In the past week, two agencies responsible for public money to confront substance use have announced initiatives to make naloxone more readily available.

By Taylor Sisk

Under most circumstances, feeling like a thousand tiny needles are being stuck into your entire body, followed by “instant shakes and fevered, flu-like symptoms” that succumb to four hours of the most intense nausea imaginable would not be considered a positive experience.

And, in fact, it wasn’t immediately apparent to JK (she asked that her real name not be used ) that something positive had occurred when she was given naloxone, the source of her misery, by an EMT.

Naloxone is a drug that abruptly reverses overdose from opioids, including heroin and prescription painkillers.

The North Carolina Harm Reduction’s Tessie Castillo demonstrates how to administer naloxone. Photo credit: Taylor Sisk
The North Carolina Harm Reduction’s Tessie Castillo demonstrates how to administer naloxone. Photo credit: Taylor Sisk

JK, 25, now living in Asheville, overdosed the first time she injected heroin, and was introduced to naloxone the same evening. It didn’t stop her from using. But it kept her alive. Today she’s been clean for six months.

An initiative announced at a press conference in Asheville on Tuesday will allow a lot more people in Western North Carolina to have a similar experience to JK’s: the tiny needles, the nausea, the remaining alive.

Smoky Mountain LME/MCO – the managed care organization responsible for public funds for mental health, substance use and intellectual and developmental disability services in the state’s most western counties – announced an initiative to partner with the North Carolina Harm Reduction Coalition to distribute naloxone nasal spray kits throughout the 23 mostly rural counties Smoky serves.

Smoky used $100,000 in Medicaid savings to purchase 2,668 naloxone kits, which the Harm Reduction Coalition will distribute through volunteers and at opioid treatment centers and will make available to law enforcement agencies.

Last week, Trillium Health Resources, the LME/MCO serving 24 counties in the eastern region of the state, announced a similar partnership with the coalition, donating $15,000 to expand NCHRC’s distribution efforts and providing 100 naloxone kits to the Jacksonville and Manteo police departments.

At Tuesday’s press conference, held at Smoky’s Asheville headquarters, NCHRC’s Tessie Castillo said that for every 10 reversal kits they distribute, one overdose is reported reversed – emphasizing that there are undoubtedly many more they never learn of.

That means that 200 to 300 lives, perhaps more, can be saved with this initiative.

Castillo said Smoky’s donation will keep Western North Carolina supplied with naloxone for the next six months.

“The fact that we chose to make an investment in Narcan,” said Smoky CEO Brian Ingraham, referring to the brand name for naloxone, “is because of the immediacy of it. It’s a way to make an impact today.”

Multiple initiatives

Ingraham serves on the Governor’s Task Force on Mental Health and Substance Use, co-chairing its opioid abuse subcommittee. He said he’s learned in this role that the breadth of the opioid issue is “almost beyond comprehension.”

Contents of a naloxone reversal kit distributed by the NC Harm Reduction Coalition.
Contents of a naloxone reversal kit distributed by the N.C. Harm Reduction Coalition. Photo credit: Rose Hoban

Ingraham referred to Centers for Disease Control and Prevention statistics indicating that in 2012 in North Carolina there were 97 painkiller prescriptions for every 100 people. That’s the 13th highest rate in the country.

According to the state Division of Public Health’s Injury and Violence Prevention Branch, 808 North Carolinians died from opioid overdose in 2014, up from 109 in 1999.

“This is why we call it an epidemic,” Ingraham said.

He spoke of the gradual transition from prescription painkiller overdose deaths to heroin. “We’re kind of in the second phase of this as a problem,” he said, “and there is not a silver bullet.

“A problem that is this significant isn’t going to be dealt with simply by one of two activities,” Ingraham said.

NCHRC has helped usher in Good Samaritan legislation that, among other things, provides limited immunity from prosecution for certain drug-related offenses for those who call for medical assistance because they fear that they or someone they’re with may be overdosing.

The coalition has now set its sights on syringe exchange legislation. They cite research that indicates that syringe exchange program participants are five times more likely to enter drug treatment than nonparticipants, that the programs have shown to significantly lower rates of hepatitis and HIV transmission among injection drug users and that the programs reduce needle-stick injuries to law enforcement officers by 66 percent.

According to research, syringe exchange programs also connect people to housing, jobs and food, thereby reducing crime.

Supportive of syringe exchange

Sen. Terry Van Duyn (D-Asheville), who spoke at Tuesday’s press conference, said, “Believe it or not, the most frequent call I get from constituents has to do with people looking for services for family members that are dealing with these problems.”

Asked if she’s supportive of syringe exchange legislation, Van Duyn replied, “Absolutely.”

Such legislation has been introduced in the state legislature in the past, but stalled. Van Duyn said it’s being discussed again, and that she would be willing to cosponsor a bill.

“This is a very pervasive public health problem,” she said. “If punishment was going to solve the problem, we would have solved it long ago. We need to be more humane in our approach, and more inclusive in our approach.”

Robert Childs, NCHRC’s executive director, said in a press release that the coalition has distributed more than 22,000 kits since August 2013, “which in turn have saved nearly 2,300 people’s lives from potential overdose deaths. Smoky’s contribution will allow us to expand our reach even more to people at risk of overdosing or who know someone who is at risk.”

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