Local Police and UMSN Team Up to Reverse Drug Overdoses with Innovative Initiative

“We’re seeing an overdose at least every couple of days,” says Lisa King, a lieutenant with the Washtenaw County Sheriff’s Department. “Opioids are a huge problem, and it’s beyond the stereotypical drug user. They’re a part of just about every community.”

In Washtenaw County alone, there were 27 opioid fatalities in the first six months of 2015, according to the Washtenaw County Public Health Department. Those numbers are roughly double compared to just a few years ago. Opioids can be highly addictive prescription painkillers such as OxyContin, Vicodin and fentanyl or street drugs like heroin. Many people who are legitimately prescribed painkillers become addicted and that can lead to illegal usage through abuse of prescriptions or turning to street drugs.  

Dr. Dahlem instructs deputies how to administer naloxone

The steady increase in opioid use, overdoses and related crimes have prompted some communities to establish special task forces focused specifically on opioids and their impact. Lt. King is a member of the Washtenaw County Opioid Project, which includes law enforcement, community agencies, schools and health care leaders. Part of the plan to address the problem is training law enforcement officers and other first responders to administer naloxone, a medication used to reverse opioid overdoses.

“You could have a save this afternoon”

The Sheriff’s Department is the first law enforcement agency in Washtenaw County to train deputies to use naloxone, also known by the brand name Narcan, when responding to an opioid overdose. 

That’s where the University of Michigan School of Nursing (UMSN) comes in. Chin Hwa (Gina) Dahlem, PhD, RN, NP-C, a UMSN clinical assistant professor, led several training sessions with groups of officers and members of Community Support and Treatment Services (CSTS) to educate them on identifying an opioid overdose and how to administer naloxone. The drug is delivered as a nasal spray and works within minutes of an opioid overdose.

“You could have a save this afternoon,” Lt. King told the officers.  “It’s somebody’s child; it could be one of our own children. If we can save their life, then we can hopefully get them into recovery.”

[September 1, 2015 update: A Washtenaw County deputy who had received the training the week before responded to a possible overdose on Aug. 28.  He administered naloxone to the unconscious 26-year-old man and within a minute, the man was revived.]

During training sessions, deputies voiced potential concerns about using the drug on someone who may be overdosing from something else or perhaps not even overdosing.

Dr. Dahlem leading a training session

“Naloxone only reverses opioid overdoses,” says Dr. Dahlem. “It doesn’t work on cocaine, alcohol, or benzodiazepine overdoses. It is safe, legal, and you cannot become dependent on it.  We know that many overdoses are due to combination of drugs.  So, it is still better to use naloxone because you cannot harm the person but you may be saving their life.”

Also, in Michigan, laws protect first responders and regular citizens who administer overdose reversal drugs in good faith. Family and friends of addicts are allowed to obtain prescriptions for naloxone.

All Washtenaw deputies are now trained to use naloxone and will carry it on every shift. “Often we beat fire and ambulance to the scene,” says Lt. King. “Now our officers have a stronger knowledge base and the ability to potentially save someone from an overdose.”

Seeing the need firsthand

Dr. Dahlem, a nurse practitioner who specializes in vulnerable populations, says she became interested in the use of intranasal naloxone through her work at theNaloxone kit Delonis Center, part of the Shelter Association of Washtenaw County, which primary serves people experiencing homelessness.

Three years ago a client overdosed in the shelter bathroom but the workers couldn’t do much until EMS arrived. The physician who witnessed the overdose, Dr. Molly Horstman, brought up the idea of using intranasal naloxone.  From there, Drs. Dahlem and Horstman developed a protocol and trained the shelter staff to use intranasal naloxone.  In the last two years, the shelter has used naloxone four times to reverse overdoses.

What is an opioid overdose?

Opioids affect the part of the brain that regulates breathing. When an overdose occurs, breathing slows and then stops leading to unconsciousness, brain damage, cardiac events and eventually death. There is an increased risk when used with alcohol or sedatives.  Contrary to popular belief, an overdose is generally not a rapid event. It can take hours for an overdose to become lethal which means there is time for intervention.

Massachusetts’ success

The state of Massachusetts has been a leader in the naloxone movement. More than 24,000 residents have been trained to administer the drug including drug users themselves, family and friends of drug users, along with first responders, teachers and community workers such as homeless shelter employees. Since the statewide program was established in 2006, more than 2,800 rescues have been reported and fatal overdose rates decreased by 27-46% in towns where the program was implemented according to data from the Boston Public Health Commission.

Not a safety net

A deputy practicing administering NaloxoneDr. Dahlem says that while naloxone does save lives, it should not be the only step when someone has an opioid overdose in both the immediate and long-term treatment of the user. “After naloxone is administered, the person must get medical attention. Opioids can stay in the system for hours so even if the naloxone is administered and the person is alert, it is still possible for someone to go into another overdose.”

Dr. Dahlem also says naloxone should not be viewed as a safety net for drug use. “It won’t work if the person is alone or too much time has passed. People with an addiction will need professional treatment for long-term recovery, but in an emergency situation, this drug can save a life and give people the second chance they need. It’s just one step towards recovery but an important one.”