In his state of the state address, Vermont Governor Peter Shumlin declared Vermont was facing a crisis of opiate drug addiction.
In 2013, Vermont reported twice the number of heroin overdoses resulting in death than the previous year. Additionally, the Vermont legislature had recently authorized the distribution of naloxone directly to citizens, including drug consumers, friends or family members through several methods. Enhanced liability protections were added for those who call 9-1-1 and use naloxone in an emergency. Medical practitioners can now prescribe naloxone directly and a pilot project was created to distribute overdose rescue kits through regional syringe exchange sites and opiate treatment hubs. Two sites distributed most of the kits in the first six months of the program with additional sites coming gradually online to cover the entire state.
Implementation of this harm reduction strategy began in December 2013. These overdose rescue kits contain two prefilled syringes of naloxone and two nasal atomizers, along with visual and written instructions for use. In the first six months of the kits’ availability, almost 400 have been distributed, and about 10% have been reportedly used to reverse an overdose. When those kits were used in a reported overdose, 9-1-1 was notified 37% of the time to report the emergency. Improving this notification of the emergency response system will be one of the state’s areas for future improvement.
In response to the increased availability and need for naloxone, the 2014 statewide EMS protocols were revised to allow EMTs to administer naloxone vis nasal atomizer. To further increase the likelihood of successful resuscitation, this protocol was updated in June of 2014 to include emergency medical responders. Didactic training was provided centrally through an online learning management system to assure consistency and psychomotor training was performed at the local level.
The rural nature of Vermont dictates that sometimes law enforcement officers are first on the scene of suspected opiate overdoses. In order to increase the speed with which naloxone can be administered, Vermont State Police recently became the first statewide police agency to equip all patrol officers with naloxone. Using train-the-trainer programs developed and delivered by the EMS Office, VSP was equipped in April of 2013. Several other local and county law enforcement agencies are now implementing this program.
New legislation in this session provided for direct dispensing of naloxone by pharmacists to clients. We hope that these efforts combined with addiction prevention and treatment strategies will decrease the mortality and morbidity of opiate and heroin-related incidents in Vermont.
Chris Bell is the director of the Office of Public Health Preparedness, EMS and Injury Prevention for the Vermont Department of Public Health.
For more on expanding the use of naloxone, read “Armed with Naloxone.” pp.28-33.