NM pilot program provides overdose patients access to naloxone
The Santa Fe County’s new harm-reduction unit aims to provide access to treatment, education and the necessary drugs before they become a statistic
By Danielle Prokop
The Santa Fe New Mexican
SANTA FE, N.M. — It’s not just about the naloxone; it’s about the relationship.
That’s the approach of Melissa Moya and Mike Milligan, the duo running Santa Fe County’s new harm-reduction unit, a pilot initiative that aims to prevent people who have experienced a nonfatal opioid overdose from becoming another statistic.
“We have all this information on what addicts do and how harmful they are to families,” Moya said, “but what about what causes them to be this way? There’s not a lot of education on that — or how to help.”
In June, the Santa Fe County Fire Department rolled out the pilot program, in which Milligan and Moya visit the homes of people who have survived overdoses and give them access to naloxone, better known by the brand name Narcan — an antidote to opioid overdoses — as well as education. And, if the patient requests it, access to treatment programs.
“We leave it open to what they might need,” Milligan said. “But we don’t force them to get treatment. There has to be a personal decision there.”
Moya and Milligan use data from the state’s Department of Health and from 911 calls to find people who have overdosed and survived.
Milligan said their goal is to make face-to-face contact with each patient three times, but half the work is finding them. People often fear repercussions and give false identifications and contact information or old addresses to emergency medical responders and emergency room nurses.
The team has made contact with eight people since its start and is searching for at least five more.
People struggling with the effects of drug overdoses often feel abandoned, Milligan said, and don’t have enough information about resources available to them — such as Social Security death benefits, grief counseling, low-cost cremation services, rehabilitation programs and support groups.
This program isn’t the first of its kind.
The city of Santa Fe Fire Department, through its Mobile Integrated Health Office, provides naloxone and educational services for people inside city limits who have survived overdoses. That office, established in 2016 to offer a range of community medical services, receives data from the state Department of Health, which collects overdose reports from Christus St. Vincent Regional Medical Center and Presbyterian Española Hospital.
Milligan is a licensed social worker who spent the past five years at Christus St. Vincent, working in the emergency room with patients showing signs of mental health issues and addiction.
Moya, a firefighter and intermediate emergency medical technician with the county for 11 years, shadowed workers in the city’s program; that helped expand her viewpoint, she said, and changed her mind about harm-reduction services.
“What I’ve come to understand in this role, as opposed to being in the field, is understanding substance abuse disorder, the trauma behind it,” she said. “Nobody just wakes up in the morning and says, ‘I’m going to be addicted to opiates today.’
“Every case that I’ve seen has had some sort of trauma in their life behind it,” she added.
The program was, in a sense, a lifesaver for Moya, she said.
She was injured last year while fighting a structure fire and was not cleared to return to active duty fighting fires and responding to medical calls.
“It was such a huge shock to me,” she said. “I went through a depression. I never saw myself not doing firefighting.”
Her gear sits on a bookshelf in her office. She’s still not ready to put it away.
But working with the new program has been rewarding, Moya said.
The pilot program, funded until September 2020, targets rural Santa Fe County, an area of nearly 2,000 square miles that stretches from as far south as Edgewood to Chimayó in the north.
“Ultimately, the goal of the program is to reduce the number of drug overdoses in the county by identifying those who are high risk and giving them resources,” said county fire Chief Dave Sperling.
For more than three decades, New Mexico had among the highest fatal overdose rates in the nation, reaching a peak in 2014. As death rates from drug overdoses have skyrocketed across the nation, however, New Mexico’s rank fell from second highest in 2014, with 547 deaths, to 17th in 2017, with 493 deaths, according to data from the U.S. Centers for Disease Control and Prevention.
Sperling hopes funding for the program will continue — and even expand — after the pilot year, allowing the team to address other needs in the community.
“There’s a lot of needs out there,” Sperling said. “This program’s scope is specific to post-opioid overdose, but they encounter a lot people with behavioral health needs — and anything they can refer, they will.”
There were three overdose deaths reported in Santa Fe County in the first week of June, and the team worries the number is higher.
“Three deaths, one week. This surprised me even after working in the ER for five years,” Milligan said. “That’s a lot, that’s no joke, and at least two of them had kids. These were young people, in their 30s.”
Back when Moya was fighting fires and responding to medical emergencies, she said, she felt like she had to put on a brave face. The community program is offering a different approach. In this work, she has learned to be vulnerable because that’s where the relationship building starts.
“I never saw myself as a person who cared that much, but I want to provide for my community that I believe in,” she said. “Especially for people who feel given up on, who are stigmatized and torture themselves.
“Everybody deserves to feel important and needed and wanted.”
How to access lifesaving naloxone
In New Mexico, Narcan — the brand name for a nasal spray of naloxone, an antidote to an opioid overdose — is available without a prescription. A 2016 law allows the medication to be accessed through a “standing order,” meaning licensed prescribers have the authority to disperse the drug by request.
“Say you or I had a friend using opioids, we could walk into a pharmacy and obtain this without a prescription because of the standing order,” said Thom Duddy, a spokesman for Emergent BioSolutions, the company that produces Narcan.
The copay for people seeking Narcan through the standing order is $17, and 97 percent of private insurance policies and Medicare and Medicaid programs cover the costs.
In 2017, an estimated 24,573 doses of naloxone were distributed throughout the state, according to data compiled by the Human Services Department, which tracked law enforcement distributions, Department of Health harm-reduction programs and Medicaid payouts.
In 2018, the number doubled to 48,464 doses.
State epidemiologist Dr. Michael Landen said the increase came from new grant funding from the Human Services Department to purchase naloxone doses for distribution by law enforcement.
For police agencies in the state, the price for Narcan is higher — $37.50 per dose, sold in packs of two — but generally is given to patients at no cost.
©2019 The Santa Fe New Mexican (Santa Fe, N.M.)