Talking Naloxone with Randy
In our last piece, we covered the opioid overdose reversing drug Naloxone where it comes from, why it is useful for combating overdoses, and how public health authorities and community groups are getting it into the hands of everyday Americans.
With the FDA joint committee hearing fast approaching, I attended a Naloxone training session led by Randy of the Steve Rummler Hope Network.
At 43, during his first college course on addiction and recovery, the executive director of the Steve Rummler Hope Foundation—at that time an organization with $100,000 dollars and one employee—spoke before his class. Randy, himself having 9 years of recovery under his belt at this time, knew that he wanted to prevent as many deaths from opioids as he possibly could, having known from personal experience the devastation that they caused.
His work with the Rummler Hope Network began on that day, becoming a volunteer for the organization, then a board member, and now he leads these addiction clinics, to show civilians, first responders, and fellow addiction/recovery counselors, how they can play a role in combating this rising public health problem.
Based on his experience, Randy felt that it was most important to review what Naloxone is, the procedures that insure it is used effectively, and why, ‘our old way of thinking about the problem is not going to work.’
Naloxone: Overlooked truths
Once an opiate overdose starts, the affected person will begin to experience slowed breathing until it stops altogether, and at this point, one only has about ten minutes before they die due to lack of oxygen to their heart and brain.
Naloxone starts working almost immediately—no matter where you inject it into the body. This could be the outer shoulder, your thigh, or easiest of all the buttocks. The needle included in these kits, and most others, must be completely embedded in the subject.
By conducting a few simple tests like: rubbing ones knuckles along the subject’s sternum, checking to see whether their pupils are constricted—appearing about as wide as the end of needle, or just checking to see that they are breathing properly, will tell you whether or not to administer the drug.
If in doubt, Randy has seen no side effects with Naloxone, aside from the symptoms of withdrawal that can set in after the administration of the drug. Most of those reported are not life-threatening.
Naloxone Side Effects
A 2015 literature review conducted by the University of Kentucky College of Pharmacy, supports his experience too. Among the cases examined, one found that among 1192 incidents that 235 people complained of confusion, 157 of headaches, 66 of nausea/vomitting, and 62 showed signs of aggressiveness. No lethal reactions were found.
With the intense potency of modern opioids, the Rummler Foundation decided to include three doses of Naloxone to dea with more extreme cases. For overdoses involving, high doses of heroin, fentenyl and carfentenyl, these doses are necessary.
According to Randy, Minnesota had at least 13 overdoses due to Carfentenyl, a synthetic opioid 10,000 times more potent than morphine in 2016. Randy accounted one incident where he administered 9 doses of Naloxone on a single person.
Forms of Naloxone
Naloxone is administered in several other forms aside from the intermuscular injection. Most of these methods are more expensive than Naloxone and concerns about brand name pricing, by the same companies involved in marketing opioids, has drawn concern from consumers across the country.
Some first responders and community groups may be lucky enough to have access to the Evizio combo autoinjector, which aside from Naloxone contains and EPI-pen and an Automated External Deliberator (AED) machine.
Despite its ease of use, it retails for about $4,800, leaving it far out of reach for most affected communities
Naloxone is often used interchangeably with the nasal spray form of the drug, Narcan, it uses the same pharmacological technique to achieve its effects. Generally they retail for about $130-$140.
This compared to the injectable forms that tend to cost about $25 on average.
Manufacturers, networks of donors, and public grants, have, for several years, helped to make Evzio, Narcan, and generic Naloxone available to the Steve Rummler Hope Network and organizations like it, so that they could supply them to the public free of charge.
Naloxone by injection is by far the cheapest route of administration and as costs of the drug soar—it will likely be the nation’s best hope to combat the opioid overdose. Thus, its worth getting used to.
No matter what form of administration that you use, always begin with rescue breaths. Seasoned heroin addicts with no trouble administering drugs via syringe still miss this step, and it is paramount to the process, as Naloxone will enable a subject to breath again, but the unconscious subject will not necessarily start breathing on their own—so don’t skip this.
First, uncap a clean syringe, pull back the plunger on the syringe, carefully insert the needle into the vial and push all the air inside the container. Next, tip the bottle, with the syringe still inside it, upside down and make sure the point of the needle is below the liquid line. After that, pull the plunger of the syringe all the way back, remove it from the vial. With your unconscious subject before you, press the entire needle into the subject and push the plunger all the way down.
Narcan is even easier to administer. After giving rescue breathes, it only requires one spray in each nostril. Each nasal applicator contains one dose of the medication.
Closing thoughts on Naloxone
Randy, now almost 14 years sober, feels that this issue has grown in importance due not only due to the rising number of deaths from opioids, but due to the change in the nature of the drug itself.
Drugs like Carfentenanil, despite being known to the medical community since 1974, has been used most notably to sedate large animals.
Fentenyl, its weaker cousin, is suspected to have been used by Russian special forces to put down a hostage crisis. Despite the use of Narcan by Russian medics, 116 hostages died.
He has witnessed firsthand the exponential climb in the potency of opioids in recent years. As the potency of these drugs has risen, the marginal effect of remedies like Naloxone, is actually going down—and people have yet to be trained in on how to use that.
As we closed up, we reflected on the ways that the opioid crisis is affecting our own community. In particular, the homeless encampment in Minneapolis that recently received attention from the national media, where groups like Natives Against Heroin are struggling to keep the scourge of the opioid crisis at bay, as residents of the encampment struggle to find affordable housing and temporary living arrangements.
Our sources at the scene tell us that there are between 2-3 overdoses per day reported from the encampment. Thanks to collaborative partnerships between groups like the Steve Rummler Hope Network and civic organizations based in the encampment, Naloxone is widely available to those that need it. These same sources reported that 3 deaths from overdoses.