Jennifer Plumb, the medical director of Utah Naloxone, was interested to learn that colleges will be able to get several free doses of a drug that can reverse opioid overdoses through an effort by the Clinton Foundation and Adapt Pharma to give 40,000 doses of NARCAN nasal spray to universities.
But Plumb, who is an associate professor of pediatrics at the University of Utah and an ER doctor at Primary Children’s Hospital, writes here that efforts to stock schools and clinics may not get the lifesaving drug into the hands of the people who need it. — Susan Svrluga
Theo came to see me in the Pediatric Emergency Department. She was not a patient, but rather a desperate mother terrified that she would lose her college-aged son Mitch to a heroin overdose. Although he was in recovery, she lived in fear that he would soon relapse.
Theo had learned about naloxone (Narcan®) on her own, and knew about its lifesaving power — if given in time. She wanted to keep the antidote nearby in case the worst happened.
After she had been refused or denied access to naloxone 10 times by medical providers, pharmacists and specialists in the recovery community where her son had been treated, coming to me was her last option.
I direct a community-based naloxone program, and she was so relieved to find us. That day, Theo walked away with a naloxone rescue kit.
In less than two weeks, she found herself living her worst fears: Her son overdosed. Luckily, with naloxone in hand at their home, she was able to save her son’s life.
In this case, as in most instances in which naloxone is used to reverse opiate overdoses, success was absolutely contingent on naloxone being in the hands of someone likely to be present when an overdose occurs. Many times, these are not public health or medical providers.
So when I hear of donation programs like the one the Clinton Foundation and Adapt Pharma have established to place nasal naloxone kits onto U.S. college campuses — all Title-IV universities and colleges would be eligible to receive up to four naloxone rescue kits — part of me celebrates that the opioid crisis is finally grabbing the attention of notable organizations and pharmaceutical companies that want to help curb opioid-related fatalities.
But another part of me worries that such programs, well-intentioned as they are, risk creating a false sense of security. They miss the mark for actually preventing opiate overdose deaths.
Naloxone on the shelf of a nurse’s office or in the cupboard of a health center is not the optimal place to store the drug simply because the window to respond to and reverse an overdose is so short — literally minutes. It is imperative that naloxone be placed directly with the people who are most at risk of an overdose or are most likely to witness an overdose: the roommates, family members, friends and even relative strangers.
This is how layperson access to naloxone has been successful at saving lives over the past two decades.
It is also essential to have broad distribution throughout a community.
Having four naloxone kits on a single campus would certainly place kits in a few locations. But considering all of the possible locations where an overdose may occur — and the limited likelihood that these overdoses would happen in a typical campus medical setting such as a clinic — one can see that what sounds like a promising idea is actually far from what is needed to truly address overdose risk on college campuses.
Increased awareness of, and access to, naloxone is saving lives nationwide. There is value in the awareness and acceptance that will come from naloxone programs coming to college campuses. But if naloxone kits are to be placed in college settings, better strategies for getting rescue kits to those who can and will use them need to be implemented.
The opioid crisis in America has reached epidemic proportions. Death rates from prescription pain medications and illicit narcotics, such as heroin and counterfeit fentanyl, are escalating with tragedy touching every element of our society. Overdose is now the leading cause of injury death nationwide. Heroin deaths alone have surpassed gun homicides. We are now losing more Americans to fatal overdoses than we lost to HIV/AIDS at the peak of that crisis.
Community-based programs nationwide, following the groundbreaking lead of programs such as the Chicago Recovery Alliance and the Harm Reduction Coalition, began increasing access to naloxone more than 20 years ago and have demonstrated the ability of nonmedical people to save the lives of individuals experiencing overdose around them.
In 2015, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report described the efforts of these programs from 1996 to 2014. They focused on the 136 community-based opioid overdose prevention programs that distributed naloxone to laypeople at 644 sites. According to the article, those programs had given out more than 152,000 naloxone rescue kits to community members. More than 26,000 lives were saved, the report found.
We are seeing neoteric blueprints for expanding these efforts into settings outside of those historically targeted by community-based naloxone programs — like college campuses — but more needs to be done.
The best way to add naloxone to college campuses is to use the lessons learned from decades of experience in community-based programs. Those strategies include: partnerships with local programs that can get naloxone directly to people in places where overdoses are most likely to occur; using less expensive generic formulations of naloxone; partnering with local EMS and law enforcement to encourage giving rescue kits at the scene of overdoses; and peer-to-peer distribution projects on campuses.
Putting kits into more hands, the right hands, will result in more stories like Theo’s — stories about loved ones who are still with us because someone near them had access to naloxone. Let’s do this in a manner that will truly make a difference, not just seem good on paper.