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COMMUNITY-BASED OVERDOSE RESPONSE NETWORKS

Improving access to naloxone for at-risk and vulnerable populations

Beacon decentralizes emergency dispatching so that anyone carrying a mobile phone and some Naloxone can be alerted when an overdose happens nearby.

Opiate abuse has been at epidemic rates for more than a decade. Several U.S. cities and states have declared a public health emergency regarding pharmaceutical and synthetic opioids such as oxycodone and fentanyl. Overdoses alone kill up to 130 people in the U.S. every day. The speed of response to this grave issue is still struggling. Opioids depress breathing, and an overdose can prove fatal as quickly as a victim can run out of oxygen. The stigma of drug abuse poses problems of its own as well. Witnesses to overdoses may be far more reluctant to call for help in traditional emergency response systems for fear of legal repercussions. When they do, some towns and counties find themselves overwhelmed by the problem too much to save lives. Emergency responders such as police officers, firefighters and emergency medical technicians are the only people who can respond to a conventional 9-1-1 call about drug abuse. But just like epinephrine auto-injectors like the EpiPen® have made it possible for bystanders to save lives, nasal or injectable naloxone make it possible for people other than medical professionals to arrest the effect of opioid overdoses.

The U.S. Food and Drug Administration (FDA) and the National Institute for Drug Abuse (NIDA) sponsored a competition for app developers “to spur innovation around the development of a low-cost, scalable, crowd-sourced mobile phone application that helps increase the likelihood that opioid users, their immediate personal networks, and first responders are able to identify and react to an overdose by administering naloxone.”

Beacon is just the innovation to quickly connect responders to overdose victims and save lives.

Why don’t you want people calling 9-1-1 first when they witness an overdose?

 

We do. Calling 9-1-1 is the best way to call for help in case of an emergency. We see this program as a “both/and” solution: “Call 9-1-1 and dispatch community responders.” There simply aren’t enough ambulances, fire engines and police cruisers to respond to every single overdose quick enough to reduce fatal opioid overdoses to 0 – which is our end goal. Some other considerations:

  • Frequency and rates of opioid overdoses have increased dramatically since 2000, taxing many local emergency response systems to breaking point. We believe that community responders can work in parallel with formal 9-1-1 responders.

 

  • In many rural communities, response times for formal 9-1-1 responders are too long. Using community responders helps reduce response times dramatically.
  • New forms of naloxone, such as Narcan®, make it easier for non-medical professionals to effectively learn how to administer a life-saving dose in time to save a life.
  • In some communities, witnesses to opioid overdoses are reluctant to call 9-1-1 for fear of legal repercussions or their own safety. Knowing that community responders with “lived” and “learned” experience with substance use disorder would also be responding could help to mitigate those fears.

How do you propose people should call for help if they won’t call 9-1-1?

 

Hopefully this is never the situation. If it is, we still propose that it should be a “both/and” proposition and not “either/or”. If the situation is such that 9-1-1 isn’t available quick enough, additional contact points for finding community responders with naloxone will increase the likelihood of overdoses being reported while filling in the gaps among belabored emergency services.

How do you guarantee community responders will show up when alerted?

 

Because we see these community-based networks as a “both/and” solution, if community responders don’t show up, it’s ok because a 9-1-1 response has already been activated. Nonetheless, getting community responders to show up when they’re alerted is crucial, and it’s also a challenge that volunteer emergency services across the U.S. solve every day. The solution comes down to strong leadership, having sufficient responders in a specific area, and aligned incentives. Sufficient numbers can be recruited and retained with a good strategy:

  • Recruit the right people – Ensure that potential responders are comfortable with a closeup look at opioid abuse and are properly trained in response protocols, such as administering naloxone=
  • Dispatch multiple responders – Create schedules for potential responders so two or more may be dispatched to a single incident
  • Offer incentives – Reward emergency responders and volunteers for their participation, keeping them active and evangelizing the strengths of the program

Do you think it’s a good idea for non-medical professionals to be administering naloxone without medical supervision?

 

Naloxone is preferably administered by or with a medical professional, but this is not always possible nor is it even necessary.

  • Many areas with high opioid abuse do not have enough medical professionals to respond in time to save lives.
  • Research has found minimal risks associated with treatment followed by release.[1],[2]
  • Non-medical professionals can be trained to recognize factors besides opioid overdose at an incident, prompting calls to 9-1-1 or medical professionals.

 

[1] Rudolph SS, Jehu G, Nielsen SL, Nielsen K, Siersma V, Rasmussen LS. Prehospital treatment of opioid overdose in Copenhagen: Is it safe to discharge on-scene? Resuscitation. 2011;82(11):1414–8. [2] Wampler DA, Molina DK, McManus J, Laws P, Manifold CA. No Deaths Associated with Patient Refusal of Transport After Naloxone-Reversed Opioid Overdose. Prehosp Emerg Care. 2011;15(3):320–4.

How do you guarantee safety for the responders?

The reality is that it’s impossible to completely guarantee 100% safety for responders, whether they’re professional emergency crews or community members. But we also think the safety concerns should be evaluate more by probability than possibility. Read this blog post to learn more.

Technology Grant for Overdose Education and Naloxone Distribution (OEND) Programs

60 Overdoses in 30 Days: At Work With the Greater Hartford Harm Reduction Coalition

Greater Hartford Harm Reduction Coalition with Hartford Fire Department Distributing Supplies for Covid

In the first 30 days of the program, GHHRC staff has already responded to over 60 overdoses, arriving on-scene on average in less than 6 minutes — and very often before formal emergency responders.

Read more

Community Responders In Puerto Rico Reverse Opioid Overdoses With Naloxone And Simple Text Message Alerts

Narcan© administered by community responders in northwestern Puerto Rico to reverse an opioid overdose after being alerted through Beacon

With just two simple text message alerts, community responders in rural Puerto Rico were able to locate an overdose victim and save their life.

Read more

Community-based overdose response networks with beacon

  • POTENTIAL OVERDOSE
    A witness to a suspected opioid overdose knows there is naloxone available in the community and calls for help.

 

  • RESPONSE DISPATCH
    A dispatcher receives the call from the witness requesting urgent naloxone delivery, enters the witness’ location into Beacon and sends it as an SMS text alert to all available community members equipped with naloxone.

 

  • COMMUNITY RESPONSE
    Community responders reply to the alert and Beacon determines the nearest and most appropriate resources and personnel to respond quickly. Responders get instructions to proceed to the incident location, with two or more dispatched for safety’s sake.

 

  • CONFIRM ON-SCENE
    Responders locate the victim and update the dispatcher through Beacon, ensuring accountability and maintaining open communications should more resources be needed.

 

  • NALOXONE ADMINISTRATION
    Responders determine if the scene is safe and then assess the patient for tell-tale opioid overdose symptoms. Naloxone is then administered to the victim. If the overdose is reversed, a life is saved. If there is no change in the victim’s condition, 9-1-1 is already en route.

 

  • INTERVENTION, TRANSPORT OR RELEASE
    Where available, responders are able to offer referral services, counseling or transport to an appropriate medical facility. Or, as is so often the case after EMS reverses an overdose, the survivor leaves on their own.

Our articles on community-based Overdose response

Uberdose: 911 for People Who Should Call for Help, But Won’t
Huffpost | Oct 09, 2015

“For as long as there have been efforts to equip police officers and public transit workers with naloxone to reverse opiate overdoses and resuscitate dying patients, it was almost a given that someone was eventually going to pipe up and say, ‘There should be an Uber for heroin overdoses.'”

Read more

Who Will Answer The 3 A.M. Overdose Wake-Up Call?
HuffPost | Nov 02, 2016

“As the death toll rises and the tragic loss of life continues to devastate families once kept at a safe distance from the grim reaches of heroin and opioid painkiller addiction, more and more politicians and public officials are finding themselves with fewer solutions to offer for a problem they weren’t ready, or willing, to deal with.”

Read more

The opioid epidemic requires American ingenuity, not Big Government
The Hill | Mar 03, 2017

“To defeat this epidemic, we must be willing, as a nation, to fully utilize life-saving treatments that can prevent overdoses and give victims a second chance at life and to overcome their battle with addiction.”

Read more

The Safety Risks for Good Samaritans Responding to Opioid Overdoses
Trek Medics Blog | Oct 15, 2019

We’ve been talking about community-based overdose response networks for a long time with public safety agencies and harm reduction groups. Both sides see the value of the progra, but each has their own concerns. Interestingly, they don’t share each other’s concerns.

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“Who’s Willing to Save A Life?”: Opioid Overdoses and the Challenges of Community Response
Trek Medics Blog | Nov 29, 2019

Community-based response networks could prevent fatal opioid overdoses. Included here are some of the common concerns raised and how we answer them.

Read more

Still Have Questions?

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