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A few years ago, as opioid overdoses began to spike, Dr. Don Stader was an emergency and addiction medicine physician facing a challenge. After years of treating patients who were at risk of overdosing, whether due to ongoing drug use, overdosing in the past, or other social determinants of health, Stader was unable to send them home with naloxone, a potentially lifesaving medication that can reverse the effects of an opioid overdose.
“I’ve always been pissed that we were not doing it,” Stader, who described himself as a “young, grizzled ER doc,” said to Direct Relief. “It’s normalized in many places to not provide people with the care they deserve, especially this marginalized class of people who struggle with substance use,” Stader said.
Fed up, Stader took action. In 2018, he began a campaign, starting in his hospital, to begin changing policies, with the goal of making it easier for patients who abuse opioids to obtain naloxone.
During a year in which almost 47,000 Americans would die from opioid-related overdoses, Stader ran into heavy resistance.
“I found it was very difficult to set up,” he said. The most common objections were that naloxone distribution was not reimbursed, that hospitals are not charities and that there were staff shortages for existing programs and responsibilities.
Stader was undeterred and remembers thinking, “We should just address the barriers, so this can become the standard of care.” Along with his nonprofit team, which now consists of Stader, two co-chairs, and two project managers, what would eventually be called the Colorado Naloxone Project (CNP) began lobbying state lawmakers to expand access to naloxone in hospital emergency departments.
In little more than a year of focused efforts, CNP led an effort to get legislation passed, with Colorado’s House Bill 20-1065, which requires insurance companies to reimburse hospitals for giving out naloxone to their insured patients, reduces liability to anyone who administers expired naloxone in good faith, and increases access to clean needles by allowing nonprofits to run clean needle exchange programs without local government approval. A subsequent bill, which CNP lobbied for, extends the coverage to uninsured patients via Medicaid.
“How you can heal [the opioid epidemic] is you have to start caring about one another. The Colorado Naloxone Project challenges the idea that these are throw-away people. It’s hard to care about people if you think it’s a hopeless cause. In medicine, we’ve not used the resources at our disposal for healing outcomes. Naloxone is the first step towards doing something for those patients,” he said.
To date, CNP has signed up 108 hospitals and emergency departments, accounting for almost 90% of all such facilities in Colorado, and 20 labor and delivery units, which is about half of all such units statewide. They have also partnered with schools, clubs and bars and with other community-based organizations to increase distribution points. Next year, CNP is looking to expand its distribution and patient screening initiatives to 10 states. Direct Relief has distributed 11,500 doses of naloxone since 2021 to CNP and more than 2.2 million doses nationally, sourced from Pfizer and Emergent BioSolutions since 2017.
“I can’t overstate how important it is to go to hospitals and give them naloxone, so they have no excuse,” Stader said.
Job’s Not Finished
Despite another record year of opioid-related deaths, which exceeded 80,800 people, a host of studiessuggesting the benefits of increasingnaloxone distribution and education, and the recommendations of several medical and governmentagencies, Stader says his group still encounters resistance to its initiatives. He said most of the hesitation results from hospital administrators and staff feeling overburdened due to the Covid-19 pandemic and the flu and RSV outbreaks. Many hospitals remain understaffed, and Stader said he is often told by staff that they cannot take on any additional work.
“It’s a very real and legitimate concern,” he said. “Some also question whether it’s a role hospitals want to take on since it’s steeped in stigma, even at the bedside level,” he said, referring to care for people who use drugs.
On this point, Stader said he could relate on a personal level.
“I used to not like people who used drugs,” he admitted, explaining that he was taught harmful stereotypes about people who use drugs. When he began practicing as a doctor, he recalled being spit on and abused in other ways by drug users.
“We (health care providers) have trauma from that patient population,” he said. “We’ve also traumatized that patient population. When they come in, we’ve given them treatment of someone you don’t like,” Stader said. He hopes that CNP’s initiatives will help cut through some of these feelings, on both sides, by providing a new path forward, one he has walked himself.
“We know naloxone saves lives, but it’s also about the restoration of that therapeutic relationship with patients,” Stader said.
“I tell them, ‘I’m worried about you. You’re a person who is worth saving. You can save your life or someone else’s life, and when you’re ready for treatment, I’m ready to treat you’… That naloxone is now a physical manifestation of that treatment,” he said.
Even if a healthcare provider or patient is not at a stage where they are open to such a relationship, however, Stader still hopes they can agree on a more basic point.
“If a patient might die, send them home with the antidote, so they don’t,” he said.
Since 2017, Direct Relief has provided 2.2 million doses of naloxone to health centers, free clinics, community organizations, K-12 schools, colleges and universities, first responders and harm reduction groups, free of charge.