Seattle Overdose Response Plan Breaks Barriers

Staff members at organizations such as DESC (formerly the Downtown Emergency Service Center) in Seattle, Washington, are on the front lines of dealing with the ongoing epidemic of opioid drug overdoses. Too often, clients overdose at DESC sites.

Like many organizations across the country, DESC is seeing more of these emergencies. Recent data from SAMHSA and the Centers for Disease Control and Prevention (CDC) have revealed that both prescription opioid and heroin overdoses are on the rise. The population that DESC serves—including many people with mental and/or substance use disorders—have life circumstances that often place them at high risk of an overdose.

“These overdose events are really accidents,” said Malone. He explained that many clients’ lives change day to day. The type of drugs they can find or afford may change. They may choose to use a different drug. They may become incarcerated for a time, which may lower their tolerance for a drug they have used in the past, placing them at risk if they resume use.

“All of those things can increase the chance of an overdose event,” he said.

To save lives when these overdoses occur, DESC recently implemented a plan for Opioid Overdose Response and Naloxone Administration. All 17 of the organization’s service sites are now equipped with kits containing the opioid overdose antidote naloxone. Naloxone can, within minutes, revive a person who has stopped breathing as a result of taking too high a dose of opioids, whether the opioids are prescription painkillers or heroin. If administered quickly, naloxone can mean the difference between life and death.

Staff members have been trained to recognize the signs of an overdose and how to respond if they witness one. First, staff call 911, and then they put on gloves and administer nasal naloxone. If the individual does not respond, sometimes a second dose is needed. But emergency personnel are always called to administer further care. So far, staff members have embraced the plan, and some have already had to administer naloxone, Malone said.

“I’ve heard a lot of positive feedback for us taking the stance that we are going to do everything we can to make sure our clients are not going to die from these accidents,” Malone said.

Such use of naloxone is becoming more mainstream. The drug has long been used in emergency rooms, but many first responders and social service agencies have begun to keep the antidote on hand. “Even the President has come out calling attention to overdoses and naloxone,” Malone said.

One of the reasons naloxone has been embraced is that it is considered very safe. Even if it were inadvertently administered to someone who is not experiencing an opioid overdose, it will not cause harm, Malone said. But emergency care is required after administering, because naloxone can wear off.

State laws may pose obstacles to administering naloxone in social service settings. Malone explained that when he first learned about a naloxone program in place at an organization called Thresholds in Chicago, Illinois in 2014, he then discovered that state law in Washington limited how naloxone could be used. Individuals who were likely to witness an overdose could obtain naloxone to use in an emergency, but an entity like DESC could not maintain a supply for any staff member to use.

“We worked with advocates and lawmakers to get the law amended in 2015,” he said.

One of the arguments Malone and other advocates made was that having naloxone onsite at social service agencies is not much different than having epinephrine on hand at schools in case a child has a life-threatening allergic reaction.

“That was the model we wanted to have,” he said.

Once the law was amended, there were other details to work out. The organization chose to stock the more expensive nasally administered version of naloxone instead of the injectable version because most staff members do not have a medical background and may be uncomfortable using needles, Malone said. Additionally, staff members are instructed that administering rescue breathing is optional. Malone explained that rescue breathing is not always necessary, and the organization did not want to put staff at any risk. Mouth guards are provided in the naloxone kits to protect staff members who choose to provide rescue breathing.

“The main emphasis is on getting naloxone into the person,” Malone said.

Ultimately, the payoff of being able to continue helping clients who experience an opioid overdose is worth the time and effort that went into crafting the plan.

“When someone is kept alive, he or she retains the ability to better his or her life,” Malone said.