shows a box containing naloxone pre-filled syringe
Naloxone HCl preparation, pre-filled BristoJet package for intravenous administration. Photo courtesy: M, Flickr Creative Commons

Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org

By Taylor Knopf

One morning in March 2015, Michael Page, now 37, found himself shivering, yet dripping with sweat while sitting on a curb in downtown Wilmington.

He didn’t know how he got there.

Michael Page today. Photo courtesy Michael Page.

His head was pounding, his senses overloaded by the sound of passing cars and the sun overhead. A firefighter repeatedly told him to stay calm. She had just brought him back from a heroin overdose.

That was the last of three separate times someone saved Page’s life using naloxone, an overdose reversal drug.

“I wouldn’t be here if it wasn’t for naloxone,” Page said.

Page was one of 1,548 opioid reversals across the state in 2015 reported to the North Carolina Harm Reduction Coalition. In 2016, there were 3,684 overdose reversals reported to NCHRC, and 1,468 reported by the end of May of this year.

Law enforcement and EMS have started carrying naloxone kits, and NCHRC and some county health departments have given them out to community members.

Law enforcement is responsible for only some of the reversals, even as 159 North Carolina law enforcement agencies in 68 counties currently have staff carrying naloxone. Of those, 65 agencies reported a total of 547 overdose reversals since 2014, according to NCHRC.

On the whole, it’s other addicts and EMS who most commonly administer naloxone.

How it works

When someone is overdosing on an opioid, their breathing slows to a dangerous level, putting them at risk of suffocation. Naloxone comes most commonly in the form of a nasal spray or intramuscular injection, and once administered, it quickly gets into the bloodstream, where it immediately attaches to opioid receptors in the brain, blocking the opioids.

How Naloxone works. Diagram courtesy: COPE Australia

Almost instantly, the person can breathe again, as the respiratory suppression is gone.

The effects of the opioid are gone too. After naloxone is administered, a person often goes into  withdrawal, experiencing symptoms such as irritability, vomiting, diarrhea, body aches, rapid heart rate and increased blood pressure, according to Project Lazarus.

The cost

Funding for naloxone kits can be a challenge, in no small part because the price of the drug has surged over the last decade. Until 2005, the price of an injectable naloxone dose was less than a dollar, according to Human Rights Watch. But prices have gone up to around $50 to $75 per kit, according to Robert Childs, NCHRC executive director. He said the prices often vary, depending on who is buying and how much they are ordering.

In the state budget approved last month, lawmakers slated $200,000 over the next two fiscal years to supply law enforcement agencies and the North Carolina Harm Reduction Coalition with more naloxone.

“We could equip about 1,300 law enforcement officers with naloxone with their portion of the money,” said Tessie Castillo NCHRC Communications and Advocacy Coordinator. “With our allocated money, I, unfortunately, can’t disclose the price of the kits we purchase from Pfizer, but I would estimate that we could purchase over 10,000 kits, which would be used by about 2,000 people over the course of two years.”

For some municipalities, buying naloxone for their first responders could mean thousands of dollars extra, said Donnie Varnell, Dare County Sheriff Department investigator and NCHRC law enforcement advisor.

But many are taking advantage of grants and donations, he added.

Law enforcement support

Varnell said the majority of law enforcement across the nation is on board with the idea of naloxone.

“It will become a standard piece of equipment,” he said. “And quite frankly, it’s a liability not to carry it.”

He said more and more, law enforcement agencies are requesting naloxone – to care for their own. Officers and EMS personnel have overdosed on crime scenes, said Varnell. If first responders are accidentally stuck with a needle or walk into a place where there is fentanyl in the air, they can experience overdose symptoms.

“Officers are very susceptible to it,” he said. “They usually have no tolerance.”

Varnell said North Carolina law enforcement is ahead of many other states on the naloxone front because of NCHRC and the information and training the organization offers to law enforcement.

He said sheriffs and police tend to be a conservative group, and there will always be people opposed to change. Some don’t like the idea of helping a person who might just overdose again the following week, such as the Sheriff making headlines in Butler County, Ohio.

“As first responders, we don’t get to choose the lives we save,” Varnell said. “Regardless of who you voted for, which team you root for or what school you’re from, you respond to that call.”

He and others are working toward more Law Enforcement Assisted Diversion (LEAD) programs that direct people to substance abuse treatment rather than into the criminal justice system.

A new life helping others

Page finally got sober on April 28, 2015, a month after the Wilmington firefighter saved his life with naloxone.

“That incident didn’t do it,” he said “I wish it had.”

Page had used hard drugs for about 14 years. That time included multiple arrests and stints in  jail, which eventually led to rehab and a court-ordered banishment from the state of North Carolina. He ended up with four felonies and nine misdemeanors on his record.

And he contracted Hepatitis C from unclean needles and was treated for the disease.

“I wasn’t getting the effect of the drug anymore,” Page said. “Unfortunately drugs were the solution to deal with myself. At that point, I needed to change my ways and do something different. The one thing that made everything OK wasn’t working anymore. I needed to give recovery a real shot. So I checked myself into detox.”

Over the past two years in recovery, Page accomplished more than just shaking his drug addiction. Page said he had to re-establish his identity.

Today, he has a master’s degree in social work and a full-time job in the mental health field. He’s a member of a church and has renewed relationships with his family.

“My family wants to be around me,” he said. “My mom use to not want me on her property, and now I have keys to her house.”

Page also volunteers with NCHRC and operates a mobile syringe exchange in Wilmington. He drives around delivering clean needles and naloxone. He said he offers hope and reminds people of their treatment options.

“The people I work with in Wilmington are dear to my heart,” Page said. “They count on me.”

“If my life wasn’t more rewarding today, I would go back to getting high,” Page added. “But each day is better than the day before.”

Taylor Knopf

Taylor Knopf covers rural and mental health news. She previously wrote for The News & Observer as a politics and general assignment reporter. Before that, she worked at a small daily newspaper in southern...

2 replies on “Naloxone 101: How It Works & Who Is Using It”

  1. I AM TRYING TO FIND OUT IF A WALL STREET STOCK CO. IS OFFERING THIS AS A PRESCRIPTION DRUG AND IS OFFERING STOCK BUYING TO THE PUBLIC.

Comments are closed.