Naloxone Distribution Project in the Emergency Department Promotes Socially Sensitive Care

Opiate overdose persists as a major public health problem, contributing to significant morbidity and mortality among opiate users globally.

Opiate overdose can be reversed by the timely administration of naloxone (frequently known by the brand name NARCAN®). Programs that distribute naloxone to opiate users and their acquaintances have been successful and have shown that nonmedical personnel are able to administer naloxone to reverse opiate overdoses and save lives. Objections to distributing naloxone to nonmedical personnel persist despite a lack of scientific evidence. Research suggests that drug users have identified societal and provider stigma as a barrier to seeking care. Hence, making naloxone readily available to drug users in their homes and communities eliminates a critical barrier to the emergency treatment of overdose.

The Naloxone Distribution Project

The Department of Health Care Services created the Naloxone Distribution Project (NDP) to combat opioid overdose-related deaths throughout California. The NDP is part of a larger initiative called CA Bridge and aims to address the opioid crisis by reducing opioid overdose deaths through the provision of free naloxone. Since October 2018, the NDP has distributed over 1,000,000 units of naloxone and recorded over 57,000 overdose reversals. The California Department of Public Health offers waivers to obtain doses of naloxone to dispense to eligible candidates.

The program went live in February. From that date through the end of 2022, 958 doses of naloxone have been confidentially distributed to community members.

Due to the social stigma of drug addiction, the success of the program weighs heavily on providing a safe, confidential and nonjudgmental approach to the care of patients and their families within the Salinas Valley Health community. Confidentiality includes maintaining the anonymity of patients or family/friends who may participate in the NDP. This is done by using a confidential log whereby nurses and other authorized clinicians document the distribution of naloxone by indicating the date and nurse’s initials for doses provided. Dose tracking and community impact are monitored on an annual basis.

Implementation of the Naloxone Distribution Project

Emergency Department (ED) physician leader Erika Locke, MD, and ED Manager Jeremy Hadland, BSN, RN, CEN, met with Allen Radner, MD, Chief Medical Officer, to review the program and discuss the possibility of the ED participating in the NPD. After a series of stakeholder meetings and collaboration with Social Work Manager Kim De Serpa, LCSW, ACM; Case Management Manager Troy Scott, MBA, MAS, RN; and clinical social worker Cailyn Hymer Costa, MSW, the team developed the plan to implement the NDP.

Close-up of a young person’s hand holding a purple ribbon.
Opiate overdose can be reversed by the timely administration of naloxone, frequently known by the brand name NARCAN®.

Dr. Locke, Hadland and Clinical Nurse Educator Leslie Trapin, BSN, RN, CPAN, ensured the clinical nurses in the ED received education and completed the program’s competency validation to support knowledge and skill in delivering socially sensitive care. This included information for nurses and other care providers about the use of socially sensitive language; for example, avoiding terms such as addiction or addict and instead using the term substance use disorder, thus treating substance use as a medical condition instead of a moral defect or personal choice. Furthermore, since a large percentage of our patients are Spanish-speaking, part of the nursing education included a culturally sensitive process for supporting this subset of patients with informational brochures written in Spanish along with the standard practice of utilizing a hospital interpreter. Once the education was completed, competency as an Overdose Prevention Educator was validated with a signed competency validation form.

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