We need to talk about overdose

Workgroup tackles community education and distribution of opioid overdose drug Narcan; International Overdose Awareness Day events planned in Fort Collins, Denver.
August 21st, 2018

Having come from a dysfunctional family in which addictive behaviors were the norm, Gina Zappia found it easy to follow suit.

“To be honest, my life seemed normal at the time,” 27-year-old Zappia explained. “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.”

And that normalization of addictive behaviors continued through her teens as she began drinking, smoking and using marijuana. She progressed to popping painkillers and then shooting up heroin.

“I didn’t think of myself an addict when I was using pills, even though I would get sick if I didn’t use,” Zappia 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.”

Zappia was soon pulled over while under the influence and in possession — and also on probation. She faced felony charges and it wasn’t until she became part of the criminal justice system that she finally found the help she needed to save her life.

She doesn’t want others to have to wait for the same fate — or possibly a much worse one — before getting help. Now, with three years of sobriety, Zappia is helping a local committee help others who may find themselves, or someone they love, addicted to opioids.

Gina Zappia sits on back of ambulance with event sign.
Now with three years of sobriety, 27-year-old Gina Zappia is part of a Naloxone Champions group that is arming the community with the opioid overdose-stopping drug, Narcan. She is helping to organize community trainings and education on the drug, as well as a local event for Overdose Awareness Day on Aug. 31.

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 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 2016 in Colorado, about one person died every 36 hours from an opioid overdose. Like Zappia, four out of five heroin users started using heroin after using prescription opioids first. 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

a narcan kit and instructions.
Narcan kits are available at UCHealth pharmacies.

When arrested, Zappia was already on probation. She thought that had been her one get-out-of-jail-free card, but through the mercy of law enforcement and the courts, Zappia was accepted to 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 six to nine years in prison, and a chance to 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 three years of sobriety on April 18, 2018. And it was while telling her story that she came across the county’s committee. “In the audience was 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. 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 have several tasks to accomplish as part of their mission:

  1. Get all first responders access to Naloxone. So far, 171 law enforcement agencies and first responders across Colorado have been trained in the use of Naloxone. They have reported more than 300 overdose reversals, but Rick Brant, the Chief Police of Evans, Colorado, has taken charge of the statewide training, and he believes that number could be three to four times more because there is no clear reporting yet. 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 to provide education for staff so they can educate their patients. Fear said the team will work with Banner hospitals next.
  3. Increase the uptake by pharmacies and pharmacists. Stoptheclockcolorado.org is a website that shows all pharmacies that have Naloxone. The team has found that only two-thirds of pharmacies are reporting that they provide the drug. The team wants to make sure that list is up-to-date and accurate.
  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.
  5. Increase access in jails and the criminal justice program. The highest risk for overdosing is by those who leave a criminal justice facility, so being able to have staff educate and provide the drug to their clients upon discharge is important, Fear said. The group is still working through the details to be able to do that.
  6. Increase public education and awareness. The group is working with Colorado State University and University of Northern Colorado students and business members to gauge their knowledge of Naloxone, which they have found is little. Zappia is helping put together trainings at public spaces, such as coffee shops, to help educate the community on the drug and its availability (See training schedule).
  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.

Training and Overdose Awareness Day

From 2 to 8 p.m. Aug. 31, 2018, at Civic Center Park in Fort Collins, Zappia and her team will be hosting an event as part of National Overdose Awareness Day.

The event is dedicated to honoring those lost to overdose and supporting those affected by substance use in the community. There will be speakers, food, music, community resources, art and memorial spaces, in addition to overdose prevention training and the distribution of Narcan.

More information at: www.larimercourtsupport.org and www.healthdistrict.org. Follow for updated information on trainings and events on these Facebook pages: https://www.facebook.com/larimercourtsupport/ or https://www.facebook.com/healthdistrict/

“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 Aug. 31 event 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, said Fear, the behavioral health manager.

“There are a lot of people on prescriptions from their doctors, and it is easy to overdose,” Fear said. “In the older population, 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,” Fear said. “What we want to stress is that Narcan is not about the person or the choice of an addict, it’s about opioids themselves and the risk of overdose they present.”

The mission continues

The Overdose Awareness Day event is one element of many supported by the Naloxone Champions.

“Our project will go until at least 2020,” Fear said, citing recent statistics that found there were more overdoses in Colorado over the past year than in the previous one. “It is still important to continue this work and education.”

Anyone interested in being trained in Narcan use is welcome to attend. Public trainings will be held in Fort Collins, Estes Park and Loveland during the following days and times:

* 6-7 p.m. Monday, Sept. 17 at Loco Artisan Coffee House, 544 Cleveland Ave., Loveland, CO. 80537.

* 1-2:30 p.m. OR 3-4:30 p.m. Tuesday, Sept. 18 at Estes Valley Library, Hondius Room, 335 E. Elkhorn Ave., Estes Park, CO 80517. (Space limited. RSVP to wgrogan@healthdistrict.org.)

* 3-4 p.m. Saturday, Sept. 22 at Loco Artisan Coffee House, 544 Cleveland Ave., Loveland, CO. 80537.

* Fort Collins info TBA (check websites or Facebook for updated information.)