‘Without it, I wouldn't be here’: How Narcan is saving lives in the fight against opioids
Mariana VelosoJustin Boomer is three years into his path to long term recovery.
He was first introduced to opiates in 2003 after getting a prescription when he injured his back during college football practice.
"It seemed like when I did physical therapy it didn't really help, and so I just stuck to the pain relievers, the narcotic pain relievers, so that turned into an addiction unbeknownst to me," the 35-year-old said.
When he dropped out of school, he wasn't able to get the medication as regularly so he resorted to street dealers. That led him to heroin.
By 2017, Boomer hit a low point in his life. He had just gotten out of prison on minor theft charges, was unable to pay rent for his Westchester Borough apartment, and his family was close to cutting ties with him after 14 years of dealing with his substance abuse.
On March 9, he shot up heroin that contained fentanyl and carfentanyl. Next thing he knew, Boomer woke up surrounded by police and EMTs, who told him they used Narcan to revive him.
"Once I regained clear conscious thought, my thought was not initially to go into treatment. My thought was, 'I hope they didn't find everything, I hope I can go get high again,'" Boomer, of Harrisburg, said. "It was just pure desperation."
Boomer ended up using again shortly after being rushed into the emergency room.
But thanks to the support of his family, he entered the Pennsylvania Adult and Teen Challenge addiction treatment center less than 24 hours after he was revived.
"When my brother had contacted me about a long-term inpatient facility in central Pennsylvania, and I found out that I was losing my apartment, I just gave up and said OK," Boomer said.
Now, Boomer is "grateful for everything.” He is going back to college, building a family of his own and just recently started working at Lebanon's RASE Project.
"(Naloxone) gives people another chance at recovery, it's a life-saving medication that's available for relatively cheap," Boomer said. "I'd like to think that I'm evidence of going from nothing to being where I am today."
Naloxone, the overdose reversal medication found in Narcan, was approved for use by the U.S. Food and Drug Administration in 1971.
In 2015, the Narcan nasal-delivery system made the medication more accessible to the public in an attempt to increase the survival rate from an overdose.
Matt Fogal, Franklin County District Attorney and chairman of the overdose task force, said that Narcan is "without a doubt" saving lives.
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York County Coroner Pam Gay agrees.
"I think, because I see all the deaths and the potential that people have that's lost, to me it just makes sense to carry something that can hopefully save somebody's life," Gay said.
Naloxone: The overdose reversal medication
Narcan is the nasal injector version of naloxone, which reverses an overdose if administered within a certain time frame.
Naloxone blocks the effects of opioids on the brain and restores breathing between two to eight minutes, according to the Pennsylvania Department of Health. Naloxone has no effect if administered to someone without opioids in their system.
When an opioid enters someone's system, it attaches to receptors in the brain that send signals that block pain, slow breathing and calm the body down. An overdose occurs when the breathing is slowed so much that it impairs the body from receiving enough oxygen.
When successful, naloxone causes the person to start breathing and experience withdrawal symptoms that Brittany Shutz, the executive director of the York Opioid Collaborative, compared to "a really bad case of the flu."
Symptoms of withdrawal include:
- body aches
- diarrhea
- increased heart rate
- fever
- runny nose
- sneezing
- goose bumps
- sweating, yawning
- nausea or vomiting
- nervousness
- restlessness or irritability
- shivering or trembling
- stomach cramping
- weakness
- increased blood pressure
If naloxone isn't administered within four to six minutes of an overdose, irreversible brain damage occurs because of compromised respiration.
"Sadly, we get a lot of those," Gay said.
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Saving lives became easier with Narcan
"Promoting the use of overdose-reversing drugs" is one of the five major priorities listed by the U.S. Department of Health and Human Services and the National Institute on Drug Abuse to combat the opioid epidemic.
Naloxone comes in three forms:
Narcan, which was approved for use by the FDA in 2015, is unique in that it requires no medical background, delivers a more accurate dosage and is readily available.
"Narcan, the nasal version, it's so easy to use for like someone who's not EMS trained, that's why that version is so popular. It’s just like using Flonase for allergies, that's how simple it is to use, just put it in their nostril and administer the medication," Shutz said.
Narcan was developed after concerns about the challenges in delivering naloxone by those without a medical background and the risk of contamination by needle. Some of the challenges include difficulty using an IV and assembly of the atomizer for the generic nasal version.
Evzio, which was approved for use by the FDA in 2014, was one of the first attempts to curb such issues. It carries only 2 mg of the medication and costs around $4,000 without insurance.
Narcan instead carries 4 mg and costs around $125 for a pack of two without insurance.
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Narcan is a tool, not a cure
Although naloxone can be used to reverse the effects of an overdose, it is not a cure for the disease of addiction.
"There’s a lot of misconceptions of what naloxone is, or Narcan. I think a lot of people think it's treatment," Shutz said. "(But those addicted) are still at risk for another overdose and obviously in need of additional services."
In 2017, the Franklin County Overdose Task Force did a survey and found that the use of naloxone carries a negative stigma. Fogal believes this has to do with comments he's heard such as "people don't deserve it ... because they brought this on themselves."
"Unfortunately, the more families that are impacted by the disease, I think it has an interesting positive impact on the reduction of stigma in that those people identify with a person, so it's not just something that they have no perspective about," Fogal said.
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Addiction is a chronic disease, like heart disease or diabetes, and naloxone is just a "chemical defibrillator," Gay said.
"When we're out in public I try to remind audiences that we are dealing with a chronic brain disease, and so this is not going to be a cure to saving somebody with Narcan, it's not going to take care of it and make them decide that they are ready to go into rehab and they will often go back out and make poor choices again," Gay said.
And treatment is a lengthy process.
"There's a lot of research that says it can take up to 18 months to kind of get those triggers away and psychologically retrain that brain," Gay said.
John Lloyd, founder of Noah's House Inc. Recovery Homes and eight years into his recovery journey, is a recovery liaison for the Get Back Up Program in Franklin County. In that position, he goes to every overdose call to try to get to those revived into treatment.
"So, not only is death being prevented I think, but I think continued addiction has been prevented by that warm hand-off process," Fogal said.
Often times, Narcan can be someone's first step on to the path of recovery.
"These folks, prevention isn't really gonna hit them, and I'm saying they're already deep in their addiction, so you have to use other means to reach them and one of them is saving their life with Narcan. The second part of it is getting them into some sort of accessible treatment program," Gay said.
Boomer, who works as the Medication Assisted Recovery Service Program Coordinator for the Lebanon RASE Project, is an example of this.
"I had actually been interested in reaching out and finding out who had responded to my situation so that I could thank them and show them that Narcan saves lives, and without it I wouldn't be here today to help others in need and give them hope through my experience," he said.
And helping those in addiction is win-win for Boomer.
"Working this job helps me bolster my recovery," he said. "Seeing people come in every day that are usually experiencing one of the worst days of their lives, it really helps me, it helps remind me that I don't ever have to do something like that again."
Overdose deaths and Narcan administrations: Are they related?
It may be too soon to tell whether Narcan utilization is directly decreasing the number of overdose deaths in southcentral Pa.
"I think you can definitely say there's probably a correlation, but you can’t show causation between naloxone utilization and reduction of fatal overdoses," Shutz said.
There are many factors to consider when making this comparison:
- Many agencies administer Narcan, from emergency personnel, to addiction service providers and loved ones.
- A single person can be administered multiple doses of Narcan in a single period or multiple times throughout the day.
- Some administrations are not reported by law enforcement because it is volunteer based and may require lengthy paperwork.
"The amount of utilization reports we receive is significantly less than the amount of times our Narcan is administered. In conjunction with the York Opioid Collaborative, we are working with regional partnerships for EMS and police to obtain more accurate information on Narcan administrations," said Narcan Coordinator for York/Adams Drug & Alcohol Commission Robert Willis in an email.
However, because law enforcement is often first on scene, there can be a positive relationship between their increased ability to use Narcan and the potential for overdose deaths decreasing.
The Pennsylvania Overdose Information Network (ODIN), which started in March 2018, is the state's attempt to get more accurate rates of administration.
"ODIN is a centralized repository to track overdoses, naloxone administrations, and investigative drug information that allows police, public safety, and healthcare professionals to share all types of information related to opioid abuse in their communities. ODIN is now used by more than 1,300 agencies in all 67 counties in Pennsylvania, including 1,000 municipal police departments," according to a press release by Pennsylvania State Police.
How to get Narcan
In Pennsylvania, naloxone products can be purchased with a prescription or the standing order, a prescription written for the general public, issued by Rachel Levine, M.D., Secretary of Health.
Those with insurance or who are in a medication-assisted program may bear minimal or no costs for naloxone. There are also events and places where Narcan is given out for free. In Pa., EMS can leave behind naloxone after responding to an overdose.
"That's where those leave behinds by EMS though can be critical, because if you are someone who's overdosed before or either your family members then they have it," Shutz said.
OverdoseFreePA's website has a tool for finding naloxone pharmacies. This site does not provide pharmacies for Adams or Franklin counties.
In Adams County, the most affordable places to get Narcan without insurance include:
- $60 at East Berlin Pharmacy, 335 W King St., East Berlin
- $80 at Weis Pharmacy, 30 Primrose Lane, East Berlin
Training for administrating Narcan can be found online.
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Mariana Veloso is the Quality of Life reporter for the Evening Sun. Mariana focuses primarily on the opioid epidemic in south central PA, along with coverage of everyday issues in the Hanover area. If you have a story idea, you can email her at msveloso@eveningsun.com. Follow her on Twitter @MariVeloso9 to stay up-to-date with her latest articles.