BANGOR, Maine — If a known opiate user goes pale and clammy, with lips and fingernails that are purple or blue, if the person can’t speak, makes gurgling sounds, vomits or loses consciousness and won’t wake up when shaken, he or she is probably overdosing.
Health experts have learned the best way to help someone in that dire situation is to quickly administer the opioid antidote naloxone, commonly known as Narcan. That’s why a Maine health agency this week began offering free Narcan nasal spray to heroin and opiate users and the people who care about them at locations in Bangor and Ellsworth.
“Overdoses … slow the heart rate and induce respiratory distress,” explained Ross Hicks, harm reduction coordinator for the Down East AIDS Network and Health Equity Alliance, which is dispensing free Narcan kits. “It will eventually cause your brain to shut down.
“In every kit they get two doses of intranasal Narcan,” Hicks said, referring to a pair of devices that each look like the tip of a nasal sprayer with a small tube attached. The tip is inserted into the overdosing person’s nose and the tube plunger is pushed to dispense 4 milligrams of the opioid antidote.
“If they’re not breathing normal or normalish within three or four minutes, you can use the second one,” Hicks said, adding the drug typically only stops opioids from working for 30 to 40 minutes.
“The opioids can still be present,” he said. “That is why it’s so important to call 911 when there is an overdose. [Narcan] is not a cure but it does buy time for professional responders to arrive. This is especially important in rural areas.
“That 30 to 40 minutes can prevent death,” Hicks said.
Health Equity Alliance is one of 15 groups in the nation splitting $1.5 million in Rural Opioid Overdose Reversal grants and is using the funds to distribute free Narcan to those who need it from its offices at 106 Pine St. in Bangor and 25A Pine St. in Ellsworth.
“Our initial order of 204 kits cost $15,300,” and the supplier gave the group a discount, Hicks said Thursday by email. That works out to $75 per kit (each with two doses).
Maine residents can ask their doctor for a prescription for Narcan, Hicks said. The out-of-pocket cost without insurance at one Bangor-area pharmacy was $188 for the same two-dose kit.
The free kits are really for people who can’t afford medical care, Hicks said. The kits will be given out to drug users, relatives and friends of users, and law enforcement and first responders “where cost is a burden,” he said.
Two other health organizations in Maine also were awarded the grants — MaineGeneral in Augusta and Diversion Alert in Houlton.
The Health Equity Alliance was created in 2013 as a way to expand services of the Down East AIDS Network to other disenfranchised groups in Maine, especially in rural areas of the state. The two groups also recently were awarded a $188,000 grant to establish a new law enforcement-assisted diversion program in the Bangor area to put those with substance abuse problems who are arrested for low-level crimes into recovery programs instead of jail.
Diversion Alert, which collects data on drug abuse in Maine for use by medical and law enforcement workers, is using the Rural Opioid Overdose Reversal grant to provide Narcan to all of the Wabanaki tribes in Maine, as well as prevention outreach and training, including a new website, hopeandhealingforcommunities.com, which features a video about take-home Narcan.
“It started as a community problem and needs a community solution,” Clare Desrosiers, Diversion Alert executive director, said Wednesday.
Messages left for MaineGeneral’s spokesperson about how the grant funds are being used were not returned.
The goal of the grant program is to reduce deaths related to opioid overdoses in rural communities. Maine saw a record 272 overdose deaths in 2015.
Bangor’s City Council at its May 9 meeting gave the Police Department permission to collaborate with Penobscot Community Health Care to get nasal Narcan into police vehicles.
Police officers often are first on scene of an overdose, and the antidote is expected to save lives, Police Chief Mark Hathaway told councilors.
“PCHC will be training our officers next week,” Hathaway said in an email Wednesday. “We are fortunate to have developed a partnership with PCHC which has allowed us to move this project along quickly. We plan to use a combination of funding from Bangor Public Health and money seized from convicted drug dealers to cover the cost of the product.”
Ensuring Narcan is available to first responders was one of the recommendations from Bangor-area health care leaders, law enforcement officials, educators and politicians who formed a community working group two years ago to come up with ways to combat growing drug abuse problems in the region.
Narcan isn’t only for drug abusers. People who accidentally overdose on prescription medications may also require treatment with the drug, according to the Substance Abuse and Mental Health Administration. Patients misunderstand directions or mix prescription drugs, which can be deadly. Drug overdose deaths nationwide have risen from around 14,000 annually in 1999 to more than 43,000 in 2014, according to the National Institute on Drug Abuse.
In addition to the overdose deaths in Maine, which jumped 31 percent between 2014, when 208 Mainers died, and 2015, the state also saw 548 opioid poisonings during 2015, according to Colin Smith of the Northern New England Poison Center. Of those, abuse is listed as the cause in 140 cases, and medication errors resulted in 79, he said.
Naloxone, which arrived on the market in 1971, will not cause any harm to people who are not overdosing, Hicks said.
Not everyone supports easy access to Narcan.
Gov. Paul LePage vetoed a bill in April that would allow pharmacists to dispense the drug without a prescription, although the veto was overridden. LePage’s statement that naloxone “does not truly save lives; it merely extends them until the next overdose,” made Hicks cringe.
“It’s actually a pretty inexpensive way to save someone’s life, and allow them to do better and try again, and be a contributing member of society,” Hicks said.
Those who want to get a free Narcan kit must go through a registration process and be trained on identifying a suspected overdose, taking steps to prevent an overdose beforehand, and how to dispense the Narcan if an overdose happens.
“If you are going to use an opiate, use it in front of someone else because you can’t self-administer Narcan,” Hicks said.
BDN writer Nick McCrea contributed to this report.