Naloxone Training Takes Off When Drug Becomes Available

The Cabell-Huntington Health Department was the first in the state to begin a needle exchange program—a program that allows addicts to exchange their used needles for clean ones in order to prevent the spread of diseases like hepatitis and HIV. Along with a needle exchange, the department has also implemented a training program to teach members of the public how to use the life-saving drug naloxone. But when those trainings began in the fall, they were sparsely attended. Things have changed though since the health department received a donation of naloxone auto-injectors. 

Credit Clark Davis / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Naloxone auto-injector kit.

Each Wednesday around 10 a.m. and 1 p.m., a Marshall University Pharmacy School Professor teaches anyone who will sit through the hour session how to use a naloxone auto-injector. The trainings however aren’t limited to just that form of opioid antagonist, but also expose trainees to naloxone or narcan nasal sprays. 

On a Wednesday in late March, three men joined the Pharmacy Professor for the afternoon session.  One man– who wished to remain nameless—says as a former heroin user who has been clean for a year, he just wants to prepare himself for the possibility of a friend’s overdose. 

“Simply because I could help somebody, a close friend of mine or something. I wouldn’t want the idea of knowing I could have helped someone and didn’t have the tools to do it with,” said the man taking the training.

C.K. Babcock is the Pharmacy school professor that teaches the classes each Wednesday. When he began the trainings in September in conjunction with the Needle Exchange program, Babcock says barely anyone came.

“Would you come to a training where you learned how to play baseball, but you never got to play baseball? No and that’s exactly how people are here, they’re not going to be able to come in for the training if they can’t get the product, well some people did without the product, but boy we’ve got a lot more with the product,” Babcock said. 

"Would you come to a training where you learned how to play baseball, but you never got to play baseball? No." — C.K. Babock, Marshall University School of Pharmacy Professor.

 In February, the Cabell-Huntington Health Department received a donation of 2,200 Naloxone auto-injectors or EVZIO from Kaleo Pharma. The injectors are filled with opioid antagonists, or drugs that reverse the effects of an overdose. When combined with additional medical care, drugs like Naloxone or narcan can save someone’s life.

Babcock says since receiving the donation, he’s watched as more and more people have walked through the door to his training. But the lack of free medications wasn’t the only thing keeping people from attending. 

Before the donation, Babock says it could often be difficult to find doctors willing to prescribe Naloxone or narcan which a law approved in 2015 allows. Now after they take the class, participants are written a prescription by Doctor Michael Kilkenny, the director of the Cabell-Huntington Health Department. The prescription is written for any of the three types of overdose medications to have filled at a local pharmacy. 

Credit Clark Davis / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Narcan nasal spray.

  “Not all physicians are comfortable prescribing this, especially for people they don’t treat, although the Good Samaritan Law allows us to do that, it still has some constraints, we do have to get educational contact with that person and we have to report who we’ve prescribed too,” Kilkenny said. 

That Good Samaritan Law was passed by lawmakers in 2015 and prevents a person from being charged with certain crimes when they call for medical help for someone who is overdosing. It paired with a bill to allow friends and family members of addicts to receive an opioid antagonist prescription to help save lives.

During this year’s legislative session another bill– Senate Bill 431– was passed which will allow pharmacists and pharmacy interns to dispense opioid antagonists, like naloxone without a prescription. The Board of Pharmacy will develop protocols for the distributions. 

And access isn’t just being expanded in Huntington. Efforts are being made all over the state to help deal with the issue of overdose deaths. Charleston received a donation of 200 cases of naloxone in mid-March. And while both the Cabell-Huntington Health Department and the Kanawha-Charleston Health Department are training the public to use the naloxone anti-dote, EMS, Firefighters and Police across the state are being trained and using them every day. In 2015 according to the Department of Health and Human Resources there were 2505 instances where naloxone was used for those suffering from an overdose. 

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

Naloxone Prescriptions Prove Hard to Come By

Along with a needle exchange program in Huntington for users who can’t kick their heroin addiction, the Cabell-Huntington Health Department is offering a certification class for a potentially life-saving drug Naloxone. However, some doctors are hesitant to prescribe the opioid overdose blocker.

Credit marshall.edu
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  C.K. Babcock, a professor from the Marshall University School of Pharmacy, will offer two sessions of naloxone certification classes every Wednesday. They’re offered in conjunction with the harm reduction needle exchange program at the Cabell-Huntington Health Department. It’s a county that recorded over 900 drug overdoses and 70 overdose deaths last year. The hope is to offer those who live and are associated with drug users a chance to be trained in the use of a tool could save lives during an overdose. 

The drug blocks receptors in the brain from attaching to opioids like heroin and Oxycodone. Narcan is the bran name for a nasal spray version of the drug Naloxone. It’s also available as an auto-injector. 

Babcock said he’s has trained medical professionals and officials on how to administer the drug. And he’s trained over 100 citizens how to use and administer Naloxone as well.

Credit Clark Davis / WV Public Broadcasting
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WV Public Broadcasting
Certificate of Naloxone Training participants receive that acknowledges they’ve been through training.

But on some Wednesdays, no one in the health department obtaining needles are there taking the Naloxone classes. Part of the reason, Babcock said, is there aren’t many doctors who will prescribe the medicine. 

“I think a lot of people are afraid of liability, people are afraid they could hurt somebody or that it could be misused, just think they don’t feel as knowledgeable as they should be,” Babcock said. “And I don’t feel that many of them feel they understand the rules from the board of medicine yet and I still think they’re trying to get their heads wrapped around those.”

The reasons vary said Babcock, from liability, to not wanting to give a prescription to one patient for it to be used on another and not wanting to be known as the only doctor in town who will provide the prescription. 

Dr. Rahul Gupta is the Commissioner for the West Virginia Department of Health and Human Resources Bureau for Public Health and the state’s Health Officer. He said doctors just need more education on the medicine and their roll in slowing down the drug overdose epidemic . Gupta said that according to a study in the Journal of Urban Health, it’s not a problem that’s uncommon in the prescribing of naloxone. He said it’s similar to the problems doctors have with prescribing opiates to patients diagnosed with chronic pain.

Credit West Virginia Department of Health and Human Resources
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“Good, prescribing doctors don’t want to be labeled as the place to go and get naloxone, however the challenge ahead of us as a community across the state is we do have this epidemic in front of us, we are all partners in addressing this epidemic and we cannot escape addressing this epidemic,” Gupta said.

Gupta said the state isn’t opposed to looking into different ideas, such as one Babcock suggested about looking into taking the doctor out of the equation. 

“I think we have to take a multi-faceted, multi-system approach toward this as we are doing,” Gupta said. “We know that our leaders are looking at this as a multi-faceted approach, so I think any and every effort that we can do at this point to address this epidemic, we must do it.”

Dr. Michael Kilkenny is the Director for the Cabell-Huntington Health Department. He said it’s those closest to the addicts who would make the biggest difference. 

“It’s going to be the family member who has the greatest opportunity to intervene in what would be a fatal overdose situation with naloxone,” Kilkenny said. “We’ve really got to push that out there to get that in their hands so that they can use it. “

Dr. Rahul Gupta said it comes down to the need for education for not just the public, but physicians as well. 

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

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