The Iowa Harm Reduction Coalition (IHRC) operates an Overdose Prevention & Naloxone Distribution program, which provides over 20,000 free doses of naloxone to Iowans each year (naloxone, or Narcan, is an opioid antagonist that “reverses” opioid overdose or toxicity, effectively “blocking” opioids from acting on the brain and thus stopping their ability to depress the respiratory system). Since the launch of IHRC’s program in June 2017, nearly 3,000 Iowans have reported using this naloxone to reverse an opioid overdose in the community. IHRC takes an approach to overdose prevention that emphasizes the need to get as much naloxone as possible directly into the hands of people who are most likely to experience, witness, or reverse an overdose, minimizing any potential barrier that may arise. This intervention is fundamentally different from a traditional public health approach to overdose prevention: traditional public health and grassroots community-based movements will inevitably ask different questions about overdose, and it is these questions that shape the interventions that are provided. Rather than consider, “Who is trained or licensed to distribute and administer naloxone?,” Harm Reductionists ask the questions: “Who cares the most about the outcome of an overdose?” and “Who could respond to an overdose and administer naloxone in as little time as possible?” While the answers to the first question are typically pharmacists and first responders (professionals), the answers to the second and third questions are typically the family and friends of an individual who uses drugs (laypersons).

Many professionals were initially skeptical of the ability of laypersons to deliver this medication, but a series of landmark reports and research studies have led the federal government to repeatedly declare that layperson naloxone use is both safe and effective. In a bi-annual report published by the Centers for Disease Control & Prevention (CDC), researchers found that over 80% of naloxone administrations in communities were completed by lay persons, with the majority of these individuals identifying as people who use drugs (PWUD). In this series of reports, the researchers noted that no more than 15% of naloxone administrations were conducted by first responders (including law enforcement). Other federal agencies, including SAMHSA, HHS, HRSA, and CMS, have studied the evidence and come to the same conclusions as the authors of the CDC report, while going even further to declare that if we want to turn the tide on the overdose crisis in America, decision-makers must focus resources on those programs that offer low-barrier naloxone access and that work deliberately to put naloxone into the hands of people who currently use drugs and the family and friends with whom they spend their time. Surgeon General Jerome Adams famously called for every American to obtain naloxone and learn to use it in order to be prepared to prevent a fatal overdose.

IHRC routinely distributes naloxone and Narcan (naloxone is the generic name of the medication, formulated as a vial and intramuscular syringe, while Narcan is a brand name medication that is available as an intra-nasal spray) directly to people who are at high risk of overdose via home deliveries, which include a one-on-one training and educational session; tele-health trainings and mail-based distribution; outreach in community settings; and a drop-in center. Yet, IHRC’s staff routinely receive inquiries and requests for naloxone training and overdose education from individuals from around the state who are seeking more formal training and education sessions. These requests are typically submitted by family members and friends of individuals who have previously experienced an overdose. They often come from direct service providers who work closely with people who use drugs and want to provide their clients with overdose prevention counselling that is appropriate, knowledgeable, and effective. Some originate within law enforcement departments, volunteer firefighters, and among emergency medical personnel: while these professionals may make up a smaller percentage of overdose reversals when compared with PWUD, their role in preventing overdose fatalities is absolutely critical and the opportunities they (will) receive to save lives with naloxone / Narcan are indisputable. For these aforementioned groups and individuals, a text message sent to a hotline, followed half of an hour later by a 15 minute naloxone administration training in their home, may not be the type of training that best suits their needs, or truly “meets them where they’re at.”

IHRC has previously been unable to accommodate requests for additional, large group, no-cost overdose prevention and naloxone administration trainings. However, in response to COVID-19 (and because of the free time it has afforded many Iowans), IHRC will host a series of trainings on overdose prevention, naloxone administration, and overdose response. The trainings will be held on a bi-weekly basis, alternating between weekdays and weekends, mornings, afternoons, and evenings, in order to meet the scheduling needs of a wide range of audiences. Both introductory sessions and “train the trainer” sessions will be provided. These two – three hour trainings are free, no continuing education credit (CEUs) will be provided, and there are no prerequisites for participation. As space is limited, we ask that only Iowans register to attend these sessions. Trainings must be attended in-person or during the live recording. At the completion of the training series, a final training may be posted to the IHRC website and circulated to the general public. All participants will be eligible to receive up to 1,000 free intramuscular naloxone rescue kits from IHRC. Please note that intranasal Narcan may be made available in small quantities, upon request. All naloxone and Narcan will be distributed to participants via mail. During the summer of 2020, IHRC will host 10 naloxone trainings. These trainings are scheduled to occur every 10 days and are offered on weekdays, weekends, mornings, afternoons, and evenings, with the goal being to vary the time and day of the week in an effort to make it possible for interested individuals to identify one opportunity that fits into their schedule.