“Hi, would you like to be trained in administering Naloxone?”
The pharmacy student was standing under the bleachers of the Wise County Fairground during the Remote Area Medical clinic, held last weekend, with a blue medical kit in hand. Admittedly, I had never heard of Naloxone, the opioid overdose emergency medication sold under the brand name Narcan. My interest was piqued and 15 minutes later, I gained the knowledge of how to recognize someone in an overdosed state, how to administer the lifesaving drug either intranasally or intramuscularly, and was also given two free doses of Naloxone.
For reference, a single dose of the injectable Naloxone costs upwards of $4,000 out of pocket.
Sarah Melton, professor of pharmacy practice at the Gatton College of Pharmacy at East Tennessee State University brought her students from the pharmacy school to train healthcare professionals, volunteers, and patients about Naloxone through a program called Revive! where the pharmacy students provide training. With guidance from Michele Thomas, pharmacy services manager at the Department of Behavioral Health and Developmental Services, over 300 people were trained over the weekend on how to save someone’s life with Naloxone.
Melton and Thomas explained the importance of the overdose-reversing drug, additionally providing some important numbers surrounding the epidemic.
“It works essentially by competitive inversion,” said Thomas. Once they enter the body, opioids attach to the receptors in your brain and mimic natural opioids produced in your body. These powerful connections made by the artificial opioids are hard to disconnect because they “fool” the brain into releasing dopamine, the brain’s pleasure, and reward neurotransmitter.
This basically creates a powerful addiction due to the overwhelming release of dopamine. “[Naloxone] has a higher adherence to the receptor than an opiate or pain medication does,” said Thomas, thus knocking the opiate off the brain receptor and giving a bystander precious minutes to call emergency services. Narcan starts to take effect within 30-45 seconds of administration and lasts for around 30-45 minutes.
Gov. Ralph Northam’s appearance at the RAM clinic posed as an excellent opportunity to address the crisis. With the year almost halfway through, Northam has to look ahead at the coming months to lower the rate for 2018. “Number one is to have the resources to be able to staff our community service boards and make sure that people can get into same-day access,” he said in a one-on-one interview with RVA Mag. He acknowledged that this is an issue that demands public awareness, not strictly professional or administrative. “One last thing I would say is making sure that we have access for families, for first responders to Narcan or Naloxone.”
After the state health commissioner announced the opioid crisis a public health emergency, a growing concern within the opioid crisis conversation is that the rate of use and the subsequent fatality rate is growing. Compared to 2016, the number of lives lost to opioid use in 2017 grew from 1,138 to 1,227. Virginia received a $9.7 million grant to combat the opioid crisis in May of this year, according to a press release from Gov. Northam. Virginia was also selected for the National Governor’s Association project to combat the opioid crisis.
Although exact numbers are still coming in, it has been confirmed that more than 10,000 cases of Hepatitis C were reported in Virginia. In 2015, Virginia reported 8,138 cases of chronic Hepatitis C, and 956 new HIV cases, all attributed alone to injectable drugs, such as heroin. According to the surgeon general, “over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half (48.0 percent) receive treatment for either disorder.”
Southwest Virginia, specifically Wise, has seen a spike in opioid cases. In the last year, fatalities rose by more than 33 percent in the county. When asked about why the region has such a high epidemic rate, Melton answered frankly. “Southwest Virginia is kind of unique because we have a lot of coal mining industry workers, so we have a lot of chronic pain injury,” she said. “But when Purdue Pharma came out with Oxycontin in the early 2000s, it was very much marketed in Southwest Virginia as a medicine that would be effective for pain that wouldn’t cause addiction.”
Within a week of it entering the market, pharmacists knew Oxycontin was addictive. Melton added that several factors play into the high addiction rate specifically for the southwestern area, including genetic disposition for addiction, sociocultural linkage with poverty and unemployment, and the rate of chronic pain due to common industries. It is important to note, however, that these aren’t the only factors that contribute to the chance of addiction: addiction can happen anywhere and to anyone.
“The recognition that this is a disease,” said Thomas, helps legitimize the addressing of this problem and disqualifies it simply as a social choice. “This is not something people do purposefully.”
The personal aspect of addiction rings loudly within the community. “We hear one story after the other about ‘If I had had this training six months ago, I could have saved my husband,’” said Melton. “It is heartbreaking when you hear that.” That is why, she said, they want to come to clinics like RAM and provide free training and doses for anyone to obtain. “We’re trying to make sure people have access to the Naloxone at no cost.”
An epidemic of this magnitude seemingly has countless solutions. But Melton and Thomas broke it down to two: education and training. “We have to educate people, train them, and then provide the resources that folks need,” said Thomas. “Our goal is once they’re safe from an overdose, if they have an overdose, when they get treated in the emergency room, they have peer recovery specialists there or case managers that are able to integrate them into treatment the next day,” added Melton.
Obviously, wrap-around services like this require financial resources, but, Melton said, they are working to address that through legislation. “We work closely with the legislators, especially on medication-related bills. We now have safe syringe exchange in Virginia. Who thought we’d ever have that this soon?”
If you or someone you love is battling an opiate addiction, visit the Virginia Department of Behavioral Health and Developmental Services office of recovery services or mental health services. To find out more about Naloxone training and how to receive Naloxone, visit here. If you happen upon someone who has overdosed, please call 911.