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Ken Duckworth wants to turn everyday people into life savers. All it takes, he says, is a few minutes of their time and a small nasal spray called naloxone, which is used to reverse opioid overdoses.
Each day, more than 130 Americans die from opioid overdoses. That amounts to about 47,000 people each year. Arming everyday Americans with a naloxone toolkit could save some of those lives, according to Duckworth, a psychiatrist and medical director for behavioral health at Blue Cross Blue Shield Massachusetts. He came up with the idea of a small, personal opioid overdose reversal toolkit while reading a story about Philadelphia librarians, who use naloxone to revive overdose victims.
“I realized I work for a very progressive health plan. Why don’t we engage with our employer groups to figure out how to train them in recognizing and responding to an overdose?” he recalled. So he pitched his idea and soon after Blue Cross launched a pilot program for Massachusetts employers, where in addition to training they would provide participants with naloxone kits the size of a small make-up bag. The toolkits, worth about $130, were provided free of charge.
“It is essentially the equivalent of a nasal spray for a cold and the training takes less than five minutes to have a good understanding,” he said. Duckworth and Blue Cross Blue Shield Massachusetts also worked on eliminating the copay for naloxone for insurees in their state.
Duckworth isn’t the only one who wants to equip more Americans with naloxone. Back in April of 2018, U.S. Surgeon General Jerome Adams issued an advisory saying anyone using opioids — whether prescribed or illegal — as well as those who interact with them should know how to use naloxone as it could help save a life.
“We should think of naloxone like an EpiPen or CPR. Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond,” Adams told NPR.
People are dying at home, in public parks, on the street, in public restrooms and even at work. The number of overdose deaths in the workplace has been steadily climbing, increasing by at least 25% each year since 2012, according to the U.S. Bureau of Labor Statistics. In 2017, 272 people died from overdoses in their workplace. That’s up from 217 people in 2016.
Earlier this year, a survey conducted by the National Safety Council found that 75% of U.S. employers were directly affected by opioids but just 17% felt prepared to handle opioid-related issues. Additionally, 79% of employers were “not very confident that individual employees can spot warning signs of opioid misuse.”
While opioids have been blamed for keeping working-age men out of the labor force, according to the National Safety Council, about two thirds of people addicted to opioids are actually in the workforce. As the opioid epidemic has made its way into the office, employers have realized that they need to tackle it head on. While some have restricted opioid prescriptions allowed under their employer-provided health insurance, others are training their staff on how to recognize the signs of an addiction and how to help reverse an overdose if needed.
Shawmut Design and Construction, a construction management firm with offices across the country, has yet to deal with an overdose in the workplace but the firm is prepared. About a year ago, the company created an opioid task force after it became clear that employees were interested in learning as much as they could about the opioid epidemic.
During the company’s annual safety week, employees are invited to attend talks on various health and safety issues. The talks about the opioid epidemic were among the most attended.
“Those talks tended to be standing room only because people wanted to get more information,” said Shaun Carvalho, Shawmut’s VP of Safety. The company held more sessions but it didn’t feel like that was quite enough. “We said: ‘There is so much information going on here. We can’t just have a speaker come in and let it lie there. We have to actually do something more.’ So we created our opioid task force.”
As part of the task force’s efforts, Shawmut joined the Blue Cross Massachusetts opioid toolkit pilot program. So far, the company has trained over 300 people who are in the field everyday and issued toolkits that are to be kept at job sites.
“Fortunately we haven’t had a need for these in the past or since we started doing this awareness training, but now we have folks that are armed with the tools should the need arise on a job site or near one of our sites or our offices,” Carvalho said.
Due to the nature of the job — with a lot of heavy lifting and a large number of injuries — construction workers are more likely to become addicted to opioids than other professions.
“Frankly, opioids are killing more people than anything else in construction,” Carvalho pointed out.
When the Massachusetts Department of Health looked at overdose deaths between 2011 and 2015, the opioid-related death rate for construction workers was six times the average rate for all Massachusetts workers. Their deaths accounted for more than 24% of all opioid-related deaths among the working population.
In an attempt to provide more funds to tackle this issue, President Donald Trump declared the opioid epidemic a public health emergency in October 2017. Two years later, the epidemic shows little improvement. About two million Americans are addicted to opioids and millions more know someone who struggles with opioid addiction.
Researcher Brett Wolfson-Stofko is one of those millions of Americans who knows someone who struggles with addiction. A while back he was driving through Miami with a family member when that family member pointed at a Burger King nearby.
“They pointed out over to the left of the side of the road and said: ‘Hey, you see that Burger King over there? I used to shoot up in that bathroom all the time because I go buy drugs on the block right behind it and then go inside there and inject and not have to worry about the cops harassing me and arresting me or me getting robbed for my drugs,’” Wolfson-Stofko said.
Surprised by the admission he began to ask questions: “What happens when you overdose? Are the staff trained to respond to an overdose?”
“Well, at least I’m not going to jail. I’ll take my chances and hope that someone in the business saves me,” his relative told him.
Like Duckworth, Wolfson-Stofko saw this as a call to action. He works as an investigator at the Center for Drug Use and HIV/HCV Research at New York University. Following the conversation with his relative, he led a research study focused on businesses with public restrooms like coffee shops and restaurants. The survey conducted by CDUHR found that 58% of New York city managers encountered drug use in their bathrooms within the past six months. About 14% encountered someone who was unresponsive and according to the survey were often unsure about how to proceed.
In response to these findings, Wolfson-Stofko’s team created a program that helps train employees in what to do in similar situations.
“We trained them on how to recognize an overdose, how to prep the naloxone, how to administer it and how to call 911, to get the ball rolling for the emergency response,” he said. “And we also trained them on how to safely dispose of syringes that they find in their bathrooms that are in their businesses.”
Eighteen employees from New York City coffee shops participated in the first training. More trainings have taken place since. Businesses are increasingly investing in such training, but at the same time prefer to keep their efforts quiet.
“I don’t know how comfortable a lot of these businesses are, with being identified as places where people are using drugs,” Wolfson-Stofko said. “They’re worried that some customers view it as condoning drug use within the business if they have naloxone with the sharps containers, even though it’s for everyone’s safety. There’s a lot of stigma involved here with illicit drug use because this country views it as a crime instead of as a public health concern and that’s a real problem.”
For programs like his to succeed, the stigma needs to be addressed, he said.
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