Get to know the facts about Naloxone

What if Naloxone is administered and it was not an opioid overdose?
If there are no opioid’s in the system, Naloxone will do no harm to the individuals

How much does Naloxone cost?
The prices range based on insurance. With Medicaid there is a $1.00 charge that CAN be waived. Commercial insurance ranges from $0-$120

Is Naloxone safe to use on children or pets?
Yes, the medication can be administer to children and pets

Can you have an allergic reaction from receiving Naloxone?
No, there are no studies showing individuals having an allergic reaction to Naloxone

What are opioids?
Opioids are natural or synthetic chemicals that reduce feelings of pain. Common prescription opioids include; Hydrocodone (Vicodin®), Oxycodone (OxyContin®), Oxymorphone (Opana®), Codeine, Morphine, Methadone, and Fentanyl

How do opioids effect your brain?
Our bodies is full of opioid receptors called mu receptors. Opioids attached to the receptors on nerve cells, spinal cord, and other organs. This allows them to block pain messages from the brain. Additionally, when these attach themselves to the mu receptors, it causes Dopamine to be released (the chemical that makes us feel reward and motivates our actions). This sends a rush of extreme pleasure throughout the body.

What drugs are most commonly used by adolescents?
According to the National Institute on Drug Abuse, alcohol and tobacco are most commonly used by our younger population, followed by marijuana.

What is fentanyl?
Pharmaceutical fentanyl is approved for treating severe pain, typically advanced cancer pain, and anesthesia. It is 50 to 100 times more potent than morphine. However, illegally made fentanyl is sold through illicit drug markets for its heroin-like effect, and it is often mixed with heroin or other drugs, such as cocaine, or pressed in to counterfeit prescription pills.

What are Opioids?

Opioids are a classification of drug that are directly obtained from the poppy plant. Opioids are highly addictive due to opioid receptors in our brains. They block pain signals sent from the brain to the body and use the receptors to release dopamine in large amounts as a supplement for the pain. However, there are side effects to using opioids repeatedly. One of these side effects is developing a dependence on them. Addiction or substance use disorder is a disease, just like diabetes or hyptension, that is managed daily. No one chooses to have a substance use disorder.

  • Prolonged drug use impacts brain function
  • Addiction can cause changes in temperament and behavior
  • These changes can cause problems like mood swings, memory loss, trouble thinking, and making decisions.

There are 3 different classifications of opioids: opiates, semi-synthetic opioids, and synthetic opioids. Opiates include Opium, Morphine, and Codeine. Semi-synthetic opioids include Heroin, Vicodin (Hydrocodone), Hydromorphone (DILAUDID), Oxycodone (Percocet), and Buprenorphine. Synthetic opioids include Fentanyl, Methadone, and Tramadol. Each category of opioids has a different level of strength.

Opioids come in many forms:

  • Pills and capsules
  • Powders
  • Liquids

They are taken in many ways:

  • Swallowed
  • Smoked
  • Snorted
  • Injected

What is Fentanyl?

Fentanyl is a powerful synthetic opiate similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. When prescribed by a physician, fentanyl is often administered by injection, transdermal patch, or in a lozenge form.

The type of fentanyl associated with recent overdoses was produced in laboratories and mixed or substituted for heroin in a powder form. Fentanyl is 50 to 100 times more potent than morphine. Two milligrams of fentanyl (equivalent to six or seven grains of salt) is a lethal dose. It has become increasingly more accessible due to how cost efficient it is. Dealers order it for illicit use off of the deep web from Canada, Mexico, and China.

Maryland’s Good Samaritan Law

Maryland’s Good Samaritan Law protects people assisting in an emergency overdose situation from arrest, as well as prosecution, for certain crimes. The purpose of the law is to encourage any person regardless of age, who experiences or observes a medical emergency caused by the ingestion or use of alcohol or other drugs, to seek medical assistance without fear of arrest or prosecution for:

  • Possessing or using a controlled dangerous substance
  • Possessing or using drug paraphernalia
  • Providing alcohol to minors

It also applies to the victims if the victims receive assistance because someone else sought assistance for them. The law protects a person from a violation of a condition of pretrial release, probation, or parole, if the evidence of the violation was obtained solely as a result of a person seeking, providing or assisting with medical help to save someone’s life.

The law does not protect persons witnessing the medical emergency if they’re not helping with the medical emergency.

The law protects persons from criminal arrest, charge or prosecution for the six misdemeanors listed below where the evidence was obtained solely because of the act of seeking medical assistance:

  • § 5-601: Possessing or Administering CDS
  • § 5-619: Drug Paraphernalia
  • § 5-620: Controlled Paraphernalia
  • § 10-114: Underage Possession of Alcohol
  • § 10-116: Obtaining Alcohol for Underage Consumption
  • § 10-117: Furnishing for or allowing underage consumption of alcohol

The Good Samaritan Law does not apply to drug felonies or other crimes not listed above. Additionally, it does not prevent law enforcement from conducting an investigation and gathering evidence.

If you would like to learn more about Marylands Good Samaritan Law please visit: https://health.maryland.gov/qahealth/substance-abuse/Pages/Good-Samaritan-Law.aspx#:~:text=The%20law%20protects%20a%20person,help%20to%20save%20someone’s%20life

Standing Order in Baltimore City

In 2015, Former Baltimore City Health Commissioner, Dr. Leana Wen signed a new standing order prescription for the overdose reversal medication naloxone that allows anyone to walk into a Baltimore City pharmacy and obtain naloxone without a special training or certificate. In 2019, Dr. Letitia Dzirasa, current Baltimore City Health Commissioner, renewed the standing order for all city residents.

Three Ways to Help

Baltimore City’s pharmacies are key partners in supporting efforts to ensure everyone can save a life with naloxone in Baltimore. Here are three ways to help:

  • Keep a copy of the new Standing Order prescription in your pharmacy for easy reference.
  • Ensure that anyone who comes into your pharmacy and requests naloxone receives it without needing additional documentation since it is now available without a special training or certificate card.
  • Recommend to anyone receiving opioids that they also consider keeping naloxone on hand.

How To Talk To Your Doctor About Pain Management

While opioids can be an important part of treatment, they also come with serious risks. That is why it is important to work with your doctor to make sure you are getting the safest, most effective care. A simple conversation with your doctor can help prevent opioid addiction and overdose.

Asking the following questions may prove to be life saving!

  • Why do I need this medication, and how can I be sure it is right for me?
  • What are the risks of using prescription opioids for pain, especially chronic pain?
  • Are there non-opioid alternatives that could help with pain relief?
  • How long should I take this medication? What if I have a history of addiction to tobacco, alcohol, or drugs or if there is a history of addiction in my family?
  • If your doctor (still) thinks your pain is best managed with a prescription opioid, then ask: Could this treatment interact with my other medicines, especially ones prescribed for anxiety, sleeping problems, or seizures?
  • How can I reduce the risk of potential side effects from this medication?

Additional tips:

  • Keep a pain journal to track pain intensity and functional impacts of your pain
  • Set goals and re-evaluate your pain plan based off of your ability to meet the goals you have set
  • Discuss treatment plan, and side effects, and other medical history with both your primary care provider and your pain management provider.
  • Make sure that another trusted family member knows all of the medications you are taking and where they are located in case of an emergency or in case you are ever rushed to your local hospital
  • Advocate for more options of complementary medicines. Find out about ways to manage your pain that don’t involve prescription opioids. Some of these options may actually work as well or better (but have their own side effects so discuss with your medical professional). Options may include: Acetaminophen (Tylenol) or ibuprofen (Advil) Medications traditionally prescribed for depression or seizures Interventional therapies (injections), cognitive behavioral therapy, physical therapy and exercise, and medicinal marijuana.

Recovery Is Just As Unique As You

There are many options for addiction treatment that you can explore! Everyone’s path to recovery is unique, with its own unique challenges and victories. Addiction treatment assists with the following: helps individuals stop using drugs, stay drug-free, be productive in the family, at work, and in society, and improves quality of life. No single treatment is right for everyone, Effective treatment addresses all of the patient’s needs, not just his or her drug use. Below is a list of treatment options that you or a loved one may look into to get started.

Tips:

  • Staying in treatment long enough is critical.
  • Counseling and other behavioral therapies are the most commonly used forms of treatment.
  • Medications are often an important part of treatment, especially when combined with behavioral therapies.
  • Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
  • Making sure to stay connected to care even after the most strenuous parts of an individuals recovery are over

There are several treatment options to choose from:

  • Medicated Assisted Treatment: Opioid agonist medications such as buprenorphine and methadone as well as antagonist therapy with naltrexone may be used to help those with an addiction to opioids. Various medications may be used to help reduce cravings and manage withdrawal from opioids, alcohol, benzodiazepines, and other sedatives
  • 12 step programs: Twelve-step facilitation therapy can be used to support those with alcohol and substance abuse. It is a form of group therapy that includes recognition that addiction has several negative consequences that can be social, emotional, spiritual and physical. Programs like Alcoholics Anonymous use group meetings for discussion and mutual support.
  • Holistic approaches: There are alternate holistic therapies that can be used to complement standard treatment. They help promote recovery through stress management and overall wellbeing. Some of the complementary therapies are acupuncture, exercise, creating an intentional diet plan, animal therapy, yoga, and meditation
  • Behavioral Therapy: which can be either individual or group counseling and can include motivational Interviewing, Cognitive and Behavioral Therapy, Contingency Management and more.
  • Detox programs: Medically-assisted detox allows you to rid your body of addictive substances in a safe environment. This is beneficial because sometimes substance withdrawal can cause unpleasant or even life-threatening physical symptoms. Because detox does not treat the underlying behavioral causes of the addiction, it is typically used in combination with other therapies.
  • Residential treatment programs: Residential treatment allows individuals to experience 24-hour care while pursuing therapy to confront the challenges of conditions related to substance abuse. At these facilities individuals are able to access a higher level of care than can be provided by individual, family, or group therapy alone. Residential treatment centers are available for both youth and adults, and stays can range in length from 28 days to six months and beyond

Know The Signs Of Addiction

Understanding the Warning Signs

Addiction is a disease with a range of harmful conditions and behaviors. Recognizing the signs is the first step to getting help for yourself or helping someone you care about. Follow the link to learn more about the behavioral, physical, and psychological aspects of addiction.

How To Identify the Signs of Addiction

People use drugs for various reasons: peer pressure, social norms, self-medication, coping with daily life, and rebellion are just the tip of the iceberg. Developing a substance use disorder depends on various factors which include, your individual biology, route of administration, effects of the drug, gender and environment. There are multiple signs of a developing addiction, these include; visiting multiple doctors for prescriptions, suddenly shifting moods, social withdrawal, unexplained financial problems, having trouble staying awake, falling asleep at inappropriate times, poor motor skills and coordination, and loss of appetite. Opioid use disorder can develop in as little as 5 days. Substance use disorder may develop as immediately as after the first use depending on the substance and other factors.

How To Talk To Your Loved One About SUD

Unfortunately, there is no one-size-fits-all solution for helping a family member who is experiencing addiction or a substance use disorder. However, research shows that family support can play a major role in helping a loved one overcome these obstacles.

Tips on how to start the conversation:

  • Don’t try to force your loved one to seek treatment. This may be the first time they’ve truly thought about their substance use – Avoid using the words ‘should/shouldn’t,’ which can seem like you’re telling your loved one what to do.
  • Try not to ask questions beginning with ‘why,’ as in “Why do you do this?”, etc. That leads your loved one to feel defensive or combative.
  • Don’t judge your loved one for their behaviors. If they did not have a substance use disorder, they wouldn’t be engaging in these behaviors. Furthermore, they’re probably feeling some shame or guilt about their behavior, and a negative tone could shut down the conversation. You can try :
  • Telling them about the information you’ve gathered and say that you’re willing to go through it with them or offer to go with them to the doctor or a therapist. If your loved one responds well, you can even suggest exploring treatment options as a team, so they’re not tackling it alone. Make sure you focus on specific motivating factors, especially since SUDs are chronic, relapsing illnesses.
  • Learn more about substance use disorders. Educate Yourself About Addiction. Until you have knowledge about addiction and the symptoms of drug abuse, it’s easy to miss the signs that are right in front of you.
  • Don’t be afraid to go to therapy to get help if you find yourself struggling due to your loved one’s drug addiction.

There are also many behaviors that are unhelpful when trying to support someone with an addiction. These behaviors include:

  • Accepting blame for your loved one’s substance use.
  • Drinking or doing drugs with them.
  • Rationalizing their behavior or accepting their rationalizations.
  • Keeping the peace by denying your own thoughts and feelings.
  • Protecting your loved one’s image by covering for them.
  • Minimizing their use to yourself or others.
  • Taking responsibility for tasks your loved one cannot complete because they’re under the influence, hungover, or absent.

These behaviors may assist with keeping an individual co-dependent and may also cause feelings of resentment.

How Can I Help Stop the Stigma?

Addiction is a chronic disease that changes the chemistry of the brain. Whether it be in the workplace, in the community, at home; those who suffer from addiction should be treated with dignity and respect. When people with addiction are stigmatized and rejected, it contributes to the struggles of dealing with SUD.

How can you help? First acknowledge addiction is a disease, not a moral failing or something to be ashamed about. Learning about the disease, the implications, & how it impacts one life can help you understand addiction better. Talking about addiction and showing compassion helps humanize the disease and shows that recovery is possible. People need support and help in a non-judgmental manner so those who do seek recovery can have continued support even if they do relapse.

Know the facts, educate yourself and others about substance use disorder and how that impacts individuals and communities. Be aware of your attitudes and behavior towards addiction, as well as the language you use. Listening to people with lived experience in the world of addiction is important, hearing their experiences and life story can reduce stigma and humanize the disease.

Harm Reduction Principles

Harm reduction incorporates strategies for safer use, meeting people who use drugs where they are at, and minimizing harm. Harm reduction principles increases access and opportunities to help people who use drugs to do so in a safe manner. Harm reduction programs have demonstrated effectiveness in minimizing HIV and HCV transmission among persons suffering from substance use disorder.

1. Respecting the rights of people who use drugs

2. A commitment to evidence

3. A commitment to social justice and collaborating with networks of people who use drugs

4. Fighting against stigma

The Baltimore City Health Department Community Risk Reduction Services team hosts a number of free harm reduction and education services throughout Baltimore City. The CRRS Syringe Exchange program has been providing services including overdose prevention education and distributing naloxone since 2004 through the Staying Alive program. Needle Exchange services are provided in multiple locations weekly at varying time slots throughout the city of Baltimore. There are several other syringe exchange sites housed throughout Baltimore City including at SPARC and at Behavioral Health Systems Baltimore, to find out more visit https://health.baltimorecity.gov/hiv-std-services/community-risk-reduction.

If you are currently using drugs, especially opioids, there are steps you can take to keep yourself safer from an overdose:

  • Never use alone.
  • Have naloxone with you and know how to use it.
  • Go slow, especially if you are using something different from what you normally have.