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Overdose reversal drug employed as part of fight against opioid epidemic in the Northland

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Marcia Gurno (from left), Deb Hernandez, Keri Hager, and Dr. Elisabeth Bilden listen to Laura Palombi during Monday’s summit on opioid use and misuse. Gurno, Hernandez, Bilden and Palombi offer frequent naloxone trainings and distribution in the region. Steve Kuchera / skuchera@duluthnews.com2 / 5
Alayna McCawley, an occupational therapy student at the College of St. Scholastica, listens to Deb Hernandez after receiving two naloxone kits at the conclusion of a summit on opioid use and misuse held at the University of Minnesota Duluth on Monday for college students in health-related fields. Steve Kuchera / skuchera@duluthnews.com3 / 5
Haley Pals speaks during Monday’s summit. Pals’ brother died of an overdose five years ago. Steve Kuchera / skuchera@duluthnews.com4 / 5
Marcia Gurno of St. Louis County Public Health and Human Services uses a doll as a training tool while talking about how to apply naloxone. Steve Kuchera / skuchera@duluthnews.com5 / 5

Editor's note: This is the second story in an ongoing series this year about opioid overdoses in the Northland. You can read an introduction to the series here.

For Marcia Gurno, it's personal. Eleven years ago, her daughter died of a heroin overdose.

"The people she was using with didn't want the inquiry," relates Gurno, who is on the substance abuse prevention and intervention team for St. Louis County Public Health and Human Services. "They dumped her body in an alley off of University Avenue in St. Paul. She was found by schoolchildren. ... We didn't have Narcan. It was not available."

Now Gurno is one of four women who are leading the charge to get Narcan — or its generic equivalent, naloxone — in the hands of as many people as possible.

Gurno; along with Laura Palombi, an assistant professor in the Duluth campus of the University of Minnesota College of Pharmacy; Deb Hernandez, health educator for the Rural AIDS Action Network in Duluth; and Dr. Elisabeth Bilden, an emergency medicine physician and toxicology specialist for Essentia Health help lead naloxone training and distribution.

Last year, the quartet offered 37 presentations, mostly on the subject of naloxone and substance abuse, Palombi said. Although one or two of them can lead a seminar, they like to function as a group.

"When one of us is missing you can definitely tell," Palombi said.

Although they come from different health fields and backgrounds, the women share a passion for getting as many people trained and equipped with naloxone kits as possible. They do so with the common conviction that at a time when an increasing number of people are caught in the grips of opioid use disorder and increasing numbers of tainted substances are in the streets, naloxone saves lives.

"It doesn't solve the problem," Palombi said. "It just gives them another chance to live."

With grant funding and money from nonprofit agencies, the foursome have given out hundreds of naloxone kits. At RAAN's office on Duluth's First Street alone, 1,990 kits were given out last year, said Hernandez's boss, Mary McCarthy.

They'd like to give out many more. A year ago, U.S. Surgeon General Dr. Jerome M. Adams issued a recommendation that "more individuals, including family, friends and those who are personally at risk for an opioid overdose ... keep the drug on hand."

Palombi, who always carries the drug with her, said she can't think of anyone who shouldn't have naloxone available.

The quartet hasn't slowed down. Less than two weeks ago, a presentation was done for the staff at Lifehouse, an agency serving homeless and street youth in Duluth. On Monday, all four participated in an "opioid summit" for undergraduate and graduate students in health-related fields at the University of Minnesota Duluth that concluded with naloxone training. Ninety-seven University of Minnesota College of Pharmacy, Medical School and College of St. Scholastica students attended, student organizer Tuyen Nguyen said. They filled the UMD Kirby Griggs Center for three hours after a day of studies. Once it was over, 90 of them lined up to receive naloxone kits from Hernandez.

Naloxone is appearing in public places: on all three levels of the main branch of the Duluth Public Library; at the downtown YMCA; in some churches. The St. Luke's hospital emergency department dispenses naloxone kits to patients when it's deemed appropriate, said Heather Blue, the department's pharmacist.

Mayo Clinic ambulances (formerly Gold Cross) are equipped with them, as are Duluth firefighters and Duluth police officers. Other police departments in the county are being equipped and trained, said Jessica McCarthy, who was hired late last year as opioid technician for the Duluth police.

During the first quarter of 2019, seven people died of opioid overdoses in St. Louis County, the most for any one quarter in the county's history, McCarthy said.

But also during the first quarter of 2019, law enforcement officers in St. Louis County used naloxone 37 times, including 11 in Duluth, said Duluth police Lt. Jeff Kazel, commander of the Lake Superior Drug and Violent Crime Task Force.

Each represents a saved life.

There are no bigger supporters of naloxone than police officers, Jessica McCarthy said.

Kazel echoed that, saying he never questions the urgency of trying to save those lives.

"We're all people in this world," he said. "We all have families. We all have friends. We all have somebody that's looking out for us. We're not the judge. People make mistakes. We want to give people that chance to turn their life around."

What it is

Naloxone was patented in 1961 and approved by the Food and Drug Administration in 1971, Bilden said. Although the names Narcan and naloxone often are used interchangeably, Narcan actually is the brand name for the form of naloxone that's dispensed through a nasal spray. The FDA approved Narcan in 2015. Previous forms of naloxone require an injection. The injection is into the muscle, like a flu shot, typically into the shoulder or the thigh.

Narcan is an appealing option, but it's also more expensive. The kits obtained by RAAN through Valhalla Place in the Twin Cities cost about $6 each for the injection models and $75 for the nasal version, Mary McCarthy said. Each dispenses two doses.

Because of the price difference, RAAN doesn't give out Narcan. "With our population, they're generally pretty comfortable with the IM (intramuscular injection)," McCarthy said.

How it works

When the naloxone four does a presentation, it falls on Palombi to explain how it works. Here's a simplified version, drawn from an interview with Palombi:

Opioids attach themselves to certain receptors in the body, including the brain. The opioid turns off the pain signals in those receptors, which is why opioids are prescribed as pain relievers. But in large quantities, it also can turn off the signal to breathe. That's what happens in an opioid overdose. The individual's breathing becomes labored and he or she sinks into unconsciousness.

Naloxone binds to the same receptors. "It's kind of like a stronger magnet, so to speak, to that site," Palombi said. "So it actually kicks the opioid off," but it doesn't send the same signal to stop breathing.

"So immediately the person's drive to breathe comes back and they'll take a big gasp," Palombi said.

Like a benign bully, naloxone pushes the opioid off the receptor but does no harm itself. It's harmless if it turns out the person wasn't suffering from an opioid overdose, Palombi said. But it has a shorter "half life" than opioids. That's why a person who has been revived from an overdose can sink back into unresponsiveness and shallow breathing. It's why someone should always stay with a person who has had an overdose and one of the reasons 911 always should be called, the experts say.

Naloxone shouldn't even be the first step after calling 911, Bilden said. The first step is "rescue breathing" — CPR without the chest compressions.

"The most important thing is getting someone oxygen," she said.

The myths

Some of the things that are "out there" about naloxone aren't true or are exaggerated, the experts said. The myths:

• "Narcan parties." The myth is that people stock up on narcan and host opioid parties, assuring guests that if they do overdose, the remedy is close at hand. There's no evidence such "parties" occur, Mary McCarthy and others said. In fact, people using opioids tend to isolate themselves, she added. Besides, no one wants naloxone, Hernandez said. "It'll take the high away. It will put them immediately into withdrawal."

• "People revived with narcan react violently." That can happen, Bilden said, but it's rare. It's more likely to happen if the individual also was using methamphetamine. "Meth revs you up, opioids put you down, right?" she explained. "So if you take away the down part, what does the methamphetamine do?" Added Palombi: "They wake up but now you're seeing the results of the meth, so they might be combative." If you feel you're in danger, "just stand back," Palombi said.

• "I have to pay for my insulin. Why should drug addicts get naloxone for free?" It's not free, Gurno said. Grants have been applied for and approved to address a major health crisis, including a $675,000 "state targeted response" grant for St. Louis County, the largest award in the state. (It runs out April 30, and Gurno and others are working on a replacement grant.) Besides, the comparison is invalid, Jessica McCarthy said. If someone with diabetes goes into shock, they're going to be treated, whether or not they can pay. Naloxone is dispensed in similar life-or-death situations.

Everyone's problem

As with Marcia Gurno, the opioid crisis is personal for Haley Pals.

Pals, who at 24 has a doctorate in pharmacy from Drake University and is serving her residency in Brainerd through the University of Minnesota, drove to Duluth on Monday to serve as one of the presenters at the opioid summit.

Pals turned to risk factors for substance use disorders, using her own profile as an example: She grew up in a small town, in a middle-class family that was loving and supportive, although her parents were divorced. Her parents weren't drinkers or drug users, although there was a history of substance abuse in her family.

On balance, it might not seem surprising that she doesn't have a substance use disorder.

She then produced a slide with an almost identical profile: that of her only sibling, Brian, two years her senior.

"I do not have a substance use disorder," Pals said. "But my brother does. He actually passed away five years ago from a heroin overdose."

By being trained and equipped in naloxone use, those in the audience were helping give people like her brother another chance, Pals said. In fact, her brother did get two more years of life because someone revived him with naloxone during a previous overdose.

Brian was 21 when he died. "It was weird surpassing 21," Pals said later.

But ultimately, it doesn't matter what the person's relationships were, Pals told her audience.

"It's not just about saving people's lives because they're someone's brother or they're someone's mother or they're someone's daughter," she said. "It's because they're people."

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Opportunity for training

Narcan training and distribution will be offered during "It Takes a Village," a sobriety health and wellness fair, offered from 1 to 4 p.m. Friday in the second floor conference center at the Government Services Center, 320 W. Second St. It also will include a resource fair, the Fond du Lac "Hidden in Plain Sight" exhibit, Hep-C and HIV testing, public defender assistance for warrant resolution and driver diversion program and an ACES (Adverse Childhood Experiences) workshop. It's free and open to the public.

Drug takeback day

April 27 is national prescription drug take back day. From 10 a.m. to 2 p.m. you can bring your unused, unneeded or expired prescription drugs for safe disposal at the St. Louis County Sheriff's Department in the Public Service Building, 2030 Arlington Drive. Other sites are Sheriff's Department offices in Hibbing and Virginia, Police Department headquarters in Ely, Eveleth and Nashwauk and the Cook County Sheriff's Office in Grand Marais.

Get help with opioids

If you witness someone overdosing, call 911. Even with successful Narcan use, overdose victims need immediate medical care.

Minnesota's Good Samaritan Law protects those who call in an overdose, and those who are overdosing, from criminal prosecution.

The Duluth Police Department has a non-emergency opioid hotline: 218-730-4009

For help with drug addiction, there are a number of local and national resources to help get referred to treatment.

Birch Tree Center

1-844-722-4724

Center for Alcohol and Drug Treatment

218-723-8444

St. Louis County Public Health and Human Services

South St Louis County: 218-726-2204

North St Louis County: 218-262-6054

Mental Health Crisis Text Line

Text MN to 741741

SAMHSA National Helpline

1-800-662-4357

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