When the Erie County Health Department started training civilians several weeks ago to use Narcan, the antidote for opiate overdoses, a local woman signed up for the course.
“I took the Narcan training in Cheektowaga because my son is a heroin addict,” she wrote in an email to Cheryll Moore, a county Health Department medical care administrator who teaches the classes.
“I only went to make myself feel better, but never thought I would have to use it.”
But “Never came fast.”
Just a few weeks later, she used her training and the Narcan kit to save her son’s life.
The county program for civilians provides training and Narcan to anybody, no questioned asked.
It follows a program that trained and equipped 2,000 local police officers and firefighters with the antidote to treat people dying from opiate overdoses.
Still, in a single week last month, 13 people in Erie County died of opiate overdoses.
As a result, the effort to get Narcan kits into people’s hands was opened to the community.
About 500 community members, ranging from medical workers to concerned parents, now have completed the two-hour training classes and received a free kit containing two doses of Narcan, a medication squirted in the nose that reverses the effects of an opiate overdose.
Narcan will save heroin addicts, toddlers who got into some medication or confused seniors who took too many pain pills.
“A community-wide issue such as this demands a community-wide response, and it is essential to put life-saving tools and skills into the hands of the people who will need them,” County Executive Mark C. Poloncarz said in a statement.
This collaborative effort involves the county Health Department, Buffalo Police, Horizon Health Services and Evergreen Health Services. Funding for the Narcan kits comes from several state programs, including one that uses proceeds seized from drug dealers. The free classes, which will run through October, put Erie County in the forefront of counties across the state in educating the public.
“In Erie County, we have really taken the bull by the horns,” said Moore, who teaches the classes with Captain Patrick Mann of the Buffalo Police Department.
By the end of April, agencies across the state had trained more than 55,000 community members and first responders to deliver Narcan, and more than 1,500 lives had been saved as a result, according to the state Office of Alcoholism and Substance Abuse Services.
The approach to the problem in Erie County is widespread because opiates — from heroin and morphine to OxyContin, Vicodin, Lortab and Percocet — are everywhere.
“Have you had surgery, been prescribed Lortab or Hydrocodone and not used all the pills?” Moore asked community members during a class held earlier this month.
Most people nodded.
The powerful painkillers in medicine cabinets can kill if they are ingested accidentally. But the more pressing problem is that of heroin use by someone who became addicted to prescription meds and could no longer get them after the state’s I-STOP prescription monitoring program took effect in August 2013.
Heroin use by people who became addicted to prescription pain pills they can no longer get “is a problem of people with means, with good health insurance,” Moore said. “Medicaid and public insurances have always had controls on their systems; private insurances were like a free-for all.”
Heroin addicts today “are not who we used to think of — a homeless person behind a Dumpster in a dark alley,” she said. “Heroin addiction is a problem of people who work, middle-class, upper middle class, upper class.”
Before I-STOP, people addicted to prescription drugs could doctor-shop for multiple prescriptions or pay cash for pills, bypassing insurance controls. Now doctors and pharmacists are mandated to sign onto I-STOP, which tracks users individually rather than by a doctor or insurance, so fewer pills are available by prescription.
Mann said that a single prescription opiate pill now costs $70 to $80 on the street, as opposed to $5 for heroin, and that is “if a pill is even available.”
The county’s aggressive move to get Narcan distributed in the community is not a response to the deaths of more affluent people, Moore said. “It’s not that the problem has become significant now because it has moved into the suburbs, but because it has become so widespread,” she said.
Moore and Mann and agency partners who assist with the training classes get glimpses of some of the tragedies of drug addiction.
One woman at a recent class asked what street drug might be wrapped in bits of aluminum foil she is finding in her bathroom.
In another class, a woman — “nicely dressed, with a chic haircut, it looked like she was with her daughter” — wept silently during the entire session, said Mary C. St. Mary, county Health Department public information officer.
The classes are designed for Erie County residents, but other than basic information for registration purposes, no one is asked why they are attending.
“As fast as we open the classes, they fill,” Moore said.
Addiction to opiates is fierce. People who are physically dependent on opiates, Moore said, need them “just to feel like they haven’t been hit by a train."
“They just want to be able to go to work and function normally,” she said. “They are going to work every day, they are doing the same things you and I do every day, they are trying to not feel like they are dying when they wake up.”
The overdose hazard arises when a heroin user buys a batch that is stronger than expected or cut with fentanyl, a powerful anesthetic and narcotic.
“There is no FDA inspecting these street drugs,” said Moore, “and the dealers do not have their best interests at heart.”
Fentanyl-laced heroin can be strong, Mann said,
“It can take up to five kits of Narcan to bring somebody out of an overdose,” he said.
Last year, 116 people died in Erie County of opiate overdoses, Moore said. That was up from 101 in 2013 and 103 in 2012.
In the first three months of this year, 39 people have died of suspected opiate overdoses, and the number will certainly climb as toxicology screening tests are completed.
“This year, we are on track to double this, at the rate we are going,” Moore said.
Of those who died, 49 percent died in Buffalo.
“That’s not necessarily where they lived, but that is where they died,” Moore said, including some who entered the city to buy drugs and used them in their cars before returning home. The suburbs, from Amherst to West Seneca, had 37.9 percent of the deaths, and rural areas, from Akron to Springville, accounted for 12.9 percent of the deaths.
People who attend the class learn to identify a possible opiate overdose in an unconscious person. Their first step is to call 911. But in rural areas, first responders may be too far away to save a person whose breathing and heartbeat are close to stopping, Moore said.
Narcan does not have any adverse effects if it is given to somebody who is not suffering from an opiate overdose, Moore said, “just a wet nose.”
Narcan kits may be sold over the counter soon, and can cost from $60 to $78. The state supplies the kits that are distributed here, some purchased with money confiscated from drug dealers through a program operated by the state Attorney General, some with state Health Department funds.
Narcan is not a long-term solution to the problem of addiction, Moore said.
“This is not the savior,” she said. “This is just a stopgap method to keep people alive and get them into treatment, or they would be dead.”
Sign up for Narcan training
The courses will be held through October from 6 to 8 p.m. on the first Wednesday of each month and from 9 to 11 a.m. on the first Thursday of each month at the Erie County Fire Training Academy, 3359 Broadway, Cheektowaga.
To sign up for the overdose prevention training class, go to http://www2.erie.gov/health and click the link on the right side of the page for Free Community Trainings in Opioid Overdose Recognition. Those without online access may call 858-7695.
Both Horizon Health Services and the county will do the training and distribute Narcan kits to community groups in workplaces, churches or other gatherings, said Moore. To set up a presentation, call Moore at 858-7695 or email her at Cheryll.firstname.lastname@example.org.