Nursing professor develops comprehensive overdose prevention education program
After an overdose occurred at the homeless shelter where she worked, Gina Dahlem, University of Michigan professor of nursing and nurse practitioner, decided to make a change. Dahlem developed a program providing opioid overdose prevention education and training for first responders and members of the community.
“Back in 2013, we have experienced an overdose occurring in our bathroom at the Shelter Association of Washtenaw County…” Dahlem said. “The chief medical resident was at the clinic at the time; she initiated the idea of having naloxone on hand.”
Naloxone is a medication used to reverse opioid overdoses, developed as cases involving opioid abuse continue to rise both locally and around the country. Between November 2016 and 2017, close to 2,749 people died of drug overdoses in Michigan — trends indicate the majority of fatalities were a resut of opioids.
Dahlem said she has seen firsthand a spike in overdoses over the past few years. The alarming trend prompted communities to create taskforces that encourage law enforcement officers and first responders to be trained in overdose reversal.
“We’ve had a steady increase since 2013,” Dahlem said. “We were having about four reversals (in 2013) and we had a spike in 2016 in which we used naloxone nine times.”
Dahlem has received grants since the start of the program from the Community Mental Health Partnership of Southeast Michigan to extend her training to Washtenaw County and its three surrounding counties. Dahlem saw an impact of her project immediately.
“We trained the deputies of Washtenaw County and within a week they had an overdose,” Dahlem said. “We are working with pretty much all (police departments) of the four counties.”
Dahlem created a comprehensive training program to combat this epidemic. Many agencies have reached out for training, including homeless shelters and mental health clinics where there is an increased risk for overdosing. She works with centers to design a program that will be most successful for them.
“The training is tailored for the agencies,” Dahlem said. “We cover signs and symptoms of an overdose and how to respond; what naloxone is and how to use it and what to do after an overdose. We also cover legislation related to overdose prevention.”
Once an overdose occurs, a trained person begins administering overdose procedures, and the patient is then transported to a nearby hospital. The University Hospital as well as the St. Joseph Mercy Ann Arbor hospital have a program that helps survivors. Along with many other services, the Recovery Opioid Overdose Team runs a hotline that sends those at the aforementioned hospitals a peer-specialist overdose survivor to speak with the survivor and provide voluntary support for up to 60 days.
“The data indicates that, yes, people do accept ROOT referrals,” Dahlem said. “People can either use (ROOT) or not and we do have a large portion of those who decline, but there is also a significant number of folks who do receive services from our ROOT team. The important thing to point out is that there is follow up in place for the survivors to connect them to treatment.”
Dahlem will spend between 10 minutes to an hour conducting a training, depending on the needs of the agencies. Over the past year and a half, she has been invited to present at conferences, train first responders and even go to schools and other community organizations. While still in the development stage, Dahlem’s team is working to create online, web-based training by December 2018.
Maryland emergency medical technician Katherine Weber, an LSA junior, said overdoses have been prevalent in her field for the last two to three years. She said police officers in her county carry Narcan, another medication that reserves overdoses, and some schools have trained staff.
Weber said there is concern as to what happens after Narcan is administered to a patient. She said patients can run off or become aggressive if people wake up completely. EMTs are instructed to administer the dose if the patients indicate respiratory distress and they suspect the overdose resulted from use of opiates. Narcan is administered to increase their respiratory drive, but patients must be transported to the hospital following the dose.
“Narcan is only a temporary solution,” Weber said, “If they don’t receive treatment in the ER, the Narcan wears off and (the patient) can fall back into a respiratory depression, but I think the positives outweigh that risk.”
Marci Scalera, the clinical director of the CMHPSM, received the grant funding through which Dahlem coordinates the program. She praised Dahlem’s training.
“Having the availability to access life saving Narcan for our law enforcement first responders or families/friends has given individuals at risk of overdose a life saving opportunity,” Scalera wrote in an email.
Scalera also said Dahlem’s overdose reversal, prevention training and Narcan distribution has made an impact on the local community. Since this initiative, they have saved over 200 lives regionally.
“We have an opioid epidemic and naloxone is an antidote. To reverse it, we need people alive, therefore I believe training to have people respond to overdose has made a huge impact in the counties,” Dahlem said. “Our motto is, ‘Dead people do not recover.’”