Why Naloxone is Important and How to Use It

Other webinars in series:

• Opioid Addiction in the United States (Part 1)
• How Your Prescription Medication Could Lead to Addiction (Part 3)
• Keeping Your Children Safe When Taking Medication (Part 4)

Videos:

• Risk Factors for Opioid Use Disorders
• How Opioid Abuse Impacts Quality of Life
• Narcan 101: How to Save a Life in an Emergency

Articles:

• Is the Opioid Crisis Only an American Issue?
• Common Opiates & Intended Use
• Common Signs of Opiate Abuse

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hello everyone. We are so excited to have our second edition, our second webinar with Miss America, Camille Schrier. We are thrilled to have had an excellent presentation last week if you were able to join us. Camille was incredible and shared so much valuable information with our audience and I hope that you found it to be useful and helpful and certainly life-saving.

So I’m very excited to get started today. If this is your first time joining us, welcome, I’m Alison Walsh with Advanced Recovery Systems. We are a national behavioral healthcare company. We actually started in Florida about seven years ago, but we have grown across the United States. We’ve got programs now in five states, almost six, and we primarily treat adults with addiction. We also have an adolescent center that’s located in Florida, but we specialize in the treatment of addiction and co-occurring mental health issues.

So we wanted to kick off this series because number one, it’s critically important that we continue to have an ongoing dialogue when it comes to addiction and mental health. Number two, it’s mental health awareness month, so what better way to celebrate awareness than to incorporate a really engaging webinar series. And we’ve also had the opportunity over the last four years to partner with the Miss Florida organization through our Real Talk program, which is an educational program that we provide free of charge to schools across the state of Florida. We’ve also done some presentations outside of the state, but once Camille was crowned Miss America, we knew we wanted to do something more and we’re very excited to be able to do this together.

So, last week she addressed the opioid addiction crisis and shared super valuable information. You can go back on our Facebook page and see that presentation from last week, but this week she’s going to be focusing on naloxone. It’s a life saving medication. So, without further ado, I’m going to turn it over to Miss America, Chamile Schrier, to give her presentation today. Welcome, Camille.

Thank you. If you’re tuning in again from last week, we talked a lot about what opioids are in general, and so this week I’m going to talk a little bit about something that has to go along with that. It’s a piece that is really incredibly important for people that are experiencing an opioid overdose. That’s really what we are afraid of when people are taking opioid medications is the opportunity or the ability for them to overdose on that medication, and it can be fatal for them. But there is something that can help with that, and so we’re going to talk a little bit about that. If you don’t know me, I’m Miss America and my platform, my social impact initiative, is drug safety and abuse prevention from pediatrics to geriatrics titled “Mind Your Meds,” and so that is the preface of what this series is all about.

Okay. This week we are talking all about something called naloxone, and I titled this “Reversing Overdoses and Saving Lives” because quite literally, that is exactly what naloxone does. It is the opioid overdose reversal medication. Overdoses frequently don’t have cures, but opioid overdose pretty much does because it has naloxone, which is an antagonist. So we’re going to talk a little bit about that. So I’m going to switch this.

I talked about this last week, but I still think it’s really important to bring up again just statistically by data. We look at how many people were murdered in the United States in 2017, 16,214. People who died in car crashes, roadway fatalities, 38,659. Firearm injury, 39,773.

Total fatal overdoses in the United States, 70,237, 68% of that, which is 47,600, that was how many people lost their lives specifically to an overdose of opioids. That is a huge amount of people; that is more people than any of those other ways of losing your life. That’s a really shocking statistic and it’s part of what made me want to address this as my social impact initiative and spend my time, previously as Miss Virginia, but now as Miss America talking about this because I feel like we need to talk about this. That number translates into 130 Americans losing their life every single day from an opioid overdose.

I talked a little bit about what overdose was, and I think that that’s really incredibly important to understand when you’re talking about something like naloxone. So I’m going to go over this one more time for those of you who maybe missed last week. So an overdose occurs when too much opioid is taken. We have these opioid receptors in our brain. They’re in lots of different pieces of our nervous system. They exist where our breathing is controlled, they exist where our pain is controlled. When they are overloaded, basically they can slow the breathing or even stop it depending on how overloaded they are.

We have natural opioids that make us happy. They’re called endorphins. We talked a little bit about that last week, but these little receptors, when they get overloaded with opioids, it can completely stop someone’s breathing, and that’s what we are incredibly concerned about when we look at opioid overdose. It’s actually the person’s inability to continue to breathe. That is very concerning. So, there is a way to treat this.

Oh, and I should mention it does not discriminate whether or not you are taking a prescription opioid or heroin, which is a non-prescription, illegal Schedule I opioid drug. They can cause an overdose just the same. It does not matter, and that’s really important to think about. You could be prescribed an opioid from a doctor, and if you’re not taking it according to the directions, if you are not paying attention to what you’re taking, maybe if you have an older adult in your life who is forgetful, be mindful of that because if you aren’t taking that medication, maybe you forgot, or that older adult forgot that they took it and they took another one or two. That can become a really dangerous situation. It’s not just with heroin and street drugs that we think of overdose. That is the other thing that you need to think of when you think of overdoses. If you are taking an opioid, you are not immune to the risk of overdose, and that’s why I really think this is important because these are very frequently and sometimes overprescribed to people without fully communicating that risk factor.

So there is a way to cure that overdose and to treat it in a really effective and quick way and it is a special medication called naloxone. This is a picture of Narcan, and we’re going to talk a lot about the different types of naloxone that exist, but naloxone is something that fits into that receptor where the opioid was in your brain and pops it off. And I think I have an image of that. Perfect.

So think of it this way. You have keys, right? You have a lock at your door and only like three keys open that lock, maybe endorphins open that lock, opioids open that lock, but also naloxone opens that lock. But here’s the real kicker, those receptors prefer the naloxone over anything else. So it will actually pull off that opioid, get it off of the receptor and block it, and that’s called an antagonist. It’s a really wonderful thing that we know about and we understand. This is why it’s really cool to learn about how this works in the brain, because when you can kind of see it as “this is my magnetic key,” yeah, I can push my key into the door and unlock my door, but I had this really special magnetic key that really wants to go in that lock, and that’s kind of what naloxone is, and it doesn’t actually activate the receptor.

So it just holds the spot and blocks the opioids from touching it, but it doesn’t activate it. It allows you to completely regain normal breathing. It reverses what that opioid overdose is doing in your body. It actually happens really quickly. If someone is overdosing and they are revived with Narcan or naloxone in whatever form they’re given, they come back really quickly. And that’s the beauty of this and that’s really the power of this chemical and receptor bonding process. I always liked that piece of it because I am a science nerd.

There are a couple of risk factors for someone to be at a higher risk for an opioid overdose in general. And these are important to think about both if you’re a healthcare professional or if you’re someone who is taking a medication like an opioid.

If you have ever had a prior overdose, you are at risk. If you have reduced tolerance (maybe you used to use a lot of opioids, and you stopped using them for some reason or another), you then have less tolerance to that medication. If you take it at the same rate as you had before, you may overdose when you wouldn’t have normally. If you’re mixing drugs, that is a huge risk for overdose. When we think about stimulants and depressants, we think “uppers” and “downers” are what some people will call them. They do not cancel each other out. It’s really important not to mix drugs, whether or not they are illicit drugs or prescription drugs or any combination of that without talking to your doctor and fully disclosing that information to make sure that you are keeping yourself safe.

Using alone. If someone, if maybe they are facing an addiction and they are using an opioid drug alone, they don’t have anyone there to call for help, that is a huge risk for opioid overdose. So that is another risk factor. Variations in strength, quality or quantity of what you’re taking. Any kind of medical conditions (because they can affect the way that you’re able to actually metabolize these drugs, and how your body can absorb them and break them down. So it’s important to know that.

Here’s the other thing, naloxone is the only effective opioid overdose cure. It’s important to think of that. When I went through my own naloxone training, we talked about some of the funny ways that people think that they can reverse an opioid overdose, or really overdoses in general, and I would love to know if you want to put in the comments, any ways that you have heard in your life, if you have been around anything that has to do with drug overdoses. There are some funny ways that people think that they can treat an overdose with things at home.

So, putting an individual in a bath or an ice bath is one way that people think that they can bring back overdose. Giving someone something that will make them vomit. There’s a lot of little tips and tricks that people say that will reverse overdose.

The reason I’m telling you this is because none of those are an actual effective remedy for an opioid overdose. The one that will work every single time is naloxone, and so it’s really important to think about that. We’re never going to do any of those home remedies to someone who is in a medical crisis, which would be an overdose. So don’t put an individual in a bath, they could drown. They’re especially likely incapacitated in a way that would be really dangerous. Don’t induce vomiting or give them anything to drink, they could choke.

The ice bath, again, do not put ice anywhere on the body, especially with opioids, which are a depressant. The body is already slowing down and that could lead to hypothermia as well, and that’s dangerous. Don’t try to stimulate the individual in a way that could cause harm, like trying to wake them up, and don’t inject them with anything, don’t try to give them other medications. That’s really, really important to look at. Again, naloxone is the only effective response to an opioid overdose emergency.

This is where we talk about what naloxone is, and I actually have a couple of different kinds of naloxone here with me that I want to share with you. Took me a while to understand this until I really got into a naloxone training myself. We hear about Narcan, and Narcan is a brand name for naloxone, but not all naloxone is Narcan, but Narcan is always naloxone, if that makes sense.

But there’s other brands and forms of naloxone that are not just Narcan. So I just want to talk to you guys about the different options that exist and they have different benefits, different price points, and so it’s important to understand that. I like to share all of those. So, the first one is traditional, brand-name Narcan, and I have Narcan right here. So I have my box of Narcan here and this is what it looks like. It’s a nasal spray. Just like I take an allergy nasal spray at night, this is the same idea, but you would not give this to yourself. That’s another myth of naloxone, and we’re going to talk about that a little bit at the end. Just as a side note, this is two doses in this particular package, which is four milligrams.

I was in Arizona about two months ago. So, it’s two, four milligram doses. So, take this whole thing, it has eight milligrams in it. I was in Arizona and a first responder told me that he had to use 24 milligrams to revive an individual. You would always do one spray first and see if the individual was revived. That would typically work, unless it was a really, really hard overdose, which maybe you would need two of these sprays, which is why there’s two sprays in this bottle and there’s some other reasons too, which we’ll talk about in a second, but 20 to 22 or 24 milligrams that he needed. That’s like three of these.

That’s a huge amount, and that’s also indicative of what we talked about, the strength of the different opioids. A lot of street heroin is now being cut in with fentanyl and carfentanil, which are increasingly potent, depending upon which one I’m talking about and how much is in there. People who have a tolerance to a certain amount of opioids are going to end up being in a really dangerous situation. We think about how much, how strong that opioid is, that’s dependent upon how much naloxone you need, because you have to get rid of that opioid from all of the receptors in the brain.

So, this is Narcan. It’s really, really easy to use. Pluses of Narcan: you can carry it with you. I usually carry mine in my purse in case I ever encounter someone who is going through an opioid overdose. It’s easy to use. It’s like a middle price point, there are cheaper options, but there are more expensive options. It’s pretty easy. It’s really common. It’s the one I probably see the most.

Next one is generic naloxone, nasal spray. If this is a brand, it’s branded naloxone as Narcan just like maybe you would go to a pharmacy and they say, “Oh, you have a prescription for branded X,” and they say, “We’re going to give you the generic, it’s cheaper.”

So, there’s also generic naloxone, nasal spray, but this one’s a little bit harder. It’s a lot cheaper. So, plus: cheaper; negative, you have to put it together frequently. It actually comes with the naloxone solution, and then you have to clip it into a device that will make it into a spray. It’s called an atomizer, and it will allow you to be able to spray it into your nasal cavity (a little bit harder). If you’re in an emergency situation, you have to clip this together first, and you have to know how to do it effectively, but it is cheaper. So again, pluses and minuses.

This one is really cool. It’s called the Vizio auto injector. It is actually made by a company in Virginia. I go to VCU School of Pharmacy (Virginia Commonwealth University in Richmond) and one of our alumni actually started this company that creates this. It’s called callejo, and they also used to make, and I think they still do, they make epinephrine auto-injectors that talk to you. It was called OBQ, there was one that was for epinephrine and so it was the same idea, it was like an EpiPen. This one, instead of being nasal, is an auto-injector like an EpiPen.

This is actually injecting the medication under the skin or into the muscle. I don’t know how far this one actually goes deep in. It’’s injecting it rather than taking it nasally. But, this one is the most expensive option. It talks to you, it actually walks you through how to administer the medication as you give it. So it’s really, really easy, but it’s much more expensive. Sometimes it’s prohibitive because of the price point. But if you want a really easy option, this one is that.

And the last one, I actually have one of these, too. This is injectable naloxone. I’m going to show you guys this. This is traditional. Like if you went to go get a flu shot and you see your doctor pull out a needle and give you an injection there are the little vials, they look like this, and this is actually the naloxone and it comes with a needle and you have to draw this up. This is actually kind of scary for someone who potentially does not have healthcare training, I got this at an event and I thought that this was an atomizer, but it is not, it is actually a needle.

So this is injectable naloxone. This is something that you would need training on how to actually do. This is harder to be something that maybe you would carry with you like I carry my Narcan in my bag with me, but this is also a little bit less expensive in some ways. Harder to use, but just as effective. So this would go down into the muscle and it does the exact same thing.

I also have, when I went to my Narcan training, I have a little bag that says “Revive” on it. It’s from the Virginia Department of Health. Mine has my Narcan. So I have one in here. I have gloves, I have some first aid equipment, like a mask to help with rescue breathing.

And then, every time (this is another fun fact) every time that you give someone naloxone, I have these stickers. You stick it on the person. When you give them naloxone in an emergency situation, you put a sticker on the person for every dose of naloxone that you’ve given them. And these are really helpful because when that person goes to the hospital, if they are not necessarily still conscious or if they’re still in an emergency situation, this can tell emergency responders how many doses of naloxone that they’ve been given. That was a really interesting thing that I got when I did my Narcan training. So, just some fun facts there.

It’s like show and tell today, but this is really to show you more than anything. When I say naloxone, it’s not just Narcan and it’s not just one thing. We can get it in many different forms and it can be given to people in many different ways, but it’s still the same medication and it does the same thing. I think for me, my personal favorite is the branded Narcan because it’s the easiest and fastest to do, and I can carry it with me, but totally depends on what your resources and situation are.

So: how to store it? This is really a good lesson if you ever take any medications in general, there’s proper ways to store your medications and they can’t just go through anything. You want to make sure that, first of all, you’re checking the expiration date. Most of them have an expiration date of two years; make sure that you’re checking that they’re not expired because if they’re expired, they’re not going to work as well.

And you might be in the great, the best situation to help someone and your medication isn’t actually the strongest, and it’s not gonna work for that person. Extreme temperatures on both sides are also huge no-no for any medication, Narcan and naloxone included. So, anywhere between room temperature, like 59° to 77°, not anything that’s freezing cold or super hot. Super short periods of time up to 104°, maybe. “Oops, I left it in my car in the summer.” Not even near the summer, probably like late spring, because your car gets really hot in the summertime. So make sure that it’s not exposed to super high temperatures.

There you go, do not store it in the car on hot summer days. Exactly. Don’t let it stay in your car in the winter, it can freeze. I really keep my Narcan in my purse so when I leave my car, it comes with me. It’s not as effective if it’s not stored properly. Light is another thing that breaks down all different types of things. Hydrogen peroxide, per my science demonstration on stage at Miss America, also breaks down medication. You always want to keep it in a dark place, keep it out of reach from children.

Safety of naloxone: this is so incredibly important. There are almost no serious side effects and really using this even if you’re not 100% sure if that person is having an overdose, you’re not going to hurt that person. It’s important that you call 911 either way in an emergency situation, because if you’re wrong about the overdose and there’s something else going on, you 100% want to make sure that there are emergency medical technicians or people that are trained to help that person who are on their way already.

But if you give this to a person and they’re not overdosing, you’re not going to hurt them as long as they have medical attention coming. That’s the really cool thing is there’s really no negatives to this. The interesting thing that people don’t always understand is that this only
reverses overdoses from opioids, not other drugs, not alcohol, not benzodiazepines, not cocaine, not amphetamines. So that is important, it only works for opioids, it doesn’t have any abuse potential, and you can use it on an adult or a pediatric patient the same. So that’s the really cool thing. We’ll make it work. I’m not trying to sell you on this, but I’m just saying that’s really important.

So here are some naloxone myths. I hear these all the time as I go around and I talk about why this is so incredibly important, and I think you guys have already figured out how I think that this is so important. The person who is experiencing overdose can’t give themselves naloxone. I said to someone at an event, I was like, “You should carry naloxone with you if you have a family member who’s taking an opioid, any of these situations you might need it” and they’re like, “Well, I’m not a drug addict. I don’t need to take naloxone.” I just shake my head at that sometimes because if you are in an overdose situation, you are likely unconscious. You are struggling to breathe. You’re not going to say, “Oh, hold on, let me go get my naloxone.” You don’t have the capability to do this.

So this is never a medication that you are giving to yourself. This is a medication that someone else is administering to you if you’re experiencing an overdose. Or, I as a person who is not experiencing an overdose, I’m giving it to someone who is. It does not encourage addicts to take more drugs, that’s another one. You know that we’re giving a person a second chance at life. Whether or not they’re abusing drugs or taking it from a prescription, and maybe they took it incorrectly or chose to take it incorrectly. We give that person an opportunity to seek medical attention, go to an addiction treatment facility.

We’re giving that person a chance to recover, and this is a life-saving medication. This is a life-or-death situation for many people, and I would never want someone to not have the opportunity to go and get help. And that is what I think of when I think of Narcan.

“Prevents addicts from seeking treatment.” The only way that naloxone could prevent an addict from seeking treatment is if they are not immediately presented with the right resources. I feel like my responsibility, if I am helping someone, and saving their life to help them get to the right place where they can seek treatment, but this is not an alternative to treatment for an opioid addiction or more education if someone is taking a prescription medication and ends up in an overdose.

It is not only given by syringe. I actually always hear that as a myth because people think that it’s like an EpiPen. Yes, it can be given by a syringe, but it is a nasal spray in many forms too. It is not expensive. Some of them are, but a lot of them are not.

A couple things about legality. This is a prescription medication, but most states, depending on your state, have what’s called a “standing order.” Basically it’s like a blanket prescription for every single person in the state to be able to walk into a pharmacy and say, “Hey, I would like to get naloxone today,” and without a prescription, that pharmacist will be able to give you naloxone. You might have to pay for it, you might not be able to get it depending on what state you’re in. I have a little map, but this map is old, I couldn’t find an updated one. This is from 2016, but just to give you an idea any state that is green has some kind of a standing order or naloxone access law for people to get naloxone from a pharmacy. It depends on whether or not you’d actually have to pay for it.

So you might have to. I got mine for free from my Department of Health in Richmond, Virginia. That’s always a great place to look if you are looking to carry naloxone. Here’s the other thing. If you are trying to help someone, it’s kind of like having a CPR or an AED certification or first aid. I would always worry about legal protection. I don’t want to be held liable if something happens to that person. So there’s something called “good Samaritan laws” where basically as a lay person, if you are trying to give reasonable assistance to help someone who is in peril or in an emergency that you are legally protected; many states have that. That would be the states that are dark green in that map. Not all states have it. The moral of this is make sure that you check with your own state laws. I have a link there at the bottom to this: https://www.safeproject.us/naloxone-awareness-project/state-rules/. That was a really comprehensive and updated way that I found each individual state information and a link to where you could find it from each state’s page. So, different by state, but most states have some form of naloxone access, which is really, really important.

The moral of this presentation really is that I think everyone should carry naloxone. I think that everyone should attend the lock zone training session, just like you would attend a CPR or an AED certification. It is a good skill to have. You can save someone’s life whether or not you have a friend or family member who’s taking an opioid medication. Maybe your grandmother takes opioid medications for chronic pain, or you quite literally encounter someone in public. I’ve heard people encountering someone in an overdose situation, in a public restroom, in certain public facilities, you can save that person’s life and that is why this is so important. You can typically get it without a prescription. You can get it sometimes for free from the health department, so carry it with you.

Here’s another thing on where you can get it. If you are being prescribed an opioid medication or someone in your family is, you can ask that doctor to co-prescribe a naloxone for you to go with it. If you are taking the opioid, maybe encourage a friend or family member to be trained on how to use naloxone. If you do get into an emergency situation, you can get it from a pharmacy usually, we talked about that, your health department. Also just Google, “naloxone trainings near me.” You will likely find some kind of naloxone or Narcan training, and many of them come along with your own free Narcan to carry with you. That is a great gift, and that is how I obtained mine. Thankfully, I have not had to use it yet.

I want to end with this. Every 12 minutes an American loses their life to an opioid overdose. So naloxone has the potential to save a life every 12 minutes of the day. If you end up being that person who can save one of these people’s lives, I think that that is probably the greatest gift that you could give someone. So if you are someone who is struggling with an opioid overdose or an opioid addiction yourself, or have a friend or family member that just wanted to finish with a few resources, of course, The Recovery Village, but also the SAMHSA treatment helpline.

If you are looking for some resources to treat your addiction or someone, send them in the right direction. So I hope that you guys learned a little bit about what naloxone is. I know that it was a really great thing for me to learn about, and I will keep talking about it.

We’re very much looking forward to next week as well, where we’re going to jump into how prescriptions could lead to addiction, so a very helpful topic there. And then the week after is keeping your kids safe, so really great information yet to be shared. Camille, you’re absolutely wonderful. Thank you so much for sharing your time with us again today and for everybody that’s listening, if you need anything, please don’t hesitate to reach out for help. If you need help connecting somebody, if you need help with advice on how to start a conversation with somebody who may be struggling, if you’re looking for resources for yourself or a loved one, there are resources out there. We have an entire team that will connect to you, whether you’re looking for something locally or if you’re willing to travel, we can absolutely help with that. So take care of yourself and again, stay safe out there and we will see you next Thursday at two o’clock. Thanks. Thanks guys. Bye everybody. Bye.

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