School, community leaders train to save a life – with Narcan
Thanks to a grant through the MO-HOPE (Missouri Opioid-Heroin Overdose Prevention and Education) Project and the persistence of the Ozark County Substance Abuse Task Force, three Ozark County high schools now have doses of the opioid-overdose-reversing drug Narcan on-hand at their school nurse’s office – and personnel who are trained to use it.
The local training
Representatives from Bakersfield, Dora and Gainesville schools participated in a three-hour training at the Ozark County Health Department on Oct. 15, learning more about the risks of opioid overdose specifically in our area and how Narcan can help minimize the number of overdose deaths. After the training, each school was given doses of Narcan to take back and keep in the nurses’ offices.
The presentation was given by Rikki Barton, director of Prevention Services at Community Partnership of Springfield. Those attending the training included Dora School nurse Shana Hambelton; Ozark County Sheriff’s Deputy Dan Israel; Suzanne Lundry from Theodosia Family Medical Clinic; Dawn Norton, pastor of The Fountain Church in Theodosia and a member of the Ozark County Ministerial Alliance; Gainesville High School principal Justin Gilmore and school nurse Cheyenne Nash; Bakersfield superintendent Dr. Amy Britt and school nurse Erin Bonham; Jeff Dotson, pastor of Mission Square Church in Gainesville and organizer of a local addiction-recovery meeting; Becky Gann and Dara Collins of MOCH (Missouri Ozarks Community Health); and Ozark County Health Department administrator Rhonda Suter. Several of the individuals who attended the meeting have been actively involved with the Substance Abuse Task Force.
‘Kind of a miracle drug’
Narcan is a name-brand version of the drug naloxone, a medication that counters the effects of opioid overdose. It is administered as a nasal spray.
“It’s kind of a miracle drug that brings a patient out of the overdose for enough time to try to get them help,” Barton said. “You place it in the nose and press the plunger hard to spray the dose into a nostril. The mist is absorbed in the mucus glands.”
Other versions of naloxone include a liquid that is injected into the muscle with a needle and a self-injecting pen similar to an epi-pen, Barton explained.
“But unless someone is in the healthcare field, they typically don’t feel comfortable using a needle, and the self-injection type is substantially more expensive than the other types,” Barton said. “So, most people would rather use Narcan than the others. They’re all equally effective.”
Barton said that opioids commonly overused to the point of overdose can include codeine, heroin, hydrocodone, morphine, oxycodone, fentanyl, methadone and others. A particularly potent opioid, carfentalil, which is approximately 10,000 times more potent than morphine and is regularly used to tranquilize elephants and other large animals, has been used more in recent years by drug users and producers.
“It’s so potent it only takes a very small amount to cause an overdose in a human, about the size of a pen tip, and it can be absorbed by your skin if you come in contact with it,” Barton said. “It’s a particular concern to law enforcement officers or other emergency responders who might come in contact with it in the course of their duties.”
Barton said popular opioids come in many varieties and delivery options including pain pills, injection into veins and even vaping; however, some users are using the drugs without realizing it.
“Drug dealers are beginning to lace their marijuana or other drugs with fentanyl or carfentanil to give the user a bigger high,” Barton said. “They all want the reputation that their drugs are the best, so they’re adding it. … The problem is, the user doesn’t know it’s in there, and they may ingest enough to cause them to overdose.”
Narcan works in about three minutes, bringing an overdose patient out of the overdose for 30 to 60 minutes, enough time to hopefully get them to a hospital.
“But if help isn’t quick enough, they can go back into the overdose state and eventually die,” Barton said.
Multiple Narcan doses can be given to the same person if one does not bring him or her out of the overdose symptoms. Barton said the drug can be used on patients of all ages and sizes, from infant to the elderly, and there are no side effects if the drug is administered to a patient who is not overdosing on opioids.
However, Barton said, when administered to someone who has overdosed, it’s wise to be prepared for the patient’s immediate reaction, which can vary: 20 percent are angry, 19 percent feel “dope sick,” 7 percent vomit and 4 percent are combative, she said.
Israel, the sheriff’s reserve deputy, said he has seen Narcan used a few times in Ozark County, and he hasn’t seen anyone react combatively.
Another important fact: state law says there is no criminal, civil or professional liability in providing Narcan to someone if you think that person is having an overdose and needs help. Also, because Missouri is a “Good Samaritan” state, someone who calls in a suspected overdose, even if he or she is using drugs themselves or has illicit drugs in their possession, will not be prosecuted – although that exemption doesn’t apply to other crimes that are not involved with the drug use, such as if a felon has illegal weapons in the house when law enforcement arrive on scene.
Barton noted that Narcan was first mandated in 2014 for use by emergency first responders by House Bill 2040. Then in 2016, it became available to the general public.
The Ozarks opioid crisis
Barton presented statistics specifically on Ozark County’s population. According to Barton, based on a 2018 survey, Ozark County youth reported that their first instance of inappropriately using prescription pain killers to get high was at age 11. Barton also indicated that 18.6 percent, or nearly one in five Ozark County youth said it would be easy for them to obtain prescription pain killers or other opioids if they wanted them.
“The statistics show that youth are 14 times more likely to use heroin if they’ve ever misused opioids,” Barton told the group. “They start with prescription pain pills. Then, as they get older, they use something more powerful to try to get that better high.”
To put the easy access to opioids in perspective, Barton presented the group with another startling statistic.
“The United States makes up only 5 percent of the world population, but we consume 80 percent of the world’s opioid pain killers… and 99 percent of all Vicodin.”
Britt, the Bakersfield superintendent, said she’s aware that drugs are prevalent in this area. “The drug problem is real, and we have seen it in our area,” she said. “We take precautionary measures at school to reduce the chances of drug use happening. We have random drug tests for students involved in extra-curricular activities. We also have the drug dog come at random times and check our parking lot, lockers and school facilities. We also talk to our kids about drugs, and even about vaping. We’ve never had to use Narcan, and hopefully the education and prevention measures we have taken will ensure we never have to.”
Controversy over Narcan use
While many consider Narcan a lifesaver in overdose situations, there is also some controversy over its use.
“Some people ask if having naloxone available increases the likelihood of people misusing opioids,” Barton said. “Won’t having it on hand cause them to be more likely to use [opioids] inappropriately because they know you can revive them? Our answer is that it’s the same as education on safe sex, seat belt use in cars, helmets for motorcycles. Just because there’s something out there that could save your life, that doesn’t mean you’re going to be more likely to risk it.”
Some schools find Narcan beneficial to have on hand, despite the controversy. Britt said Bakersfield is participating as a precautionary measure.
“I know there is a lot of controversy with this subject. Some people view Narcan as a saving grace to give someone a second chance at life and make better choices,” Britt said. “Others view having Narcan as an enabler to allow drug addicts to keep using, and maybe even use more, because they know they can be revived. Either way, we decided it was good to have in case of accidental exposure by our very young students or even staff while searching a locker or bag.”
Gainesville High School principal Justin Gilmore agreed that having Narcan in the nurse’s office is a good measure.
“I’m not sure if it’s a good or bad thing for the school, but I do think it is necessary,” he told the Times. “It’s necessary because it has the capability to save a life. I always ask, ‘What would you do if that was your child overdosing? Would you just let them die, or administer Narcan?’ I think that’s a relatively easy question to answer for most. We’re not the judge of who should live and who should die.”
Ozark County Sheriff’s Department Deputy Dan Israel told the Times that people should also consider non-addicts who may inadvertently ingest high levels of opioids.
“It could be an elderly parent or a dementia patient who takes their prescription medication more than once because they don’t remember they had already taken it,” Israel said. “Or it could be a young child who somehow got into their grandparents’ medication. It could also be someone using marijuana who did not know it was laced with fentenyl. Or someone who has just accidentally touched carfentinal. There are a lot of scenarios out there in which Narcan can be lifesaving that do not revolve around opioid addicts or habitual overdosing patients.”
Israel said some families like to keep the drug on hand if they have opioids in their homes, just in case a child or elderly person accidentally consumes too many, and begin to overdose.
How to obtain Narcan
Narcan is available to the general public. Pharmacy owner Craig Atkins says Court Square Pharmacy carries it.
Barton said major pharmacies like Walmart and Walgreens also carry Narcan. Barton said she believes the cost is under $150 per box, which includes two doses, at most pharmacies. Those purchasing the drug do not need a prescription. The drug has a shelf life of at least 24 months, Barton said.
Times readers may wonder about this story in today’s edition reporting on a Narcan training session attended by representatives of three of the county’s four high schools – after our Oct. 23 edition included a report of the Oct. 8 meeting of the Ozark County Substance Abuse Task Force that said the group had discussed why schools were reluctant to participate in Narcan training. It’s believed that the task force member who submitted the meeting report to the Times misunderstood the group’s discussion about how many Ozark County schools were reluctant to participate – and the Times editor failed to check the information provided and to verify who attended the Oct. 15 Narcan training session, believing it to be for first responders.
We regret the error.