In addition to working to put naloxone in the hands of intravenous drug users and their families and friends, public-health advocates are seeking to increase access to naloxone training.
Simmons, a researcher with the nonprofit National Development and Research Institutes, in New York, responded to many states’ calls to require naloxone training by creating a short instructional course that both EMTs and laypeople can complete online. She intends to collect data from users of GetNaloxoneNow.org to evaluate its helpfulness, and says that since November the website has reached 8,000 individuals nationally.
“There’s a lot of people dying from prescription overdoses, people who are using alone, who are isolated from other people who are using, and we need to reach those people. And the way to reach those people is not through the traditional channels,” Simmons says. “They’re not going to syringe exchanges. They’re not going to harm-reduction sites. They might not even be going to community agencies.”
Getting opiate users trained on how naloxone can prevent overdose death is also key to making sure more people are taking advantage of the drug. And it’s important for users and their families to have the antidote before an overdose occurs, because if you have to go get it at the time of an incident, it’s too late.
This information is also important for pharmacists, who have one of the best chances of engaging with drug users visiting the pharmacy to purchase syringes. Green says pharmacists should be trained to offer naloxone on a more regular basis.
“Store by store, we visited pharmacies in a community to ask them to offer it to literally everyone coming in purchasing syringes, to offer them naloxone directly,” says Green.
Pharmacists are particularly suited for increasing access to naloxone for several reasons. “They understand the pharmacology of what is happening in addiction,” Green says. And of the nearly 3,000 pharmacists she has trained in naloxone distribution, Green says, many “understand that this is no different from other chronic diseases in many respects.”
And public-health advocates say an understanding of the effects opiods have on users is important for pharmacists and others who may be helping users transition out of rehabilitation or incarceration.
“There is a lot of potential for death reduction by focusing on incarcerated populations, people leaving detox, and people who are transitioning from the emergency departments after having been medically treated for an overdose,” says Green. “Those instances and those transition points we know are very high-risk.”
For example, periods without opioid use lower an individual’s tolerance. Thus, a typical amount used before a period of detox could be a fatal amount after.
This kind of knowledge can be life-saving for an opiod user coping with addiction. But it’s difficult for public-health advocates to stay on top of the epidemic when the opiod drugs on the street are in constant flux.
“The challenges that we have now are not the challenges that we had yesterday,” says Green. “Five years ago, we were dealing with prescription opioids and a little bit of heroin, and now we are dealing with a lot of heroin and a little bit of prescription opioids.”
For instance, batches of fentanyl-laced heroin have entered the supply in Allegheny County, causing almost two dozen deaths in 2014. New developments like these leave the public-health community struggling to get ahead of this deadly issue.
But part of that effort also involves changing perceptions about users. Advocates say this includes a commitment to recognizing the humanity in intravenous drug users, and treating them like any other patients with a disease.
“You can live with addiction — in your past, your present and potentially, you never know, in your future,” says Green. “You can succeed, and you’re human.”