A clinical pharmacist in Cabell County, West Virginia, is distributing naloxone through a community outreach program that includes training for local residents about how to administer the opioid reversal agent to save the lives of friends and family members.
Megan Peterson, Clinical Pharmacist in Ambulatory Care at Valley Health Systems in Huntington, led the first in a series of training sessions on June 4. At the session’s end she gave each attendee a 4-mg intranasal formulation of Narcan, Adapt Pharma Inc.’s naloxone product.
She said the session, though small, accomplished its main goal of “getting more Narcan into the hands of the community,” especially family members of those at risk for opioid overdose.
The next session, scheduled for July 22, has been more widely promoted in the area, with announcements emphasizing that attendees will receive naloxone, Peterson said. Each session is free and open to the public.
The project is funded through a 2018 grant administered by Marshall Health and Great Rivers Regional System for Addiction Care, in support of the Provider Response Organization for Addiction Care and Treatment (PROACT). PROACT is a Huntington-area nonprofit collaborative whose members include Cabell Huntington Hospital, St. Mary’s Medical Center, Marshall Health, Thomas Health, and Valley Health.
The naloxone training program was developed by the West Virginia Department of Health and Human Resources (DHHR).
In addition to working with community members, Peterson in June started providing the training to patients who are enrolled in her organization’s medication-assisted treatment (MAT) programs and family members of these patients.
She said the MAT training program showed its worth right away.
“Within the first couple weeks, we had two reported saves,” she said. “It was very satisfying. It’s a long road that we have ahead of us, but I feel like I’m making a difference.”
West Virginia ranks high among states most severely affected by the opioid crisis. According to federal data, there were 833 overdose deaths involving opioids in the state in 2017, or 49.6 deaths per 100,000 population. That rate was the highest in the nation and far exceeded the U.S. rate of 14.6 deaths per 100,000 population.
Huntington, the Cabell County seat, has been described in media reports as the epicenter of the nation’s opioid epidemic.
“We have historically had some of the highest overdose death rates in the country,” Peterson said.
In August 2016, the county made national headlines when more than two dozen cases of opioid-related overdose were reported over a five-hour period. An Ohio man was sentenced to federal prison in 2017 in connection with the outbreak, which was blamed on heroin laced with fentanyl and carfentanil.
West Virginia has taken multiple actions to stem the opioid epidemic, including initiatives to increase the availability of naloxone.
DHHR launched a program in 2015 to train first responders in naloxone use and later expanded the program to include other state and local officials and community members.
A state law that went into effect last year requires all first responders to carry naloxone and be trained in its use, subject to the availability of naloxone and state funding. DHHR reported in June 2018 that it had purchased about 34,000 doses of naloxone for first responders.
In November 2018, DHHR implemented a two-dose naloxone prescription as a standing order. This allows anyone to purchase the reversal agent from a pharmacy without first obtaining a patient-specific prescription.
Peterson said the standing order is critical for her community outreach program, because the order allows her to dispense naloxone directly to session attendees instead of sending them to a pharmacy.
Attendees at the first community training session included area residents whose family members suffered from opioid use disorder, local teachers, DHHR staff, a pharmacist looking for information on how to help address the opioid epidemic, and a student pharmacist.
Peterson said attendees’ biggest concern was what would happen if they administer naloxone to someone who isn’t having an opioid overdose.
“I always stress to them that if there’s any doubt whatsoever, use the Narcan,” Peterson said. “It won’t hurt them to get the Narcan if they haven’t used.”
West Virginia in 2015 enacted a Good Samaritan law that provides liability protection to trained health professionals and community members who administer naloxone in good faith to reverse an opioid overdose.
After the law was passed, Peterson started providing mandatory naloxone training to Valley Health System’s clinical staff.
“We also train a lot of clerical employees,” she said. “They’re not required to come, but I’ll train anybody that wants to be trained.”
She said the training sessions are an opportunity to dispel misinformation about treatment for opioid use disorder and to counter concerns that naloxone makes it easier for people to abuse opioids.
“We have had in this county, of course, reports of reviving the same person over and over again,” Peterson said. But she said that doesn’t mean those people won’t be ready to accept help one day.
“Substance use disorder is a disease, and relapse is part of this disease. So it’s something that we should expect,” she said.
[This news story appears in the November 1, 2019, issue of AJHP.]