A Case For Crowd Sourced Naloxone
In 2017, more than 47,000 people died of an overdose involving opioids. This death rate is more than any year on record and has quintupled since 1999(1). This unprecedented rise in mortality is attributed to the proliferation of illicitly made fentanyl and other highly potent synthetic opioids. At the same time, more people are receiving high dosages of prescription opioids for chronic pain management. Even when taken as prescribed, these medicines can result in overdose and will often result in addiction and Opioid Use Disorder (OUD).
One major problem relates to EMS response times. The National Fire Protection Association’s (NFPA) standard for response time is four minutes (2), but even urban jurisdictions struggle to respond within six (3). In fact, recent research reports seven-minute response times in urban settings compared to 14 minutes in rural settings(4), creating a critical time gap that could be bridged if naloxone(5) were administered in time. Response time is a critical success factor to opioid overdoses, as this variable almost singularly determines morbidity and mortality outcomes. Moreover, the costs associated with trying to meet this response time are measured in the millions and tens of millions of dollars for municipalities, and almost exclusively amount to adding capacity to the traditional hub-and-spoke response model established by the first 911 system in 1968.
While much has been invested to find innovative ways to disrupt opioid supply chains and more effectively treat OUD sufferers, the fundamentals of overdose response have not changed since these first 911 systems were implemented. Communities that can afford to are adding “more of the same” in response to rapidly increasing overdoses: they hire more emergency medical responders, update information technology, and equip law enforcement with the overdose reversing drug naloxone and training to administer it; this is all managed through the traditional 911 system. This makes no accommodation to connect overdose victims with naloxone via other registered populations within the community, which could include volunteer organizations, family and friends of OUD sufferers, and the larger healthcare community (e.g., employees of major hospital systems, institutions, universities, or off-duty first responders). Connecting these potential naloxone sources with overdose victims could radically increase the likelihood of administering naloxone within the NFPA four-minute standard at a negligible cost to the community.
NaloxoFind is a free app for Apple and Android smartphones that augments the current hub-and-spoke model of overdose response, as orchestrated by the 911 system, with a peer-to-peer mesh network of registered naloxone carriers. This enables anyone around an overdose victim to send anonymous alerts to naloxone carriers based on their geographic proximity. All registered naloxone carriers in a pre-selected radius are automatically notified and the requestor is prompted by the app to dial 911, which is essential when any person overdoses. Since emergency medical services do not always arrive in time to prevent brain damage or death, the administration of naloxone to bridge that time-gap can be critical. When registered naloxone carriers accept an alert request, the app automatically guides them to the patient, enabling timely administration of this critical medication. Version 3.0 of the app recently launched and also includes registered locations that offer naloxone (e.g., wall mounted naloxone).
4. Mell HK et al. Emergency medical services response times in rural, suburban, and urban areas. JAMA Surg 2017 Jul 19; [e-pub]. (http://dx.doi.org/10.1001/jamasurg.2017.2230)
5. Naloxone is a short acting medication that rapidly reverses an overdose and is available in a nasal spray (i.e., Narcan). More details can be found at https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio.