Transforming Loss into Preventing Opioid Overdose Deaths

We talk with Alaska itinerant public health nurses Denise Damewood and Claire Geldhof about Project Gabe, an effort stemmed in saving lives from opioid abuse and overdoses through the right tools, education and partnerships. Learn how any community can take and adapt Project Gabe to tackle stigma around substance use disorder, educate communities about naloxone and other life-saving tactics and work together to prevent opioid overdose deaths.

Transcript

Denise Damewood  0:00  

I simply could not bear the thought I couldn't. Not one more Gabe, not a Gabriella, nobody losing their life to opioids.

Beth Brown  0:14  

Welcome to Breaking Barriers in Rural Health, a limited series podcast from Mountain Pacific. We are sharing what is working in rural mental health and health care and discussing ways to replicate these successes. We're also shining sunlight where it's needed by identifying breakdowns and gaps in care. Ultimately, we aim to improve the health and well being of our health care communities and anyone listening in to this podcast. Now here's the latest episode in Breaking Barriers in Rural Health.

Amber Rogers  0:49  

Welcome everybody, to Breaking Barriers in Rural Health. My name is Amber Rogers, and I'm from Mountain Pacific Quality Health. And I have with us today some very special guests from Sitka, Alaska, as well as my coworker who is in Wasilla, Alaska. Today we're going to talk to you about a very important project of an intervention using naloxone that I had never even heard of before. I'm going to let everybody introduce themselves. I'm going to turn it over first to Kyla Kyla?

Kyla Newland  1:24  

Yeah, thanks, Amber. So Kyla here in Wasilla Alaska, for Mountain Pacific Quality Health. I'm an account manager and a pharmacist. It's a pleasure today to introduce Denise and Claire, who have been very instrumental in getting what we call Project Gabe off the ground here in Alaska. So I will let you ladies introduce yourselves. And thank you so much for being here today.

Denise Damewood  1:48  

Thank you, Claire. My name is Denise Deanwood and I'm excited to share with you that I'm in my 50s. A mother of fantastic boys and a registered nurse and I've been a registered nurse for over 20 years. I've worked in various fields of nursing over the years and have been enjoying community and public health for about over eight. My partner Gary and I moved from Idaho to Alaska four years ago, when I accepted a job working for the state of Alaska as a public health nurse here, what I have affectionately termed as bush nursing, as I serve rural communities as an itinerant nurse in the southeast portion of Alaska. I live mainly and serve mainly in Sitka Public Health as their public health nurse and I absolutely love it. Gary and I have a total of five boys, all grown now and doing their own thing. And Gabe is the oldest of the boys and it is his tragic story that brings us together today sharing about Project Gabe. Project Gabe is a project born out of profound grief, tragic loss, and deep concern for others who live with opioid addictions. And the hope centered around naloxone, an opioid reversal drug that can and does save lives.

Amber Rogers  3:04  

Awesome. Thank you for that already. I can't wait to finish that conversation. Claire, do you want to introduce yourself? 

Claire Suzanne Geldhof  3:12  

Thank you so much. My name is Claire Suzanne Geldhof and I was born and raised in Juneau, Alaska. A lifelong Alaskan resident and lover of the outdoors, I returned back after nursing school with the University of Vermont in 2011, and have been practicing nursing in Alaska for 12 years now. I am also an itinerant nurse in the southeast region. And I cover six remote communities and off grid areas with no roads that connect them. So it's a pleasure to be with you guys today and a delight to just talk about our naloxone distribution efforts in rural Alaska with you all. Thank you.

Amber Rogers  3:56  

Wonderful. So just for our audience, if you are not familiar with naloxone, just remember that naloxone is the same medication as Narcan. Many people don't realize that Narcan is the brand name and then the generic name is naloxone. So most of us in the medical field do refer to naloxone. But just as a forewarner, for our audience that may not be as familiar.

Kyla Newland  4:25  

And Amber, this is Kyla. I'll add to that. In the state of Alaska, we actually, through our state distribution program, we use a product called Kloxxado, which is newer. It's a higher dosage of naloxone, so that's another thing to just keep in mind.

Amber Rogers  4:42  

And we may slip between all of those words, so the audience will just have to bear with us as we slip into our professional roles on occasion. So Denise, tell us a little bit more about Project Gabe and how that came to be. 

Denise Damewood  4:59  

I'd love to, thank you Amber. I think I will first start with the when, why and how, and I promise I'll circle back to the what is Project Gabe, okay? Project Gabe started in January of 2022, after the death of my stepson, Gabe Johnston. Gabe was a bright, very witty, adventurous ball of energy. He absolutely loved the outdoors, and it was a rare day when one could find him indoors. He had to have the outdoors type of job, and I can remember sitting and working with him on his resume and applying for everything outdoors. I was like, "Gabe, is there something specific that we can shoot for, or is it just you need to be outside?" And he was, "Yeah, I need to be outside and enjoying the outdoors." But he did love to work with big machinery. So we kind of paired the two and he was in heaven with his job. He absolutely loved working with the oil lines, gas lines, you know, that type of a thing. He lived in Oregon during this time. When he wasn't working though, he was hunting, fishing and just being with friends and family, typically around a barbecue or a lake. He would be the one surrounded by friends laughing and the center of attention, you know, and you'd point out, "Where's Gabe?" Well, you knew where he was, he was over there with all of the laughter. To put it simply, Gabe loved life. He loved every minute. He lived life to the fullest every minute. When Gabe was young, younger teenager, he was first introduced to drugs by a friend whose father had been prescribed opioids as a pain medicine after a really bad car accident. His friend and Gabe experimented with that prescription and the attraction of becoming high led both him and his friend down a very dark road very quick. Unfortunately, Gabe became seriously addicted, which led to over 14 years of poly substance abuse. Gabe passed away January 31, 2022, from an opioid overdose that he didn't know was mixed with a myriad of drugs, one of them being carfentanil. For those of you that don't know, carfentanil is not meant for human consumption, but it is actually used as a tranquilizing agent for elephants and other large mammals. Carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl alone. Kind of puts it in perspective. Although he did not know what was in there, he didn't test it for fentanyl, or that would have shown that there was fentanyl in it and then he would have known not to have tested but he didn't. And he also knew not to use alone. Again, he had been using for over 14 years, so these are things that when you are addicted to opioids, you know these things, but sometimes you don't follow all the rules, right? So he used alone that evening in the house. I think the rest of his family went camping that weekend, and they left him because he had to work. Something along that line. But the next morning he was found by one of his family members that had came home from the trip. And we received that phone call in the morning that a parent never wants to receive that forever changed many lives. Gabe touched many lives and has a big family, so it was hard for us. Sadly, Gabe's story is not unique. And the more I talk about Gabe and the more I share my grief and my story, and naloxone and to the communities, the more I hear that many people have similar stories, tragedies and struggles. We didn't want Gabe's beautiful life to be remembered by his mistakes. Who wants to be remembered for the worst decision you ever made, right? No one wants that. After we cremated Gabe, because that's what he wanted, we were left with a Gabe-sized, dark hole; lonely and feeling quite a loss and alone. We didn't know what to do with it. As a public health nurse, I tend to navigate towards wanting to fix things right? You know, helping others and that's just who I am, that's just my nature. And if you knew me, you would also know that I don't do anything small, but everything I do is a big thing. I don't just grow a few tomatoes, no not me. I grow a community garden and I feed hundreds. I don't just buy some honey when I need honey, but no, I endeavor to buy five hives, a business license and make my own honey and then sell it at market. So that's kind of the size of big that I talk about. Gary is Gabe's father, and he always says to me, "You definitely do the 'Go big or go home,' don't you?" Knowing that about me and that type of big. And also if you live in Alaska, you know, or visited Alaska, that it is, where I live, is a big fishing town. So that's Sitka. And in the southeast, we're just all about fishing. And after January, which was when Gabe passed, and we got back from what we needed to do was February. And after February comes March, right? I'm getting to a point here. All of that means herring season starts and the fishermen wake from their slumber and start their long season of fishing. And herring is that opening season. So here it is, February and my mind has already moved on to March, what is next and herring season. And I can remember being in the clinic and getting ready to take naloxone to a couple of the seafood plants. I work closely with the seafood plants in Sitka, and needed to restock their opioid emergency boxes that contain the opioid reversal drug. So I was talking to Gabe, as I did often early on after his death. I was gathering naloxone, and it hit me. All of the fishing boats that would soon fill our waters had no naloxone in them. Fear struck me. How can we start a fishing season and not really be ready for a medical emergency deep at sea? And that is a nurse's worst nightmare. Now throw in there that in my mind's eyes, I could see a Gabe on every boat in the sea, and I just couldn't have it. I went back to my cabinets and I pulled out about 100 white paper sacks. You know, those sacks that the teenagers walk out of public health with they typically have birth control? Well, this time, these sacks were going to be filled with naloxone, I crammed a few other emergency items in there. So some education on how to use naloxone, so that we would be in compliance, and so that people would know how to use it and use it correctly. I also put in there how to get a hold of me to replenish their stock, and in a few things like that, right? So I get all that stuff together, crammed it all into these white sacks. And then I call my friends at the seafood plants. And I told them my biggest fear. And one of them had called me just just a few days before I put this together and, and said, I am so sorry for your loss. And the fishermen were so supportive and the seafood, that my office was filled with flowers. It was heart touching. And it was quite quite a time that we shared together. If anybody gets me, they get me. These fishing people get me, because they've been through hard times, tough times, they get it. When one of your own hurts, they surround you with love. So I was surrounded in flowers. I had all of these white sacks crammed with naloxone and everything else I could put in there. And then I call my seafood friends at the plants here. And I hashed out a plan on how to get those bags in as many boats as possible before the herring opened. And again, like one of the managers had said to me, "Is there anything I can do?" And I'm like, "Oh, yes, there is. There's a lot we can do. Let me tell you, Do you have an extra 15 minutes in the middle of preparing for herring season to listen to what I want?" Right. So I mean, they got fish on the brain, things going on. They've got their own world and you know, they stopped to listen to one mom who was missing their son. And that knew that what she had to say was important, and involved them. That's how amazing they are. But what a crazy flurry of activity started from that one thought. I simply could not bear the thought, I couldn't. Not one more Gabe, not a Gabriella, nobody losing their life to opioids. So after all these sacks were put together and my friends were called I thought "Oh, I better call Gabe's father." Call him to the clinic and, and tell him I had an idea that couldn't wait. And he knows me, the woman with big ideas. So it couldn't wait, but I needed his blessing before I could dive in. Because before anything happens and happened with Project Gabe, I made sure that I had Gabe's blessing and his dad's blessing before I moved an inch forward. So Gary in minutes came to the clinic and saw all the white bags and the three little emergency opioid red boxes that I have left, that's what I had in stock at the time. And I lined them up on the floor. But he knew what all of that was, he had seen that suck before, because I had put five of them in his seafood plant just a few months prior to Gabe's passing, so they were aware of it. All of the bags were surrounded, if you can imagine this, with a piece of cardboard, propped up with the name project Gabe, and a picture of an acoustic guitar pasted to it. It was not a showstopper, but it did say what I wanted it to say. I was trying to figure out a color. And I remember Gabe loved all colors. There wasn't one color Gabe specifically like more than another. But I do know that Gabe loved the acoustic guitar. And to me, that was his color. So I put a single guitar on there with the Project Gabe, and that represented the color of music, and that represented Gabe. So when Gary got in, I blurted out, "It's herring season in a couple of weeks and all the boats don't have naloxone on them." And he's looking at me. And I said, "Do you think Gabe would be okay with getting naloxone on them, and do I have your blessing?" I'll never, ever forget his eyes. He looked down at the bags and they looked at mine and he said, "Yes, Gabe would love that. And you have my blessing." And quickly he turned on his heels and said, "Thank you, Denise," and left, with tears welling up in his eyes. That is the when, why and how project started. And the what, I promised I would get to is this, Project Gabe is Alaska's division of public health effort to provide opioid misuse awareness, education and prevention resources to industrial workers in Alaska. So Project Gabe distributes naloxone, a medication that reverses opioid overdose, and fentanyl test strips, which can test for the presence of fentanyl in drugs as a tool for harm reduction. Project Gabe also provides opioid misuse awareness, education and recovery tools to create a healthy workplace for Alaska industrial workers in a manner that is accessible, easy to understand and easy to implement at no cost. The project is supported by overdose response programs, Overdose to Action, OD2A, and that's through a CDC grant. Taking a quote from Alaska's chief medical officer, Dr. Anne Zink, "Project Gabe builds on a work already being done through the state, by delivering an important message directly through workplaces to working Alaskans. Naloxone is safe to use and easy to administer. Project Gabe makes it even more accessible, as time is critical in an overdose. Naloxone can save a life when it is used the right way, and we need to ensure it is widely available in every workplace in Alaska. Project Gabe is a critical step in that direction. Sadly, in memory of a young man gone too soon. That's from our medical director. The approach is actually quite simple. There are three main components to it. Provide education, provide emergency first aid tools, most importantly, the opioid reversal drug, and lastly, to build partnerships. When we provide education, we are addressing and erasing the stigma associated with substance misuse, increasing awareness and knowledge of opioid misuse and dangers of addictive unknown drugs, or fillers such as fentanyl or tranq that we're starting to hear about now. And all the devastation that tranq is doing to a lot of people, definitely those that are homeless and on the streets, and is addictive. So adding all of those fillers, in addition to the opioids, is causing quite a stir and it's quite sad. Education on how to recognize the signs and symptoms of an overdose and education on how to use fentanyl test strips in a way to reduce harm prior to using. And I know I've said that before, that as a harm reduction or as, you know, a way to reduce harm. And that's all it is. Oftentimes though, in a perfect world, a person that was addicted to opioids would test their pills or liquid before using it, right? That way they would test it for fentanyl. If it had fentanyl, in a perfect world, they would throw it away. They wouldn't use that. But we aren't in a perfect world or these things wouldn't even be here and as a way to have eyes be more open to what it is that they're taking, the fentanyl testing strips is a great and easy and cheap, definitely if you get it through us it's free. And there are other organizations as well that will supply those for free. But it will test for fentanyl in that drug or liquid. And it's just as simple as scraping off a few pieces of that pill and putting it in a little bit of water and then sticking a strip in there. And it will let you know if it's positive or not. Now, like I said, in a perfect world, we wouldn't have drugs and or they would not use them if it had fentanyl in it. But at least we are saying, if you're going to use it, and continue to use it, even if it tests fentanyl, then use less of it. There is the never use alone. And there's a never use alone hotline as well, you know, so that they can make sure that they're really not alone when they use it. But that's what we mean by harm reduction. So if you're going to do it, then let's do it in the way that is the safest way. And let's support them that way. So with this education that we provide, we do this through just various means. But say we're working with an organization and we're working on bringing naloxone into the workforce, we can do that through new hire orientation. And also we can do it as a nurse providing first aid training, or we can show a PowerPoint and provide literature. And then also we have a website through Alaska state for information, all kinds of information out there on drug and opioid use. So I've rambled on a little bit, but that was to provide education. Quickly I'll explain the provide emergency first aid tools, and then lastly, build partnerships, and then I'll come up for air. So it's kind of like a three pronged approach, right? We provide the education, we provide the tools and then we build partnerships. And the providing the tools, that looks like supplying the industries with the opioid emergency boxes that I've talked a little bit about that are mounted on the wall. We just asked them to mount them with their other life saving equipment. So mount that by your AEDs, your first aid kit, fire extinguishers. It's just another life saving tool that can be at your fingertips, if needed. And then we also have the dry bags that you can carry with you and take with you. And those work great for like boats, off road vehicles, in mines, wherever you need to go when it's not so dry, which some days in Alaska, that's like every day, those bags would work really great. Also, Project HOPE provides individual kits that have a couple of naloxone in them with some other goodies packed in that, and they can be taken as well wherever you go. So that's kind of nice. The last part to this is the building the partnership. And it's not a do it by yourself alone project. It requires partnership and collaboration between the public health staff, when we're doing it, and the company receiving or wanting the project. And then this is a long lasting, local state community partnership. This part is promoting equitable and inclusive overdose education, prevention and response efforts and provides a linkage to care for more resources and also continued follow up and the replenishment of supplies. So that's basically Project Gabe in a nutshell, looking at like the three pronged approach of providing education, provide emergency first aid tools and then building partnerships. Like I said, That was long winded, but that is Project Gabe. 

Amber Rogers  23:32  

Wow.

Kyla Newland  23:33  

I just I think we just need to pause and just acknowledge what a powerful story. And thank you so much for your courage and tenacity, sharing this with us.

Denise Damewood  23:45  

Thank you, thank you very much. It's all of us. It takes us all and it is something that started here through me. But I definitely do not own this project. This project has never been mine. This project is all of ours. And it's just the right timing, the right place and the right purpose and and all the stars aligned for something like this to just really be very successful.

Amber Rogers  24:14  

Well, I would add tenacity to that list of attributes. Yes. You know, the power of one woman to start a process is amazing. You know, you talked a lot about stigma. And that really is a barrier to a lot of the larger components related to harm reduction. Some people what I've heard is, "I don't want to put that in my place of business because if you build it, they will come." When you're dealing with partnerships, how do you address that? 

Denise Damewood  24:51  

Yeah, that's, that's a good question, Amber. I know after doing this and just the years of nursing and public health nursing deals with a lot of different stigmas. So that's kind of something we're steeped in every day. But I know that change is often slow to come. And it takes patience and grace, but persistence, because it does pay off. And people are more understanding than you think when their eyes are open to a problem that requires, you know, an active solution, such as opioid misuse. As opioid misuse continues to rise, well, so does crime, the reports of new and more dangerous drugs that we talked about. You know, the cocktails from the streets that lead to all of the senseless brutality and death, and quite honestly, our innocence is lost. Stolen, really, right from underneath our feet. These opioid waves have a, I don't know, I like to say a ripple effect that touch all humanity. These type of hard lessons in life bring schooling to our people. One can't bury their head for long before something involving drugs hits a little too close to home. When this happens, stigma seems silly, really. It's hard to express unless you walk in our shoes, but what really matters is not what someone might think of you or of the user. But when will enough simply be enough? When will hope start to shine? As for pushing my agenda? I don't have one. I'm the one who stops, listens and offers a solution to those who are asking what I can do. We might feel urgency to get everything done, and I know that Claire and I do and many of us do. We want to get the help out there. We see the need. And we, it's like a storm brewing and coming in, we get anxious, and we want to help as many people as we can and get like naloxone into many hands, as it will accept it right? I know I share in that. But honestly, as the drug issues grow, so will the need to do something proactive about it. And that's when stigma takes a second place and taking part in the solution takes first place. And that's what I've seen. There might at first be conversations that we have that they say, "I don't want to put that in a public place. If you bring that, if we publicize it, well, it will be here." The facts are it is already here, and we just really can't look the other way for too long. It's not helping ourselves, it's not helping understand others and it's not providing the cure. And then what happens is, Claire and I will get a phone call, and it's from a mayor in one of the villages or from somebody in one of the villages it says, "We've had a catastrophe. We've lost one, we've lost two. We've we've lost some people to an opioid overdose. And what was that stuff you were talking about?" It's it's one of those things where you wish you could do everything, but sometimes you can just do what you can do at the time. So I don't really push an agenda or push Project Gabe or naloxone. But what I do is I stop, and I listen. And when they're ready to talk about a solution, then I've got some things that maybe will help. That's what we do. That's what public health nursing is all about. That's what community care is all about. That's what our community task forces are great at doing. That's where our mayors come into place. These are our city workers. These are our, our people that are on assemblies. These are the people making the rules. These are the teachers, these are the educators, these are the people that will come to you and will listen. And like I've said, I'm starting to see that change. Conversation really, quite honestly is not around stigma much. We're starting to lose that innocence. And we're starting to gain a perspective on the reality that opioid addiction and abuse is everywhere you are willing to look, and they need our help. And we have, maybe not the answer to all questions and maybe not the answer to all opioid addictions, we don't have that. But what we do have is a simple tool that can reverse the effects. We do have education to educate and help with addictions before they even go down that road. It all takes its place. It's like a big puzzle, but it all takes its place. Regarding stigma, I really am seeing a change. Claire, what do you think on that?

Claire Suzanne Geldhof  29:39  

Yeah, I was thinking about the word stigma, just because it's a word that we see in a lot of contexts. And stigma is a set of negative or unfair beliefs that a society or group of people have about something, and this is taken from Merriam Webster. So thinking about that, you know, a negative and unfair set of beliefs that's following something around, and in this topic, we're talking about substance use, we're talking about addiction, we're talking about harm reduction practices, and how do we help support our people around us, our loved ones, our family members, our community members that are struggling with these things? And so to help dissolve that stigma that has long loomed over these topics of social care and medicine, and nursing, I think that in this way, Denise, like we are going out into communities, and we're having these conversations. And I think by that nature of connecting with people and talking about the realities, talking about data, but also hearing, listening to these stories that are surrounding us. It's profound to think that in one way, that stigma is slowly lessening its grip on these outreach efforts, by the fact that so many families and so many individuals in communities are untouched by this opioid epidemic, and just kind of the devastation of its breakdown. So when I think of stigma, I think that we come together, and we talk with people. And we show through our work and our actions and our day to day lives that this is not a negative, unfair belief system that we have to continue following and that there are actionable steps, there are things that we can do. People can get help, people can get treatment, and and we know that people do recover. And I'm thinking of a dear friend of mine, Christina Love, that recently said, "If you don't believe someone is capable of recovery, and doing that work, that's your work to do. That is your work to do." And so I carry that every day as a nurse, and think about all the individuals I've met in this career path and how that relates to just knowing that we can help individuals and individuals can help themselves. But we do that best when we work together as a community. And we do that best when we dissolve as much of the stigma as we can.

Amber Rogers 32:25

I don’t have a word to say in addition. You guys have been so eloquent in your response. Kyla, any thoughts?

Kyla Newland 32:36

Oh I completely agree. Thank you so much for sharing your unique perspectives and really just having such good insight.

Amber Rogers 32:45

And for those of you that would like to follow along with Project Gabe as they continue to expand their partnerships, expand their reach, which is incredibly impressive, how do we keep ahold of you? How does somebody reach out?

Denise Damewood 33:03

The best way to get more information and to keep up with the growth is actually through an email. We have hope to build a weblink or website in the future. Definitely we could sorely use this. The best way, truly, until we have more funding and we have more support; it is just a few people running this project kind of behind the scenes in addition to what, you know, we already have on our plate. So, until there’s a little bit more funding and more people at the table, you’re kind of stuck with some of these public health nurse elves running around trying to do most things Project Gabe. But uh, so the email is easy. It’s just ProjectGabe@alaska.gov. We look at it every day and uh, we really do our best to correspond. We do a pretty good job, I think, at doing that. So if you wanted to get involved, or if you had some ideas, if you want to know more, if you want to be able to curtail this to your community, it is just so easy. It is easy to take Project Gabe and make it your own. And um, and that is the next steps for us, as we look in the future. It all happens so fast, it was a whirlwind of activity, just like it started, you know. It has continued to just take us one direction and another. We’ve grown across all of the state of Alaska and we are in so many villages and so many rural areas all over the state. And we continue to work on ways to get Project Gabe into those communities and education into those communities. And as we’re continuing to do that, we’re also working on the next steps in Project Gabe, and that’s finding out ways to make this your own. So, I literally have another screen up on my computer right now and I’ve been working on putting Project Gabe into a, basically a one-page steps on how to do it. It’s that easy. That way, the communities that are like, “Whoa, I wonder how easy that is to make it Project Tammy, make it Project Whatever. How we can do that.” And it’s quite simply done, especially if you already have something going on in your state or in your community that you can kind of dovetail into, such as we have. We have Project Hope that has been handing out naloxone kits for quite some time. And Project Gave just kind of spurred off of that into working with the industries. So working not as an individual one-on-one, but seeing a big picture and saying, “Okay, instead of training 500 people, how can we do it in a way that we can add that into orientation, train those 500 people we’re hiring.” I’m thinking like the seasonal fishing employees, you know, that come in a group like that. Train them on naloxone, what to look at for opioid misuse, what to do, the next steps and where these kits would be mounted. So, the next steps for us, and what I’ve been working on, is how do you make that your own? Because it’s really, truly simple. If you only knew me you would know it would have to be. I just don’t do hard. I don’t do difficult and complex. I’m just a practical, easy, A-B-C kind of lady. And so this is just something that is just, came to my head. And if it came to mine, trust me, it’s pretty simple, and can be, um, made into, transformed into whatever it is that you’ve already got going on and enhance it. Or, if you’ve got nothing going on that you are aware of and, as you look deeper into it you find out, no we really don’t have something that we could use, this can be curtailed to anything and changed into, changed into it very simply. 

Claire Suzanne Geldhof 37:04

I will add, Denise, I think with AED devices too, that’s been as we’ve talked about some of the stigma during this and for listeners that are wondering like maybe you don’t have a program like Project Hope in your state or in your community that already has a system in place that’s distributing naloxone. We know that this year there’s been some monumental changes so that now naloxone is starting to be made available over counter, but we also know as public health nurses that we need to continue furthering these efforts. Just because something is available over the counter, there still are barriers that exist like walking into a pharmacy, the cost might be a barrier. So, if you are listening from a state where you don’t have some type of program run through county or state public health departments or even through your local community efforts and like a syringe access program. Thinking about ways that you could work together with a local coalition and design a program that could piggyback on efforts like AED devices or tourniquet devices that we’re seeing pop up in a lot of public spaces. How can you combine naloxone into those existing kits? How can you advertise? I think back to the nursing process, I hate to bring that into this but it rules over us all, of just looking at, okay, we recognize that there’s this issue that’s been long-standing and going on. Substance use is endemic, meaning that it’s always going to be around, and so we need to kind of engage on these harm reduction strategies and these local conversations that embark on strategies for how can we help keep people safe, healthy and informed? And so, we kind of turn back to our nursing process of assessing what are the resources available out there, who can we call into these conversations and how do we engage with them to kind of design out and map out? And then you have amazing champions like Denise, that has developed this incredible program across the state of Alaska, that can help give you that one-page pointer and then some more on some framework of how you can build that out and spread that. And for us in Alaska in these rural communities, part of the joy is that we have the benefit of going sometimes door-to-door or calling on landlines, because cell phones don’t exist, to sit down and meet with village members and community members and talk about these practices that we know are effective, we know they save lives and we know that they can get people to the next level of care and treatment when they’re ready.

Denise Damewood 39:46

Ya, Claire, I can remember the first time I did an interview talking about Project Gabe. Oh, it’s been over a year now. And he said, “Well, where do you put these boxes that you’re talking about?” And I realize I probably didn’t explain those very well, right? So, these opioid emergency boxes are a mountable, red device. They look just like the fire extinguishers. They look just like first aid emergency kits that are mounted on the wall. So, the very first time this reporter said, “Well what do I do with that?” I said, “Well, you put it right next to your AED and your fire extinguisher and your first aid kit that’s already mounted there, and it just joins that assembly because it’s one more life saving tool. That’s all it is.” And he was just like, “Oh, that’s really easy! This I got.” You know? And it’s like ah, okay. Like I said, it really is easy, because it’s just one more life saving tool. And the things you can do with it, and make it your own. One of the things is when your community does like CPR training and, you know, maybe the Red Cross or whomever is doing the CPR training, maybe it will become a thing. I believe it will be, that naloxone training is just part of CPR training. Oh how that will erase stigma, won’t it? So, it’s just evolving and changing and organically growing. Naloxone is just one more tool, one more resource, and it can be put into and should be put into all CPR training because we don’t know why a person is on the floor, unresponsive. We don’t know the situation for everybody. Naloxone should be part of that, and if there’s no harm in providing naloxone, if the person is not unresponsive because of naloxone, well that’s okay. It’s not going to cause any harm by applying it. And if they are on an opioid, well then that will reverse that and then you can continue with your other protocol with CPR. But it is so easy to bring naloxone, and should naturally be in that, and I think we’re starting to see it. I just renewed by BLS, and in that training I was so happy, and I scored well, by the way. I got a 10 out of 10 on that one. But on naloxone, you know, they just brought that into the training and I was, I was over the moon. I was the happiest student taking BLS, I can tell you that. But, it’s just easy to integrate that in, as Claire was saying. You know, in your community let somebody’s idea go. It’s not yours, it’s not your project. It’s all of our project. So to be able to have, you know, somebody calling me and saying, “Hey, can I have some naloxone?” and “Do you have some expired naloxone I can use as trainers, because I’m giving a CPR class?” If you want to make me the happiest woman, that is how you do it. You know, you just call up and say that and I’m just over the moon happy. Because yes, it’s just part of it. So, a lot of our CPR training now that’s going on in Sitka, and we have a lot, with the fire, the rescue, the forestry service, we have a lot of CPR training that goes on here. They are putting that into all of their training. Go naloxone training! So, it’s exciting. 

Amber Rogers 43:15

That is very exciting, and I’ll just end with, if they can do it in Sitka, Alaska, there’s no excuse for Missoula, Montana, or Laramie, Wyoming, or Honolulu, Hawaii. Anybody, big or small, big resources, small dollars, can do something to make a difference. 

Denise Damewood 43:40

Absolutely.

Amber Rogers 43:42

Thank you both. This has been fantastic. And I hope it gives our audience some good ideas for how to make changes within their own communities and break down those barriers. Thank you guys. 

Claire Suzanne Geldhof 43:57

Thank you, Amber, Denise, Kyla. Thanks so much. 

Kyla Newland 43:57

Thank you.

Denise Damewood 44:01

Thank you.

Beth Brown 44:08

Thank you for listening. Be sure to subscribe to Breaking Barriers in Rural Health and learn more about Mountain Pacific at www.mpqhf.org.