Overdose is a term whose familiarity has grown in direct proportion to the opioid epidemic of the last several years. Yet relatively few people have ever actually witnessed an opioid overdose. It can be shocking and deeply unsettling.
The person’s face will be pale and their body limp, so much so that they may look dead at first glance. But they’ll still be breathing. Their breath, however, will be erratic and faint. And it will grow fainter by the minute, the longer they go unattended. The person’s face and fingertips will turn blue because they’re not getting enough oxygen. Eventually, they’ll stop breathing altogether. Then their heart will stop.
But bystanders, if properly trained and equipped, can step in to reverse these overdoses using Narcan, also known as naloxone, a medication that counters the effects of prescription painkillers, heroin, and other opioids.
Empowering a Community
Between January 1, 2018 and July 18, 2020, 26,335 emergency room visits for opioid overdoses were recorded across Pennsylvania. And this is not just an issue in major urban centers like Philadelphia. In Chester County, 282 people died from opioid overdoses over roughly the same period. Over the last five years, opioid overdoses have claimed the lives of 622 people in Chester County alone.
The statistics are sobering, but another set of data demonstrates the power of bystanders to save lives. In 2015, the Centers for Disease Control and Prevention (CDC) reported that from the more than 152,000 Narcan kits that had been distributed nationally by community organizations to friends and family to reverse opioid overdoses between 1996 and 2014, nearly 27,000 lives had been saved.In other words, about one out of every six kits is used to save a life
Chester County Hospital took the lead in a similar effort. Twice over the past six months, the hospital’s Opioid Use Disorder Task Force partnered with Chester County Drug and Alcohol Services and Good Fellowship Ambulance & EMS Training Institute to host a public Zoom presentation and discussion about opioids, overdoses, Narcan, and local treatment resources. Participants were then invited to pick up a Narcan kit the following evening at a temporary station set up outside of the hospital.
“I think we may actually have had greater success with it as a virtual event because participants were able to listen without being seen, which helped with some of the stigma that can surround opioid use disorder and even Narcan,” says Heather Teufel, a pharmacist at Chester County Hospital. Teufel also has led the hospital’s multidisciplinary Opioid Use Disorder Task Force since its inception, in 2018.
In addition, as September was National Recovery Month, the team also held a (virtual) Voices of Recovery Panel where individuals in recovery themselves as well as a family member of an individual in recovery, shared their stories of hope.
The group was established to improve the care delivered to patients with opioid use disorder in Chester County. Early on, that entailed addressing barriers to treatment and changing perceptions among the hospital’s clinicians, Teufel says. More recently, the task force has helped grow the hospital’s medication-assisted treatment (MAT) program and partnered with community organizations to facilitate warm hand-offs, which are meant to bridge the gap between an ER visit, or hospitalization, and long-term treatment, and other evidence-based practices that increase the likelihood of someone seeking and staying with treatment.
With this latest endeavor, Teufel and the task force are attempting to get Narcan into the hands of those who need it urgently, a movement that began in earnest a few years ago, when it started to become clear that opioid use was in fact an epidemic. The program is slated to continue on at least a quarterly basis going forward.
In October 2015, Pennsylvania’s Physician General issued a standing prescription for Narcan. Essentially, anyone can walk into a pharmacy anywhere in the state and get it without an individually written prescription from their own family doctor. (This includes CCH’s own outpatient pharmacy, which opened in January.) And about a year earlier, then-Governor Tom Corbett signed into law legislation that provides immunity to anyone providing care to someone suffering from an opioid overdose.
Narcan is covered by most insurance plans. For those without insurance and who are unable to afford the $150 cost, the hospital will provide it, free of charge, through a charitable grant.
The cost, however, is only one of the potential obstacles that can keep those who need it, including friends and family of someone with a substance use disorder, from getting it, Teufel says. “Many are concerned about how they’ll look asking a pharmacist for it,” she says. “And even getting to a pharmacy can be a challenge for some.”
Erasing the stigma and removing barriers to picking up the lifesaving drug are a priority: Only about half of the 50 participants in the hospital’s June forum came to the hospital’s outpatient pharmacy the next night to collect their Narcan kit.
“I think everyone who came showed a lot of courage,” says Karen Novielli, BSPharm, MBA, the director of the hospital’s pharmacy. She is also a member of the task force, and she helped distribute Narcan kits as part of the June and September community outreach events. “And I think we were able to break through the barrier and let them know that picking up naloxone is a benign process. They didn’t even have to get out of their car for it.”