The sun was scorching on the afternoon of May 6, when a small crowd gathered in the shade of an awning outside Moab Regional Hospital to learn more about naloxone, a drug that can reverse the effects of an opioid overdose. About a dozen people attended the first of three sessions facilitated by staff from the hospital and from Utah Support Advocates for Recovery Awareness, a statewide nonprofit dedicated to helping those with addiction. Participants received boxes of Narcan, a brand-name of naloxone, and separated into small groups where facilitators explained the signs of an opioid overdose and how to administer the nasal spray naloxone dose and answered questions.
“Does it degrade in the heat?” one participant asked. “Can I keep it in my car in the summer?”
The drug’s packaging directs that it be stored below 77 degrees fahrenheit, but Dr. Lauren Prest said she keeps a dose in her car so she has it just in case—even if it doesn’t work as well as it could, it’s better than not having it when you need it, she said.
Prest is MRH’s medical director of health and recovery services, and she has been promoting awareness of the widespread use of opioids, and particularly the rise in use of the powerful synthetic opioid fentanyl. [See “Raising awareness of fentanyl in our community,” April 21 edition. -ed.]
Fentanyl was developed in the 1960s as a potent pain medication. It is said to be 50 times more powerful than heroin and 100 times more potent than morphine, other opioids that have similar effects on the brain. Manufacturers and dealers of illegal drugs have found that producing fentanyl is cheaper than producing other drugs like heroin or oxycodone; law enforcement and health officials nationwide have been observing that many drugs obtained illegally, including methamphetamines and marajuana, have actually been laced or cut with fentanyl. Often, users aren’t aware that they’re taking fentanyl.
That can be extremely dangerous, especially for someone who is “opioid naive,” meaning they don’t have any developed tolerance for opioids. A dose as small as 2 mg of fentanyl is enough to be lethal; in other words, an amount equal to that found in a single-serving packet of Splenda could be 500 lethal doses.
Facilitators at the workshop also distributed simple test kits that can reveal whether a substance contains fentanyl. Prest said she’s seen patients who think they’re taking oxycodone, but a test indicates fentanyl is present in what they believe to be Percocet pills. Drugs obtained from a regulated pharmacy or dispensary can be considered to be the substance they are labeled as being, but drugs purchased on the internet or from an unregulated source are suspect.
Naloxone works by removing opioid molecules from receptors where they’ve attached to the brain. Because fentanyl is so powerful, Prest said, it may be necessary to use more than one dose of naloxone to reverse an overdose.
“I’ve seen five or six doses used before getting a response,” said Prest. An additional dose may be needed over time, as well. Naloxone can clear the system in 30 to 90 minutes, depending on the person, and that might not be long enough to keep the opioid molecules from returning to brain receptors and causing an overdose. Anyone thought to have potentially overdosed on opioids should seek professional medical attention as soon as possible, even after taking naloxone.
“I’ve had patients still die because they didn’t come in [to the hospital] and they went back to sleep after the Narcan,” said Prest.
She warned that the experience of having opioid molecules “kicked off” brain receptors is very unpleasant; it’s like experiencing withdrawal. Someone reviving after a naloxone dose might be angry, she said, even though the dose could have just saved their life.
Fentanyl panel discussion
On May 4, ahead of the in-person naloxone training, MRH hosted a panel discussion on Facebook Live about the rise in and dangers of fentanyl use. Prest was joined by Jay Tinkler, special agent in charge of the Utah District Office of the Drug Enforcement Administration, and Debbie Marvidikis, health promotion director for the Southeast Utah Health Department.
“The impetus for tonight’s presentation is based on a noted rise in fentanyl use, particularly among our city’s youth,” said Prest in introducing the panel. “As fentanyl is known to be the leading cause for opioid overdose and death, we hope to offer more details to you all about what fentanyl is and how you may interact with it in a safer way.”
Tinkler described how fentanyl in powder form is indistinguishable by sight from other opioids like heroin, and how it may be deliberately disguised as a familiar prescription drug like Percocet pills. He also described its effects:
“It basically works on the brain the same way other opioids do: it creates that sense of euphoria, that relaxation, that sedation—one of the dangers of it is, it also causes respiratory depression, so that’s what we see with a lot of folks that overdose.” Too much of the drug will cause a person to stop breathing. One of the signs of an overdose discussed at the naloxone workshop is gurgling, snorting, or snoring—those may be indicators that a person is struggling to breathe.
These workshops and discussions on fentanyl are part of an effort by MRH and community partners to expand mental health and addiction treatment services, a field that was recognized as a community need in both the 2016 and 2019 community needs assessments conducted by the hospital. The hiring of Prest in 2019 was part of an effort to meet that need; an ongoing, broad expansion of hospital services will include a new building to house out-patient treatment services for patients with substance abuse disorders.
Advocates for addiction treatment emphasize the importance of removing the stigma associated with addiction.
In 2020, the SEUHD created a harm reduction program called the Southeast Disease Prevention Coalition, which offers access to clean syringes and provides recovery and testing services. Marvidikis said the program also works to help destigmatize discussions of addiction and recovery.
“I think what we do for people who aren’t ready for change is we meet them where they are and help them with the change that they’re comfortable with,” said Prest during the Facebook discussion.
That philosophy is shared by USARA, who welcomes anyone dealing with addiction without a requirement that they stop using before coming for support.
“We meet people where they are,” agreed USARA Executive Director Mary Jo McMillen at the May 6 workshop.
Other service organizations in the community partner with the hospital and agencies like USARA to help their clients. Several staff members from the Moab Valley Multicultural Center attended the May 4 workshop, even though that organization doesn’t specifically address substance abuse in its mission. For many clients, issues with housing or employment are entwined with substance use issues, and MVMC staff regularly refer clients to services offered by other agencies.
“A lot comes up in our intake interviews,” noted Liz Donkersloot, housing coordinator for the MVMC, while attending the naloxone workshop.
Opioid use has long been a problem throughout the nation and throughout Utah. In 2017, the Utah Department of Health launched a “Stop the Opidemic” campaign in response to a dramatic rise in opioid overdose deaths in the state in the mid 2010s. In 2018, Grand County was one of many municipalities across the nation to bring a lawsuit against pharmaceutical companies who manufactured prescription opioids and marketed them as safe. Opioid overdoses have declined in Utah since a mid-decade spike, but during the pandemic, opioid use appeared to be on the rise again. This past winter, police apprehended a man on Highway 191 who was found to have hundreds of pills made to look like prescription oxycodone, but which actually contained fentanyl.
Prest said that in the last two years, she’s noticed an uptick in patients using fentanyl; Tinkler noted in the panel discussion that fentanyl has long been prevalent in large cities on the coasts of the United States, but more recently its use has been spreading to the interior of the country to places like Utah.
For anyone looking for help with substance abuse for themselves or a family member or friend, various local agencies offer resources. Moab Regional Hospital and the Southeast Utah Health Department offer free naloxone kits; contact MRH addiction treatment services at 435-719-5585 or, for the SEUHD, Opioid Prevention Specialist Michelle Ward at 435-637-3671. The USARA phone number is 435-210-0952. Other resources include Narcotics Anonymous (877-479-6262) and Four Corners Community Behavioral Health (435-259-6131). Utahnaloxone.org is an online resource for more information about opioids and overdose prevention, as well as a source for naloxone kits.