects of the loss and trying to carry on and trying to you know honor their legacy and their memory because they were just the funniest smartest goofiest Bearer says trailing off it's not something a family ever forgets the two brothers were always close growing up in New Jersey Beer recalls they shoveled snow together they skateboarded and snowboarded they were part of the same friend group and went to the same parties and they experimented with drugs together once Bayer Sons started using drugs she says navigating treatment options was extremely challenging they tried out ofate residential options over the course of years the cost of treatment reached more than $500,000 both young men made strides Bayer says Brian attended Johnson and Wales University and Alex graduated from full sale University but the road to recovery is not straightforward and they face stigma strict rules and other challenges at times Suboxone a medication taken daily that can reduce symptoms of withdrawal and Cravings helped Alex in his recovery but there were barriers that made it hard for him to continue using it once he was discharged from recovery program he was placed in a sober living home that did not allow residents to take medications for opioid use disorder Bayer recalls Bayer's experience has made her an advocate for improving policies and treatment options related to opioids she has led community outreach for nonprofits including project opioid and through her work she's pushed for more availability of evidence-based treatment options including medications like the one her son used in the past she explains many people viewed medications that treat opioid addiction is trading one drug for another but she says it's akin to treating any other disease like taking insulin for diabetes some folks may not need it or want to be on it Bayer says other individuals may need it for a short term others may need it for life Andrew kadney medical director of the opioid policy research collaborative at brandise University emphasizes that overdose deaths can be prevented by expanding access to medications that treat opioid use disorder to this day one of the main policy failures is a failure to recognize that this is an epidemic of opioid addiction an epidemic of people with a preventable treatable disease he says if you miss that piece of it you miss more of the Upstream interventions like prevention and treatment of opioid addiction people whose treatment involves medications like buprenorphine which is in Suboxone and methadone are less likely to relapse or fatally overdose if we really want to see deaths coming down in the United States in the short run you would want to see that everyone who's opioid addicted can much more easily access borine than they can heroin or fentanyl kadney says Dr Arin Gupta sees the impact the medication can have on people's recovery aarian and the chair of project smarts treatment program Gupta has specialized in addiction medicine since 2006 and is a strong advocate of medication assisted treatment 85% of his patients are stable and in long-term recovery they have jobs they excel in work they excel in education they're back with their families they go to church they buy new houses they buy new cars he says despite evidence demonstrating the effectiveness of medication for supporting recovery many people don't receive it nationwide 87% of people with opioid use disorder are not taking medication as treatment one of the main challenges according to Gupta is a shortage of Physicians willing to prescribe bup andorine there is stigma around treating addiction he says doctors also have to comply with strict regulations putting them at legal risk if they misstep a federal policy change at the end of 2022 removed one barrier Physicians are no longer required to get a waiver to prescribe borine a shift that theoretically makes prescribing the medicine easier Gupta is skeptical that will make a difference on its own treating addiction requires expertise he says and many doctors are unwilling to take on the issue another Co era change has been promising Federal Regulations historically required patients to be evaluated in person to get their prescriptions but early in the pandemic rules were relaxed allowing Physicians to meet with patients and prescribe borine via teleah Health filling a gap in their existing treatment or giving them time to connect with a longer Term Provider the pandemic era rules are not permanent and the federal rules for telea health prescribing going forward are still being debated and revised but Research indicates tella Health leads to higher retention rates in treatment than only iners Services patients and doctors reported benefits like flexibility with few downsides and there was little evidence that the drug was more likely to be diverted and misused Bayer recalls that when her sons were navigating recovery the model for addiction treatment was tough love over the years she has seen more leaders and community members come to understand that such a punitive approach doesn't work many responses are politically contentious but there have been shifts and with that a cause for Hope Bayer sees more widespread agreement around the importance of medications for opioid use disorder she's noted a growing awareness of mental health issues which often correlate with substance use the crisis continues to take a toll every day but she says I like to think that as a nation we are coming together around some of these complex issues this episode of the rotary magazine podcast was produced by JP Swinson and edited by W Wong with production by Yu Kim I'm Scott Thomas if you enjoyed the show greatest five stars on Apple podcast and Spotify the article originally appeared in the January 2024 issue of rotary magazine rotary magazine is the official monthly publication of Rotary [Music] International