Battling the scourge of heroin addiction

MIDDLETOWN — The 27-year-old female on the floor was unresponsive and turning blue. Her life was in danger.

A heroin overdose was unfolding in front of arriving Middletown Police Department officers on July 31.

Officer Julia Fabbroni reacted by using a department-issued Nasal Naloxone (also referred to as Narcan) kit, spraying the antidote into the female’s nose. The woman regained consciousness and began breathing regularly, and New Castle County Paramedics took over from there.

Pictured are two naloxone or Narcan kits designed to reverse the effects of heroin and other opiates. (Submitted)

Pictured are two naloxone or Narcan kits designed to reverse the effects of heroin and other opiates. (Submitted)

She was transported from the downtown area to the Middletown Emergency Department by the Middletown Volunteer Hose Company as the emergency response brought her to full medical care.

With a $106 kit that’s becoming more widespread throughout Delaware, a life had been saved.

In Middletown, police decided to dedicate budget money to purchase the kits, also used by the New Castle County Police Department and Ocean View Police Department. Kits without temperature-controlled pouches can run from about $39 to $44.

“We paid for our kits and look forward to any money saving/grant opportunities we can secure to maintain the program in the future,” Middletown Police Capt. Michael Iglio said.

“We became involved in this program after seeing a lot of success by other police departments in the area who were utilizing it …”

Another time recently, Capt. Iglio said, Middletown Police provided a kit to medical personnel to save another person apparently overdosing on heroin.

With two saves since the naloxone program debuted in late June, law enforcement in the southern New Castle County town believe the money was well spent.

“The program is invaluable as it has already saved a life; this is an epidemic and we in law enforcement need to throw every resource at the problem we possibly can. Enforcement, although very important, is not the only answer to combating this epidemic,” Capt. Iglio said.

The state recently received 2,000 naloxone auto-injector units donated from Kaleo, a Richmond, Virginia-based company. (Submitted)

The state recently received 2,000 naloxone auto-injector units donated from Kaleo, a Richmond, Virginia-based company. (Submitted)

As each work shift begins, patrol officers check out a Naloxone kit and add it to the rest of their gear designed to protect and serve the community. Each Middletown officer has been trained in how to administer the antidote in a pre-hospital medical response that’s now available.

“We seek to provide the citizens of our town the highest level of service possible,” Capt. Iglio said. “Our main goal is to reduce the number of fatalities which can result from opiate overdoses.”

Fast acting relief

Administered nasally and through intramuscular injection, Naloxone brings initial positive effects within 30 seconds, and reaches full strength within two to four minutes.

In the first seven months of 2015, there were a suspected 78 overdose deaths, according to the Delaware Department of Health and Social Services. In 2014, 185 deaths were believed to be overdoses, often caused by heroin or prescription painkillers.

Naloxone reverses the effects of heroin and painkillers, and a push for its use is growing statewide. According to Amy Kevis, director of Emergency Services for the Division of Substance Abuse and Mental Health, state government wants to some day see that all fire company ambulances are carrying the antidote.

A number of law enforcement agencies also are inquiring about joining the program, Ms. Kevis said.

After a session of 45 to 60 minutes provided by Brandywine Counseling, a trainee will be able to administer Narcan, which causes no damage when used properly, Ms. Kevis said.

“It’s such a simple kit to use,” Ms. Kevis said. “It’s very basic and is pretty much a little tube with a funnel.”

As many as 400 community members have received the training, Ms. Kevis said, before adding, “We’ve expanded our reach exponentially to so many people.”

Naloxone’s arrival was spurred through a collaborative effort by Delaware Department of Health and Human Services and grassroots advocacy group AtTAcK addiction, and arose to meet the growing concern of heroin and other opiate usage. In 2014, Gov. Jack Markell signed legislation expanding the use of Naloxone within the community and through voluntary participation among law enforcement agencies.

“[At some point we realized that] we can’t arrest our way out of this,” Ms. Kevis said.

“It would be great if we could, but we have to take a different approach.”

Earlier this week the state announced the arrival of 2,000 Naloxone auto-injector units called Evzio from kaléo in Richmond, Virginia. The kits were destined for the Board of Education, participating law enforcement agencies and addiction treatment centers.

According to Ms. Kevis, both the Evzio and nasal kits are for one-time use. The Evzio kits typically have a two-year shelf life, but the ones DHSS has in stock expire in February.

Schools are involved

Officials from the state Department of Public Health distributed the Naloxone auto-injector kits at a lead school nurses meeting Aug. 4, said Susan Hoffmann, the school nurse at W.B. Simpson Elementary School in Camden and lead nurse for Caesar Rodney School District.

Ms. Hoffmann, who is also the president of the Delaware School Nurses Association, said the kits are “a preventative approach.”

In June, the National Association of School Nurses adopted a position paper supporting the use of Naloxone in schools, citing the 2013 Partnership Attitude Tracking Study in which almost one in four American teens reported abusing or misusing a prescription drug at least once in their lifetime, and one in six reported doing so within the past year.

Dr. Linda C. Wolfe, director of School Support Services in the state Department of Education, said in a statement that, providing Naloxone to school nurses is proactive.

“I am unaware of any deaths occurring in a school due to overdose — anywhere in the nation,” she said. “However, given the rate of overdose and death in Delaware, we are supporting Public Health’s proactive outreach to community partners who work with vulnerable populations

Ms. Hoffman compared the kits them to AEDs, or automated external defibrillators.

“People said we’ve never needed an AED in school,” she said, “but since then we have used an AED to revive a student.”

As far as she knows, she said, Delaware is one of the first states where Naloxone is available in public high schools.

“We’re actually a trend-setter. We’re kind of early in this, but this is definitely a movement that this would go nationwide,” said Ms. Hoffmann.

“Within the last few years, we’ve seen first responders … in different communities have had this, so this is kind of an expansion that school nurses will have this as well.”

The Department of Public Health made the Naloxone available to every public high school.
Nurses received two doses, enough to respond to at least one emergency situation.

Ms. Hoffmann said the nurses received simple training, since the drug is designed for lay-people to administer.

The state Department of Public Health wrote the guidelines for distributing it; the drug can be used if there is a “suspected or confirmed opioid overdose” with respiratory depression or unresponsiveness.

Naloxone is considered a safe medication and will not cause further harm to an individual who receives it.

As part of their role, school nurses need to be prepared for emergencies in their building, Ms. Hoffmann said, and when there’s a problem at school, they become the first responders; they need to have the right equipment to deal with the situation.

“It’s vital that a positive response come and that it’s a positive outcome,” she said.

New Castle’s approach

The New Castle County Police Department currently has 38 kits deployed; 32 in the Uniform Patrol Section, four with the Mobile Enforcement Teams and one each in the 24/7 Public Information Center and Prisoner Processing Area.

Kits were deployed in the last month of April, resulting in eight successful uses, Cpl Tracey Duffy said. Four men and four women ages 19 to 45 received the Naloxone.

“In some instances, the victims were given the second dose of Narcan and all were saved and eventually released from the hospital,” Cpl. Duffy said.

Officials said County Executive Thomas P. Gordon and Col. Elmer Setting instigated the push for the program.

“They were some of the first public leaders to speak of the heroin epidemic in Delaware and work to not only combat the spread of heroin through enforcement, but also through education and prevention efforts,” Cpl. Duffy said.

“As public servants, we are all sworn to preserve the life of those we serve. With Narcan, it is another tool, just like an AED and first aid kit, that officers can use to save someone’s child, parent or loved one.”

According to Cpl. Duffy, county police officers are issued a kit with two tubes of Narcan (four doses), gloves and a basic CPR mask. Along with each kit, a full-size bag valve mask is issued in case CPR or rescue breathing is needed, she said.

The total cost per officer is about $110 and the Narcan has a shelf life of about 18 months, Cpl. Duffy said.

Added Cpl. Duffy, “We have been surprised with how many saves our officers have already had. Narcan can be utilized for both intentional and accidental opiate overdoses.

“We have the support and assistance of addiction groups and [Attorney General] Matt Denn that also see a need for community based Narcan. Executive Gordon and Col.
Setting remain committed to protecting our citizens from heroin through continued enforcement, education and prevention efforts.

“We hope to secure funding to grow our pilot program in the future.

Narcan was an answer to rising overdose deaths in New Castle County, Cpl. Duffy said.

“With the number of overdose-related deaths we were seeing, we could not just stand by and watch more lives lost when an easily used item like Narcan existed,” she said.

“We are sworn to protect the lives of those we serve, and Narcan has allowed us to save eight lives and give those individuals a chance to escape heroin’s grasp.”

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