Under new Delaware law, pharmacists can sell overdose antidote over the counter

Frances Russo-Avena won't ever forget her son screaming for help.

It was January and a family friend staying with them overnight began making a gurgling, snoring noise. Her son tried unsuccessfully to wake the friend, then realized he was overdosing.

"It was the most frightening experience in my life," said the nurse, who has spent much of her career in the emergency room and school nurse's office in Red Clay Consolidated School District. 

Russo-Avena, however, had naloxone, an overdose-reversing drug that has saved the lives of thousands of Delawareans, including her house guest that night in January. After administering two doses of naloxone, more commonly known by the brand name Narcan, through the intranasal spray, he came to and survived.

Paramedics who arrived nearly 25 minutes later to their New Castle County home told her that was their fourth or fifth overdose that night. 

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The signing of Senate Bill 48 by Gov. John Carney on Thursday in Dover allows anyone to walk into a participating Delaware pharmacy and purchase naloxone from a pharmacist so the overdose antidote can be kept bedside, as Russo-Avena's was, or in a first-aid kit.

"To me, it's a no-brainer," Russo-Avena said of the new law expected to take effect later this summer. "We should be treating patients who overdose, and everyone should know how to use it."

Last year, naloxone was administered 1,535 times statewide, according to the state Department of Health and Social Services, and used 866 times in the first half of 2017. Even so, 308 people died of drug-related overdoses.

Without the overdose-reversing medication, advocates like Dave Humes with the grassroots addiction advocacy group atTAcK Addiction believe more lives will be lost. So far this year, 121 people have died in Delaware, according to the state.

"I know that naloxone is not the be all, end all — it doesn't end the opiate/heroin epidemic," Humes said. "But the tool is an important tool because it lets us save someone's life and lets them seek treatment."

Already, Delawareans can attend community training sessions like the ones offered by Brandywine Counseling in order to obtain naloxone. These courses are offered about 12 times a year, though community members can schedule individual training if they're looking to obtain the medication. 

A standing order by Dr. Karyl Rattay, the director of the state Division of Public Health, allowed this distribution of naloxone, but the availability to the public remained a hurdle. This new law protects pharmacists from legal liability if they sell naloxone to a person and it wouldn't work.

"We know naloxone saves lives," Rattay said, stressing that within three to five minutes of administering the medication, it can turn around an overdose. The mixing of additional opiates like fentanyl, considered 50 times stronger than heroin, can require additional doses. 

Those purchasing naloxone at a pharmacy will need to undergo a short training, according to the state, but after paying for the naloxone, they can leave with the overdose antidote. 

With Thursday's signing, Delaware joined at least 40 other states who already make naloxone available to the general public. It's one of the few areas where the state has fallen behind in the fight against the heroin and opiate epidemic, Humes said.

Many police departments and emergency responders carry naloxone due to the efforts of groups like atTAcK Addiction. New Castle County police, one of the first departments to carry it, have been administering naloxone since spring of 2015. 

"Sometimes, a matter of seconds can mean the difference between life and death," said Col. Vaughn Bond, chief of the New Castle County Police Department. 

Already this year, 30 of the state's 121 overdoses have occurred in New Castle County, Bond said, and another 106 overdoses were reversed.

Critics argue that the drug only tells those suffering from addiction that there's a lifeline and that the community will continue to save them even if they continue to use. 

But advocates like Russo-Avena and police chiefs like Ocean View's leader Kenneth McLaughlin compare naloxone to a defibrillator for someone having a heart attack or an EpiPen for someone suffering from a peanut allergy. 

The medical world would never turn these people away because of their illnesses, Russo-Avena said.

"The more that it's accessible, the more lives it'll save," she said. "The stigma has always been a barrier to connecting people to services." 

The medication also makes those living in recovery homes more comfortable, said Sammi Mills, who now works at an atTAcK Addiction women's safe home. The 27-year-old woman has used naloxone twice during her time there — though it wasn't completely necessary the first time she administered it.

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That's the benefit of naloxone — it won't hurt someone if it's used accidentally or on a person who isn't experiencing an opiate-related overdose, said the woman who has been in recovery for 10 months.

Her second time administering naloxone, however, was to a woman who had turned blue. One dose wasn't enough to bring her back, but a second dose revived her, Mills said.

"At first, I thought, 'Why would we need this?'" she said. "Then when it happened, I was so glad we had it here. ... If it wasn't, the one girl could have died that night."

It's also one of the few issues in Delaware that has bipartisan support from the General Assembly and lawmakers throughout the state. State Sen. Stephanie Hansen, who co-sponsored the bill, said she believes that's why Delaware has been able to so quickly advance against an epidemic that continues to take lives every day.

But there's still a lot of work to be done, she said.

"We're losing an entire generation ... and we're still losing them," Hansen said. "This is a monster that we do not have a handle on."

Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.