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Opioid Overdose and First Responders: How Naloxone Administration Can Save Lives
Damonica Gomez-Samuel
OPIOID OVERDOSE AND FIRST REPONDERS 2
The alarming rate of preventable deaths per year due to opioid overdose is stocking, and
is now labeled a national opioid epidemic. The American Society of Addiction Medicine
(ASAM) stated that overdose is the leading cause of accidental death in the U.S. claiming more
than 47,000 in 2014. Healthcare, governmental, and community organizations cant agree on
how to slow the trend or stop the deaths caused by overdoses. The need to intersect deaths and
recovery users has caused non-medical first responders like police authorities and firefighters to
be equipped with the antagonizing opioid agent, naloxone. Some researchers protest the
approval of first responders and bystanders administrating naloxone during an overdose. Using
peer reviewed based researched journals, this paper will give attention to the positive and
negative aspects, the reasons for supporting or opposing against nonmedical first responders like:
police, and firefighters administering naloxone. And consider possible consequences of not
giving naloxone, and discuss possible barriers for better patient outcomes when compared to
current systems already in place. Ideally, this position statement will initiate deliberate
conversations among healthcare leaders and politicians to make advances toward regulation and
control over the current crisis that has drastically affected and crossed all social, economic, and
racial classes.
OPIOID OVERDOSE AND FIRST REPONDERS 3
Over the past decades, overdoses caused by heroin and prescribed opioids have caused
unnecessary and preventable deaths. Deaths due to overdose continue despite substance abuse
rehabilitative inpatient clinics, counseling, and other interventions to stop opioid abuse. The
American Society of Addiction Medicine (ASAM) found that drug overdose is the leading
cause of accidental death in the US. There was 52,404 lethal drug overdoses in 2015 with
20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related
to heroin in 2015. In 2010, West Virginia had the highest drug poisoning death rate of 28.9 per
100,000 people (Beheshti et al 2015). To say that there is an opioid crisis is a complete
understatement of reality. The current events prove that it is a national epidemic. Overdosed
deaths will continue because the addiction cycle is difficult to break and usually starts with
prescribed opioids that progresses into opioid tolerance. Tolerance eventually becomes
dependence, which grows into abuse. As abuse continues it culminates into addiction and death
caused by overdose. For people struggling with addiction, it is difficult to watch them destroy
their lives, witness multiple overdoses, become unconscious, and risk death. Studies show
abstinence and full recovery is impossible for most because overtime neurobehavioral
adaptations Kerensky (2017), occur and become embedded with each opioid use. This
environment has created an unrelenting addiction cycle that is said to be impossible to break.
In response to the current opioid epidemic, The US Department of Health and Human
Services has set three priority areas that address the current opioid epidemic: (1) opioid
prescriber education, (2) community naloxone access, and (3) improved access to medications
for opioid use disorder. Studies show heroin uses usually started with abusing prescription
opioids, hence the need for prescriber education and monitoring cannot be overstated. Opioid
OPIOID OVERDOSE AND FIRST REPONDERS 4
overdose education and community naloxone distribution (OEND) can actually reduce overdose
death rates Kerensky (2017). There is growing interest in and minimal opposition to overdose
education and naloxone distribution (OEND) programs Muller et al (2015). These programs are
vital in the community and offer overdose response training that includes calling 911, rescue
breathing, administering naloxone, and staying with the victim until recovery or help arrives
Mueller et al (2015). These state sponsored programs aim to prevent or reduce fatalities by
providing naloxone to users or persons addicted to opioids, outside of a medical setting, and
offer training on opioid overdose prevention, recognition, and response Muller et al (2015).
However, overdose education and naloxone distribution (OEND) clinics are only offered in some
states, and more local naloxone distribution programs are needed to meet the demand. Bazazi
(2010) said, naloxone distribution programs remain among the last harm reduction programs to
be implemented widely. Research proved that from 1996 to 2010, OEND programs had trained
and distributed naloxone to over 50,000 persons and reported that over 10,000 overdose
reversals were made during that time Mueller et al (2015). In 2010, a community coalition in
Revere, Massachusetts, requested that the citys reghters be permitted to administer naloxone
through the OEND program. Fire fighters were the first to arrive even before the EMS service.
Revere became the rst re department to join the OEND program and all reghters were
trained on the proper use of naloxone, and all of their vehicles were equipped with IN naloxone
kits. Between 2010 and 2013, Revere reghters administered naloxone 114 times Davis et al
(2014). In addition, in 2017 The Centers for Disease Control and Prevention (CDC) awarded
$28.6 million in additional funding to 44 states and the District of Columbia to support their
responses to the opioid overdose epidemic. The funds will be used to strengthen prevention
Before 2017 only a fraction of the states offer OEND training, this may imply that drug
users are considered an unpopular population that carry a negative social perception and
overdose deaths affect poor racial minorities who cycle in and out of the criminal justice
system Bazazi (2010). This notion may have influenced and possibly delayed the creating and
making policy changes for drug users who are considered a low social priority. Some opposed
to improved access to naloxone, feel that this population cannot handle the responsibility of
administering naloxone during an overdose Doyon (2014). They highlight that the wide
distribution of naloxone opioid use has actually increased opioid use and that naloxone only
offers abusers a false sense of security Doyon (2014). The same author highlighted that only
10 60 % of cases were being reported to 911 by bystanders. It is argued that this hesitation may
drug seizures, fear of eviction, and threat of arrest or incarceration Doyon (2014). Some argue
that when they witness an overdose, they delay calling 911 for fear of arrest of heroin
(2015). Skeptics argued that when naloxone is used, overdose survivors are unlikely to seek or
engage wholeheartedly in addiction treatment (Kerensky 2017). They argue that first responder
naloxone administration enables opiate users to reverse an overdose without being admitted to a
medical setting and that it delays entry into a drug treatment program Bazazi et al (2010). In
addition, it allows people to continue using opiates without facing some of the negative
consequences of opiate misuse. Bazazi et al (2010). Many agree that having naloxone might
reduce the likelihood that emergency services would be called, but according to Bazazi et al
(2010) no data demonstrate this. In fact, a study done on one prevention program in New
OPIOID OVERDOSE AND FIRST REPONDERS 6
York City found that 74% of participants called for help after administering naloxone.
Available naloxone kits would be beneficial for this group because they are acting as first
responders.
When an overdose occurs and 911 is called, police and firefighters usually arrive before
the EMS. These first responders must be equipped with naloxone in order to save lives. In 2010
the Office of National Drug Control Policy stated that naloxone should be in the patrol cars of
every law enforcement across the nation Davis et al (2014). States like Michigan permit police
to carry and administer naloxone. However, in a few police authorities dont have the option to
administer naloxone and save lives. According to Wootson (2017) Sheriff Richard Jones of
Butler County, Ohio, refuses to let his police officers carry Narcan (naloxone). Even the spray
form is rejected. He stated We don't do the shots for bee stings, we don't inject diabetic people
with insulin. When does it stop? Then he went on to say I'm not the one that decides if people
live or die. They decide that when they stick that needle in their arm. In addition, Jones's claims,
that naloxone recipients wake up agitated and ready to fight Wootson (2017). Although Sheriff
Jones view is extreme many critics silently agree with him. They dont understand that opioid
addiction is like a disease that most dont recover from. Sheriff Jones said Narcan is the wrong
approach for a war on opioids that we're not winning, and said he favored stronger prevention
efforts to prevent people from first using the drug (Wootson 2017). Naloxone is viewed as a
quick fix that offers immediate help but does not solve the problems associated with addiction.
But as patient advocates we have to help people in times of need and ensure that first responders
During an opioid crisis overdose, naloxone must be given before overdose symptoms
cause death. Giglio (2015). This timely first dose should be given within the first few minutes
by anyone available including non-medical first responders like police and fire fighters. Death
typically occurs within 1 to 3 hours after an overdose and is usually caused by respiratory failure
Giglio (2015). Naloxone is a potent opioid antagonist that is FDA approved for emergency
treatment of opioid overdose when respiratory and/or central nervous system depression is
present. Injectable naloxone dose concentration is 0.4 mg/1 ml Kerensky (2017). Since 1971
naloxone has been used to reverse opioid overdose Mueller et al (2010). A study of adverse side
prevention programs focusing on education and awareness are safer alternatives that reduce
opioid use than naloxone (Beheshti et al 2015). Nevertheless, naloxone administration is needed
during an overdose and together with overdose education programs and support the odds of
There is concern about the relatively short half-life of naloxone when compared to
that of some opioids, because it could lead to further respiratory depression Doyon (2014).
The same author also recommended that naloxone be prescribed in two doses, and given within
the first few after the first. Other objectors feel that the activity of naloxone is considered unsafe
because it causes a complete reversal of narcotic effect that could result in acute withdrawal
syndrome which may include tremulousness, nausea, vomiting, and other more severe
symptoms as respiratory distress, tachycardia and possible cardiac arrest Beheshti et al (2015). In
addition, the same authors said that not only should naloxone be carefully administered but
OPIOID OVERDOSE AND FIRST REPONDERS 8
patients should be continuously monitored after receiving doses because the duration and action
of some opioids take longer to leave the system compared to the short half-life of naloxone is
an extremely intense surge and craving for more opioids. Some critic feel that his side effect of
naloxone has led to secondary overdosing resulting in death. In the HBO documentary film by
Peltz (2017) Warning: This Drug Can Kill You a young man named Brenden Cole 23 years
old, was found unconscious due to an overdose of heroin and was given naloxone, then taken and
sent home from the hospital. He died that same day from the second heroin overdose. His mother
said that the EMS gave naloxone but it did not work the second time. First responders to need to
know that naloxone can cause intense craving for more opioids after receiving naloxone. These
and other very unpleasant symptoms can be managed with overdose education and naloxone
distribution (OEND) training, first responders have improved confidence and feel equipped to
administer naloxone safely and effectively Muller et al (2015). Because of this, critics question
the ability of nonmedical first responders during a crisis, and objectors say examples like
Brendens is proof that only medical professionals in an acute care setting should give naloxone.
As a registered nurse I agree that naloxone should be available to the public and used by
nonmedical first responders. However, most nurses may only use naloxone on an inpatient
setting and on rare occasions. The challenge for most healthcare professionals is to understand
and realize that possible overdose and death is an everyday reality for people addicted to opioids.
They need naloxone when they overdose and first responders like police authorities and fire
fighters along with EMS should administer correctly when needed. Research has proven that
even trained bystanders administration of naloxone scored high for: safe administration,
overdose recognition, and overdose response verses those untrained. These results prove that
OPIOID OVERDOSE AND FIRST REPONDERS 9
with proper teaching and hands on training good technique can be achieved when the participates
First responder naloxone administration compared with the goals of Healthy People 2020
Highlights- naloxone has been used to save lives and has proven to have few side
effects
Drawbacks- withdrawal: with an abrupt discontinuation of an overdose caused by a
tolerated high ends with intense cravings for more of the drugs; withdrawal period
varies and is unpredictable
Losses- bystanders may not call 911 after administering naloxone, users may suffer
more severe symptoms that could cause death
Conclusion
Although naloxone has proven to be a valuable tool in reversing overdose deaths it is not
the answer to the overall problems associated with addiction. There are drastic changes and an
increased need for education and training of people addicted to opioids. However, equipping rst
responders with naloxone will not only save lives but will offer hope to the recipient with the
possible outcome of better health free from opioid abuse and addiction. In addition, methadone is
currently used to help curve withdrawal from opioid and heroin cravings. Kerensky (2017)
added that treatment with a daily long-acting opioid agonist, like methadone or buprenorphine,
is the most promising way to work towards engaging him or her in treatment.
The importance for first responders and nurses to know how to care for and monitor
patients who received naloxone was proven by this discussion. Evidence shows that within the
first few hours after naloxone withdrawal symptoms are at its highest and continued monitoring
is required for users to recover and reach stability after an overdose. In addition to monitoring an
OPIOID OVERDOSE AND FIRST REPONDERS 11
adequate discharge plan that includes following up with recovery and abstinence counseling with
possible inpatient services from a state sponsored clinic may be needed. Due to the complexity of
recovery, it usually depends on the patients participation and efforts to control their own
behaviors and feelings regarding opioid abuse and addiction. Overdose education and naloxone
distribution community programs must continue their efforts in educating users on the use of
naloxone may persist because of the concerns related to lack of education, administration of
naloxone, failure to call 911, failure to recognize signs of overdose, there will continue to be
objectors to wide spread distribution of naloxone. Here in Michigan, a law was passed in
September 2017 that allows naloxone to be sold as an over the counter drug at places like
Walgreens, and CVS, and no prescription needed. Indeed, legislation is supportive of non-
medical responders administering naloxone, but it must be available to them, to save lives. And
in 2014 the CDC announced an award of one million dollars to the state of West Virginia to
improve the drug-monitoring program for prescription drugs Beheshti et al (2015). My hope is
that the healthcare organizations and community organizations team up and encourage the
development of increased mandatory state and federal laws that demands all first responders
References
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OPIOID OVERDOSE AND FIRST REPONDERS 13
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OPIOID OVERDOSE AND FIRST REPONDERS 14