Narcan is a name that many people recognize. Anyone working in a medical field is likely to be intimately familiar. It is a brand name of the FDA-approved drug Naloxone, an “opioid antagonist” that works to quickly and safely reverse an overdose, though it does not work on other types of drugs such as methamphetamines or cocaine.
Although widely regarded in the medical field as a miraculously life-saving drug, it carries with it a heavy stigma, like most things related to opioids and substance-use disorder. Front-line workers and activists have been doing their best to dispel the cloud of misinformation and taboo that surrounds Narcan, including Tri-Town residents like Sienna Wurl and those professionally involved like Plymouth County Outreach certified recovery coach Haley Kennedy.
“The lie, ‘not in my backyard,’ is dead,” Kennedy stated. “Substance use occurs in every community, in all kinds of families, with all kinds of individuals of various backgrounds.”
Kennedy and Wurl spent four hours at the Mattapoisett Police Station on July 29, distributing Narcan and educating the public through conversation. “I really believe everybody should carry it. It should be part of a standard first-aid kit at this point,” Kennedy stated.
The prevailing portrait of an opioid user is not a flattering one. It conjures images of illegally bought street drugs, organized crime and violence. But that picture is at best incomplete and overwhelmingly inaccurate.
“The disease of addiction doesn’t discriminate,” said Kennedy, adding that accidents can happen anywhere to anyone, be it a stranger in a parking lot or a child who got into their grandparent’s pain medication. She emphasized that Narcan saves lives.
Wurl, a pharmacy student in her final year, was quick to agree.
“I’ve lived in Mattapoisett my whole life. I think that it’s time that we have this conversation just because we don’t want to have it, and (we want to) turn a blind eye doesn’t mean that people we know and we love aren’t silently struggling,” she said.
While there are numerous contributing factors, overdosing is a potential side effect of any opioid, explained Wurl, regardless of where it was obtained or an individual’s history of use. It is for this reason that Narcan is often provided to those prescribed opioids, even if only for short-term use.
There are multiple FDA-approved types of Naloxone detailed on the FDA’s website, including those administered via injection like the lesser-known brand ZIMHI, and nasal spray, the form that Narcan comes in, as well as Kloxxado and generic Naloxone.
“Narcan should be seen as a fire extinguisher,” Wurl said. “You have one in your house, and in your kitchen, just in case something happens. That doesn’t mean that you are necessarily going to use it, and you hope that you never do. But if you did have a fire in your kitchen, you’d be really, really happy that you have that extinguisher there.”
“It saves people. People. Not addicts, not all those other derogatory terms. It just saves lives,” Kennedy said.
The Good Samaritan law in Massachusetts protects those helping in the event of a suspected or actual drug overdose. Passed in 2012, it ensures that both the bystander calling for help and the individual experiencing an overdose are immune from arrest or legal prosecution. There are a few exceptions, including gross negligence and, as Kennedy phrased them, “the three W’s: warrants, weapons and weight.”
This means that if the individual has active warrants, illegal weapons, or possesses a quantity of drugs above a certain weight, enough to be classified by law enforcement as potential for “trafficking” rather than just personal use, the individual can be arrested and charged. The administration of Narcan comes with no such caveats.
“Narcan itself does not cause addiction. It will not have any side effects on someone who has not overdosed,” Wurl clarified. “So if you don’t have any opioids in your system, you’re not going to experience any side effects from the medication. So even if you see someone who has passed out, you don’t know what happened to them, administering Narcan is not going to hurt them. It would only help them if they do happen to be overdosing.”
Narcan is not the final step in responding to an overdose. The person still needs to seek medical treatment, as Narcan’s effects are temporary and might not outlast the opioids in their system. Several applications of Narcan, alongside other medical treatment, might be needed. Much like CPR or the EpiPen, Narcan is an emergency measure that helps stabilize someone for long enough to get them help.
“Narcan is a life-saving tool that allows people to live for long enough to seek support, treatment (and) recovery,” Kennedy explained. “No one who uses needs a ‘free pass.’ (They) do not need ‘permission.’ It’s just a fabricated idea. (Overdoses) are going to happen regardless. So having these tools for safety and to help support people until they’re able to find whatever their recovery looks like is the goal.”
Narcan is part of an approach called “harm reduction,” which groups, including Plymouth County Outreach employ. The National Harm Reduction Coalition’s website describes some aspects of harm reduction, such as group-therapy programs, needle exchanges and supervised-use sites and associated hotlines, so individuals do not resort to using alone and increasing the risk of a potentially lethal overdose.
“Someone who has overdosed can’t ‘Narcan’ themselves,” Kennedy stated.
Regardless of personal feelings about drug use, it is a part of the world we live in and a complex issue with no easy answer. Even the matter of scary-sounding Fentanyl isn’t black and white; the Mayo Clinic notes that Fentanyl is used to provide fast and effective pain relief in hospital settings, oftentimes before or after surgery. The problem arises when unregulated Fentanyl is distributed on the street, used to “cut” other drugs like cocaine or pressed into pills and sold as pharmacy-crafted products.
Kennedy noted that Narcan itself reacts differently to Fentanyl than other opioids. It will effectively reverse the overdose, but the lifespan is shorter when acting on Fentanyl than it is with other opioids. Still, Narcan saves lives.
“Even expired Narcan is better than no Narcan,” Kennedy stressed.
When faced with potential naysayers or community members whom would rather this all be left undiscussed, Wurl had a passionate rebuttal.
“No one chooses to struggle with substance-use disorder. It’s a disease just like anything else,” said Wurl. “No one wants to have high blood pressure, but it happens to people. So it is better to have the medication there and with you in order to save somebody else’s life. Because unfortunately, a lot of times the resources are not available to those struggling with substance-use disorder.
“Stigma is a huge barrier as well as shame and guilt, and if we continue to let the way that we perceive the world impede healthcare for those that need it, we’re never going to allow people to recover. And by continuing to believe that things can’t happen to us, can’t happen to our loved ones, can’t happen in our community, we’re just further impeding care for those people.”
Both Wurl and Kennedy repeatedly underscored the importance of education when dealing with the topic of drug use. Events like these and groups like Plymouth County Outreach, as well as the National Harm Reduction Coalition offer a number of opportunities for anyone of any background to learn more about the reality of substance use and how best to help, whether that be a heartfelt conversation with a loved one, a few hours volunteering at any number of harm reduction events, or simply picking up a box of free Narcan to keep with you for emergency use.
“I think educating yourself is the first step. In order to be empathetic, be a resource for others, you have to go into it with an open mind … and understand the world in a way that’s different than you might expect,” Wurl said. “I want my town to be a place where people are able to seek help if they need it, and I don’t want stigma to get in the way of that.”
By Jack MC Staier