The Ocean View Police Department last week hosted a Delaware Overdose Survival Education (DOSE) workshop, conducted by Brandywine Counseling & Community Services.
About 16 members of the public, along with the entire police department, attended the training session on overdose prevention. The workshop was funded through a grant from the Sussex County Council.
The workshop was led by Domenica Personti, director of adolescent services and prevention at Brandywine. Following the training, attendees were certified to purchase and administer naloxone, also known as Narcan, which can counteract an opiate overdose.
Personti said that an overdose can happen when a person’s body ingests more of an opiate than it can handle.
“That can be dependent on lots of things,” she explained. “Someone who has pre-existing medical conditions — people who are asthmatic, people who are diabetic — they’re all at higher risk for opiate overdose.”
Overdoses are rarely instantaneous, Personti said, but it can happen.
“Normally, you’re not going to see someone use an opiate and then fall out on the floor, but it does happen,” she said, noting most overdoses occur within 45 minutes to an hour after use. Overdoses can also happen up to three hours after opiate use.
She explained that opiates connect to the receptors that control breathing, “so it directly impacts your respiratory system. Once your respiratory system is impacted, the amount of oxygen that goes to your brain is impaired.”
She added that a person’s heart can stop due to an overdose, and they can become unconscious, go into a coma and/or die.
“The one thing people don’t talk a whole lot about is what happens when someone overdoses and doesn’t necessarily die,” said Personti. “There are long-term effects that can happen that are fairly substantial. We’ve seen clients who have overdosed by themselves, fell on their left side and were in that position for a long time… Sometimes they’ll have permanent nerve damage because they cut their circulation off because of the way they were positioned.
‘We’ve also seen people with cognitive impairment because they were unconscious for so long that lack of oxygen resulted in brain damage. There’s a plethora of things that can happen, leading up to a fatality, that are significant and can be life-changing.”
The most common scenario for an overdose that Brandywine has seen recently, said Personti, is due to a tolerance shift, following a period of abstinence, or no use of the drug.
“Then they go back to using at the level they were prior, and all of a sudden they’re overwhelming their body,” she said. “That can happen in as little as three days of abstinence.”
Other risk factors include mixing drugs, which increases a risk of overdose two-fold, she said, and the person’s physical health.
“People who have previously overdosed are at higher risk of an overdose. People who are above 55 are at higher risk of overdose. People under 18 are at higher risk of overdose.”
Switching from snorting or smoking an opiate to injecting it also puts the user at a higher risk of overdose. Any variation in strength and content puts a user at higher risk.
Personti said that, with the many distribution drug arrests throughout the state, along with doctors’ offices being shut down, users will move on to a different supplier. Then they end up buying drugs from new person, and the purity, content and strength of the new supply may be totally different than what they’re used to.
Personti said using alone also puts a user at higher risk.
“Trying to convince a drug addict to not use alone is very difficult thing, because they often view that as having to share drugs. It’s really important that, in the event that you talk to someone in active addiction, this is one of the most important things to talk to them about.
“No matter what they have to give up in order to be safe and not use alone, it’s one of the best things we can teach active users to stay alive. It’ll be a strong argument, but it’s really important.”
Calling 911 immediately is vital
Overdose response myths she said, are just that. For those who are in a situation where they must help someone who may have overdosed, Personti said calling 911 is the best course of action. People should not do such things as inject saltwater/saline into the user, give them a cold shower or burn them.
Personti said that, if one fears someone is in overdose, they should immediately call 911. Even if they are trained and have naloxone handy, calling emergency services first is crucial.
“When we administer a dose of naloxone, that medication is only going to be good for 30 to 40 minutes, depending on their size, metabolism… What you don’t want is a rebound overdose if you walk away.”
She said that, although the naloxone could bring the person temporarily out of the overdose, to the point where they can verbalize that they are OK, “When that medication wears off, all those opiates reattach to their receptors, and they have a rebound overdose.”
“That’s why we stress, please call 911. We actually had a Brandywine client overdose four months ago, and then had to give her four additional naloxone doses in the hospital, after we sent her there with two.”
Ocean View Police Department Chief Ken McLaughlin asked whether multiple doses of naloxone being administered can have a detrimental effect.
“You’re not going to overdose them on naloxone,” she said.
Naloxone is an opioid antagonist medication that reverses only opioid overdoses.
“This medication is very benign. It won’t work on anything else. It doesn’t have a lot of side effects. You’re not going to get high from it. It can’t be abused. It is only goes to work on an opiate overdose.”
Personti said naloxone stays active for 20 to 90 minutes, depending on the person’s metabolism and how much of an opiate was used.
Naloxone doses are good for two years from the time of purchase. The medication is dispersed in both nostrils, via an atomizer. Following the administration of naloxone, CPR should be performed until emergency personnel arrive on scene.
“Remember, brain damage can occur after 3 to 5 minutes. Delaware has one of the best ambulance/police response times in the country. Even with the best response times, it can still take someone three minutes to get to you… In your mind, remember — brain damage can happen in as little as three minutes. The biggest thing is to keep breathing for them until the paramedics get there or until the naloxone kicks in.”
Personti said administering naloxone generally does not have an immediate effect, referencing the overdose scene in the film “Pulp Fiction.”
“It doesn’t always work instantaneously,” she said. “If the person doesn’t respond in the first 2 to 3 minutes, give the second dose of naloxone.”
Once the person temporarily comes out of the overdose due to the naloxone, Personti said, it is important to explain to them what has happened.
“Don’t allow them to do more opiates. Some people will come-to, and when the naloxone takes all of the opiates off their system, they’re not going to feel well — they’re going to feel angry, potentially aggravated and sick.” That could lead to them taking more of the opiate.
Personti said barriers to reporting a possible overdose include fear of legal risk, loss of housing, personal embarrassment and family-services involvement. Anyone who goes through the training is eligible to carry naloxone and administer it. And Personti said that the state’s Good Samaritan law, implemented in 2013, aims to quell the fear of reporting — be it to police, a doctor or hospital.
“In the event that there is a medical emergency and someone intervenes, as long as you do it in good faith and give accurate information, then you have immunity from any kind of prosecution or charges.
“In the event that you don’t do it in good faith; or you call and say, ‘This person is in cardiac arrest,’ and you know it’s an overdose; or if there are other criminal circumstances around that are bigger than that immunity… Those are all things that are still left up in the air.”
She said the law was implemented to reduce barriers, so that people would be encouraged to call 911 when they suspect an overdose.
“We’re there to save a life. We’re not there to make an arrest,” added McLaughlin. “We view that Good Sam’ law as immunity. If you know someone that’s overdosing, or overdosing yourself, you take it upon yourself to call 911. We’re not coming there to make an arrest. We’re there to save a life.”
Currently, the OVPD is the only police agency in the state to carry naloxone, though others are now getting certified to do so. McLaughlin noted that, although enforcement is a part of solving the drug problems in the state, it is only a small part.
“I can tell you, within one mile of where we’re sitting right now, there are so many people that are battling addictions, so many families who are going through it who were reluctant to come out of the shadows tonight… We’re here to help.”
Naloxone can be the start of recovery
Personti said that the first 24 hours following an overdose is “prime time” to get a user into treatment.
“The one thing we try and stress is we also tie in the treatment component. … Naloxone is the buzz word right now, but we still need to have conversations about what happens after the naloxone, because you don’t want to have to do this 20 times to one person.
“You do it to save them, but the goal is always for us to connect them to care also — to make sure this is a learning experience and maybe the first steps to getting them into treatment.”
The difficulty of getting into a treatment program was also discussed at the workshop. Personti said that if someone shows up at Brandywine seeking treatment, they will receive it. But those wishing to receive treatment from Brandywine will have to be a Delaware resident or gain residency in the state within 14 days.
McLaughlin said his department has people come in looking for help on a weekly basis; however, they, too, are limited in what they can do.
“We’re limited in what we can do down here. It’s a sad reality,” he said, noting that many are going to get a mental health committal to get help. “Most of the folks who are coming to us have said they’ve tried on their own, and they’re coming to us thinking that we’re the police — that we might have an in. And we can’t do anything better than they can… It’s extremely frustrating.”
Personti said treatment centers in the state are at capacity, which can force those who are seeking treatment to wait days, and sometimes months, to be admitted to a facility.
“We get about 30 people who show up at our two sites in Wilmington a day… We can only take eight at each site,” she said, adding that part of the problem is a lack of doctors working in the field.
Personti said that all providers are impacted by the rising number of people seeking help, and added that the State is taking a look at what it can do to help. She said providers are actively working to expand resources to Sussex County and recently held a workshop at Camp Rehoboth.
“I had a 16-year-old Sussex Central student who told me there were 500 kids in her class and if she had to on average give me a number, at least half of them are on opiates,” recalled Personti. “So this 16-year-old girl asked, ‘Will you please come talk to the kids at my school?’ That’s heartbreaking, because I can talk to them until I’m blue in the face, but where do I send them?”
McLaughlin and Personti both said the number of overdoses reported to the State is not accurate, as many fatalities are listed as “cardiac arrest.”
“In Delaware, when we track the data, it’s ‘toxic death.’ So it’s any toxic death. If someone takes Tylenol, it’s toxic death. If someone takes an herbal supplement and has an adverse reaction and dies, it’s a toxic death. There’s no breakout of how many people are dying from benzyls, alcohol, opiates. It’s all lumped together… We’re one of seven states that doesn’t track specifically [that data].”
“I bet you the numbers are 10 times higher than what they’re reported to be, from what I’m hearing,” said McLaughlin.
One attendee at the workshop said their son was in treatment for drug abuse and that a rehabilitation campus is desperately needed.
“We need to get vocal with our legislators… We need to get working on this.”
Extended-release drug can help break addiction
Personti also discussed Vivitrol, or naltrexone, an extended?release injectable suspension drug that can help users stop using opiates.
“We’re seeing a lot of success with it,” she said. “In a very simplistic way, think of it as a 30-day time-release of naloxone. It helps with cravings and triggers. So someone who’s somber for five to seven days, with no opiates in their system, we can start them on Vivitrol.”
She said that while someone is on Vivitrol they would be unable to get high. A great deal of the drug’s success has been found in drug-court populations, for which programs run six to nine months.
“If they get the Vivitrol for the six to nine months they’re in the program, by the time they graduate, they change so many of their behaviors … that it sticks.”
Baltimore, Md., she said, did a trial run in their prison population for two and a half years, inducting prisoners on the medication prerelease.
“They had an 81 percent non-recidivism rate after 18 months. Their statistics are amazing.”
Vivitrol is currently available by visiting a rehabilitation center, such as Brandywine, or going to a family physician. At Brandywine, Personti said, those who wish to be put on the medication must submit to a “Narcan Challenge.”
“That way, if they have opiates in their system and they weren’t honest with us about it, it’s only a tiny bit and they only get sick for maybe an hour… If we give them Vivitrol and they haven’t any opiates in their system, they’ll go into automatic withdrawal.”
Personti said Vivitrol is great for a working population and good for those who do not want to use methadone or suboxone.
“It’s not an addicting medication, so once the 30 days ends, they’re done with it,” she said, adding that there have been reports of side effects such as cravings, which can be dealt with if the person is in active recovery.
She added that methadone or suboxone do have a place in recovery, noting that many users who are placed on that regimen of treatment are longtime users who are only able to be sober, stable, maintain a job and see their kids when they are on that treatment.
“It’s almost like the lesser of two evils,” she said. “It also makes them less of a menace to society, because when they’re using they’re out stealing, robbing, they’re impacting the resources of the criminal justice system.”
One attendee asked Personti why Vivitrol isn’t used all the time. She said that, although it was approved to treat alcoholism in 1993, it was only within the last five years it was approved for opiate-relapse prevention.
“I think it’s a learning process for everyone,” she said.
Personti added that Vivitrol is quite expensive — about $1,600. If someone is uninsured, the State will pay for the shot, and if a patient is insured, the shot will be free once their yearly deductible has been met.
“What they say is around 18 months is where they see the best success rates,” she said.
Removing the stigma of addiction also a goal
Personti said that, no matter what treatment may be available to someone seeking recovery, there is still a great stigma attached to drug use that may prevent them from getting the help available.
“The goal of this is to get it in the hands of people who need it… That stigma that is around addiction is so strong.”
One attendee said there are families who, after the passing of a loved one from an overdose, write an obituary that helps de-stigmatize addiction.
“Then you have the brave parents who write, ‘passed from their long, hard struggle from addiction.’ It’s like, ‘Thank you.’”
Personti said that addiction has been proven to be a disease but isn’t necessarily viewed as one by society.
“It is hard. I don’t know that’ll change until we do things like this and we have communities together.”
The next DOSE workshop in Sussex County will be held on March 18 at 6 p.m. at Bethel United Methodist Church, located at 129 West 4th Street in Lewes.