How to save a life: Officials push Naloxone trainings into the community

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Seante' Hunt stood in front of 16 trainees in a county health department conference room Monday morning and held up a plastic syringe filled with a clear, unassuming liquid. That watery substance is Naloxone, the miracle drug that, as she explained to a group of teachers, social workers and others, allows "for life to begin again" in a person on the edge of death from an opioid overdose.

Hunt is the opioid misuse prevention coordinator and overdose response program coordinator in Howard County, a position becoming increasingly vital as the county continues an unrelenting battle against opioid abuse.

One of Hunt's main responsibilities is training groups and individuals in the county on the use of Naloxone, explaining to everyone from school nurses to prison guards to parents how the drug works to stop the effects of opioids in the body.

Every person who attends one of Hunt's trainings sponsored by the county's Health Department walks out with two doses of Naloxone, enough to bring a person back to life if they are in the midst of an opioid overdose, an occurrence that is becoming increasingly common in Howard County. Ten people died between January and March this year from heroin-related causes, compared to five people during that time last year, according to state data.

Hunt said she administers the trainings both at community meetings like Monday's, which anyone can attend, as well as at the request of different groups in the county, such as the staff of the Department of Public Works and high school nurses for Howard County schools; in January she trained she trained more than 100 county school nurses. .

When the county first started offering the trainings in 2014, Hunt said they were given once a month by Bethany DiPaula, an associate professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy. When Hunt began in her county job in 2015, she started out offering approximately two trainings a month, but since then she said that number has grown dramatically; so far she has scheduled eight trainings for August.

The number of individuals getting trained has also increased dramatically. Hunt said when she started she trained roughly 200 people a year; last year, she trained 715 people, and she expects that number to be even higher this year.

Hunt spent the hour-long training explaining to attendees how Naloxone works in the body, and took participants step-by-step through how to put together and administer the nasal applicator. Trainees repeated back to Hunt to give half the dosage in each nostril and to administer rescue breathing after the Naloxone, and then practiced putting together an applicator.

Sarah Madison, a social worker with the Howard County Department of Social Services, said she attended Monday's training because she comes across drug use while on the job and also because she lost a friend to an overdose earlier this year. Madison, who elected to attend the training on her own, said she would like to see her entire department trained.

Madison said after the training that she felt "absolutely ready" to administer the drug if needed.

"I'll carry it in my purse and have it on me always," she said.

Hunt said most people who sign up for the community trainings are professionals such as social workers, counselors and nurses, but that approximately 20 percent are people concerned about a family member overdosing. She said these are the individuals who often need the medication the most, which is why she also offers one-on-one brief training sessions for parents and others who need to quickly learn how to administer Naloxone and can't wait until the next offered training.

"Everybody just can't wait, and I don't want them to wait, if they need [Naloxone] today I want them to get it today," Hunt said. "When you're in crisis, all you need to know is these are the signs and here's what you do. All they want to know is 'How do I save my child?'"

Naloxone is an "opioid antagonist," used to counter the effects of opioids in the body, said DiPaula. The medication blocks opioid receptors in the brain, stopping the drugs from producing an effect on the body.

As a depressant drug, Hunt said during the training, opioids tell the body to shut down, and in the case of an overdose, stop breathing. Naloxone replaces opioids in the receptor site and allows the body time to recover and begin breathing again.

DiPaula compared Naloxone's effect to putting bricks in the seat of a car. If opioids are the driver of a car but there are bricks in the seat, the driver can't make the car go.

However, DiPaula cautioned that a dose of Naloxone has a shorter effective life span than opioids, meaning that it will wear off sooner than the drug's potentially fatal effects. If an overdose victim doesn't receive further treatment soon after receiving Naloxone, they can be sent back into an overdose.

"At some point the bricks are no longer in the seat of the car, and if I, the driver, am sitting outside the car waiting, I can make the car go again," DiPaula said.

There are two ways to administer Naloxone, one is to push the drugs into the body through the nose using an applicator, and the other is to inject the medicationthrough the shoulder or thigh. DiPaula likened Naloxone to carrying an EpiPen for allergic reactions.

"If you have friends or family with [a substance abuse] disorder or are on opioids because of pain, having Naloxone with you can be really important, because sometimes overdoses are accidental," DiPaula said.

The medication is safe to use on children and pregnant women, and does not give the user any sort of "high," Hunt said. She recommends giving Naloxone to someone showing symptoms of an overdose — including pale skin, loud gurgling noises and blue lips and fingertips — whether or not it's confirmed that the person has opioids in their system.

Naloxone has been used in hospitals for years, but DiPaula said its use at the community level in Maryland has become more widespread in the last four to five years as the opioid crisis has taken hold. The Overdose Response Program run by the Maryland Department of Health certifies local public or private entities to host training programs in overdose response tactics; there are currently 80 approved programs statewide, three of which are in Howard County, hosted by the county's health department, police department and the Maryland Jockey Club.

In June, the potential for Naloxone's use in Maryland grew even further when the state passed a new standing order to allow pharmacies to dispense the medication to anyone, regardless of whether they have been previously trained or certified in Naloxone administration.

Under the new standing order, a person-specific prescription is not required for a pharmacist to dispense Naloxone. The state's previous order, which was passed in December 2015, required that a person be certified under the Maryland Overdose Program to receive a dosage of Naloxone from a pharmacy.

That new order means that anyone can be ready to administer the medication if needed. Even for those who don't know someone personally who is at risk of an overdose, Hunt said being Naloxone-trained could help save a life.

"I tell people to look at it just as they would CPR. You're a bystander in the community wanting to help someone in need," Hunt said. "Overdoses don't just happen in back alleys, they happen in Walmart, gas stations, local restaurants. You can be potentially anywhere and have the opportunity to help save a life."

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