HEAL expands naloxone access to turn the tide on overdose deaths

Aug. 31 marks International Overdose Awareness Day, a time when attention is directed toward raising awareness about opioid overdose and ways to reverse the deadly effects.

One such way is naloxone, a medication that has become more available throughout Kentucky in recent years with the University of Kentucky’s HEALing Communities Study playing a significant role.

Naloxone is a medication that when given in time can quickly reverse the effects of opioids and help restore breathing in someone who is experiencing an overdose.

Increasing access to naloxone is one of the evidence-based strategies implemented by the HEALing Communities Study to reduce opioid deaths in Kentucky. Launched in 2019, the $87 million study is focused on 16 counties hardest hit by the opioid epidemic. The goal is to develop sustainable solutions that can be scaled across the Commonwealth.

So far, the study has helped thousands of Kentuckians get access to the lifesaving medication. Since the first unit of naloxone was distributed in April 2020, more than 86,000 units of naloxone have been distributed across the 16 counties participating in HEAL.

To put it into perspective — in 2019, the year before the HEAL intervention was launched, that number was just about 7,000, says Trish Freeman, Ph.D., a professor in the UK College of Pharmacy who leads the HEAL Prevention Team and coordinates HEAL’s naloxone education and distribution efforts in Kentucky.

In 2022, 2,127 Kentuckians died from a drug overdose, with 90% involving opioids. While Kentucky’s overdose death rate decreased by 5% last year, it’s still among the highest in the nation.

“No one should die from an overdose and naloxone is one of the most effective ways to intervene and save a life,” said Freeman. “By getting naloxone into the hands of more Kentuckians, we are saving lives today while informing the blueprint for the most effective way for communities to do so going forward.”

Most of the naloxone distributed by HEAL is delivered through partnerships with various community organizations and agencies including treatment, criminal legal system, social service and public health programs.

The study, which is broken down into two waves of eight counties each, has partnered with 245 agencies across all 16 counties. The HEAL Implementation Team, led by Hannah Knudsen, Ph.D., a professor in the UK College of Medicine, works hand in hand with partner agencies to provide the support needed to implement overdose education and naloxone distribution with their clients. 

Knudsen’s team of implementation facilitators meet with a wide range of agencies to share information about HEAL’s overdose education and naloxone distribution program and then work with agencies to establish a workflow and provide technical assistance to ensure effective implementation.

The HEAL Prevention team operates a naloxone distribution hub in the Center on Drug and Alcohol Research for partner agencies that also includes training materials, because education about overdose and how to use the medication is required. Under a standing order agreement, HEAL co-investigator Michelle Lofwall, M.D., professor in the UK College of Medicine, signs the order as the physician of record for all naloxone distributed.

The agency partnerships reach those at highest risk for overdose, especially within the criminal legal system, where HEAL has partnered with jails and prisons, drug court, pretrial services, police departments, and probation/parole programs.

The risk of overdose is increased when people are released from a correctional facility because tolerance for the drug can decrease significantly during a period of abstinence. After release, an attempt to use the same amount of opioid may lead to overdose or death, says Carrie Oser, Ph.D., professor in the UK College of Arts and Sciences and co-lead of the HEAL Criminal Legal System Team.

Most jails partnering with HEAL offer naloxone as part of the discharge process. Some, including the Madison County and Jefferson County detention centers, have opted to install “vending machines” in lobbies or discharge areas. The digital kiosks streamline tracking and mandatory training.

“The agencies we work with choose what works best for them given their unique staffing and organization needs. The most important thing is that people who are discharged are getting access to naloxone during this critical time,” said Oser.

Beyond agency distribution, naloxone is dispensed through the HEALing Communities Study comes from its own outreach team. HEAL prevention specialists reach people directly at venues like community events, social service agencies, businesses, schools and addiction treatment and recovery facilities.

In addition to educating people on how to recognize an overdose and properly administer naloxone, the team addresses a lot of myths and misperceptions people have.

“People need to know it’s safe to use on anyone and won’t hurt someone who isn’t overdosing,” said Gabi Deaton, a HEAL prevention specialist coordinator. “We also talk about the Good Samaritan law, which protects people from prosecution when they report a drug overdose. Our goal is to make sure they’re confident, equipped and ready to intervene in the case of an opioid emergency if they ever need to.”

Deaton serves as the prevention specialist for Campbell County and organizes the outreach efforts of her colleagues assigned to the seven other counties in the HEAL’s second wave.

While the team generally visits locations with people at higher risk of overdose, they reach a larger cross section of the public compared to the agencies. Their visibility helps reduce the stigma surrounding opioid use disorder and ensure that more family members, friends and bystanders are carrying naloxone. 

Deaton says people sometimes reach out to thank her after the naloxone she gave them is used to save a life. There are too many to remember them all, but she still keeps in touch with some who are now in recovery.

Soon, it will be easier to access naloxone nasal spray products, including brand name Narcan and its generic counterparts. These products were recently approved by the U.S. Food and Drug Administration for sale over the counter (OTC) and should be available in pharmacies and other retail stores that sell OTC products by mid-October.

Overdose education and naloxone distribution by a wide range of agencies will likely still be needed to ensure that cost is not a barrier and that people learn now to effectively use naloxone to respond to an overdose.

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number UM1DA049406. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.