The (Stunted) Role of Narcan in Facing the Opioid Epidemic

"We can’t deny our way out of this crisis..."
Paul Lavella Jr. MA, LPC, LCADC, ACS

Earlier this month, speed-walking up 7th Avenue in New York City (as you do), I had a moment that brought my professional life as an addictions counselor and my personal life as a human being crashing together in a way I had never imagined. In a completely non work-related setting, I saw what appeared to be an overdose.

I was rushing to a fundraising event, supporting a friend and the work that his organization does. Feeling the evening caffeine lull, I swung into one of the many Starbucks on the 16-or-so block walk. It’s a coffee shop in Manhattan during rush hour - you can’t move 3 feet without accidentally bumping into someone. In the midst of all the commotion (loud conversation, latte orders being shouted out, people texting and taking selfies), I happened to notice a person half folded-over in the window.

Approaching the door as I walked out of the shop, the man (who looked to be in his late 30’s or early 40’s) was stationed at the bar-height ledge directly in front of the pane glass storefront, for all of 7th Ave to see. At first glance, he looked as though he was bent over looking for something on the floor, however the way his one hand was clenching his coffee cup on the table ledge while the other was dangling by his side gave warning signs that something was not right.

Something was definitely wrong. The gears of my assessing mind finally clicked into place when I was outside of the store, looking at him through the glass. He hadn’t moved. Certainly if he was looking for something he would have shifted position by now. Truth be told, he looked like he was slumping further down. Nobody was doing anything… Nobody noticed him.

And then the thought dawned on me: I wonder if anyone in this coffee shop even knows what an overdose looks like. Then again, If anyone did notice it, would anyone know how to help him, or care to?

It’s no secret that The Opioid Epidemic has been a focus of media attention in the past few years. The President’s Commission on Combating Drug Addiction and The Opioid Crisis has recently compiled its report of findings with recommendations for how we, as a nation, proceed moving forward in addressing this public health emergency. Quite simply put, the strategies outlined within are not able to be supported, in their entirety, by its budget. We have quite a list of ideas; ideas with an evidence base of efficiency, but lack the funding to execute it appropriately.

There is no blame to place for this disheartening reality, it just is what it is. And yet, there is so much more. Budget aside, public perception - stigma, bluntly - is something that can be addressed at a community level, and it doesn’t carry too heavy a cost.

In a shop full of bystanders, no one seemed to notice, or care, possibly, about the man who was slowly nodding out and drifting away in front of them. Now why is that? As I had previously mentioned, I am an addictions counselor. My professional life is immersed in partnering with people and families who are working toward recovering from the effects of substance use. Some of their stories include near fatal overdose, some include overdose reversal, and some unfortunately include loss. I know what people look like when they’re under the influence of a drug, and what an overdose looks like. One does not need to be professionally trained, however, to see that something was wrong. People were electing to not respond to a person in need of help.

Thankfully, for this man, this was no overdose. Once I came to my senses after the shock of what I thought I was seeing, I started yelling and forcefully smacked the pane glass window in front of him. On the second thud, he sprang up and started frantically looking around, re-orienting himself to his surroundings. When we exchanged glances, my suspicions were validated. His pupils were pinned (a pronounced symptom of a person who has recently used opioids). “Are you OK?” I yelled. By means of response, he haphazardly gathered his things and quickly left the store, shuffling in the opposite direction.

Let’s change the scene for a moment - same night, same coffee shop, same hustle-and-bustle. What if, instead of this man appearing high, he suddenly grasped for his neck, made gasping noises, and was struggling to breathe? What if he grabbed at his chest and began lowering to the ground with groans of pain? Surely someone would react to these signs of a person needing help.

Public awareness and training on signs of choking or heart attack are far-reaching. Even if a person doesn’t know how to appropriately perform the heimlich maneuver or CPR, it’s fair to say that an average lay-person would know how to identify symptoms of these medical crises.

Beyond this, it’s fair to say that the average person would feel compelled to intervene - to step in and help save a life or at least raise the alarm to others who may be more equipped to handle the crisis.

In facing this Opioid Epidemic, this willingness to help someone in need is imperative. We need to be willing, as a community, to show concern for people who are in the depths of this disease, when they need our support the most.

NARCAN, a nasal spray form of the medication Naloxone, has been used for upwards of a decade to aide in reversing the symptoms of opioid overdose. As a simplified explanation, the effects of opioids (prescription pain medications as well as heroin and fentanyl) suppress vital body systems, including respiration and overdose occurs when a person’s vital functions have been suppressed to the point where they go into failure - most accidental overdose deaths from opioids take the form of respiratory depression.

NARCAN, and other forms of Naloxone, remove the opioid from the receptor site, therefore restoring these vital functions, reversing the effects of the drug, and effectively saving lives. I’ll say that again: WE HAVE A WAY TO SAVE THE LIVES OF PEOPLE OVERDOSING DUE TO THE OPIOID EPIDEMIC. Why is it that the majority of the public is not aware that Naloxone exists? Why are more people not attending training on how to use NARCAN?

Summit Behavioral Health’s very own Chief Clinical Officer, Maria Ulmer is featured in a recent NJTV News segment discussing how the naloxone reversal drug is a step in a larger effort to get individuals the help they need to recover from addiction.

Breaking our cultural stigma toward addiction and increasing awareness of the acute signs of opioid intoxication and overdose needs to be a priority. True, there are many ways which members of the general public can receive this information, usually without a cost, however stigma remains a barrier to attending these trainings.

Ask yourself, Have I been to one of these trainings? If you have, more likely than not, you’ve attended the training because you’ve been personally affected by addiction or you work professionally in the field.

However, for your consideration, when you learned the signs of choking or heart attack, did you voluntarily elect to attend the training, or was it something that was mandatory? (My first training, for example, was part of my middle school health curriculum.) If you were trained in the heimlich maneuver or CPR, did you receive the training because you were personally affected by someone who had choked or had a heart attack, or because it was a valuable skill to have that may benefit others at some point in the future?

Is this all making sense yet?

The Opioid Epidemic has (finally) been categorized as a public health emergency and we are still walking past it with our noses upturned. As a community, we need to run toward the man who may have just given himself a lethal dose of opioids. Pretending we don’t see him won’t change our nation’s situation. We can’t deny our way out of this crisis.

Community members need to know what the effects of opioids look like. They need to know what Naloxone is, and how (with a simple, free 1 hour training) they can be better equipped to help a person who has overdosed. If you don’t know where to find these trainings, call a local treatment provider or contact your county Department of Health & Human Services office. There is generally no fee to attend, the training is not time intensive, and attendees are usually able to walk away with a free dose of the overdose reversing medication.

These trainings need to be mandatory in professional settings and educational institutions, in addition to the voluntary community based trainings already offered across the country. If a business owns an Automated External Defibrillator (AED), it needs to carry a NARCAN or EVZIO kit; if a school carries an emergency EpiPen, it can easily stock a dose of Naloxone right alongside of it.

For the sake of brevity, the nation has pressured this administration to acknowledge The Opioid Epidemic for what it is; it’s time for our community’s culture around the topic of addiction to be addressed. This complex, multifaceted issue has many areas that require attention (and funding). Changing culture, addressing stigma, and disseminating lifesaving information need not be a barrier to another life being saved. 


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