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Nurse practitioner Michelle McKenzie from Rhode Island's Preventing Overdose and Naloxone Intervention (PONY) teaches Emily Weber of Concord how to administer intranasal naloxone, also called Narcan, at the HOPE for New Hampshire Recovery rally on Saturday in Concord's White Park. Weber said she lost a close friend to a drug overdose and hopes learning how to use the overdose-reversal drug could help her save someone else's life. (Shawne K. Wickham/Union Leader)

Narcan may have saved thousands of lives in NH


Emergency medical responders have administered more than 2,800 doses of the overdose-reversal drug Narcan in the first eight months of this year, according to state data. The use of the drug each month has doubled over last year's figures.
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In just one six-hour period last Wednesday, Manchester EMTs used Narcan to revive six overdose victims.

Now the state is about to unveil new initiatives to make the drug, also called naloxone, more widely available to addicts, their families and friends.
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On Tuesday, Gov. Maggie Hassan and other state officials will announce plans to distribute 4,500 naloxone kits to law enforcement agencies, emergency rooms, community health centers and community groups.
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Jake Leon, director of communications for the state Department of Health and Human Services, said the department plans a series of sessions “to train the trainers.”

“Once that's in place, concerned citizens can then go to these organizations that have the inventory, get trained themselves on how to administer the naloxone and then take it with them,” he said.
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The naloxone distributed at these locations will be free of charge.

Meanwhile, pharmacies across New Hampshire are also gearing up to provide Narcan to customers.

The state boards of pharmacy and medicine have been putting together a protocol to allow physicians to write standing orders that pharmacies can use to dispense naloxone to customers without a prescription.
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It's akin to the sort of standing order that lets you walk into a drugstore and get a flu shot or shingles vaccine, explained Michael Dupuis, executive director of the state pharmacy board.

Dupuis said pharmacists here are willing to take on the role of educating customers about the proper use of Narcan for an overdose. “I think they understand how much of a public health concern this is,” he said.
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“It's the right thing to do.”

Leon said with that new protocol in place, individuals who want to have Narcan on hand will have options. “They can go to a pharmacy where there is a standing order already established, or they can go to a provider who will give them a prescription they can then take to the pharmacy to get filled.”
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Dupuis said Narcan previously was used in hospital settings for acutely ill patients as part of pain management. Physicians and retail pharmacists had no experience with the drug, he said.

“So it's a big learning curve for everyone,” he said.
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Dr. Seddon Savage, director of the Dartmouth Center on Addiction, Recovery and Education, has been instrumental in developing the state's new Narcan initiatives. “I think it's going to save lives,” she said.
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Savage, who co-chairs a task force on opioid addiction, has heard the concern that making Narcan more available could encourage some to try heroin, or use more, without fear of overdose. She said that may happen.
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“That's really regrettable, but I think on balance, more lives are going to be saved.”

And she said, “I don't think that having it not available is going to stop people from using heroin.”

Ann Rice, deputy attorney general, has been working with the medical and pharmacy boards on the naloxone protocols. “A doctor is writing a prescription where there isn't necessarily a doctor-patient relationship, which is a little unusual,” she said.
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Rice said she's spoken with representatives of retail chain pharmacies, which may not be stocking naloxone yet, but plan to do so once customers request it. “I've been assured by the main chains that they are prepared to have it in the stores,” she said.
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According to the Chief Medical Examiner's office, there have been 232 fatal drug overdoses in New Hampshire so far this year; 211 of them involved opiates, including heroin, fentanyl and a combination of the two.
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But it's the naloxone numbers that show the real scope of the epidemic.

In 2014, emergency responders administered 3,275 doses of Narcan in 1,921 separate “events,” according to data compiled by the state Bureau of Emergency Medical Services.
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Through August of this year, EMTs already have given 2,813 doses in 1,860 events.

As the state grapples with the opioid epidemic, Savage stressed that Narcan is “an end-stage intervention.”

“What we really want to be doing is reaching people before the point they get to an overdose,” she said.
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She's part of a broad coalition of medical, law enforcement and community groups working on a broad range of responses, such as encouraging primary care physicians to screen patients for addiction, prevention strategies for youngsters and increasing treatment options.
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When someone overdoses, there's a window of opportunity to get that individual into treatment, Savage said. She'd like to see a recovery coach respond to the emergency room every time an overdose occurs, to offer the addict support and treatment options.
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Experts say people are beginning to recognize that the opioid epidemic is affecting every community, small towns and large cities alike.

“Whether it's you or your family member or your community, it's having an impact on all of us,” said Leon. “So you see more and more communities rising up and taking charge, and the state's doing the same.
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“And I think that coordinated effort is crucial to understanding the issue and finding solutions.”

“There was a time when many Americans didn't know anybody who's ever had this problem,” said Savage. “But I think everybody's family or community or church or social group have been touched by this epidemic, so I think people are beginning to understand.
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“It's coming closer to home.”

Naloxone comes in three forms: intramuscular injection, intranasal and an auto-injector.

The first two cost between $30 and $50, while the auto- injector can cost $500 to $700; some insurance plans cover the drug.
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The advantages of the auto-injector are that it's pre-filled, FDA approved, prevents needle sticks and has audio instructions as soon as it's activated, according to Savage.
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“When people are in crisis and can't think straight, it tells you exactly what to do – including calling 911,” she said.
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