Free Naloxone available to the public at Prowers County Courthouse

Most people in Prowers County are probably unaware of the availability and easy accessibility of something that could save lives at no cost to them.  Inside the Elm Street entrance to the Prowers County Courthouse is a purple box with a large label reading “Free Naloxone”.   Inside are rows of small white boxes, each containing two doses of the lifesaving medication, available for free to anyone in the community. The dispensing machine has information on how to recognize an overdose and how to properly use the drug.  Naloxone, commonly known as Narcan, is a nasal spray which, if given in time, can quickly reverse the effect of opioids such as Oxycodone(OxyContin), hydrocodone (Vicodin), codeine, morphine and fentanyl. While it rapidly reverses an opioid overdose, it has no effect on someone who does not have opioids in their system, so is safe to use even if an overdose is only suspected.  Important to note is that Colorado has a “Good Samaritan Law” which provides immunity from criminal prosecution for a person other than a health care provider to administer naloxone to another person whom the person believes to be suffering an opiate-related drug overdose.

Wendy Buxton-Andrade, Prowers County Commissioner, recently brought to my attention the box in our courthouse at a recent meeting and we felt it prudent to let the people in our area know about it and encourage all families and individuals to obtain the medication to keep on hand in case of an emergency.  The free doses are made possible by various State grants from Public Health, which is how Prowers County is able to obtain and dispense them.  The goal is for every home to have the drug in their “medical tool box”.

Sadly, Narcan has been stigmatized so that many people immediately associate its use with drug addicts.  What the public needs to remember is that MANY people are at risk for a drug overdose, not just those who use opioids recreationally.  Carrying a dose of Narcan should be viewed as no different than carrying an Epi-Pen to help someone with life-threatening allergies.  With the spike in fentanyl-related deaths, even the most “innocent” use of street drug thought to be otherwise harmless is potentially deadly, not to mention the possibility of accidental skin contact with fentanyl pills or powder. In Pueblo recently, a bus chartered for a 4th grade field trip was found to have a quantity of unknown pills loose on the floor which tested positive for fentanyl which was not brought onto the bus by the students.  Fortunately, none of the young children touched the pills or the situation could have had a tragic ending.  Many of us have elderly parents who have been prescribed these drugs, often in high doses, for chronic pain and who cannot remember when or how many to take.  Research reported at the Alzheimer’s Association’s International Conference revealed that starting on an opioid after getting a dementia diagnosis was frequent and was associated with a markedly increased risk of death, particularly in the first two weeks of beginning an opioid.  A Denmark study of persons diagnosed with Alzheimer’s disease found that one-third died within 180 days of the first opioid dose, five times as many of those with the disease who didn’t take opioids.  Among patients who used fentanyl patches as their first prescription, nearly two-thirds died within the first 180 days.  80% of all overdose deaths occur inside a home.

The following information was provided courtesy of Jose Esquibel, Director, Colorado Consortium for Prescription Drug Abuse Prevention, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus.

Prescription Opioids and Access to Naloxone

Research indicates that clinicians prescribing Naloxone along with prescription opioids may reduce risk of opioid-related emergency room visits and prescription-involved overdose deaths.

Naloxone should be made available to individuals with chronic pain who are prescribed high doses of opioids, especially those receiving daily prescription opioid dosages of 50 morphine milligram equivalents (MME) or greater or those receiving benzodiazepines (Naloxone Co-prescribing to Patients Receiving Prescription Opioids in the Medicare Part D Program, United States, 2016-2017 | Substance Use and Addiction Medicine | JAMA | JAMA Network)

In 2018, rural counties had the lowest Naloxone dispensing rates and were nearly 3 times more likely to be low-dispensing counties compared to metropolitan counties. (When to Offer Naloxone to Patients (cdc.gov))

Guidelines from the U.S. Center for Disease Control recommend that Naloxone be offered to all patients prescribed opioids, particularly to patients who are at an increased risk for opioid overdose. In addition, there is the recommendation to offer naloxone to a patient’s family and caregivers and direct them to resources that will teach them how to administer Naloxone.

There are some situations and conditions may make a prescription opioid overdose more likely. The following factors increase risk of prescription opioid overdose:

• Patients with sleep-disordered breathing
• Patients taking higher dosages of opioids (e.g., ≥50 MME/day)
• Duration of opioid use, such as long-term use of prescription opioids for chronic pain
• Extended-release and long-acting opioid formulations

Source: Colorado Prescription Drug Monitoring Program, 2017-2021

The rate of prescription opioid overdose deaths is highest in Southeast Colorado.

Ms. Buxton-Andrade said it best: “We have lost too many children, sisters, brothers or parents in our community.”

By Barbara Crimond