School prepares for opioid overdoses

Ron Burtz
With 130 Americans dying every day from opioid overdoses and the country’s opioid crisis pushing even into rural areas like ours, the Custer School District is taking steps to protect students from death by overdose. 
At its October regular meeting, the school board gave second-reading approval to a policy that will allow the administration of opioid antagonists by specially-trained school staff to persons suffering the effects of an overdose. 
The purpose of this medication with the odd-sounding name of opioid antagonist is to counteract the effects of the drug — chiefly the slowed heart rate and respiration — and get the victim breathing again. 
Hapsie Nutley has been an emergency medical technician (EMT) with the Custer Ambulance Service for the past 17 years and has had to administer Narcan, the most commonly used opioid antagonist, three times in her career. 
She explains the science behind the drug this way: “Basically you have opioid receptors in the body. What Narcan does is, it comes in, bumps off the opiate and then takes its place on the receptor site and then blocks it from coming back and sitting back on that receptor site.” 
In layman’s terms, that means Narcan counteracts the effects of the opioid and then blocks it for about 90 minutes. 
Nutley says Narcan can save the life of a person who has overdosed on opioids like heroin, hydrocodone, oxycontin, morphine, oxycodone (aka Percocet) and the increasingly common illicitly manufactured synthetic opioid fentanyl.  
She says the drug can be administered either through a one-dose nasal spray or by injecting it into an IV. It is most commonly used on patients who are unconscious and unresponsive with breathing rates that are slow or nonexistent. EMTs look for telltale “pinpoint pupils” and also  for signs that the patient has been using either prescription or illegal drugs. However, she says the medication won’t work on meth or other non-opioid drugs. 
“It works to restore the breathing drive so they can breathe again on their own,” said Nutley. 
Once administered, Narcan can take anywhere from 30 seconds to three minutes to take effect, but when it does, the revival can be dramatic...and even violent.  
“Sometimes they come out of it on the fight,” said Nutley. “Because they haven’t been breathing very well, their brain is deprived of oxygen and some of that fight is from that lack of oxygen. Maybe they remember where they’re at, but then all of a sudden you’ve got five people around you instead the two that were there, but the two that were there took off.” 
Custer school resource officer Deputy Matt Tramp, who has had two experiences with administering Narcan — once as an EMT in Hot Springs and another time with other deputies on a drug overdose in Hermosa — agrees with Nutley’s description of those coming out of an overdose.
“You wake up with strangers standing over you in your own house,” he says in explanation of the patients’ panicked reactions.  
Tramp says the increase in overdoses among drug abusers can be at least partially explained by the tendency of illicit drug dealers to lace drugs like marijuana and meth with fentanyl to increase the high. 
Because of that and the potential for an accidental exposure to opioids leading to a medical emergency for a law enforcement officer, Tramp says every Custer County deputy now carries a dose of Narcan in his vest. 
Tramp says he knows of police officers in other states who have been exposed to high doses of drugs while conducting a search, either by breathing in the substance or by contact through an opening in the skin. In those cases, a dose of Narcan potentially saved the life of the officers. 
But it is not just users of illegal drugs and law enforcement officers who can be victims of overdose. For instance, Nutley says sometimes those who have been prescribed an opioid can take the wrong dose, leading to a dangerous situation. 
Nutley gives the example of an elderly patient who has a compression back fracture: “Doc gives them a small dose of hydrocodone because they’re in a lot of pain and, because of their age and their underlying medical conditions, that very small dose could be too much.”
But why is there a need for ready doses of Narcan at the other end of the age spectrum — in our schools? 
“It’s important,” says Tramp, “because even though we haven’t really seen the major effects of the epidemic here, we are seeing parts of it.  Places as close as Rapid City are starting to see the effects of the opioid epidemic. It’s only a matter of time before we start seeing more. Better to take a proactive approach. We’d be foolish to think it doesn’t effect our youth.”
As a deputy, Tramp keeps Narcan in his uniform vest, but doesn’t aways have it immediately at hand at school. So, in addition to the school nurse keeping a dose on hand, Tramp says several other school staff members will be trained to administer the drug and a dose will be kept locked in the school office. 
Incidentally, there is virtually no concern related to administering Narcan to a person who does not need it because it has no known side effects and essentially has no effect on a person who has not taken opioids. 
While Narcan is not cheap — a pack of two doses costs around $180 — with more than 47,000 Americans dying as a result of an opioid overdose in 2017, the price of not having it on hand when needed is even higher. 

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