Gina Zappia says she came from a family in which addictive behaviors were the norm, and she found it easy to follow suit.

“To be honest, my life seemed normal at the time,” said Zappia. “How I grew up and what I saw, I assumed that’s how it was supposed to be. I didn’t know anyone that didn’t drink, so I also didn’t know anyone in AA. Seeing substances abused was a normal thing.”

In her teens, Zappia began drinking, smoking and using marijuana. She progressed to popping painkillers and shooting up heroin.

“I didn’t think of myself as an addict when I was using pills, even though I would get sick if I didn’t use,” she said. “I just thought I liked it, and it was a normal thing. … Then at about 23 years old, I made the switch to IV (for heroin). I normalized that decision as well because everyone I was hanging out with was doing it, so the switch was easy. But after that, things went downhill quickly.”

Like many people who suffer from addiction troubles, Zappia eventually found herself in the criminal justice system and at rock bottom.

Now, sober since 2015, Zappia wants others to address their addiction problems before they end up in the system, or worse. She is helping a local committee help others who may find themselves, or someone they love, addicted to opioids.

Three years ago, Zappia, now 28, became part of a Naloxone Champions group that has been arming the community with the opioid overdose-stopping drug, Naloxone. She is helping to organize community trainings and education on the drug, as well as a local event for Overdose Awareness Day to be held on Aug. 30.

Drug of choice

Zappia first used opioids at 16 years old.

“I loved it and was doing it to feel better after a night of drinking and doing other drugs,” she said. “Most people don’t realize is that you can get any drug in Fort Collins; there is always someone who knows someone if you really need it, and once I got to that point, I was using something every day.”

She wasn’t alone in her habit – or the risk. In 2017 in Colorado, a person died approximately every 15 hours from an overdose involving opioids — a record high, according to the National Institute on Drug Abuse.

Like Zappia, four out of five heroin users started using heroin after first using prescription opioids. She, and a handful of her acquaintances, ended up in an emergency room for overdosing.

“One time I was really messed up and got up to go to the bathroom and fell asleep,” she explained. “The person with me called the cops, and EMS came and gave me Narcan.”

The overdose drug

Narcan, the brand name for Naloxone, is a drug that can reverse an overdose from heroin and opioid painkillers. Since 2015, the drug has become more available to the public because of a standing order by the chief medical officer of the Colorado Department of Public Health and Environment to allow the drug to be dispensed by pharmacies and harm-reduction organizations to those who may overdose or know someone who could overdose. Prior, the drug was only available to emergency responders and medical staff.

A Narcan kit, provided by a pharmacist, includes two doses of 2 milligrams of Naloxone in a nasal spray, educational materials and illustrated instructions on how to administer the spray. A pharmacist also provides direct counseling about the use of Narcan to the receiver at the time it’s dispensed. Like the emergency allergy drug epinephrine, Narcan expires, and it must be replaced after 18 to 24 months if not used.

Arming the community — including pharmacies, emergency responders and the public — with Narcan has become Zappia’s mission as a member of the Larimer County Naloxone Distribution Committee.

The Larimer County Naloxone Distribution Committee

Zappia was accepted into the 8th Judicial District Adult Drug Court, a program that serves as an alternative to incarceration for eligible participants to balance treatment and community safety. It gave her a chance to avoid incarceration and get sober.

She only remembers about three of her first 18 days in drug court while she detoxed off of opioids and other prescription medications. A horrible experience, she said.

“But it did get me clean,” she added. “It was the first time I had been completely clean since I was 12 or 13.”

Zappia continued through the program and graduated in July 2016. She celebrated four years of sobriety on April 18, 2019. And it was while telling her story that she came across the county’s committee. “In the audience was a member of the Health District of Northern Larimer County,” she said.

The district facilitates and supports the Mental Health and Substance Abuse Alliance, which has about 25 agencies and was created to change systemic barriers to mental health and substance use care, according to Jess Fear, manager of behavioral health strategy and implementation for the district. She said that from that group came the prioritization of access to Naloxone (Narcan). Those working on it became the Naloxone Champions workgroup, and because of Zappia’s experience, she was asked to serve on the committee.

The mission: Empowering people to save lives

The Naloxone Champions’ mission is as follows:

1. Get all first responders access to Naloxone.More than 200 law enforcement agencies and first responders across Colorado have been trained in the use of Naloxone, according to Rick Brant, the police chief in Evans, Colorado. He has taken charge of the statewide training. They’ve also worked with UCHealth EMS and Poudre Fire Authority to train and educate their staff on Naloxone.
2. Make sure all emergency rooms have access to Naloxone.The district has worked closely with UCHealth Emergency Rooms to provide education for staff so they can educate their patients. The team also has expanded to physicians’ offices to help those professionals better connect patients to medication-assisted treatment and access and training for Naloxone.
3. Increase the uptake by pharmacies and pharmacists. StopTheClockColorado.org is a website that shows pharmacies that have Naloxone, but making a phone call to area pharmacies is the surest way to know whether Naloxone is available. The team is taking a statewide approach to training, siting Good Day Pharmacy as a great example with regular informational sessions for staff on opioids and overdose that is practiced at its more than a half-dozen locations throughout northern Colorado. The team hopes to see other pharmacy chains adopt similar practices. UCHealth pharmacies, including those at Greeley Hospital, Longs Peak Hospital and UCHealth Pharmacy – Harmony Campus, all of which are open 24/7, dispense the medication to anyone needing it; family and friends do not need a prescription.
4. Educate and equip primary care providers.The group has teamed up with Northern Colorado Health Alliance to incorporate training on Naloxone into already established training for primary care providers in the community. The focus is on destigmatizing medication-assisted treatment by explaining the brain science behind addiction.
5. Increase access in jails and the criminal justice program.The highest risk for overdosing is by those who leave a criminal justice facility. Having criminal justice staff educate and provide Naloxone to their clients upon discharge is important, Fear said. In April 2019, Larimer County Jail introduced medication-assisted treatment for clients who had been previously prescribed the treatment by their physician prior to incarceration. In June, it expanded as an option for replacement of withdraw protocol for clients who had not previously used medication-assisted treatment. Jail staff have been trained on medication-assisted treatment and Naloxone, Fear said.
6. Increase public education and awareness.The two Overdose Awareness Day events in Fort Collins and in Greeley are part of the group’s effort to educate and raise awareness.  Learn more here.
7. Increase access through the Northern Colorado AIDS Project and treatment organizations. The champions are helping with training for those organizations that don’t currently supply Naloxone.

Overdose Awareness Day

Last year’s Overdose Awareness Day events in northern Colorado supplied participants with 20-24 different resource booths. In Fort Collins, more than 250 people were trained and provided more than 200 doses of Narcan.

“Addiction is a thing we sweep under the rug,” Zappia said. “And because people aren’t shooting up and dying under the bridge, people think it’s not happening here. But I know at least five people who have died because of their addiction… Death by addiction, it’s not something we talk about.”

Before Zappia was arrested, her mother tried to get her help, but they struggled to find the resources they needed within the financial parameters they had. The Overdose Awareness Day events will have those resources in one place, providing addicts and their families a place to find what they need.

“It’ll be a place where people can come and hang out and see that there are people out there and places that will help with recovery and help you live a better life,” she said.

Narcan is not just for addicts

The risk of overdosing on opioids is not just an addiction problem, Fear said.

“There are a lot of people on prescriptions from their doctors, and it is easy to overdose,” Fear said. “For example, sometimes they forget if they’ve taken a pill and take another.”

Keeping prescriptions in a safe place, away from children, is also important to prevent overdoses.

“Narcan is like a fire extinguisher: You may not need it but you may want to have it around just in case,” she said. “What we want to stress is that Narcan is not about the person or the choice of someone experiencing addiction or substance use disorder, it’s about opioids themselves and the risk of overdose they present.”