Part II: Naloxone in Nevada
(Note: The following update, Naloxone in Nevada, is a guest post from Morgan Green, MA, who joined the team at CASAT at the University of Nevada, Reno in April 2018 as a project coordinator for the State Targeted Response and the State Opioid Response grants. Currently working in that capacity with the many agencies across the state to help address the opioid crisis in Nevada, Ms. Green received her BA and MA from the University of Nevada, Reno and has been working in the field of substance abuse and the Nevada System of Higher Education the past 10 years. Her experience extends across criminal justice, nonprofit agencies, and academics. To contact Morgan for additional information about Naloxone in Nevada, email her at: Morgan Green, MA firstname.lastname@example.org.)
Naloxone in Nevada
Opioids have remained at the forefront of discussion through media (both mass and social), press releases, public awareness campaigns and personal experiences. Many of these sources often focus on the tragedy surrounding the misuse of opioids, the pharmaceutical role in the opioid crisis, and prescribing practices. We have heard from families who have lost loved ones, children that have been placed into foster care (NPR, 2019) due to parents struggling with addiction, and the declining lifespan of those living in the United States (AAFP, 2018).
While there has been a significant focus on the struggles at both a personal and social level, sometimes the positive work that is being done to assist those most affected is lost. On April 21, 2017, the Department of Health and Human Services (HHS) announced that funding would be available to states through the 21st Century Cures Act to address the opioid crisis based upon state needs. The State of Nevada received $5.6 million over a period of two years to influence the way that Nevada approached opioid prevention, treatment, and recovery.
One of the priorities through this funding has been to build and grow a strong overdose education program and establish naloxone distribution centers throughout the State of Nevada. Naloxone is not an answer to the opioid epidemic but instead is one-step. It is a means to keep a person alive long enough to seek help because a person does not have the opportunity to get help if they die. Naloxone was introduced to the medical field in the 1960’s to treat opioid induced constipation but was quickly discovered to act as an opioid antagonist (Admin, 2017). Naloxone binds with the same receptors in the brain effected by opiates, reversing the potentially fatal respiratory depression caused by opiates. Though naloxone has been found to be effective in opioid overdose reversal, it is only as effective as the ability to access it.
Naloxone expansion programs have been shown to have multiple benefits for both the community and community members when applied correctly. Programs have been found to; increase recognition and knowledge of overdose among community members (Green 2008; Bennett and Holloway 2012, Strang 2008, Wagner 2010, Jones 2014), improve community responses to overdose (Galea 2006, Doe-Simkins 2009, Wagner 2010, Lankenau 2013, Enteen 2010, Tobin 2009, Bennett and Holloway 2012), and improve the confidence of laypeople in the ability to administer intravenous and intranasal naloxone (Ashrafioun et al. 2016). Research has shown that drug use does not increase as programs are implemented (Galea 2006, Banjo 2014, Dettmer 2001, Doe-Simkins 2014) and in fact are likely to decrease overall drug use (Seal 2005, Wagner 2010). That may be due to the increase in drug treatment and ongoing attendance (Wagner 2010, Seal 2005) within those communities.
Nevada began the first steps of making naloxone easy to access to residents with the expansion of the Good Samaritan Act (SB 459) signed into law May 2015. This act ensures civil, criminal, and professional immunity for people who prescribe or administer naloxone. It does not protect against violent crimes, active warrants, or child endangerment. Within the medical field the act allows for Third Party Prescribing permitting prescribing to “friends, family, or anyone in a position to assist” (SB459, 2015) and pharmacists can issue naloxone without a prescription. Lastly, standing order prescriptions allow for a community-based organization under the authority of a licensed prescriber (physician, physician assistant, and advanced practice registered nurses) to distribute naloxone free of charge. This act opened several new avenues for Nevada citizens to access naloxone.
In addition to the legislation, overdose education and naloxone distribution (OEND) has started at the community level. Integrated Opioid Treatment and Recovery Centers, community coalitions, distribution centers, and the University of Nevada, Reno are currently providing this training. The purpose of the training is to provide overdose education to agencies and community members that have been affected by opioid crisis, provide services to those affected, or are concerned about opioids in their communities. This often includes law enforcement, medical professionals, behavioral health professionals, families and friends, and neighbors.
Access to naloxone can be the difference between life and death for individuals who experience an overdose. It can be a tool for family members who previously had to wait for first responders to arrive to help their loved ones. Family members and friends are often able to be the best position to administer naloxone during an opioid overdose (Bagley et al., 2017). It is easy to use and can be a powerful agent for change for both the person administering it and the individual being administered to. This supports the need to educate a much larger portion of the population on how to recognize and respond to an overdose. Relying only on first responders can delay care or result in individuals being missed. In Nevada, we have regions where there are limited emergency response teams that are responsible for expansive areas. This can severely extend response time, time that is critical for saving a person’s life.
As of April of 2019, 4,925 naloxone kits have been dispensed through the STR/SOR grants to individuals throughout Nevada. 2,892 naloxone kits have been provided to first responder agencies, and most importantly 277 opioid overdose reversals have been reported. Southern Nevada Health District has been supporting Las Vegas and the surrounding areas through another funding source. For individuals seeking out naloxone, distribution centers provide naloxone with no questions asked at no cost. Large pharmacies are also carrying naloxone without the need for a prescription. For an updated list of distribution centers please visit https://www.nvopioidresponse.org/naloxone-finder/.
The Nevada State Opioid Response – An STR/SOR Project website contains a wealth of information. The following links are provided for your convenience.
What Is Opioid Use Disorder? Contains information on the following:
-Get The Facts On Opioid Use Disorder
-Storage And Disposal Of Medication
-Good Samaritan Law
State Initiatives Provides information on the following:
-State Targeted Response
-State Opioid Response (SOR) Request For Application
Screening & Intervention Information is provided for:
Treatment & Recovery Contains links to:
-Integrated Opioid Treatment and Recovery Centers (IOTRCs)
-Recovery Friendly Workplaces
Training Links to information about:
-Opioid Addiction In Nevada Video Series
-Become a MAT Waivered Provider
Resources Provides information on the following:
-Prescriber Resources – Prescribe 365
-Publications and Documents
Admin. (2017, July 05). The History of Naloxone. Retrieved July 19, 2019, from http://cordantsolutions.com/the-history-of-naloxone/
Ashrafioun, L., Gamble, S., Herrmann, M., & Baciewicz, G. (2015). Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods. Substance Abuse,37(1), 76-81. doi:10.1080/08897077.2015.1110550
Bagley, S. M., Forman, L. S., Ruiz, S., Cranston, K., & Walley, A. Y. (2017). Expanding access to naloxone for family members: The Massachusetts experience. Drug and Alcohol Review,37(4), 480-486. doi:10.1111/dar.12551
Banjo, M. O., Tzemis, D., Al-Qutub, D., Amlani, A., Kesselring, S., & Buxton, J. A. (2014). A quantitative and qualitative evaluation of the British Columbia Take Home Naloxone program. CMAJ Open,2(3). doi:10.9778/cmajo.20140008
Bennett, T., & Holloway, K. (2012). The impact of take-home naloxone distribution and training on opiate overdose knowledge and response: An evaluation of the THN Project in Wales. Drugs: Education, Prevention and Policy,19(4), 320-328. doi:10.3109/09687637.2012.658104
Dettmer, K. (2001). Take home naloxone and the prevention of deaths from opiate overdose: Two pilot schemes. Bmj,322(7291), 895-896. doi:10.1136/bmj.322.7291.895
Devitt, M. (2018, December 10). CDC Data Show U.S. Life Expectancy Continues to Decline. Retrieved July 18, 2019, from https://www.aafp.org/news/health-of-the-public/20181210lifeexpectdrop.html
Doe-Simkins, M., Walley, A. Y., Epstein, A., & Moyer, P. (2009). Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose. American Journal of Public Health,99(5), 788-791. doi:10.2105/ajph.2008.146647
Enteen, L., Bauer, J., Mclean, R., Wheeler, E., Huriaux, E., Kral, A. H., & Bamberger, J. D. (2010). Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco. Journal of Urban Health,87(6), 931-941. doi:10.1007/s11524-010-9495-8
Galea, S., Worthington, N., Piper, T. M., Nandi, V. V., Curtis, M., & Rosenthal, D. M. (2006). Provision of naloxone to injection drug users as an overdose prevention strategy: Early evidence from a pilot study in New York City. Addictive Behaviors,31(5), 907-912. doi:10.1016/j.addbeh.2005.07.020
Green, T. C., Heimer, R., & Grau, L. E. (2008). Distinguishing signs of opioid overdose and indication for naloxone: An evaluation of six overdose training and naloxone distribution programs in the United States. Addiction,103(6), 979-989. doi:10.1111/j.1360-0443.2008.02182.x
Jones, J. D., Roux, P., Stancliff, S., Matthews, W., & Comer, S. D. (2014). Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users. International Journal of Drug Policy,25(1), 166-170. doi:10.1016/j.drugpo.2013.05.006
Lankenau, S. E., Wagner, K. D., Silva, K., Kecojevic, A., Iverson, E., Mcneely, M., & Kral, A. H. (2012). Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses. Journal of Community Health,38(1), 133-141. doi:10.1007/s10900-012-9591-7
Neilson, S. (2019, July 15). More Kids Are Getting Placed in Foster Care Because Of Parents’ Drug Use. Retrieved July 17, 19, from https://www.npr.org/sections/health-shots/2019/07/15/741790195/more-kids-are-getting-placed-in-foster-care-because-of-parents-drug-use
SB459. (2015). Retrieved March 10, 2019, from https://www.leg.state.nv.us/App/NELIS/REL/78th2015/Bill/2161/Text
Seal, K. H. (2005). Naloxone Distribution and Cardiopulmonary Resuscitation Training for Injection Drug Users to Prevent Heroin Overdose Death: A Pilot Intervention Study. Journal of Urban Health: Bulletin of the New York Academy of Medicine,82(2), 303-311. doi:10.1093/jurban/jti053
Strang, J., Manning, V., Mayet, S., Best, D., Titherington, E., Santana, L., Offor, E., Semmler, C. (2008). Overdose training and take-home naloxone for opiate users: Prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction,103(10), 1648-1657. doi:10.1111/j.1360-0443.2008.02314.x
Tobin, K. E., Sherman, S. G., Beilenson, P., Welsh, C., & Latkin, C. A. (2009). Evaluation of the Staying Alive programme: Training injection drug users to properly administer naloxone and save lives. International Journal of Drug Policy,20(2), 131-136. doi:10.1016/j.drugpo.2008.03.002
Wagner, K. D., Valente, T. W., Casanova, M., Partovi, S. M., Mendenhall, B. M., Hundley, J. H., Gonzalez, M., Unger, J. B. (2010). Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. International Journal of Drug Policy,21(3), 186-193. doi:10.1016/j.drugpo.2009.01.003