10 things to know about the drug tackling Connecticut’s opiate overdose epidemic

Enough prescriptions for opiate painkillers were written in the United States in 2010 to “medicate every adult American around the clock for a month,” according to a page on Connecticut’s Department of Mental Health and Addiction Services’ (DMHAS) website. This bit of information, and many others, are featured on the site to explain the need for the department’s Opioid Overdose Prevention and Naloxone (Narcan) Initiative.

In recent years, opiate use and abuse has increased significantly in the U.S., and the numbers show that New England — and, specifically, Connecticut — has been more strongly affected than the rest of the country.

“This is a public health crisis in New England and across the country, and what’s most important is that people are taking the appropriate steps to address it as a public health issue,” said Chris Heneghan, Board Member with the Greater Hartford Harm Reduction Coalition (GHHRC.)

Opioid addiction took 380 lives in Connecticut in 2015. And according to a page on the Connecticut Office of Injury Prevention’s website, residents are more likely to die from unintentional drug overdoses than from car accidents. The majority of these overdoses are linked to opioid painkiller use.

Now, many health care provider organizations and institutions across the state are turning to the overdose reversal drug Narcan, an intra-nasal drug that comes from the chemical Naloxone, in the hopes of saving lives. Below, 10 things you should know about Connecticut’s opiate abuse epidemic and the state’s plans to distribute Narcan to those in need:

Opiates make the brain forget to tell the body to breathe. Narcan reverses that.

Opiates attack the receptors in the brain that send signals to the rest of the body to perform basic functions that keep a person alive. Once the body forgets to breathe, a person enters a period of overdose that often leads to death.

Naloxone, the working chemical in Narcan, is an opioid antagonist that blocks the effects of opioids on the brain and body, said Susan Clark-Levin, a volunteer with the Connecticut Department of Public Health’s (DPH) OPEN Access CT Narcan Initiative. Narcan is easily dispensed intra-nasally and works by attacking affected brain receptors and signaling them to tell the body to commence breathing. According to Clark-Levin, the drug takes three-to-five minutes to reverse the effects of an overdose.

Emergency personnel have had access to Narcan for years, but now the focus is trickling down and reaching a community level.

The goal of Connecticut’s Narcan distribution programs is to get the drug beyond EMTs and police and into the hands of other people with more direct access to opiate users, such as clinicians and family members, and perhaps even into the hands of the users themselves. “We really try to get it directly into the hands of people most at risk,” said Heneghan. “That’s really the most effective way to kind of curb this epidemic.”

Pharmacies across the state are working to make Narcan available without a prescription.

“All the independent pharmacies, well about 60 of them, in the state now — that’s where you can go in and they’ll do the prescription themselves. You don’t need a prescription; you just bring your insurance card in…. And they do a little training, and it’s wonderful,” said Clark-Levin.

Narcan distribution programs are specially targeting users who have recently gotten out of jail or treatment programs.

Heneghan and Clark-Levin pointed out that people returning home after extended stays, whether in prison or rehab programs, are especially at risk of overdosing. To account for this, the Greater Hartford Harm Reduction Coalition and OPEN Access CT are implementing extra measures to ensure people in these categories have access to the overdose reversal drug.

Narcan has fewer side effects than baby aspirin.

Narcan and the Naloxone chemical within it take a targeted approach to opiates within the body and brain and remove only opiates alone, Clark-Levin said. In addition, the drug has zero abuse potential, zero street value, and it doesn’t encourage drug use — a “great safety profile” overall, according to Heneghan.

Connecticut healthcare centers will receive more than $2.5 million in federal money to focus on improving substance abuse services, especially those for opioid users.

Recipients of the funds include Community Health Center, Inc. (Middletown, Meriden, New Britain, New London), Community Health Services, Inc. (Hartford), Cornell Scott-Hill Health Corporation (New Haven), Fair Haven Community Health Clinic Inc. (New Haven), First Choice Health Centers, Inc. (East Hartford), Optimus Health Care, Inc. (Bridgeport) and Staywell Health Care, Inc. (Waterbury).

The funds are part of a $94 million federal initiative and is estimated to “support treatment services for 124,000 patients” in Connecticut, according to a report by FOX 61.

No one person is officially appointed to oversee Narcan distribution efforts in Connecticut.

“OPEN Access Connecticut is the name of the whole initiative, let’s say, but nobody is an employee that sits in the office all days that says, ‘You do this. You go over to Derby. You go to Shelton.’ You know? So everyone’s kind of picking up what they can,” said Clark-Levin, one of many volunteering her time to personally distribute Narcan to individuals statewide.

She said she decided to volunteer because the Narcan movement was “too slow-moving” before, and she wanted to step in to help. “Nobody gets paid for the Narcan part,” she said. “It’s all volunteers.”

It’s possible for an overdose to return, so although calling 9–1–1 is not required, it’s highly recommended.

Once an initial dose of Narcan has been administered, it can take up to five minutes to work, but Clark-Levin said she and other providers within the OPEN Access CT network generally provide a second dose if respiration has not resumed within three minutes. She said she’s seen a “divided” need for the second dose among those who had overdosed, but does remember a few instances of patients in New London that required a third dose due to the high levels of opiates in their systems.

Technically, it is not required to call 9–1–1 if you or someone you know experiences an overdose and recovers through a dose of Narcan, but Heneghan insists it’s the right thing to do. “The reason we recommend 9–1–1 be called is because if you only have one dose of Naloxone, and that person has a strong dose of opioids in their system, the Naloxone could wear off an the O.D. could come back.” Cases in point: Clark-Levin’s New London examples.

Fortunately, Clark-Levin and Heneghan said they generally distribute two Narcan kits at a time, in the hopes of providing enough of the drug to reverse even the most serious overdoses.

Many opiate users start by abusing prescription painkillers then move on to desiring the quick, cheap, accessible high provided by heroin.

Clark-Levin said many opiate addictions start at home, often before people even realize they’re addicts. In the years leading up to the opiate abuse epidemic, doctors were probably overprescribing painkillers, she said. Problems arose when curiosity got the best of people and old prescriptions hadn’t been eliminated from the options in the medicine cabinet.

“Once they took them, and because they were an addict and didn’t know it, they took to the feeling, and they just kept taking it. And then when that ran out…they didn’t have any doctor to go to. That’s when they heard about what’s cheaper and easier to find: heroin,” she said.

We could learn a lot from Massachusetts.

Our neighboring state led the way in the overdose prevention movement, according to Heneghan. For instance, it was the first state to have a standing order that said Naloxone could be accessed without a prescription.

This story was originally published on March 28, 2016.