Naloxone program continues to save lives, despite deepening crisis

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BURLINGTON — People have reported reversing more than 1,200 overdoses since December 2013 with free naloxone provided by the state, according to the program's director.

Naloxone is a drug that's effective at reversing an opiate overdose and is often referred to as Narcan, the brand name of a nasal injector.

"If people don't survive their overdose they can't make it into recovery, and that's really what it comes down to," said Chris Bell, director of the Division of Emergency Preparedness, Response and Injury Prevention for the Health Department.

The total number of overdoses reversed with free naloxone is likely much higher, according to Bell and others involved with the program, because many overdose reversals go unreported. The reversal figures are collected via surveys that people fill out when they return to one of close to 30 distribution sites across the state to get a refill.

It's a cost-effective program, with Vermont having spent only $1.15 million over the last 3 years. That's largely because the Health Department relies on existing needle exchange or treatment and recovery programs to do the distribution and collect survey data from people who use it.

Despite the success of Vermont's naloxone distribution program, and its drug treatment system of care — which experts say has among the deepest penetrations into the drug-addicted population of any state in the country — overdose deaths in the state spiked in 2016. Health Department figures show they are on pace to increase again in 2017.

"I think it's an incredible use of the money, and people's lives are better for it. There's plenty of people who are alive because of this program," Bell said, pausing before he added, "We just hope that at some point it won't be as necessary."

As part of the same program, the Health Department began providing emergency medical services providers with free naloxone in mid-2016. EMS agencies reported reversing overdoses in another 587 people that year alone, according to a Health Department data brief released last month.

The Health Department also began providing police agencies that want to carry the drug with free naloxone at that time as well, though the data brief does not include reversals by law enforcement.

Safe Recovery, a needle exchange in downtown Burlington operated by the Howard Center, is by far the largest distribution site, having passed out 71 percent of the 3,286 naloxone kits distributed thus far in 2017, according to the organization's internal figures and those released by the Health Department.

Tension arose between Safe Recovery and the Health Department earlier this year when workers at the needle exchange became concerned that the Health Department was trying to limit how much naloxone Safe Recovery staff could give their clients.

Bell had sought to impose a one dose per person limit, arguing that it should only take one dose to reverse an overdose. However, Safe Recovery cited Centers for Disease Control and Prevention guidance saying it frequently takes multiple doses to reverse an overdose. Clients are also frequently providing naloxone to friends who are also using opiates, they added.

Health Department figures on the naloxone distribution program show that in the first half of the year, people reported using 226 doses to reverse 142 overdoses, reinforcing the idea that it often takes multiple doses to revive someone.

The flap appears to be resolved, with Bell saying that all distribution centers are now encouraged to "use their own judgment" when it comes to how many doses to provide people with.

Grace Keller, Safe Recovery program director, said the Howard Center "collaborated with the Health Department to come to place where we would not be limited in the amount of doses we could give out."

Keller said that Safe Recovery is closing in on its 1,000 reported overdose reversal. That means the other 29 sites around the state are responsible for close to 200.

Safe Recovery figures show 34 percent of its clients who received naloxone come from outside Chittenden County, Keller said, as do 22 percent of the reversals reported to Safe Recovery.

Bell said it's not surprising that Safe Recovery has a statewide reach, as it was among the original distribution sites when the Vermont's naloxone distribution program began as a pilot in 2013, and Howard Center is the state's largest social service nonprofit.

Keller said Safe Recovery tries to refer clients to naloxone distribution sites that may be closer to home, but many return because they know Safe Recovery is open five days a week 9 a.m. to 5 p.m. Other sites may have more irregular hours, she said. Still, making people aware that naloxone is available nearby could help save lives, Keller said.

The EMS data reported by the Health Department shows that, while the largest number of overdoses occur in Chittenden County, the rate of overdose is actually higher in at least eight of Vermont's 13 other counties.

The rate is highest in Windham County at 14.3 overdose-related calls per 10,000 residents, more than twice the rate of 6.9 in Chittenden County. The data did not include rates for Essex and Grand Isle counties.

Survey data reported to distribution sites offer a rough sketch of the average opiate user in Vermont. New clients in 2016 were on average 37-years-old, and overwhelmingly white — 93 percent. A little over half were men. A quarter reported having overdosed at least once, and two thirds said their most recent overdose occurred while using heroin.

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