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 connect potential responders to overdose victims in time to 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
Why 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 or 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.,
- Non-medical professionals can be trained to recognize factors besides opioid overdose at an incident, prompting calls to 9-1-1 or medical professionals.
 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.  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.
HOW IT WORKS
COMMUNITY-BASED OVERDOSE RESPONSE NETWORKS
1. POTENTIAL OVERDOSE
A witness to a suspected opioid overdose knows there is naloxone available in the community – but does not have it personally, cannot determine if the situation is safe or is hesitant to call 9-1-1. Good Samaritan laws and 9-1-1 immunity protocols are not enough to convince them. But the local public health department has a hotline for anonymous overdose reporting.
2. EMERGENCY ALERT
A dispatcher for the hotline receives the call from the witness requesting urgent naloxone delivery. The dispatcher enters the witness’ location into Beacon and sends it as an SMS text alert to all available community members equipped with naloxone.
3. COMMUNITY RESPONSE
Potential responders reply while 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.
4. CONFIRM ON-SCENE
Responders locate the victim and update the dispatcher through Beacon, ensuring accountability and maintaining open communications should more resources be needed.
5. ADMINISTER NALOXONE
Responders determine if the scene is safe and the symptoms resemble an opioid overdose. Naloxone is then administered to the victim. If there is no change in the victim’s condition, responders report that other factors are involved and call 9-1-1 for a conventional response to an unresponsive patient.
6. TRANSPORT, RELEASE, AND INTERVENTION
If the patient is resuscitated with naloxone, responders draw on their training and local knowledge to suggest referral services, counseling or transport to an appropriate medical facility. Beacon receives the outcome from responders, who respect the safety and wishes of the patients as well as the need for their own safety.
Articles we’ve written on community-based overdose response