Naloxone Program Becomes Key Treatment Component
By KEVIN CORVO
ThisWeek Community News
As the number of drug-related overdoses in central Ohio emergency departments began to rise sharply several years ago, OhioHealth practitioners realized a new course of action was required.
A pilot program, started in April 2017, provided naloxone kits to patients treated for an opiate overdose at four OhioHealth facilities: Grant Medical Center, Pickerington Medical Campus, Westerville Medical Campus and Marion General Hospital.
Naloxone is a nasal spray commonly known by its brand name, Narcan. When naloxone is directly administered into the nose of a person who has overdosed, it reverses the dangerous effects of the opiate the person has taken.
“It saves lives and gives a person a chance for treatment and successful recovery,” said Paula Kobelt, a nurse and outcomes manager at Grant Medical Center. “We started this project to provide naloxone to high-risk emergency department patients [who overdose] in response to the opiate crisis in central Ohio and as part of an initiative to create a community standard in the emergency department.”
But putting naloxone in the hands of at-risk patients and their family members or caregivers is just one prong of OhioHealth’s program. It also includes education and encouragement to seek the professional intervention required to treat and recover from a substance use disorder.
Currently, there is no formal follow-up but these patients are connected to treatment or sent home with a number of resources to get help when they are ready, including contact information for treatment programs, said Wendi Hayes, a clinical nurse manager at Grant Medical Center.
The kits include two doses of naloxone and instructions on how to administer the medication.
“There is a stigma and a bias associated with substance abuse [and] we work diligently to address it,” Hayes said. “It’s getting better, but there are still some people who we cannot convince that [substance abuse] is not a choice. They cannot stop without treatment.” The opiate, whether it’s a prescription drug such as Oxycodone or an illegal drug such as heroin, “hijacks the brain,” said Grant Walliser, a pharmacist at Grant Medical Center.
“It tricks the brain into thinking the only way to achieve euphoria is to use the drug,” he said, but soon the user is taking the drug not for the euphoria but to avoid the symptoms of withdrawal.
Substance use disorder develops for several reasons, Kobelt said, including early exposure, individual environment and possibly genetics.
The brain of a developing adolescent is much more susceptible than a fully developed adult exposed for the first time to an opiate, Kobelt said.
“Adverse childhood experiences and exposure to any of a variety of drugs at home or among peers adds to the propensity and prevalence of addiction,” she said.
Walliser said that while there might be an initial choice by a first-time opiate user, substance use disorder “is truly a disease.”
“Recovery is like any other chronic disease, something a person with substance use disorder must be vigilant about the rest of their lives,” Hayes said.
Erasing the stigma associated with substance use disorder is an important first step toward the success of the naloxone program.
“We want to make people feel it’s OK to get treatment [and] words matter,” Kobelt said. “Our patients aren’t addicts or junkies; they are people with a substance use disorder.”
It is a treatable medical condition that knows no bounds and has no limits like other medical conditions, Kobelt said.
“It doesn’t matter how rich you are, how poor you are, how pretty you are, or your culture or religion. Denying that is a danger. We need to create awareness and emphasize prevention factors,” said Kobelt. Hayes recalled providing care to an emergency patient who died just shy of her 18th birthday from a heroin overdose, the result of a dependency rooted in the prescription drugs she received after a sports-related injury.
For Hayes, the epidemic hit much closer to home.
Her 41-year-old brother died in October from an opiate overdose and another brother is battling with substance use disorder, she said.
“I silently worked on [the naloxone] project for a while and it was hard to hear what other people said about the overdose patients seen in the ED,” Hayes said. “I fought bias at work for staff to give the Narcan that could save these lives.”
The logic behind doing so is to give patients the opportunity to seek the help they need, Kobelt said.
“Some people say, ‘Why give it to a person if they are going to use again?’ And they probably will to prevent going into withdrawal unless they opt into a treatment program,” she said. “But with [our naloxone program] they are alive for us to offer treatment. That’s the essential part of the program, to prevent death.”
OhioHealth’s program to provide naloxone kits extends to its facility in Marion, about 50 miles north of Columbus.
“We currently distribute the kits to high-risk patients and family members due to elicit opioid use, misused or highdosage prescriptions, or following an overdose,” said Dr. Matthew White, who is medical director of emergency services at Marion General Hospital. “For us, the key to success has been identifying high-risk patients and working closely with our physicians, pharmacists, EMS teams and nursing staff to formalize processes and educate about the use and benefits of the kits.
“The more Narcan in the community, the more we can save or change a life.”
Photography: Lorrie Cecil/ThisWeek News