South Florida Naloxone and Harm Reduction

Unfortunately, opioid dependence and overdose are serious problems in the United States. An average of 128 people died of an opioid overdose per day in 2018. Opioid overdose can occur from the use of prescription painkillers, heroin, or synthetic opioids such as fentanyl.1

In Florida, there are 15.8 opioid overdoses for every 100,000 people, a rate higher than many other states.2 In 2018, more than 2/3 of the state’s overdose deaths involved opioids.2 To curb the tide of opioid-related deaths across the state, naloxone is becoming increasingly available. We’ll show you how to find it and discuss how to use it effectively to help prevent a person from dying after experiencing an opioid overdose.

Naloxone Basics: What Is Narcan?

Naloxone is an opioid antagonist medication that can displace opioids from the body’s opioid receptors and reverse the effects of a painkiller or heroin overdose. An overdosing person who is given naloxone may begin breathing normally again after experiencing life-threatening respiratory depression.

Naloxone comes in several forms including a nasal spray, branded as Narcan,  and a now discontinued autoinjector, Evzio, which is still available while supplies last and may be used until its expiration date.3,4 Naloxone is also available in kits for injection into the thigh, butt, or arm, as well as in kits that allow for the assembly of a nasal spray using a specific type of syringe and mucosal atomizer. Both the injection and intranasal atomizer kits are more complicated to use in an emergency when every second counts, so often it is the one-step Narcan nasal spray which is the preferred method for friends and families of opioid users looking to keep naloxone with them in case of overdose.3

Where to Find Narcan (Naloxone) in South Florida

Naloxone is available in Florida without a prescription and is sold at CVS, Walgreens and other pharmacies throughout South Florida. While naloxone is a prescription medication, Florida has a standing order that allows pharmacists to legally distribute naloxone to individuals who request it without having a prescription, making it akin to an over-the-counter medication.

Additionally, IDEA Exchange, Florida’s first needle exchange program based in Miami, provides free naloxone to the community.

You can also search the website I Save Florida to find locations near Hollywood that distribute naloxone.

When to Use Naloxone

Naloxone is given when it is suspected that someone has overdosed on opioids. If you think someone has suffered an opioid overdose but you’re not 100% sure, it is still okay to give naloxone. The medication will have no effect on someone who has not used opioids.3

If you’re unsure of whether someone is overdosing on opioids, look for the 3 classic signs of an opioid overdose, called the “opioid overdose triad”:

  • Reduced or loss of consciousness.
  • Breathing very slowly, irregularly, or not at all.
  • Small (pinpoint) pupils.

Other signs that someone may be suffering an opioid overdose include:5

  • Clammy, pale, or cold skin.
  • Limpness of the extremities.
  • Choking, snorting, or making other odd breathing sounds.
  • Bluish nails and/or lips.
  • Slowed or stopped heart rate.

Could My Loved One Overdose?

Anyone who uses illicit or prescription opioids is at risk of overdose; however, the following factors may put someone in even greater danger of overdosing:6

  • Mixing an opioid with alcohol or other drugs such as benzodiazepines. (More than 30% of opioid overdoses involve benzodiazepines such as Xanax.7)
  • Being over the age of 65.
  • Taking a high daily dosage of prescription painkillers.
  • Taking more opioid painkillers than prescribed.
  • Taking an illicit opioid (i.e., purchasing heroin or opioid painkillers off the street).
  • Having an underlying medical condition, such as sleep apnea.

Having a doctor’s prescription for an opioid doesn’t remove a person’s risk for overdosing. In fact, opioid pain medications are sufficiently dangerous that some states—including Florida—have begun mandating that naloxone be co-prescribed with certain opioid medications. In Florida, pain patients with a severe traumatic injury who are prescribed a Schedule II opioid such as oxycodone (OxyContin) or hydrocodone (Vicodin) must be prescribed naloxone along with the painkiller.8

Florida Narcan Law: Can I Be Arrested for Drugs if I Call 911?

If you are intoxicated and/or in possession of illegal drugs, it can be scary to call 911 for yourself or for someone else. Hesitation or refusal to call 911, however, can result in needless deaths. To reduce the numbers of opioid overdose deaths in Florida, state legislators enacted the 911 Good Samaritan Act (F.S.S. 893.21) in 2012.9,10

Under this Good Samaritan immunity law, if you seek help for an overdosing person (including yourself) and you do so “in good faith,” you cannot be arrested or prosecuted for possessing a controlled substance or drug paraphernalia if the discovery of the substance was made as a result of you seeking help. If someone seeks help for you, you are afforded the same legal protections.9,10

You are also protected from penalties for violation of a condition of pretrial release, probation, or parole if the evidence for the violation was discovered as a result of the request for medical assistance.10

How to Use Narcan

Detailed instructions explain how to use Narcan, but in general, the nasal spray is used in one nostril while the person is lying on their back.3 The spray dispenses a single, prefilled dose of naloxone.3  Often, a naloxone kit comes with two doses of medication in case a person’s breathing isn’t restored after the first dose and he or she requires a second dose before emergency responders arrive on scene.11 With the increasing potency of illicit opioids due to the rise of fentanyl and fentanyl analogs that often show up in heroin and illegally obtained street drugs, it is increasingly possible a person will need more than one dose of Narcan to begin breathing adequately.3

The steps for responding to an opioid overdose with Narcan (or another form of naloxone) are as follows:5,12

  • Try to illicit a response from the person. Speak loudly or rub their breastbone with your knuckles.
  • Call 911. Do not skip this step. Emergency care is required for an overdose, even if a person appears to be breathing adequately.
  • If you think that the person has overdosed, give a dose of naloxone and inform the 911 operator you are with a person who is not responsive and you believe may have overdosed on an opioid.
  • Follow the instructions of the 911 operator. He or she may tell you to grab and use an automated external defibrillator (if available), a device that can restart a normal heart rhythm and is easy enough for laypersons to use. They may also guide you in administering a second dose of naloxone about 2-3 minutes after the first dose and may have you perform CPR. For a list of CPR and first aid classes in South Florida, visit the Red Cross website.
  • When the person begins to breathe and as they regain consciousness, put them on their side with knees bent and airway open in case they vomit to prevent choking.
  • Stay with the person and monitor their condition until first responders arrive on scene. The person will need follow-up treatment, as Narcan’s effect on reversing breathing abnormalities may be only temporary and the person can again experience slow or stopped breathing and lapse back into unconsciousness.

View a Short Narcan Training Video from American Addiction Centers

 

Opioid Harm Reduction Resources in South Florida

The dangers of drug use are not limited to overdose. For example, drug users are at high risk for infection by bloodborne diseases such HIV or hepatitis C, especially if they inject drugs. In Broward County, more than 1,800 cases of hepatitis C were reported in 2018 alone, and more than 21,000 Broward County residents are living with HIV.13

Harm reduction measures are created with the knowledge that societal abstinence from all drugs is not an attainable goal and instead seeks to reduce the harm associated with drug use.14,15 This view and subsequent harm reduction efforts are controversial. They are often mistakenly viewed as promoting drug use; however, harm reduction programs such as needle exchanges have been shown to be effective in:15

  • Reducing disease transmission.
  • Decreasing numbers of overdose deaths.
  • Increasing the chances that drug users will enter treatment at some point.

According to the Centers for Disease Control and Prevention, new users of needle exchange programs are 5 times more likely to enter an addiction treatment program and 3 times more likely to get sober than those who don’t utilize these programs.15

Hollywood, Florida residents may access the following harm reduction resources to mitigate some of the dangers associated with opioid abuse:

  • Needle collection at these pharmacies in Broward.
  • Needle exchange programs, which are legal in the state of Florida, where you can obtain clean needles. Miami-Dade County has a large program, and such a program is soon to arrive in Broward County. Services offered in the Miami-Dade program include:
    • Safe injection kits.
    • Testing for hepatitis C and HIV, bloodborne diseases transmitted through injection drug use and unsafe sex.
    • Free condoms.
    • Training in overdose prevention.
    • Bandages and other basic supplies for wound care.
    • Treatment referrals.