“So much for that idea,” thought the mom in her 60s, who asked to remain anonymous, as she took the key out of the ignition. She bolted inside her front door, tossed her bag down, and yelled to her son, David, that she’d be staying home tonight. When she heard no answer from David, Levine knew in her gut that something was wrong. She ran to his room and saw the 30-year-old lying on the floor unconscious, foaming at the mouth, eyes rolled back into his head. It wasn’t the first time David had overdosed on opioids. In 2018, Levine watched emergency medical service workers revive him with Narcan (naloxone), a drug that can reverse an opioid overdose, on the floor of her home. The medication works by binding to the brain’s opioid receptors and rapidly stopping the effects of opioids, allowing the person to breathe normally. Since then, she had kept Narcan at her home. Even though David had been doing better, Levine still regularly checked the expiration date on her supply and replaced it as necessary—just in case. That stormy afternoon in June 2021, Narcan would save David again. Only this time, Levine didn’t have to wait for an ambulance—she administered the nasal spray herself. The effects can last as little as 30 minutes, but that gave her enough time to call 911 and get David rushed to the hospital, where he was treated for aspiration. “The minute I saw he was asleep in the hospital, I got in the car and drove to Walgreens for more Narcan. I will never be without it in my home again,” says Levine. Like many people, David can trace his opioid addiction back to the painkillers he was prescribed after undergoing surgery as a teenager, which eventually led him to use heroin and fentanyl. Research shows that people face a 44% increase in the risk of long-term opioid use if they receive a prescription for these drugs after a surgery that involved a hospital stay of less than 24 hours. Opioid addiction doesn’t discriminate—it’s a mental health condition that can happen to anyone. And the rise of opioid overdoses during the pandemic has driven many communities to ramp up Narcan trainings this summer, giving anyone who wants them the tools and knowledge they need to save someone from an opioid overdose. Here’s why now, more than ever, you should consider learning how to use Narcan.
Opioid Overdoses During the Pandemic
David’s story fits into the broader opioid epidemic, which has gotten significantly worse during the pandemic. Rates of overdose deaths from all drugs in the U.S. climbed a staggering 29.4% in the year leading up to December 2020, killing more than 93,000 people. About 75% of those deaths were from opioid overdoses. “In heartbreaking numbers, the social isolation of the pandemic with its negative impact on mental health was a driving force behind the surge in overdoses, in addition to financial stressors and lack of access to treatment programs that either closed or reduced capacity,” explains Patricia Aussem, LPC, MAC, associate vice president of consumer clinical content development at the Partnership to End Addiction. A large reason for the rise in opioid overdoses has to do with fentanyl. The drug is up to 100 times more powerful than morphine and often mixed with other substances, like cocaine and counterfeit pain medication—sometimes without the user’s knowledge. The financial struggles many people faced during the pandemic has created a “trickle up” effect of people using fentanyl, says Sarah Bass, PhD, associate professor of social and behavioral sciences and director of the Risk Communication Laboratory at Temple University’s College of Public Health. “Meaning that if users can’t afford normal product, dealers will respond to ensure profit, and they responded by using more fentanyl in products because it’s easier and cheaper to produce and cut with drug,” she said. “So, what used to be more a heroin-specific issue now became an issue with other drugs, like cocaine or tranquilizers. And people using these substances had never used fentanyl before or didn’t realize it was in the drugs they were using, causing overdose or death.”
Communities Respond With Narcan Trainings
While reducing opioid overdoses will require a range of strategies, one thing that could help save lives right away is increasing access to Narcan. In fact, statistical modeling from 2020 estimates that 21% of opioid overdose deaths could be avoided with high rates of naloxone distribution in a community, largely driven by everyday people knowing how to use the medication and having it on hand. In response to the worsening opioid crisis, organizations in cities across the country have doubled down on their Narcan training programs, now offering virtual sessions on Zoom, pre-recorded videos, and self-paced online courses, in addition to in-person workshops. “Everyone should have Narcan and know how to use it because you can’t assume that overdoses only occur in certain places. Substance use is a public health issue that occurs everywhere, in all races, ages, and socioeconomic strata,” says Bass. Some naloxone trainings can be done in as little as 20 minutes. The programs usually teach participants about the opioid epidemic, the risks of these drugs, how to recognize an opioid overdose, and how to administer naloxone.
Importance of Training
Do you have to get trained to use Narcan? Not necessarily. The medication is considered very safe and rarely causes side effects. While the injectable version can be a bit harder to use, the nasal spray naloxone can come in a pre-assembled, pre-filled device that you can gently place in someone’s nostril and press to release the medication. For Levine, it was “no more difficult than putting in eye drops or any other nasal spray.” While she did not receive formal Narcan training, Levine credits a local support group for teaching her other important details of about using the medication to save her son’s life—like the fact that it only lasts 30 to 90 minutes. Since opioids can stay in the body much longer than that, the person administering Narcan needs to seek out medical help right away, even if the person who overdosed seems to be revived. “Had I not been in that support group, I would not have known to call 911. I would have believed that once he sat up, I had resuscitated him and he was fine,” says Levine. “I think formal training is important and the person administering the Narcan needs to know that a 911 call must be made, regardless of using it.” Search for “naloxone training” and your city or state to learn about upcoming programs near you. You can also take a bystander training program online through Get Naloxone Now. Once you feel confident using naloxone, you can pick up the medication from a local pharmacy. In some states, you may not need a prescription for it, and it can be covered by health insurance (but check with your policy, just to be sure). You can also get Narcan from some local health departments and community-based organizations. Red Cross First Aid for Opioid Overdoses Online Course
“Anyone can be trained to administer naloxone and it can save a life if used in time,” says Aussem. “It’s especially important to have it on hand and know how to use it if you know a person who is using opioids or has been prescribed opioid pain relievers.”
More Work to Be Done
Teaching more people to use Narcan can certainly reduce opioid overdose deaths. But experts, as well as people directly touched by the opioid epidemic, say that it’s not enough to stop the opioid epidemic. “Narcan is helpful and creates another layer of assistance. However, it’s a pebble in the ocean. Greater interventions need to occur to combat overdoses,” says Ben Brafman, LMHC, a behavioral health expert, certified addiction professional, and co-founder of The Sylvia Brafman Mental Health Center. He’d like to see more regulation of drug rehabilitation centers to ensure people get the care they need, and these programs become more affordable and available in at-risk communities. Teaching people who use drugs about the dangers of fentanyl in a judgement-free environment and giving them tools and strategies to prevent an overdose is also key. “Harm reduction means meeting people where they are in their substance use and not assuming that everyone wants or needs to be in rehab or not using substances,” says Bass. “With the rise of fentanyl in almost all types of street drugs, overdose is a significant risk and providing education, fentanyl test strips, and talking through strategies with people is really important.” Aussem adds that finding more non-opioid options for people to manage their pain, whether it’s from a surgery or chronic condition, could help curb the development of substance use disorders. “I won’t say it was the doctor’s fault for prescribing [David] OxyContin [an opioid pain medication] when he was in excruciating pain, but it set him on a path,” says Levine. “I was ignorant, I had no idea how addictive it was. Now I’d say to anybody, don’t let your child, especially in those teenage years, take Oxy.” It’s been about a month since Levine revived David with Narcan. He recently completed an intensive outpatient treatment program for drug recovery and is working with a career counselor to find a job. Levine continues to let him live at home, under the condition that he takes a drug test every day. But the journey has been difficult. A prior conviction for a felony for drug possession makes David ineligible for many positions in his field, despite having an Ivy League education. Getting turned down for job after job is stressful and often leaves him depressed. Worried about David overdosing again, Levine says she’s now “afraid to go anywhere” and often cancels her own plans so she can be at home with him. “I’m OK right now to be his guardian, as long as he’s in therapy and he’s being tested and going to meetings,” she says. “You have to hope for the best and prepare for the worst. And as far as prepare for the worst, well, that’s the Narcan.” Fortunately, a medication called naloxone (Narcan) can reverse opioid overdoses. You can learn how to use Narcan through a local community training or a virtual program that takes as little as 20 minutes. While learning how to use naloxone won’t solve the opioid epidemic, it could give you the opportunity to save a person’s life and give them a chance to recover from a substance use disorder.
