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Nasal Spray Could Save Lives in Indian Country

The statistics are grim. Prescription drug overdoses are up for the 11th straight year, and according to the Center for Disease Control (CDC), 44 people die every day from a prescription drug overdose-- usually involving opioid painkillers. Increasingly, patients who become addicted to prescription painkillers turn to heroin as a cheaper equivalent. The surge in demand for heroin has led to a surge in the use of adulterants like fentanyl, which in turn has contributed to a nearly 300% surge in heroin-related deaths.

The bright side is that people who do recover from opioid overdoses, and receive counseling and resources during their time of crisis, are more likely to make the effort to overcome their addiction. Law enforcement and first responders can play a key role in that "intervention moment" when they are trained to administer Naloxone (often known by its brand name of Narcan). Naloxone is not a substitute for emergency care but temporarily counteracts the opioid effects and provides more time for medical units to arrive and treat the victim. It can't be abused, and has no ill effects for someone not using opiate drugs, although it can cause withdrawal symptoms in chronic opioid users. While it's been available for intravenous administration for a long time, the recently introduced Naloxone nasal spray has encouraged much broader use.

Michael Botticelli, Director of National Drug Control Policy, recently described a broad partnership with the CDC, the Department of Justice, the Governor's Association, and SAMHSA to encourage training and supplying Naloxone nasal spray to all law enforcement and first responders. In a public forum sponsored by The Boston Globe and Harvard's School of Public Health, Botticelli described how the personal impact of losing community members to opioid abuse inspired law enforcement officers, fire chiefs, and emergency medical professionals to become champions of Naloxone use.

Describing national trends of nasal Naloxone use, Botticelli said, "We have seen a tremendous amount of partnership between law enforcement and public health. Not only do they want to reduce overdoses, but they're looking at ways to partner with the treatment community and the recovery community to use those as intervention opportunities get people into care. So they understand the significance not only of saving someone's life but using it as an intervention opportunity and follow up to get someone into care."

Washington's Lummi tribe was among the first in the nation to make Naloxone kits, along with prevention and education training, standard for law enforcement. The tribe acted in response to an "epidemic of drug overdose and death due to illegal drug use by community members of all backgrounds," according to one FBI press release. In partnership with Lummi public health agencies, Lummi Nation police officers were trained to recognize the signs of opioid overdose and to respond appropriately. Within six weeks of training, officers had reversed three overdoses.

Recently, the Suquamish tribe announced a partnership to equip and train all officers, as well as members of the general public, with Naloxone kits. Access for individuals is critical for rural populations, where emergency response may take too long, presuming the drug users were willing to call emergency services for help in the first place.

When these tribal communities saw an increase in prescription drug abuse and then heroin use, the tribal governments, health departments, law enforcement and community members collaborated on a response. The tribal councils passed "Good Samaritan" laws to ensure that someone trying to help would not be liable for the outcome. Tribes worked with local pharmacies to keep supplies of the kits available, and to distribute kits and training to individuals.

While tribes in PL 83-280 states like California, Minnesota and Wisconsin may benefit from state or county responders being equipped with Naloxone, this simple and effective tool is not experiencing widespread use in tribal communities, despite Indian Country suffering a higher overdose rate than the general population. In areas of the country without protection for first responders to administer Naloxone, tribes may be wary of negotiating state laws regarding the administration of Naloxone, especially where cross-jurisdictional agreements are in place. In New Mexico, which was among the first to provide law enforcement with Naloxone, jurisdictional disputes may prevent Santa Fe County responders from administering Naloxone to the many Pueblo residents.

Also, despite strong federal support for Naloxone use, the FDA still has yet to approve many Naloxone products, including the nasal spray, although the agency "fast tracked" the applications in 2014. However, with federal encouragement, states are increasingly likely to encourage the widespread use of Naloxone in emergency situations. Without FDA approval, or other legal protections in place, some insurers are wary of underwriting its use or its cost. At $20 per dose, the unsubsidized cost could impact some cash strapped tribal programs.

As for reluctance on the part of law enforcement to "enable" drug use, Botticelli disputed that responders feel their mission is clear. "People understand fundamentally that this is not about enabling, but this is about saving someone's life and that we have a responsibility—just like we do if someone has a heart attack—to save someone's life regardless of whether or not they choose to be compliant with treatment," he said. "We save their lives because their lives are worth saving."

Walter Lamar, Blackfeet/Wichita, is a former FBI special agent, deputy director of BIA law enforcement and is currently president of Lamar Associates. Lamar Associates' Indian Country Training Division offers culturally appropriate training for Indian country law enforcement and service professionals with both on-site and online courses.