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story.lead_photo.caption Missouri River Regional Library circulation manager Jessica Wieberg, Director Claudia Cook and adult services manager Qhyrrae Michaelieu discuss the training they've received to be able to administer Narcan. Narcan is considered an opioid antagonist and is typically administered to individuals who have overdosed on the drug. Photo by Julie Smith / News Tribune.

Cole County Sheriff's Department deputies have saved the lives of three people this year by administering Narcan to people who have overdosed on opioids.

Two were within the past six weeks.

Last year, Sheriff John Wheeler announced deputies would receive training and carry Narcan in their cruisers as part of local efforts to curb the nationwide opioid epidemic.

The U.S. opioid epidemic refers to a rapid growth in use of prescription and non-prescription opioids, beginning in the late 1990s and continuing today. The use of opioids led to "epidemic levels" of opioid overdose deaths, according to the U.S. Drug Enforcement Agency. In the past few years, there have been more than 50,000 overdose deaths in the United States annually.

Narcan is considered an "opioid antagonist," that reverses opioid overdoses.

Each Cole County deputy receives two hours of training in administration of the Narcan nasal spray, Maj. Aaron Bolinger said. Geographically, overdoses seem to occur everywhere in the county, he said.

"It's just pretty much widespread," Bolinger said. "There are no specific locations in the county where this kind of thing occurs."

State and federal officials consider the epidemic a public health crisis, and in July, the Missouri Department of Health and Senior Services announced a series of actions intended to ease and reverse it. Department Director Randall Williams said at the time that the state is dealing with an increased presence of fentanyl and carfentanil — synthetic opioids similar to morphine but much more powerful — which creates an even greater risk for opioid overdose.

He called for the state to concentrate on an "upstream approach" to the epidemic, meaning a focus on prevention of opioid misuse rather than an approach that waits until people are dealing with misuse disorders.

That shouldn't rule out the use of treatment and recovery services, said Brenda Schell, executive director of the Missouri Recovery Network.

It's a continuum of care, she said.

For example, Schell said, if a person were to undergo knee-replacement surgery without receiving physical therapy, he or she wouldn't heal properly.

"The same goes for substance use," she said. "If people get treatment and don't get recovery services — the after-care, which they're not getting — then people aren't going to sustain their recovery."

People who enter rehabilitation treatment programs generally receive four to seven days of detox — a period when they rid their bodies of toxic or unhealthy substances. Then they receive two weeks or more of residential treatment — in which they live in a contained environment, are supervised and receive counseling and therapy.

Without ongoing care, once people are released from residential treatment, they can fall back into addictions that landed them there.

"The state knows it's a problem," Schell said. "And they're not doing anything about it. The problem is that funding tends to go to treatment and not to recovery."

Addiction is an illness, like any other disease, she said. It takes much more than two weeks to get people well, she added.

The Missouri Recovery Network's mission is to strengthen and empower the recovery community by creating hope, healing and sustainable change through support, education and advocacy, according to its website. It has a goal of eliminating barriers to recovery for all affected by substance use disorders.

It is not a treatment provider, Schell said. Nor is it a recovery support provider.

The network is made up of individuals who wish for people with substance use disorders to attain four dimensions of recovery, she said. They are "health," making good choices for their physical and emotional well-being; "home," having a stable and safe, drug-free place to live; "purpose," having meaningful daily activities like jobs they enjoy, attending school or participating in activities; and "community," having networks and support.

The organization is beginning "Smart Recovery" programs across the state. Much like Alcoholics or Narcotics Anonymous, participants at meetings help each other resolve problems with addictions, which can include gambling or overeating, Schell said.

"Participants develop the power within themselves to change their lives," she said.

The program is based on four points: building motivational change; coping with urges; managing thoughts, feelings and behaviors; and living a balanced, positive and healthy life.

"It's all about behavioral change."

Within its July announcement, DHSS called on communities to increase agency collaborations. It said the department, through funding from the Centers for Disease Control and Prevention, is working to finalize county-level vulnerability assessments to help identify places in the state at greatest risk for overdoses and blood-borne infections.

It also expanded access to Narcan for emergency use in high schools, colleges, YMCA organizations and libraries.

Six staff members at Missouri River Regional Library have undergone training to administer Narcan and the library has received nasal dosages of the opioid antagonist, library Director Claudia Cook said.

Last year, staff participated in Project Homeless Connect Jefferson City, a one-day event to remove as many barriers to permanent, stable housing for those experiencing homelessness or near-homelessness.

They ran into folks from the Missouri Recovery Network. Network people recommended the library consider allowing staff to train to administer Narcan.

"I asked some of the staff if they would be willing to voluntarily administer it," Cook said. "They said, 'Yes,' but they wanted to be properly trained."

Missouri Recovery Network provided some training, but staff felt they might like more. So Cook brought in a paramedic to provide more training.

EMTs, Cook said, told staff the response from someone who has overdosed and been revived through the use of Narcan may be violent. The person who is revived may vomit. They may be angry because Narcan has taken away their "high."

"It's not a peaceful wake-up," MRRL circulation manager Jessica Wieberg said.

Staff had to come up with procedures. After holding discussions with emergency personnel, they understand Jefferson City Fire Department crews also carry Narcan. So there should always be some emergency personnel nearby who can respond to reported overdoses at the library.

Staff decided if dispatchers tell them some can respond within three minutes, they will wait for those folks to arrive and administer the dosage.

"We're going to rely on emergency services first and foremost," Cook said.

Staff also decided there must be at least two people on hand any time Narcan is administered. The first job for one is to call 911.

"They said it was really important that we clear the area," said Qhyrrae Michaelieu, adult services manager at the library. "That no patrons would be close to this situation."

One of the concerns staff overcame was whether Narcan would have an effect on someone who they mis-diagnosed as having an overdose.

"It's not going to hurt anyone who is not overdosing," Wieberg said. "I could do it right now."

Staff were very concerned about what to look for, Cook said.

"The EMT did a very good job of going over that," she continued. "They were very descriptive about the possible side effects of administering Narcan."

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