MIDDLEBURY — The call came in at around 11 a.m. this past Friday. A local man traveling in a car headed down Route 7 South in Middlebury was overdosing on heroin. He needed help. Fast.
Middlebury Regional EMS and Middlebury police sped down the highway and intercepted the vehicle near Martin’s Hardware. Rescue officials loaded him into an ambulance and made a beeline for Porter Hospital.
“He was unresponsive when I left (the scene),” said Middlebury Police Sgt. Mike Christopher.
Fast forward a few hours, the patient — who as of this writing had not been cited for any offense — was “up, conscious and talking,” Christopher recalled.
The man’s seemingly miraculous emergence from an opiate-induced coma came as a result of rescue officials giving him a dose of Narcan, the brand name for the pharmaceutical drug Naloxone.
Naloxone is used to treat respiratory depression caused by opioids, such as heroin, morphine, oxycodone, methadone, hydrocodone, codeine, Fentanyl and other prescription pain medications. These opioids produce their effects by acting on opioid receptors in the brain and nervous system. Naloxone blocks these opioid receptors, and reverses the effects of the opioid. Consequently, overdose patients can be brought back from the brink and then placed into recovery programs in order to kick their addiction before it’s too late.
That benefit is not lost on state officials, who are in the process of expanding access to Narcan as a means of saving and reclaiming lives.
On Wednesday, May 28, the Middlebury-based Turning Point Center of Addison County will offer free Narcan emergency kits to anyone seeking the product to assist a friend or loved one who is believed to be at risk of overdosing on opiates. Narcan cannot produce a high in the user and is only effective in treating an opiate overdose, officials said. It is also not harmful if it is mistakenly administered to someone who is not overdosing on an opiate, they said.
Addison County’s will be the first Turning Point Center in the state to pass out the free Narcan kits as part of a pilot program endorsed by the state Legislature last year through Act 75.
“The whole idea behind this is that until we get people off heroin, opiates and prescription drugs, we need to do what we can to salvage these people,” said Bill Brim, director of the Turning Point Center of Addison County.
“This is one more way to help the community.”
Vermont Gov. Peter Shumlin emphasized the battle against drug addiction as one of his top priorities for the 2013-14 biennium, and Act 75 provides for Narcan to assume a higher profile in waging the fight, according to Michael Leyden, deputy director of Emergency Medical Services for the Vermont Department of Health (DOH).
The new law calls on the DOH to work with community organizations to set up a Narcan pilot program to run for three years (through 2016). Bankrolled at $50,000 for year one, the program is already up and running at the Howard Center in Burlington, the Good Neighbor Health Clinic in White River Junction, and the West Ridge Center for Addiction Recovery in Rutland, locations where free Narcan emergency kits are being distributed to people with connections to addicts who could be saved from an overdose.
Each emergency kit, valued at $30 to $40, includes two separately packaged doses of Naloxone, an instructional booklet and a nasal atomizer syringe to administer the substance. Anyone who requests a kit is shown how it should be used. The vast majority of these kits get used in suspected heroin overdoses, according to Leyden. He likened Naloxone’s lifesaving value for addicts to the benefits of an epi-pen to those allergic to bee stings, or the importance of a defibrillator to a heart attack patient.
“In order for (Naloxone) to do its thing, it has to be in the right place at the right time,” Leyden said.
Leyden said that as of last week, approximately 300 of the kits had been given out through the pilot program. He pointed to reports indicating 18 of the kits have been used by Vermont citizens. Those who administer the kits are also instructed to call 911, as it is critical for each recovering overdose patient to receive additional care for their recovery. Those who use the kits are encouraged to return for another, which provides an additional way for officials to trace their use.
“That does not universally happen,” Leyden said of the requested 911 call. “So we’ll never quite know how many kits get used, because we may not find out through that mechanism.”
Act 75 also allows for Naloxone to be prescribed to individuals who have a relative or friend who is at risk of overdosing on opiates.
“This isn’t for self-administration,” Leyden said. “You’re going to use it on your friend, or friend’s friend. And the law protects everyone in this chain. The law put in specific protections for the prescriber, the people who dispense it and for the end-users of the kit. The whole principle here is that these are critical events, where someone is at risk of dying literally in front of you, and we want people to take action.”
The Legislature, at the end of the 2014 session, passed a new law that would give pharmacies the option of dispensing Narcan kits without a prescription, according to Leyden.
“We have to figure out how it would be paid for at (the pharmacy) level, but this will be a big shift,” Leyden said. “It’s up to the DOH and the pharmacy board to set up the protocols for this. This should be one step forward for public access.”
NALOXONE TRACK RECORD
Naloxone has for years been a tool used by advanced life support ambulances with highly trained crews with paramedics and advanced EMTs, to administer either nasally or intravenously. The state revised its policy, as of April 1, to allow Narcan to be administered nasally by regular EMTs. Vermont State Police, beginning early this year, were also given the training and supplies to administer Narcan.
Narcan has been used by Middlebury Regional EMS since the early 1990s, according to a paramedic with the organization who wished to remain anonymous. The paramedic said Narcan has proven itself over the years.
“It can be a life-saver,” she said.
But she stressed that people should not think that Narcan can work in isolation. She said that most patients that are revived from an opiate-induced episode vomit profusely upon regaining consciousness. That leaves the patient vulnerable to choking.
“You have to be able to manage how that patient is going to come around,” she said. “My concern is that when people give Narcan, they might think everything is wonderful and not get (the patient) to the hospital.”
Located mid-way between the Naloxone distribution centers in Rutland and Burlington, Turning Point Center of Addison County officials earlier this year offered to dispense the kits. Leyden and Tom Dalton, coordinator of the Howard Center’s Safe Recovery Support and Education Program, accepted the offer. A cluster of Fentanyl-related deaths in Addison County last fall also led state officials to deem it a good idea to distribute the overdose rescue kits in Middlebury. Dalton said Vermont averages approximately one fatal overdose per week.
The Howard Center has been dispensing the Narcan overdose rescue kits since Dec. 6, 2013, Dalton said.
“It’s been pretty successful,” he said of the program.
“We weren’t sure what to expect.”
Howard Center officials had checked with the Chicago Recovery Alliance prior to setting up the Burlington-based program. The Chicago Recovery Alliance was the first organization in the country to publicly distribute opiate overdose rescue kits that have resulted in almost 3,000 overdose reversals between 2001 and 2011, according to the program’s website.
“(The Alliance) assured us we were going to get reversals, but it’s hard to know what to expect,” Dalton said. “We are happy with the results so far, but also want to be making sure access is available to anyone who needs it. We don’t believe we have reached everyone who might use it yet.”
Some lawmakers, while debating the merits of Act 75 last year, wondered if the availability of Narcan kits would embolden some addicts to use opiates more aggressively with the knowledge they had a potential life preserver nearby. Dalton said that concern has proven to be unwarranted.
“It’s the same concern some people had with legislation around seatbelts — would seatbelts make people feel safer driving faster and actually make the roads less safe?” Dalton said. “Community-based distribution of Naloxone has been happening in other parts of the country for over 10 years, and they haven’t had that happen. There has been no evidence of people taking more risks just because they have access to this.”
Brim said the kits will be distributed at the Turning Point Center’s headquarters in Middlebury’s Marble Works complex from 1 to 5 p.m. on Wednesday, May 28. Those who pick up the kits should expect 5-10 minutes of training. He sees the distribution of the kits as one in a range of services the Turning Point Center provides to recovering addicts. Those services include a litany of peer-to-peer recovery support meetings for those addicted to alcohol and/or drugs, as well as a safe, friendly and substance-free environment where people in recovery — as well as their family and friends — can meet for support, social activities, recovery coaching, education and advocacy. The Turning Point Center of Addison County gets around 750 visitors per month, according to Brim.
“I feel (the distribution of overdose kits) is a long time coming in this community,” Brim said. “(The kits) can save somebody. It is great that the state is stepping up and being progressive with opiate problems in Vermont.”
Looking beyond the May 28 event in Middlebury, the DOH is looking to export the Narcan pilot program next in the Berlin area.
“Then we’ll see where we’re at with our resource pool,” Leyden said. “We’re trying to get that appropriate blend of being a good steward of resources as well as being responsive to community needs.”
Reporter John Flowers is at firstname.lastname@example.org.
TURNING POINT CENTER of Addison County Director Bill Brim announced that the Middlebury organization will be passing out free opiate overdose rescue kits on May 28. The kits contain a Narcan nasal spray.
Independent photo/Trent Campbell