Leslie Dawn Cooper of Portsmouth, Ohio, died at age 34 of an opioid overdose. She did not die alone, but no one with her had the antidote that could have saved her life. A project started in Cooper’s name gives people who witness an overdose the ability and training to administer that antidote, naloxone.
The Ohio Department of Health started Project Deaths Avoided With Naloxone (DAWN) in Scioto County in 2013, and shortly thereafter a program for Cuyahoga County was founded by Joan Papp, MD, an emergency physician at MetroHealth in Cleveland. Project DAWN is an opioid overdose education and naloxone-distribution program designed to find a more efficient way to ensure naloxone is available to those who need it most.
Since 2013, Project DAWN Cuyahoga County has distributed more than 5,000 overdose-prevention kits, with five walk-in sites, a jail program, and take-home kits available to patients in the emergency department, inpatients units, primary care clinics and available at all MetroHealth pharmacies behind the counter without a prescription. The program’s impact is most deeply felt in one number: the 740 opioid overdoses reversed so far through use of the Project DAWN kits.
Emergency physicians typically do not have expertise in addiction, Dr. Papp said. Yet emergency physicians take care of patients who struggle with addiction every day. “We reverse their overdoses. We manage their withdrawal. We treat them when they are seeking help or have complications from their drug use,” she said.
However, emergency medicine is not the kind of profession that allows a lot of extra time for pursuing projects. Yet Dr. Papp felt compelled to go beyond her typical duties to develop Project DAWN.
Dr. Papp has experienced addiction up close and personal. She had family members throughout her life who struggled with the disease. “I felt like I am in a unique position to do something and this is something that desperately needs to be done,” she said. “I think there are few specialties that use naloxone more than emergency medicine.”
“To be perfectly honest, this kind of hit home for me,” Dr. Papp said. “Sometimes we forget that the patient in front of us isn’t just a patient; they’re part of the community.”
“They’re a father or a mother, a sibling, a son or a daughter,” she said. And when they walk into the emergency department, they are looking for help not just from a physician but from a fellow human being.
Between 2014 and 2015, the state saw an increase of 21.5 percent in drug overdose deaths, according to the Centers for Disease Control and Prevention.
With Project DAWN, Dr. Papp takes on the role of community educator. The project holds small-group and community-education events with speakers such as law enforcement, judges, recovering patients, parents of overdose victims, and the county medical examiner. Together, Project DAWN can paint a “broad picture of what’s going on in the community,” Dr. Papp said.
“I was actually quite surprised, when we started our program, by how much support we got from the health department and from the county,” Dr. Papp said. “One of the things that helped us most in starting our program was collaborating with our medical examiner, because nothing is more powerful than having an advocate who can give you all the numbers of overdoses in real-time trends in what’s going on.”
Cuyahoga County’s medical examiner provides Dr. Papp and Project DAWN with updates monthly, at the very least. These updates show the project “what’s going on, what are the trends, is there a fentanyl outbreak, are we seeing an increase in cocaine deaths?” Dr. Papp said. “It really helps us to not only advocate, but also helps us to change our approach when we notice that there’s a batch of a stronger or different drug out there.”
So how important is naloxone in the emergency department?
“Unfortunately, it’s becoming more common,” Dr. Papp said. But treating a patient with naloxone in the emergency setting allows for a good opportunity to intervene. “We know that individuals who have recovered or survived an overdose, about 26 percent of those will go on to seek treatment in the next 30 days. That really gives us an opportunity to step in … we’re pretty lucky to have access to that population.”
Giving a rough estimate based on her firsthand experience, Dr. Papp said about half of patients are willing to accept an overdose-prevention kit when they are given. “Sometimes people are just not in the mindset to accept new information or accept help at that particular moment,” she said. “But it is a very important time to try to intervene.”
Every conversation Dr. Papp has about naloxone and the overdose-prevention kits includes information about treatment options in the community for the patient. But, “the sad truth is they’re inadequate,” she said. “I can give a person information about treatment, but there is inadequate availability of methadone for medication assisted therapy, there is inadequate availability of public housing or other services in the community.”
“It may be 30 days before they get into treatment. They may not be able to find a person who is able to prescribe suboxone,” she said. “That is truly where we are failing our patients.”
“It’s very gratifying to save somebody’s life, no matter what the cause,” Dr. Papp added. “With that, we are lucky that we have such a good antidote … I wish we didn’t have as much opportunity to use it.”
The AMA has long advocated for expanded access to naloxone and, to date, nearly every state has legislation that allows for greater access to the life-saving antidote. The AMA Task Force to Reduce Prescription Opioid Abuse is leading these efforts.