Pharmacists Turn Naloxone Training Programs into Video for Broad Audience
A pharmacy project to train emergency medical services (EMS) and law enforcement personnel in how to administer naloxone in cases of opioid overdose has grown into an educational effort that features a video aimed at any potential responder.
The 19-minute video "Opioid Overdose and Naloxone Reversal," available on YouTube (https://youtu.be/KcjF9Iw0iuw), had its national debut in mid-December and was produced at Red Lake Indian Health Service Hospital in northern Minnesota.
Clinical pharmacist Kailee L. Fretland, the primary narrator, said the goal was to take pieces of the facility’s training programs and produce an instructional video that anyone can incorporate into local educational efforts.
Fellow pharmacist Samantha Gustafson said the video additionally can serve as a training or retraining tool for law enforcement officers and pharmacists.
Gustafson and Fretland are pharmacy officers in the U.S. Public Health Service on assignment with the Indian Health Service.
The video provides an overview of the problem of opioid overdose, explains the signs of an overdose and the actions a responder should take, and walks viewers through the steps of administering naloxone by means of Narcan Nasal Spray (Adapt Pharma), an Evzio autoinjector (Kaléo Inc.), or the more informal combination of an intranasal mucosal atomization device and naloxone hydrochloride injection.
Fretland said the impetus for the overall project was the openness of the Red Lake community to addressing its opioid overdoses and turning the tide on overdose-related deaths.
Efforts to have clinicians coprescribe naloxone with opioids were getting underway when Fretland arrived in Red Lake 5 years ago, as were efforts to increase naloxone use in community-based settings.
Those efforts began with development of an "EMS naloxone kit" for use by emergency responders, Fretland said.
Gustafson said that when she arrived in Red Lake 2 years ago, she immediately started developing a collaborative practice agreement enabling pharmacists to prepare a prescription for naloxone and dispense the drug to any patient who uses an opioid for pain relief.
"From there," she said, "we looked at expanding [naloxone access] to law enforcement" personnel and "third-party" personnel who want to carry naloxone for use in the event a family member or someone else overdoses from an opioid exposure.
Regardless of the audience, Fretland said, one aim of the pharmacists’ video presentation is to reduce the stigma of opioid overdoses.
"We’re not here to judge," she said. "We’re not here to condemn [opioid users or abusers] or tell them that they’re wrong or made poor choices. We’re really here to help them and to give our community a tool to save lives."
Educational sessions focused on opioid abuse and naloxone reversal often occur in the community, not at the healthcare facility, Fretland said, noting that she and Gustafson often provide education and training at community health fairs, community drug summits—even at the high school level. "We demonstrate how to use naloxone, we talk about opioid overdoses, how to access naloxone, [how to] get refills."
One such event was a January 12 "Take Back Our Community" program at a local events center. Staff from the hospital showed the video and provided live naloxone training at 2 workshops. Financial support for the daylong program was provided by a Rural Opioid Overdose Reversal grant from the federal Health Resources and Services Administration.
A law signed by Minnesota Governor Mark Dayton in May 2014 allows the following types of workers to obtain, possess, and administer naloxone: law enforcement personnel, emergency medical responders, and the staffs of community-based health, disease prevention, and social service programs.
The same law allows for the prescribing of naloxone to a person who intends to administer the drug to another person.
"A lot of our training is probably with that third party," Fretland said.
Gustafson said that even patients who are not using opioids come to the facility requesting naloxone to have on hand for an opioid-using family member.
And the pharmacists are ready to fulfill those requests, Fretland said. "Any of our pharmacists are able to jump in and [provide naloxone education and doses] as part of our initial staffing requirement."
Pharmacists in general, she exhorted, need to become comfortable in talking about naloxone with someone who may need to have a supply on hand by "reaching out to that person as a person—not as an opioid user or i.v. drug user or someone at high risk for opioid overdoses."
In addition, Fretland said, pharmacists who provide naloxone education and doses should be able to direct people to additional local resources.
ASHP in 2015 adopted a policy statement regarding naloxone availability. Developed by the ASHP Council on Therapeutics, the statement declares ASHP’s support for efforts that safely enable more people to be able to administer naloxone when the drug is urgently needed to reverse an opioid’s effects.
[This news story appears in the March 15, 2017, issue of AJHP.]