2016-10-13
Story

Naloxone, shown here, can block the effects of opioids and prevent overdose deaths.

Photo by Robert Nickelsberg/Getty Images

By Anna Boiko-Weyrauch

Florence, Colo. police officer Michael Gordon, 25, has seen four or five overdoses in his two years on the police force. He said he was called to respond to another one on Aug. 6 at 1:43 a.m.

A man was banging on the door of the Florence Police Department, panicking and asking for help. Gordon ran over to his car and saw an approximately 20-year-old woman with her eyes closed.

“She was real clammy, lethargic, not really responsive,” Gordon said. The woman was breathing deeply but her pacing was off, halting longer than usual between breaths.

The woman had taken heroin, and now she appeared to be overdosing. Gordon went to his patrol car and grabbed a dose of naloxone, an opioid overdose antidote.

In an opioid overdose, the drug depresses the respiratory system and users typically die from lack of oxygen. Naloxone works by knocking opioids off the relevant brain receptors, making it possible to breathe more easily and get medical help.

Gordon sprayed the drug in the woman’s nostrils, as you’re supposed to do.

“You gotta breathe, stay with me, you’re going to be fine,” he said he kept telling her. “You need to breathe, you need to breathe.”

After a minute, the woman made a face when Gordon rubbed her sternum—a technique for assessing responsiveness—and squeezed his hand a little. He knew then that the antidote was working, he said.

Heroin’s death toll has increased across Colorado. In 2014, 899 people died from drug overdoses, according to an analysis by the Colorado Health Institute, a grantee of The Colorado Trust.

In communities like Florence in Fremont County, as well as in counties to its south and southeast, rates of overdose deaths have risen higher than the national average. Fremont County’s drug overdose death rate in 2014 was 16.1 to 18 people per 100,000, up from 10.1 to 12 people per 100,000 a decade earlier, according to the analysis. That equates to about seven or eight deaths in the county in 2014. The national average that year was 14.7 deaths per 100,000.

Twelve Colorado counties had overdose death rates of more than 20 per 100,000 people in 2014, making them among the highest rates in the country, according to the analysis. Nine of those 12 counties are in rural Colorado.

Many people in those counties are trying to save lives using naloxone. The Florence Police Department is one of 23 departments that has trained and equipped officers with the opioid overdose antidote. In September, Attorney General Cynthia Coffman announced a program to train every municipal police and county sheriff’s department in 17 of the counties most affected by the heroin epidemic.

However, the need extends farther than the counties included in the project, such as in rural Custer county, which went from 6.1 to 8 overdose deaths per 100,000 in 2004, to 18.1 to 20 deaths per 100,000 in 2014, among the highest rates in the state.

Seven or eight additional jurisdictions have contacted the attorney general’s office asking for naloxone and training, said José Esquibel, community engagement director for the Office of the Attorney General.

“If we can expand (the program), yes, we’ll try and do that,” he said.

Pharmacies are also making naloxone available to the public. In fact, in theory, Colorado Senate Bill 15-053 last year changed the law to enable “standing orders” for naloxone, meaning anyone who shows up to participating pharmacies can get the antidote without a prescription. Last year, Larry Wolk, MD, Colorado’s chief medical officer and executive director at the Colorado Department of Public Health and Environment, issued a standing order for the state to access naloxone under his medical license.

Ideally, that would mean users, their friends and family, and harm-reduction organizations could obtain naloxone to keep on hand in case of an emergency.

Yet at present, the ability to provide or receive this life-saving drug in Colorado still depends on geography and uptake by law enforcement agencies and local pharmacies.

Access to naloxone at pharmacies is still getting up and running, said Robert Valuck, PhD, pharmacy professor and coordinator of the Colorado Consortium for Prescription Drug Abuse Prevention. King Soopers, Rite Aid and a handful of independent pharmacies have standing orders to dispense naloxone. Walgreens currently requires a prescription in Colorado; however, the chain is in the process of training pharmacists on the medication and plans to offer naloxone without a prescription in October, Walgreens spokesperson Phil Caruso said.

It’s important to raise awareness among doctors and pharmacists as well, Dr. Valuck said: “It’s going to take a lot of work to educate people and to get enough places to have it readily (available).”

Prowers County communities in southeastern Colorado have been slow to accept the scale of the heroin problem there, said Tammie Clark, director of Prowers County Public Health and Environment.

“It seems that we have to keep saying the same message to begin making some progress,” she said.

But finally, some progress is being made, Clark said. Prowers County will train local law enforcement officers on naloxone in late November.

Access is lagging in Pueblo because there aren’t enough pharmacies that use standing orders, said Michael Nerenberg, MD, a former emergency room doctor in Pueblo and a founder of and volunteer at Access Point Pueblo needle exchange. For example, the nearest King Soopers for people who live in Pueblo West is about 20 minutes away.

“Not ungodly or anything, but if you don’t have transportation, that’s a long way,” Dr. Nerenberg said.

Another challenge is funding community naloxone programs. Denver-based Harm Reduction Action Center Executive Director Lisa Raville uses operating funds to buy naloxone because she said she can’t find grant funding for the medication, which she distributes to opioid users for free.

“My folks aren’t going to go to a pharmacy—they want to come here,” she said.

Stigma keeps Raville’s clients away from pharmacies because they have had bad experiences with some pharmacists who chose not to sell syringes over the counter to drug users, she said.

The San Luis Valley Area Health Education Center (SLV AHEC), a past grantee of The Colorado Trust, received $100,000 from the U.S. Department of Health and Human Services to reverse opioid overdoses in rural areas. It was one of 18 grants spread across 13 states and lasted a year.

The initiative included 52 trainings with 560 people, including 133 law enforcement personnel and 427 community members, SLV AHEC Executive Director Freddie Jaquez said. But the length of the grant was “way too short,” he added, and the group had to stop just as they were getting started, leaving five towns in the San Luis Valley that need naloxone virtually untouched.

Despite the short duration of the training, it was “very, very successful,” Jaquez said. Nine people have been saved from overdoses by naloxone in the area since April, he said.

Anyone can attend a free two-hour training on naloxone organized by the Colorado Attorney General’s office. To view the schedule and sign up, visit this page.

Anna Boiko-Weyrauch
Journalist
Denver, Colorado