[B]URLINGTON — The state’s largest distributor of an opiate overdose antidote is pushing back against a state policy aimed at limiting how much naloxone can be distributed.
The Health Department provides naloxone, known by the brand name Narcan, to a network of distribution sites across the state.
The state allows one dose per person in most cases, according to Chris Bell, who oversees the program.
Tom Dalton, the outgoing director of Safe Recovery, said that policy is dangerously misguided because it frequently takes multiple doses of Narcan to revive someone who is overdosing.
Safe Recovery is a Howard Center program that provides drug users with clean needles and works to connect them with treatment and other social services in addition to providing them with Narcan.
Dalton said he and other Safe Recovery staff who have reversed overdoses using the drug have had to administer multiple doses. Howard Center CEO Bob Bick said he was told of a recent situation where a person overdosing was brought to Safe Recovery, and it took four doses plus rescue breathing from a staffer to revive the person.
Vermont’s Narcan distribution sites collect survey data from the people they serve. Bell said the Health Department has not reviewed the data collected from distribution sites to see how many doses people are reporting that they use when reversing an overdose.
“It’s problematic if they’re not looking at their data to see that people often need more than one dose,” Dalton said.
An analysis of the survey data shows there were just over 1,000 reported overdose reversals since the program began in December 2013. Of that total, more than 800 were reported by people who received Narcan from Safe Recovery, according to Dalton.
Friction over the distribution policy began in July 2016, when the state switched to a more effective injector from a nasal syringe. The injector delivers 4 milligrams of the drug, while the syringe holds 2 milligrams.
The state asks sites to give out a single injector.
Bell said the state understands there are situations in which people need multiple nasal injections.
“We’re not watching them that closely where we’d call them up and ask them, ‘Hey why did you give this person that much Narcan?’ We understand that there may be special circumstances,” Bell said.
Though they technically have the leeway to give people more than a single dose, Dalton said Safe Recovery has been under constant pressure from the Health Department to give out less of the drug.
“The enforcement mechanism is that the’ve told us they’re going to limit the amount we can get,” he said.
The 4 milligram injectors come in packages of two, Dalton said. He and his staff were uncomfortable with the Health Department’s directive to open the packages and hand out only single doses, he said.
That’s in part because the directions on the packing say to administer an additional dose, if available, every two to three minutes if the person isn’t revived with the first dose.
Safe Recovery and the Health Department butted heads over the policy for close to a year, but the disagreement came to a full boil this month when Safe Recovery became convinced they would run out of the drug before being resupplied.
The Health Department ultimately relented and has agreed to provide Safe Recovery with more Narcan. Bell said Thursday they will be reviewing the their policy to see if it should be revised.
After VTDigger contacted Bell, Dalton received an email to that effect.
Bell says that in most cases one dose is sufficient. If additional doses are required, emergency responders can provide them, he said.
The state law authorizing the naloxone distribution program requires people to call 911 after administering the drug and provides immunity from prosecution for those who do, he said.
“Our instructions to anyone who gets Narcan at any of our sites, our direction is to call 911 and administer Narcan. We have EMS that responds everywhere in the state,” Bell said.
In Chittenden County, emergency response times are only a few minutes, Bell said.
But 25 percent of the people who get Narcan at Safe Recovery live outside Chittenden County where emergency response times are much longer.
“A delay can cause brain damage. If it’s someone you love, are you going to want any delay?” Dalton asked.
One reason it’s important to have multiple doses on hand for drug users or their friends and family is because of the increasing presence of fentanyl and other powerful synthetic opioids in the street drug supply.
A 2015 alert for health professionals from the CDC says that, “Multiple doses of naloxone may need to be administered per overdose event because of fentanyl’s increased potency relative to other opioids.”
Typically drug users don’t know if what they’re ingesting contains fentanyl, according to police and social service providers. Fentanyl was present in 51 of 106 fatal opiate overdoses last year in Vermont.
Part of the problem is that the Health Department is trying to be judicious with limited resources and to ensure that all distribution sites are able to get enough Narcan, Bell said.
The appropriate management of resources “is a legitimate priority for the state” and the Howard Center, Bick said.
“There are differences about what’s the best way to marshal those resources, but we both have the aim of getting this life saving drug out to the people who need it,” he added.
