Tuesday, January 30, 2018

Naloxone Training And The Opioid Crisis

I recently attended REVIVE! training on how to administer Naloxone and left feeling empowered, scared, and educated. The training was hosted by the Rappahannock Area Community Services Board (RACSB) and attended by everyone from regular citizens like myself to local school employees. Due to the nature of the discussions held, I'll refrain from using actual names of people or places. But more on that in a minute.

The training itself was relatively simple. Simple enough that anyone older than 13 could, and should, attend a session. This wasn't an in-depth first aid training session with scenarios that involved gushing blood or delivering babies. This was just a few slides, a short video, and the most complex part was the hands-on portion where we learned how to administer the Naloxone itself. And even that was simple enough that a young adult could learn how to do it in a few minutes. In theory somebody younger could administer the drug but should rescue breathing (also known as mouth-to-mouth breathing) or chest compressions (also known as CPR) be required, they may not be strong enough to render first aid effectively. But the key to the training wasn't the first aid, it was the Naloxone.

But let me back up a minute and talk about the opioid crisis itself. For me personally, it was one of those things that I knew about, read about, and saw on the news. But largely dismissed because, like most drug-related issues, figured it would never impact me or those around me. But as I went through the training, there were a few things I learned about that made me realize it could hit closer to home than expected.

None of my friends or immediate family are drug users, at least as far as I'm aware. But I do know people that could be taking an opioid legally for pain management. And when you combine an elderly patient that may not remember when they last took a dose, it is possible for somebody to accidentally overdose. On top of that, I frequently use the bathroom outside of my house. Gas stations. Local retail stores. All are common places for an overdose victim to be found. As I learned in training, some of the symptoms of withdrawal are nausea and diarrhea. Which could send a person to the bathroom to begin with, but it's also a place they can use in private.

So as I quickly learned in the session, encountering a person that has overdosed is distinctly possible. And being prepared for it was the key point I learned. I left the training feeling empowered knowing that I would have the medication on hand to save a person. Medication that, for lack of a better description, is a miracle drug that can bring somebody back from the brink of death in seconds.

Naloxone is the generic name of the drug that essentially kicks out the opiod (Narcan is the brand name). On a molecular level, Naloxone is smaller than the opioid and is able to take over the opioid receptors inside the body. It doesn't get rid of it, only replaces it, and only for about 40 minutes. So even after you administer Naloxone, it is possible for the person to overdose again without using again because the opiod is still present in their system. But that's about the only draw back to Naloxone that I heard in the training class. You can't overdose on it. There's no negative side effects, even for accidental usage. You can't abuse it or get high from it. The dosage is the same for children and adults. And what really blew me away was that most first responders use it on cardiac patients as soon as they arrive on scene simply because it really has no negative impact on the patient and could save them if it was an overdose.

Despite all of this good news about how Naloxone worked, learning about the opiod crisis and hearing stories left me feeling scared. As a father with kids nearing high school age, hearing about overdoses in high school left me feeling nervous and out of control. Once upon a time, I was in high school myself. There were always rumors of drugs in school but I never heard a rumor of anything other than marijuana. I did know of people and had friends that drank alcohol but that was as far as it went. At least that I knew of.

Without violating the privacy of those that attended, hearing about multiple overdoses in multiple area schools left me shook. These were first hand accounts from reliable sources. And I think what scared me the most was the comment from one attendee who said their high-school aged child wanted to attend a training session because they had seen friends overdose. Absolutely depressing and scary all at once.

The discussion of schools then left us all with a bit of confusion when that same person asked if their child , as a student, could carry Naloxone in school. Because many rural rescue departments have long response times or may not even carry Naloxone as part of their standard equipment, the student wanted to be prepared for a future overdose. The trainer wasn't sure but we discussed it as a group some. And even though the Naloxone is a prescription drug, we felt confident that anyone, student or teacher, could carry it in school as long as they had filled out the appropriate paper work. Similar to a student carrying an inhaler or Epi-Pen, it should be allowed to be on the person at all times if that's what the prescription calls for. The problem seemed to be the usage of Naloxone. As an example, if a student has a prescription for an inhaler and lets another student use it, they would get in trouble. But for Naloxone to work, you need to give it to the person in distress. So like an Epi-Pen, it doesn't make sense to save a life only to get suspended from school for breaking the rules.

Which brought me to my conclusion that we need, at the state and local levels, rules in place to protect the patient and the good Samaritan. Some protections are already in place, but the policy in schools should include Naloxone as a protected medication that can be used by anyone from a Nurse to a teacher to a student. On top of that, schools should have an open prescription for Naloxone, just like many already do for an AED (automated external defibrillator) and Epi-Pen.

As I walked out the door, feeling a little rattled by the information, I felt like it was a worthwhile training session. It was certainly worth the money (it was free) and absolutely worth the time (90 minutes). I left with a lot of information that I hoped I never needed but was glad to have. All attendees also got a small first aid kit that had gloves, rescue breathing mask, and stickers. The stickers are to be put in the hair of anyone we administer Naloxone to. And while the Doctor that usually attends wasn't there to give us the Naloxone itself, we were able to fill out paperwork to get the medication in the near future.

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