As heroin overdoses continue, pharmacists urge more awareness of Narcan availability
New London — Five more people were treated at Lawrence + Memorial Hospital for heroin overdoses since late Saturday night, bringing the total number of overdose patients since Jan. 27 to 18.
“Clearly this is above and beyond anything we’ve seen in this type of cycle,” hospital spokesman Mike O’Farrell said Monday afternoon. “We certainly hope it’s over.”
In addition to those treated and released from the hospital, at least three overdose victims died in various communities around the region over the last week. Neither The William W. Backus Hospital in Norwich nor The Westerly Hospital are reporting any similar spike in overdose activity. Many of the overdose victims at L+M were addicts who apparently used their regular amount of the drug but were unable to tolerate a particularly potent or tainted batch of the drug being sold in and around the city, according to hospital officials.
In response to the current heroin crisis in southeastern Connecticut, the executive vice president of the Connecticut Pharmacists Association on Monday called for greater awareness of a new law that gives the public greater access to naloxone, also called Narcan, at local drug stores.
The medication, which reverses the effects of opiates, can now be prescribed by pharmacists who complete an online training course. Thus far, 107 pharmacists around the state have taken the course since it became available at the end of September, with five to 10 completing the training weekly, according to the state Department of Consumer Protection. As part of the training, pharmacists are given information about treatment resources that they are required to provide to those who request Narcan.
“I hope people are aware that they can now walk into a pharmacy and request a prescription,” said Marghie Giuliano, pharmacist and executive vice president of the association. “I don’t think the public understands that they can do that. It’s something we supported because pharmacists are stewards of public health, and this removes a barrier.”
Previously those who wanted Narcan had to obtain a prescription from a physician.
Pharmacists who now can prescribe the medication to addicts or to their loved ones and provide them with training in how to use it, Giuliano added.
All of the five most recent victims brought to L+M were given Narcan by emergency medical technicians at the scene of the overdose, according to Ron Kersey, chief of emergency medical services at L+M. All but one of the other victims also received Narcan from EMTs, with the other receiving it at the hospital, Kersey said. Although many local police now routinely carry the drug, police did not administer it in any of the recent cases, Kersey said.
The drug can be given intravenously, through injection or in a nasal spray. Kersey said EMTs are most frequently using the nasal spray.
“Once the Narcan is absorbed, you are removing the effects of the opiate and people can go into withdrawal quickly,” he said. “In a number of cases they start vomiting and are very confused. Seizures can happen, and other effects.”
Sometimes patients wake up and resist being taken to the hospital, he said. This is particularly dangerous because the effects of Narcan wear off much more quickly than the opiate, meaning the patient is at risk for a second overdose and needs to be monitored for several hours, Kersey said. In addition, Narcan does not counteract the effects of any other drugs that might have been taken with the heroin.
“We tell our EMTs that they have to be prepared to continue supportive treatment,” he said. “The effects of the drugs can come back and be as dramatic as before they stopped breathing.”
If people give Narcan at home, he said, they should be aware that the overdose victim will still need medical care.
Pharmacist Lori Lord, manager of the Greenville Drug Store in Norwich, said she has completed the training to prescribe Narcan, but has not yet had any requests from the general public. She has provided it to local drug treatment centers, however.
One of the obstacles for many people who may want to have Narcan, she said, is the cost. A Narcan kit with two doses of spray costs $115 to $140, she said. While some health insurers are reimbursing for the cost, others are not. Some of the reimbursements provided are below the wholesale cost she is paying, she said.
Greg McKenna, a pharmacist with Higganum Pharmacy, part of the local chain of Quality Care Drug stores, has also completed the training but has not had any requests for Narcan from the public yet.
“It’s a lack of knowledge,” he said. “I do try to tell people about it. I’ve spoken to physicians and encouraged some people to get it and carry it with them. The need is there.”
While there are inconsistencies between private insurers about reimbursement, McKenna said Medicaid will reimburse for the medication.
McKenna said at least one of the pharmacists who works at Quality Care Drug’s New London store on Ocean Avenue has also completed the training and can provide Narcan.
“I just believe people should have it if they’re narcotics users,” he said.
Annik Chamberlin, pharmacist at Beacon Prescriptions in Southington, said the demand from the public for Narcan has been slow thus far. Since completing the training at the end of September, she has filled “one prescription every two to three weeks,” she said.
Another pharmacist, Jacqueline Murphy of New Haven, said she has filled 18 Narcan prescriptions since completing the training at the end of October.
“It’s been a cross section of people, some addicts who say they’ve been saved by the drug in the past, some are loved ones of addicts,” she said. Others are those using high doses of prescription opiates who want Narcan on hand in case someone uses their medications who shouldn’t, she said.
“People are still finding out about it,” said Murphy, who works at Hancock Pharmacy at Long Wharf in New Haven and is president of the state pharmacists association.
Mary Kate Mason, spokeswoman for the state Department of Mental Health and Addiction Services, said the department is trying to get the word out about the availability of Narcan at pharmacies. The department has created a video to spread the word.
Mason also said that DMHAS mobile crisis team workers are available to come to L+M to provide information to overdose patients and their families about treatment.
“If we got a call from L+M asking our mobile crisis teams to come out, we’d respond,” she said. “We have not gotten that call from L+M.”
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