When a new employee starts at Places for People, one of the items on his or her orientation checklist is CPR certification.
One day soon, new employees will learn another lifesaving measure, too – how to administer Narcan.
“It’s such a powerful life saving tool. It’s an easy lifesaving tool. It’s a safe lifesaving tool. The threshold for using it should be low and we all need to be comfortable with this as a team,” Places for People Medical Director Dr. Meredith Throop said.
Narcan is a medication used to counter the effects of an opioid overdose. The proposed policy is just one way Places for People is attempting to be at the forefront of harm reduction techniques and is attempting to remove the stigma associated with substance use treatment.
According to the Missouri Department of Health and Human Services, there were 951 opioid overdose deaths in Missouri in 2017. This means that an opioid overdose was the cause of death for 1 in 65 people in Missouri in 2017. Of these, 441 deaths by opioid overdose occurred in St. Louis City and St. Louis County in 2017. Opioid misuse also contributed to more than 8,000 Emergency Room visits in 2017 in Missouri. (Source: http://ago.mo.gov/opioid/news-and-statistics)
“It needs to be connected in our minds – If we are in emergency mode, we need to ask ourselves ‘what are my tools? CPR is my tool. Narcan is my tool.’ We should think of these in conjunction, especially in this climate.”
Currently, every nurse and prescriber at Places for People has two Narcan kits with them at all times in case of emergency. These kits have been donated by National Council on Alcoholism and Drug Abuse (NCADA) and Missouri Institute of Mental Health (MIMH).
Throop would eventually like to have kits for every employee of Places for People who goes out in the community. Places for People will also soon have kits available in wall mounts in every common area and team rooms, with ease of access similar to a first aid kit or AED.
“We need to make sure they’re visible and normalized in our public spaces. In the event of an emergency, they need to be accessible and ready.” she said.
The kits have become easier to use over the years, transitioning from a needle stick to a simple puncture to the current kits that are administered like a nose spray. Throop said previous versions created more inadvertent barriers. “I’m happy that we have the intra-nasal kits available. Using a life-saving device that is non-invasive is often psychologically more comfortable,” Throop said.
Making Narcan kits more accessible will be accompanied by increasing educational opportunities to help staff members approach overdose situations, and also helping individuals served by Places for People obtain a kit if they are at-risk.
The individuals who might need a Narcan kit at home might not be someone who uses heroin or fentanyl.
“Frequently people who are prescribed opioids for pain, and taking as directed, will say ‘but I’m not a drug addict, I don’t need one of those,’” Throop explained. “It is a gross misunderstanding that those who are not using opioids illicitly are not at risk of overdosing. It is our unfortunate reality that anyone who uses opioids is at risk of an OD.”
This is where applying the principles of harm reduction comes in to meet people where they are.
“We can help to reduce stigma by being more aware of the language we use,” Throop said. “If we avoid using the term ‘overdose’ and instead explain that if your body reacts poorly to the medicine that you took, or if you ‘accidentally took too much, this is a tool that will help you.’ This can encourage people who do not see themselves as ‘drug abusers’ to be comfortable having a Narcan kit at home.”
The need to have Narcan kits accessible will increase as Places for People’s Outpatient Substance Use program continues to grow, but is not limited to individuals served by that program.
Places for People’s array of programs can help provide support beyond administering Narcan. Places for People offers case management, therapy, and evidence-based treatment options for people living with substance use concerns.
The organization also offers a suboxone clinic, in partnership with Dr. Franco Sicuro. Suboxone takes away cravings by attaching to the same receptors as opioids. It is a long-term treatment for individuals trying to manage opioid use.
Throop would like to also offer suboxone to individuals who are targeted at “vulnerable points.” This would include experiences such as returning from jail or prison, or exiting an in-patient treatment or prolonged hospitalization.
“Individuals can leave prison after 10-20 years and they can still experience cravings, especially when they are back in familiar – and triggering – environments. They may go to their old neighborhoods and want to use right away,” Throop said. “This is a dangerous combination when their tolerance for opioids has decreased significantly, making it extremely easy to overdose.”
Another vulnerable point occurs following an overdose. “The physiological and psychological withdrawal from opioids is one of the most severe,” Throop said. “They’re at an extremely vulnerable time to use again when they’re in full withdrawal, simply to ease their suffering. These people feel so physically ill. Nearly every system in the body is affected by opioid withdrawal.”
Throop believes starting individuals on suboxone during these vulnerable times can help provide a bridge that might lead to a healthier outcome. “The hope is that they won’t want to use if they’re on suboxone, as those intense cravings, as well as withdrawal symptoms, are alleviated. And overall risk of harm to themselves is greatly reduced as a person cannot overdose on suboxone.” Throop said.
These policies are still a work in progress, but Throop is excited about the possibility of enacting them in the near future.
“It comes down to the need to shift well-ingrained cultural beliefs about substance dependence and addiction. As a society, it just takes time,” she said. “As an organization, we need to be at the forefront of early adoption of life-changing, life-saving practices. We need to play a powerful and innovative role in shifting this culture.”
If you or someone in your life recognizes that your alcohol and/or drug use is causing you problems or is limiting your success, we can help. Call our Outpatient Substance Use team at (314) 615.2119 to speak directly and confidentially to one of our team members who is trained to address your substance use concerns.