By Lincoln Wright
South Bend Tribune
INDIANAPOLIS — Despite growing efforts to battle the opioid crisis in the United States, overdoses continue to rise. To combat the trend, U.S. Surgeon General Dr. Jerome Adams last month issued the first health advisory from the office in 13 years. In it, he urged more Americans to carry the overdose-reversing drug naloxone.
It’s a push many health officials are backing. But others are concerned that lay people should be trained before they begin carrying the drug that’s administered as a nasal spray.
Backing Adams, Indiana officials are helping the public obtain naloxone, also known by the brand name Narcan. Officials at the Indiana State Department of Health, which has shipped more than 13,000 doses of naloxone to local health departments in the past year and a half, believes the more available Narcan is, the more those struggling with opioid abuse can find the help they need, said Katie Hokanson, director of trauma and injury prevention.
“Anyone and everyone should obtain naloxone,” Hokanson said. “You never know whether someone is struggling with misuse. Ensuring everyone has it, that’s one opportunity to help.”
But, it’s because of training concerns that the St. Joseph County Health Department isn’t currently giving naloxone out to the public, Robin Vida, director of health education, said. The department is licensed to distribute the overdose antidote, but it chooses to do so only to community partners like the Center for the Homeless and Hope Ministries.
“There has to be some level of education provided,” she said.
Following the surgeon general’s advisory, the Marshall County Health Department decided to start offering to train the public on Narcan use. The county’s overdose deaths went from just one in 2015 to 16 last year.
So far, the department has offered training in Plymouth, Bremen, Argos and Culver, said Theresa Budd, health educator and emergency preparedness coordinator. Budd also will train individuals who come to the health department.
The public is interested in carrying Narcan, Budd said, many people saying they have a loved one or friend struggling with addiction. Those coming to a Marshall County training also are able to leave with a free Narcan kit.
While the Narcan nasal spray appears simple to use, St. Joseph County health officials still think anyone who wants to carry the drug should have knowledge on how to administer it.
“Always when you’re giving drugs to people, I think you should have some training on it,” Andy Myer, South Bend assistant chief of emergency medical services, said.
Although he’s generally a proponent of training the public in using Narcan, Myer has some concerns about doing so. Currently there is no training model in place for Narcan, he said, which could bring up liability issues.
“There’s nothing out there that structures how we teach people how to use it,” Myer said. “We have to be careful.”
But he’s open to starting a program. Approved EMTs are able to train and certify people in CPR, he said, so maybe Narcan will be the next step. Budd said her department is not concerned with liability issues because they are following guidelines from the state health department.
St. Joseph County Coroner Michael McGann also supports citizens having Narcan as long as they are trained, he said, because there’s no question it works.
Last year saw a slight decrease to 67 overdose deaths in the county and so far this year there have been 15, McGann said. While unfortunate, that number isn’t an alarming spike, he said, and it could be much worse.
McGann likened the current state of overdoses to playing Russian roulette. Though he said it could be worse, there is an increase in overdoses involving drug cocktails. He called them “designer types” of fentanyl known to be far more powerful than heroin. It’s getting laced and cut with other drugs and “people never know what they are getting,” he said, making Narcan an important tool.
“Had it not been for the fire and police departments using Narcan, the mortality rate would be much higher,” he said. “Narcan is doing its job.”
Earlier this year, the national Centers for Disease Control and Prevention released a report showing overdose cases had climbed by 30 percent at emergency rooms in the U.S. from July 2016 to September 2017. Indiana was at about 35 percent; the Midwest was the hardest-hit region, seeing a 70 percent increase in emergency room visits.
In the event of an overdose, Myer warns that Narcan is not a cure-all. You can’t just administer the drug and then sit back, he said, which gives him concerns people won’t be prepared for the situation.
It’s essential, he said, that bystanders also call 911 and administer CPR.
“The main thing is restoring the respiration because if they are not breathing that’s when we get into problems,” he said.
Because of all the different concentrations of opioid drugs and the issue of a bystander not knowing how much of a drug someone has used, there’s no clear amount of time it could take for the naloxone to take affect, Myer said. And, he said, every second counts when someone isn’t breathing.
“My concern is not that people have it and not that people use it,” Myer said, “but that people will think this is the only thing they can do to help someone.”
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