Naloxone carry programs are becoming increasingly common among agencies serving justice-involved populations, and Nebraska’s probation officers are considered among those who are positioned to engage people at risk for drug overdose. The Administrative Office of the Courts and Probation (AOCP) supports access to and use of naloxone as a safe and efficient response to someone showing signs of an opioid overdose or incidental exposure.

Quick-rescue intranasal naloxone is being made available for probation personnel to help protect themselves, protect probationers, and protect the public from an opioid overdose.

Naloxone is designed to temporarily reverse the effects of opioid medicines and will not adversely affect someone who has overdosed on other (non-opioid) substances or alcohol. When overdose symptoms are observed, prompt action to administer naloxone greatly increases the probability of survival. Allowing use of naloxone has the potential to be an invaluable tool for the field. It may help address several key concerns, particularly as levels of opioid use and addiction are trending upwards.

Why is There an Opioid Crisis?

According to the Center for Disease Control, the “opioid crisis” has been decades in the making. It first started in the 1990s with prescription pills, and then reached a “second wave” in the early 2000s with heroin, followed by a “third wave” in the past few years with the introduction of illicitly manufactured opioids such as fentanyl. Prescription drugs taken for reasons or in ways or amounts not intended by a doctor can result in severe adverse health effects including substance use disorder, overdose, and death, especially when combined with other drugs or alcohol. Individuals with a history of drug use who are leaving jail or prison have a great likelihood of overdosing in the first two weeks following discharge because tolerance to the drug decreases substantially during periods of incarceration.

Access and Training 

The Substance Abuse and Mental Health Services Administration has awarded more than $43 million in grants over multiple years to help communities and healthcare providers prevent opioid overdose deaths and provide treatment for an opioid use disorder. In partnership with the Department of Health and Human Services, Division of Behavioral Health, the AOCP is working to secure sustainable funding for naloxone.

Minimal training is required to administer this intranasal drug effectively. Staff must be able to recognize the symptoms of opioid overdose and apply the correct technique to administer naloxone before being allowed to carry or use this medication. An administrative protocol and training opportunities will be coordinated by the AOCP to assist with these expectations.

Safeguards 

Standing orders or protocols for naloxone dispensing are an effective strategy for increasing community access to naloxone. On May 27, 2015, LB 390 was signed into law, which authorized the expanded access to naloxone, and helps address the fear of prosecution that individuals experiencing an overdose or witnesses of an overdose may have in seeking assistance from law enforcement or medical personnel. Neb. Rev. Stat §28-470 protects from administrative action or criminal prosecution when a pharmacist dispenses naloxone under the following limited circumstances:

• A person who is apparently experiencing or who is likely to experience an opioid-related overdose; or 
• A family member, friend, or other person in a position to assist a person who is apparently experiencing or who is likely to experience an opioid-related overdose. 

Providing education about overdose risk, recognizing an overdose, performing rescue breathing, and calling 911 can all be lifesaving interventions. Helpful information on how to prevent and manage overdose is available from Prevent & Protect at http://prevent-protect.org/.

Submitted by Renee Faber, Supportive Services Specialist | Rehabilitative Services