Free Access to Drug Overdose Antidote Hopes to Prevent Opioid Deaths in Nebraska

Nebraskans who worry about a family member or neighbor at risk of an overdose of opioids are being encouraged to learn about an effective antidote that could save someone's life.

In some places, naloxone, the drug used to revive those who have overdosed, is offered for free under a new state program.

"We want people to have it available as an option that can save a life," said Lindsey Hanlon, the manager of the DHHS sponsored program.

The availability of federal funds made the unique free Naloxone program possible for three pharmacies in Omaha, Lincoln, and Auburn on a trial basis. The state agency partnered with the Nebraska Pharmacists Association.

Public health leaders decided on creating a pilot program to allow community members to access a free Naloxone kit at a local pharmacy. Hanlon said the drug and training would be available "to those using opioids if they felt they were at risk of over-dosing" or those who knew someone at risk so they could provide emergency treatment before calling emergency medicine providers.

Nebraska has one of the lowest death rates from opioid abuse of any state in America, according to the Centers for Disease Control, the numbers crept higher in recent years. Deaths caused by opioid overdose were estimated at 121 in 2017. By 2018, the most recent figure available, the number had climbed to 167 fatalities.

Hanlon says the low numbers should not be taken as a reason not to provide access to emergency treatment.

"We can never be too prepared for this," Hanlon said. "That's kind of where the prevention piece comes in, if we would see a surge in opioid overdoses or if that opioid epidemic (seen) on the east and west coast finally makes it here."

For years law enforcement and medical response teams in the state have been aware of naloxone. EMT's in Grand Island have carried the treatment for 25 years.

While on patrol, most law enforcement agencies now routinely carry naloxone (or its trade name Narcan) since it is considered an instant cure for an overdose of opioids.

It has dramatically changed the recommended response by first responders and become one of the few bright spots in the battle against those highly addictive drugs.

In 2018 a Nebraska State Trooper working in Blaine County used naloxone to save a woman suffering from an overdose.

The stories can be dramatic.

In the fall of 2019, Officer Phil Tran, the school resource officer from the Lincoln Police Department, made his morning round outside the school and in the surrounding neighborhood.

Tran recalled he got an emergency call to respond to a possible overdose just as he approached a street corner where students often smoke.

"We had a teacher who heard one of his students screaming for help," Tran said. "I was not even a block away."

Approaching the circle of students, "it was pretty obvious what was happening," he thought. "It was an overdose."

An 18-year-old in the group, not a student, took pills, a bunch of them, He may not have known everything he had just swallowed, but whatever it was, the meds hit hard and fast. The man had trouble speaking, trouble standing, trouble breathing.

He collapsed.

"He was essentially unconscious. He was on the ground. He was foaming at the mouth.

Something Tran had learned during his police training clicked: these were symptoms of an overdose.

"That's the big thing is if you can't have effective breathing, that's a sign of an opiate overdose," Tran said. "He's either not breathing well enough for his body or finished breathing completely."

In this instance, "it got to the point where I couldn't get a pulse on him."

Tran reached for the single-dose dispenser of naloxone he kept with him at all times. It's dispensed like a nasal spray and is supposed to reverse the mind-numbing effects of the opioids immediately.

Not only was this the first time he had encountered a situation like this, but he had also received training only a few weeks before that day.

Officer Tran sprayed the mist into the young man's nose and, as he explained, "it was kind of incredible because you see someone that's obviously struggling to breathe, struggling to live and, within a few moments, you can see him start breathing again. You can see him started waking up."

Train said, "It's almost like be able to flip a switch."

After that, the emergency medical team from the Lincoln Fire Department took over.

Officer Tran found the use of the emergency dosage "much easier than I thought" and "easy enough for me to do it as a non-medical professional."

Naloxone is now in the pockets of first responders all over the state.

The use of the drug has become the recommended emergency response nationwide and was incorporated into protocols developed by the U.S. Government's Substance Abuse and Mental Health Services Administration.

"It's nice to have options, and it's nice to be able to help," said Officer Tran. "That's why, ultimately, all of us became police officers, and this is just one more tool, and one more way we can help our community."

In eastern Nebraska, Nemaha County Sheriff Brent Lottman now requires his deputies to carry it.

At first, some officers shared mixed reactions to the idea they would supply emergency medical care, traditionally the role of the Volunteer Fire Departments in the county.

"I had a couple that were fine with it," said Sheriff Lottman, "and I had a couple where they're like EMS is supposed to do that, and we're supposed to do the law enforcement."

Minds changed when they heard examples of naloxone saving the lives of other cops when they inadvertently overdosed during drug busts when handling potent concentrations of the opioid fentanyl.

Warnings about inadvertent exposure to high concentrations of opioids were issued to first responders nationwide by the Centers for Disease Control and the Drug Enforcement Administration.

Lottman noted the especially hazardous effects of fentanyl, an exceptionally powerful opioid often manufactured and moved through the black market.

"They like to 'powder-it-up' from China when it gets to here," said the Sheriff. "That can easily become airborne, so you have dust and just touch it if you don't happen to have gloves on, it absorbs through, and you can overdose completely unintentionally."

That is not a scary hypothetical situation. Some of the largest fentanyl trafficking cases in the United States ended when Nebraska police intercepted the smugglers. The investigating officers and federal agents had to handle the toxic narcotic safely.

During a 2018 drug bust in Lancaster County, a sheriff's deputy treated a Lincoln police officer who felt the symptoms of an overdose while he worked a traffic stop that turned into a drug bust.

"It's a fellow officer preservation thing," explained Sheriff Lottman. "They have the ability to buy some time until EMS gets there, and they get to the ER."

His deputies and jail staff have naloxone available at all times now.

In Nemaha County, it's not just first responders keeping naloxone handy.

A drug store in Auburn is taking advantage of the free Narcan program developed by DHHS in the hopes area residents will want to help family and friends in the event they suffer an overdose from opioids.

Pharmacist Hyrum Wilson supported the program from the start as a board member on the Nebraska Pharmacist's Association. He agreed to have his drug store next to the Nemaha County Hospital.

He says supporters of the naloxone project "wanted to get it into the hands of people who could use it." In most instances, friends and family members use it rather than the person using the opioids.

The emergency can occur, according to Wilson, "because once they overdose, they kind of fall asleep, so they usually don't know they're overdosing.

A friend or family member who encounters the emergency would have to right medication in the correct dosage to respond.

Demonstrating the product for a visitor, Wilson took out a dispenser, which looks like a small plastic nasal spray containing a single dose.

"Just kind of grip it in your hand, between two fingers and your thumb on your trigger, point it up their nose and then push the trigger down," which Wilson acted out as if dispensing the medication."

Anyone who feels they would like to obtain a dose for treatment can do so by answering "a couple of questions just to make sure that you are somebody who could be in a position to help somebody who could potentially overdose."

There's a two-minute training that Wilson and his staff conduct when anyone picks up the product, "so you know how to use it properly."

The trial project hopes anyone who wants access to the treatment will be able to do so comfortably.

"There's no stigma here," said Wilson. "We don't judge people for coming in, because we do know that. If it saves a life, I mean, there's really no reason not to.

Nebraska has allowed people to obtain the drug without a prescription for some time. What's new are federal funds paying for education programs and offering the drug at no cost.

Because without regular insurance, a prescription of naloxone can range from $75 to $120, Hanlon, the DHHS project manager, said getting the drug distributed at no cost to the public was an essential part of the program.

Hanlon said, "a lot of physicians, if they're prescribing an opioid, they may do a co-prescription for Naloxone as a preventative measure, but a lot of people won't take them up on that solely due to the cost."

Nemaha County Sheriff Lottman says this program is a rare case where making a prescription drug widely available and free has no obvious downside in communities struggling with drug abuse.

"You're not handing out Adderall or some sort of drugs (and saying) 'hey, look, we can get high off this,' said Lottman. "This is meant to save lives, and it really has."

There's not a tally of how many lives naloxone may have saved in Nebraska, but there have been stories of police reviving the addicted and cops who've come in contact.

Officer Tran is glad he was there in time.

"If I can do it, anyone can do it," Train said, laughing.

The officer gets very serious when recalling the teenager he helped revive with a single blast of the naloxone spray.

"He went from having a bad, bad day to be able to, at least, pick his head up and start breathing. If you're breathing, that's always the best thing we can ask for."