Starting in January, a new law, SB450, will make it much easier for hospitals and doctor’s offices in Oregon to distribute naloxone, an opioid reversal medication.
The law exempts naloxone (brand name Narcan) from drug labeling, storing and record-keeping requirements, meaning doctor’s offices and hospitals can skip the paperwork and quickly give naloxone, in the form of a nasal spray, to patients.
“We can have it at bedside in the ER and the nurse can just hand it to the patient,” said Jason Whitley, the critical care clinical pharmacist for Adventist Health Columbia Gorge (formerly Mid-Columbia Medical Center).
Whitley helped create the law, with an eye to increasing naloxone access in the community. He wrote a legislation proposal last fall and sent it to Daniel Bonham of The Dalles, then a candidate for the Oregon Senate.
Once Bonham, a state representative at the time, won his Senate seat, he sponsored the legislation. Bonham could not be reached for comment.
“We’ve never had Narcan in PCP (primary care provider) offices because of the regulatory requirement from the Oregon Board of Pharmacy and Oregon Medical Board,” Whitley said. “Now, providers could actually have a basket or vending device of Narcan in their waiting room if they wanted it, and patients could take it. We will also be able to strategically place Narcan vending dispensing machines around the community.”
Opiate prescriptions can be high risk for people who are obese, have sleep apnea or respiratory disease, or if the dose is inappropriately too high, Whitley said.
Narcan supply could potentially be obtained through state programs or hospital community benefit funds.
Normal medication dispensing protocol — removed by this new law — requires a provider or pharmacist to prescribe it, a pharmacist to fill it, label it, and then counsel the patient.
The label requirement alone includes 13 pieces of information that are specific to the patient, and prescription records have to be kept for three years, Whitley said.
With overdoses increasing, largely due to the powerful synthetic opioid fentanyl, Whitley said naloxone should be so widely available that it’s standard in every First Aid kit and medicine cabinet.
When someone needs naloxone, they have already overdosed and are unresponsive and cannot give it to themselves. “It doesn’t necessarily need to go to the users, it’s better to go to their family members or loved ones because that’s who’s going to administer it,” he said.
Studies have shown naloxone is up to 95% effective at reversing overdose, he said. Also, it does no harm and has no side effects if given to a person who is not experiencing an opioid overdose.
The problem is access to the medication.
The federal government made naloxone an over-the-counter medicine earlier this year, but it has not been rolled out yet in retail settings. Several local programs, including YouthThink, the Wasco County Prevention program, provide free naloxone, but not everybody knows how to access it, Whitley said. For free naloxone, or to get a training on using it, call YouthThink at 541-506-2673, or visit their website.
Access to fentanyl, however, is easy.
“Fentanyl is way too easy and cheap to make, it’s not going anywhere,” he said. “It’s only getting worse. The best way to combat it is harm reduction, education at an early age, and lifesaving support through Narcan support.”
Fentanyl has been used in medicine since the 1960s as a powerful pain reliever. It first appeared in Oregon as an illicit street drug in 2019 and its prevalence has skyrocketed since.
Over the past couple of years, Whitley noticed an uptick in overdoses in the ER. He began focusing on the issue after responding as a critical care clinical pharmacist to yet another overdose one day.
“It really just kind of occupied me for a couple of days and I came to the conclusion, ‘What can I do to help?’ There’s obviously a problem in the community,” he said.
In March he testified before the Senate Healthcare Committee on the legislation he’d proposed. The legislation passed both the House and Senate with just one “No” vote. It was signed into law in July.
The new law will help quickly put naloxone in the hands of patients, especially those who immediately leave the hospital against medical advice after their overdose is reversed.
“You literally have five minutes to give it to them before they go out the door,” he said. That’s often not enough time.
He has chased people into the parking lot to give them naloxone to take with them.
These patients are either afraid the hospital will report them to police — which isn’t the hospital’s role, Whitley said — or they have such immediate intense withdrawal symptoms they leave to get more drugs to relieve those symptoms. Those withdrawal symptoms include severe anxiety, nausea, muscle pain and tremors.
People who leave the hospital against medical advice can either go back into withdrawal once the naloxone wears off (in about 20 minutes), or they go and immediately take more drugs, but because the naloxone is counteracting the opiate effects, they take more and more, and once the naloxone wears off, they are back into overdose, Whitley said.
The people seen in the ER for overdoses are “all ages. It’s intentional, it’s unintentional, it’s accidental. There’s a large spectrum of who an overdose patient is. It can be anyone from an illicit drug user to your grandma who had hip surgery and took too much pain medication,” Whitley said.
Whitley also sits on the Wasco County Overdose Prevention Task Force that meets at least monthly. This is a task force of 15-20 volunteers that range from social/addiction health specialists, to law enforcement, to EMS and others.
The message from Whitley and the task force is that “there are people in the community that care about those affected by the opiate pandemic and they are actively working on programs and solutions.”
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