Countermeasures Season 1 Episode 1 Podcast Transcript: Responding to Opioid Overdose Emergencies
Narration [00:00:02] This is Countermeasures, brought to you by Emergent, maker of NARCAN® Nasal Spray.
Join us as we explore the shifting, complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance, and offer a way forward to a better future.
Across the country, Americans from all walks of life have been impacted by the opioid epidemic. For Crystal, a mom from Missouri, the epidemic hit home the night her teenage son overdosed on her front lawn. The incident was recorded by the family’s Ring camera, and Crystal uploaded the video to social media to help raise awareness about accidental overdose. She has since become an advocate in her community for education about the dangers of accidental overdose, and the importance of carrying Naloxone, an opioid antagonist that can rapidly reverse an opioid overdose.
Crystal [00:01:12]: The night that the video was taken, I had let my 16-year-old go out with a friend who I typically hadn’t let him be around. he had gotten in some trouble with him, but they had recently had a friend overdose and die, on Fentanyl. I had seen that child at the funeral and I, I thought these boys seeing their friend in a box, that they would learn. I really trusted him after that because he did. I mean, he looked me in the eyes and he said, never again. And I believed that, and I allowed him to hang out with that friend.
The next thing I knew was I heard the dog bark, and our dog never barks at night, rarely barks at all. Um, and so I kind of woke up a little bit, but enough to see my phone flashing because it was giving an alert, I thought that that was odd. And so, I grabbed my phone, and it was the ring doorbell and I brought the live feed up and all I saw was our front yard, but I knew that the dog had barked, so I thought, I’ll watch for another couple seconds. And the next thing I knew, I saw my son being carried by a friend to my front door.
Narration [00:02:55]: EMS arrived, and Crystal’s son’s life was saved by Naloxone and the provision of emergency medical care. Afterwards, he went to rehab in order to start his journey to recovery. A journey he is still on today.
Crystal [00:03:10]: So it was, it was hard for both of us, obviously. We had never been apart like that. He came home, and he seemed to have his head on a little bit straighter, and we decided that we were gonna work on his mental health and we would think about school when we needed to. And, um just really focus on getting him healthy.
Well, after eight months, he relapsed and I came home to him slipping in and out of, you know, consciousness. And thank God for the education I had gotten because I was able to administer the Naloxone myself, and get him to the hospital myself this time. As a mother that breaks your heart. I was mad, and I was sad, and I still am…disappointed. There was a lot. It’s, there’s a lot of guilt too, a lot of emotions that go with all this. And there’s no rule book for how to, you know, get your kid healthy from something that’s so addictive. He did go back to rehab. This time on the other, on the other side of the state. So there, my kid is gone again. He was gone for another 60 days. He came home, and it wasn’t even a week, and I found some things and he’s currently in rehab again.
Narration [00:05:13]: In this episode, we explore accidental overdose – the signs and symptoms, and how Naloxone works to reverse an overdose. We’ll speak to some of the advocates and professionals working to ensure the public knows the importance of carrying Naloxone, and how and when to use it.
Overdose deaths – the majority of which involve opioids – continues to be one of the leading causes of injury-related death in the United States.
Last year, approximately every seven minutes one life was lost due to an opioid overdose…that equates to more than 200 fatal overdoses every day, each with its own emotional toll.
The opioid crisis does not discriminate, and can affect anyone, no matter their age, sex, race, or socioeconomic background.
Dr. Bonnie Milas [00:06:05]: So, what happens during a drug overdose? And it’s important to recognize that nearly all of these overdoses involve an opioid. What’s happening is first the individual becomes unconscious, they fall asleep. If they’re discovered, you cannot wake them up. But then the other effect of the opioid on the brain, besides causing them to be overly sedated is that their breathing slows.
Eventually their breathing will stop, and at that point, the brain is no longer getting oxygen, and the brain is critically dependent on oxygen for survival. And once you get over five minutes of not having oxygen to the brain, then brain injury can occur. But in that process, the heart is no longer getting oxygen either.
So, the heart will eventually slow and stop as well. And that’s what happens. That’s the sequence of events when someone suffers a drug overdose. So, the sooner that we intervene the individual is just falling unconscious, and their breathing is just starting to slow…that’s the point at which it’s critical that we intervene.
Of course, you can intervene at any point, but if we can intervene at that point, at its earliest, then that’s how we can prevent either permanent brain injury and or death. But it’s most important to understand that this is not a cardiac, a primary cardiac event. This is not a primary cardiac arrest.
Instead, this is a primary respiratory arrest. It’s the breathing that stops first, and then eventually, if no one intervenes, then that’s how the heart eventually stops. So, it’s important for the public to recognize that it’s not the same, and you do have the opportunity to save them from dying.
Narration [00:08:01]: The voice you just heard belongs to Dr. Bonnie Milas, a Penn Medicine physician, and Professor of Clinical Anesthesiology and Critical Care. Dr. Milas has both professional and personal ties to the Opioid Epidemic. As an anesthesiologist, she handles opioids every day as part of her work. She has also tragically lost two sons to accidental overdose.
A large part of the work Dr. Milas does is to educate the public on the importance of carrying Naloxone, whether someone you know is at risk of accidental overdose, or if you think you’d never have to use it.
Dr. Bonnie Milas [00:08:39]: Things that the public can do to intervene in an overdose situation would be to educate themselves first and foremost. So, there are many sites that you can turn to to seek out that information. Namely, I have, through my professional society, I have spearheaded the REVIVEme.com campaign.
That is a website that is rich with content, and in fact, if you’re someone who needs to be convinced as to why you need to be ready in the home or in a public space with Naloxone, there is a, It’s kind of like a, uh, TED style talk where I try to convince people of the urgency that I have felt in the home because I have had on occasion in the home to have to rescue one of my sons. On a number of occasions. I have the skillset, but not everyone has that skillset. So, if you go to the REVIVEme.com website, it teaches you and implores you to be ready. And it also has links to where you can find Naloxone. It also talks about the importance of rescue breathing and maybe even the need for full on chest compressions or CPR, so that’s just one site that you can go to.
The American Heart Association has a very nice opioid educational component as well, and in fact, the ASA and the American Heart Association we have a very close relationship. We have a joint statement essentially saying how important it is for the public to be educated and to intervene. And if you need CPR basic life support training, you can go to the American Red Cross and get that type of training as well. So those are just three websites that can be used for the public to become educated, to really know what to look for.
So, things that I’m doing out in the public space is, first of all, I certainly do go out and talk to other physicians. I try to stimulate interest in my, not only my own professional society, but I’ve also spoken to family practitioners, pediatricians, about what we can do to really stem the tide of loss of life due to drug overdose.
In addition, I also go out and talk to community groups. I work locally with my county health department and we teach people the very basics of what do you look for, calling 911, having a Naloxone product immediately on hand. And then basically, how do you rescue, what is the importance of that? And then where do you put your hands to intervene, If you really don’t want to rescue, breathe, if you don’t know the individual and you’re only willing to do hands only CPR.
Narration [00:11:55]: Gay Owens, Senior Director, Global Medical Affairs at Emergent, has spent her career studying opioid antidotes – she knows the importance and impact of Naloxone becoming available over-the-counter for expanded community use.
Gay Owens [00:12:11]: So, what I think is the biggest benefit to now having community-based Naloxone available in a retail setting is really for everyone to understand where there’s a risk of having an opioid…someone experiencing an opioid overdose. And that really has, unfortunately, in this opioid epidemic, really broadened, um, one from initially when the epidemic started from a prescription problem to now an illicit fentanyl, or adulterated drug problem.
And so that now the epidemic numbers have continued to rise, and so having something available to the broader consumer and community use will allow someone to understand and recognize signs and symptoms of an opioid overdose, and now be able to actually have something to take action.
So, a couple of things I think are needed in this environment in order for folks to understand where and when are the signs and symptoms of an opioid overdose, how to recognize them if you come upon someone who may have experienced an opioid overdose.
And now, how to understand that there is a product available that could be utilized to potentially save a life. And as I mentioned, utilizing our human factor studies, understanding that a consumer could go in and be able to pick up this product, potentially have it in their home, have it on them available in order to save a life.
It’s now really more critical than ever that people have something at the time, or when they witness a potential opioid overdose. Timing is critical, hence why we now have something available to a broader consumer group to make it more accessible.
Dr. Bonnie Milas [00:13:53]: The significance of having Naloxone over the counter…I had already mentioned it’s easy access, but the other thing in terms of stimulating conversation, I think most people think of, first of all, of having a substance use disorder as being something that, well, they made a conscious choice to take that drug.
Even at an initial stage, early on, early age, and that you willingly made that choice and therefore you can willingly stop anytime you want. Well, if you are knowledgeable about addiction and how that occurs, you would clearly understand that, we all make decisions and we may try something or do something, but very few of those decisions, especially at an early age, are something that ultimately you cannot undo.
With the understanding of addiction, and with the way the brain receptors get reset, that they reset, in a manner in which the brain is constantly chemically imploring the individual to use. So, they’re constantly getting that messaging, and if they stop that, they are going to have a sickness, they’re gonna have withdrawal symptoms.
So, you know, having the drug over the counter should stimulate discussions about addiction and about that mechanism. And I think too, that if we see people picking up Naloxone, and people are talking about it, that the image that we have of what a drug dependent individual, what they look like will also change.
Because what is often portrayed in the media are pictures of, you know, I live in the Philadelphia area, so they’re pictures of Kensington…there are pictures of individuals who live in the Tenderloin area in California, and it’s an image of someone who is dipping out, falling asleep. Their pants are halfway down, or their dresses halfway up around their neck, and they’re urinating and defecating in public and they have a needle in their arm, and that’s the image that many people in the public have of this is a picture of what a drug addict looks like.
Well, I can tell you that most individuals don’t look like that. And I know that my children, you would’ve looked at them, you would’ve met them, and you would have never guessed what they were struggling with.
Highly educated, successful, and in fact, you may be working with somebody in your office space that is using on a daily basis, but you don’t know that.
Narration [00:17:08]: Gay further emphasizes the importance of carrying Naloxone
Gay Owens [00:17:12]: When you look at this from your own personal perspective, there are many variables that could potentially predispose someone to an opioid overdose, and those, some of those factors you may not know. So risk of having opioids, taking them either illicit or illicitly, but now as I mentioned, exposure to adulterated drug substances has really been what’s driving the opioid epidemic.
So, you may not even know that someone’s at risk for an overdose. You may be in a situation where you’re not sure of what someone’s taken, and now as I mentioned, timing is critical. So now you have access to a product that you can utilize, but essentially an opioid overdose can occur at, you know, to no fault of one’s own doing.
Where they may not even be aware, they’re exposed to this and yet their breathing has slowed, and now you have access to a product that could restore their breathing. Regardless of whether it’s in your home at an event, riding transportation. There are many scenarios where you may not know, and most likely you won’t know what someone’s taken, but now you have an ability to take some action that could potentially save their life.
Narration [00:18:31]: But what can you do if you see someone you suspect is having an overdose, and how can you identify the signs?
Dr. Bonnie Milas [00:18:40]: So, some of the signs that you would look for, say for instance, you are on public transportation…someone appears to be sleeping, but you notice that maybe their position is a little bit off, they’ve fallen forward where, um, anyone who’s not impaired, they might catch themselves. So, you see their positioning’s not quite right. Something about that doesn’t look right.
Or maybe you see paraphernalia around that individual, but you might go over and see if you can wake them up. And you try to rouse them or shake them gently and say, “Hey sir, miss, are you okay?” And if it seems as though you cannot get them to respond to you, and if there’s also maybe nobody else around them that you can ask their circumstance, you know, did this person recently use, do they, do they use substances?
From that point on, if you cannot wake them up, you would certainly want to call 911 at that point. Now, after that, you can also look at signs on the individual or about the individual. So if their pupils are pinpoint, see if they are breathing to see if their chest is rising and falling.
Well, certainly if they are not breathing or if they’re breathing less than eight times per minute, then you know that something is clearly wrong. Their pupils are pinpoint, we’ve already mentioned their fingertips are blue or their lips are blue. And then you could say, well, even in the absence of, I don’t know, there’s no paraphernalia around the individual. I don’t know much, but that’s enough to get you to think that this is probably a drug overdose.
Since I carry Naloxone, I would administer that nasal spray and if they are still breathing, I would potentially turn them on their side and I would stay with them until trained help arrives. If they are not breathing, if this is someone I know and somebody that I feel comfortable rescue breathing, then I would give two breaths and then a breath every five seconds.
And if I didn’t know this individual and it was a situation where they were on the train and I didn’t have any protective mechanism, like a face mask where I could protect myself against the individual, then I might only do hands-only CPR. But those are kind of the basics.I have enough information there to tell me this is probably a drug overdose.
Narration [00:21:21]: When it comes to reducing the number of deaths from accidental overdose, stigma remains a major barrier. Conversations about accidental overdose and opioid use are still considered taboo in many circles. Breaking the silence and stigma is critical as we continue to fight against the opioid crisis.
Gay Owens [00:21:40]: So, stigma I feel, has played a big role with where we are with Naloxone education awareness, and now, distribution, or having folks have access to the product. So, stigma, again is this crisis initially started was around prescription opioids and those using prescription opioids as unintended potentially, or misuse and abuse of prescription opioids.
That market then shifted to more one of heroin. And then now if you look at the waves of the epidemic, it’s illicit manufactured fentanyl, as well as adulterated drug substances. And so I think stigma along the way… the data lags behind, we’ve always been looking at this product, or naloxone, as a potential for those with substance use disorders or opioid use disorders. We haven’t, again, normalized this to anyone in any situation could actually come across someone experiencing an opioid overdose.
Again, unintentional, these are not intended opioid overdoses. And so now unfortunately, folks are being exposed to products that may not even be aware of because of the adulterated drug supply. And so, I think stigma really needs to be addressed. And now with potentially having, or now that we’ll have an OTC product, we can actually educate a broader consumer group on who could be, um, who has the potential to save a life, but who could potentially suffer an opioid overdose and what those signs and symptoms look like.
And again, now with a broader distribution of Naloxone, we hope to have enough to avert, start to avert opioid overdose deaths from occurring.
Narration [00:23:15]: After posting her video on TikTok, Crystal saw firsthand the power of speaking up and breaking the silence on how the opioid epidemic envelops families and communities like hers.
Crystal [00:23:27]: Because awareness is the only way we are going to even get a handle on this. My son didn’t have time. His friend didn’t have time. You know, if, if we do not get a handle on this, I’m gonna have more friends lose children. The more that it gets out there, the more chance a mother knows what to do if that were to happen to her kid.
I can’t urge enough. You, you have to have it on you ,and you have to know how to use it. It is very important. It’s just as important as you know, talking about other things that you talk to your teenagers about. Your kids need to know about this. I even know some of my teenage family members, who are carryingNaloxone because better safe than sorry.
You know, and I want to bring awareness. I can’t get sober for my son, but I can share the video that literally makes you feel something inside when you are watching what happened to my kid and put that on a mom’s heart.
You know, one thing is, is that when you, when you are big on social media, which I am not, that is the only video that has gotten that many video or views, um, I feel like you can get negative comments on anything that you could say, you could say “this cat is cute”, and somebody will have the nerve to say “No, it’s not.” I’ve had nothing but great. Comments, of people are sharing their sobriety number of years. Moms who said, “I’m going to show this to my kid when they get home from school.”
Just wonderful comments. Andt hat shows me that the reason for me putting it out is working because that’s all I want. I feel like if it’s kept quiet, it’s gonna hurt more people. So I say, say it loud and, and be truthful.
Narration [00:25:36]: Dr Milas, Gay and Crystal are all outspoken about the importance of openness, awareness and education when it comes to accidental overdose.
Dr. Bonnie Milas [00:25:48]: Reasons why people might think that, well, I don’t really need this drug. I, I hear a lot of times because someone might say to me, well, “I don’t have that problem in my family,” or “not my kid.” But what they are failing to recognize is that many people experiment, and they try a substance for many different reasons.
And if they are inexperienced, and they’re not tolerant, then it could be a first time that someone tries a substance that they would indeed overdose. So, you might think that I don’t need this in my home, but in fact, you very well may and it’s too late. Once you discover your adolescent, or your family member down to say, oh, I guess I really did need that.
It’s emergency protection that every home should have. So, if you either have someone in your home that has a substance use disorder, you have opioids in your home, or if you have anyone who may try a substance, then it is probably in your best interest and theirs, particularly in their best interest, for you to have that immediately available.
I think if anyone is listening to me and you’ve heard what I have to say, that that in and of itself should be enough to stimulate you to go out and pick up the medication. It’s too late when you’ve already discovered the actual circumstance right in front of you.
Now, why would you want to necessarily carry it in public?
I would tell anyone that having Naloxone on you is essentially a sign that I care about members of my community, I care about my neighbors. I care enough that I went out and I obtained this medication. I have it on me. I have it with me, and I am willing and ready to respond.
I consider this to be a sign of good citizenship, to have this available and to be willing and able to respond.
Narration [00:28:21]: The Opioid Epidemic does not discriminate, and an accidental overdose can happen anywhere, anytime, to anyone.
Carrying Naloxone puts the power to help reverse an opioid emergency in your hands, and has saved lives, including the life of Crystal’s son.
Naloxone is just one tool in the fight against the opioid crisis. In this series we’ll explore the stories of people working to change the trajectory of the crisis.
For more information about opioid overdose and the important resources available to you, please go to the links in the description of this episode.
Thank you, Crystal, Dr Milas and Gay for sharing your stories and expertise.
Thank you for listening to this episode of Countermeasures.
To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com
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