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Interviewer: Dr. Jennifer Plumb is one of the founders of utahnaloxone.org and is also in pediatric emergency medicine at University of Utah Health. From what I understand, the chances of me dying from an opioid-based overdose now is greater than me dying in a car crash. That shocked me when I heard that. Does that shock you? Should I be shocked?

Dr. Plumb: Well, you know, it doesn't shock me because I spend a lot of time thinking about and educating about in this world, but it's the truth. Right now, if you were to look at the most likely cause of death for yourself, opioid overdose would surpass cars, would surpass guns.

Interviewer: Some of this other data that had been released also says that you're more likely to die from opioids than falls, drowning, or even a gun assault. And again, these are all things you hear about all the time.

Dr. Plumb: Right.

Interviewer: We think this is the big threat, but it's actually that little bottle of pills in your medicine cabinet.

Dr. Plumb: Right. Well, or think about your family members, the children in your home, the people around you, as well as yourself, the things that you would be most concerned about, and I'll tell you, when I speak with families about keeping their kids safe, it isn't always on the top of their list of things that they worry about. They think about helmets, and they think about gunlocks, and they think about car seats.

Interviewer: All good things.

Dr. Plumb: Really important, smart things that we should all have in our homes. We should all have fire extinguishers. But for whatever reason, we have not been as astute and as knowledgeable about opioids and their potential risk in our homes and in our lives. We've gotten to this dreadful point.

Interviewer: Now, are we talking about pain pills or overdoses on legal opioid-based drugs?

Dr. Plumb: More illicit substances?

Interviewer: Yeah.

Dr. Plumb: So all of the opioids get lumped together when we look at data, and, personally, I think that's appropriate. It really is the substance that's killing someone. And if we go down the path of saying, "Well, you know, pain pills, that's different than heroin," we go down the same path of not acknowledging that, actually, those substances are very chemically similar, and they lead to overdose the same way, and the overdose death risk is equally high for them, and you respond to them the same way with having naloxone. So I think that, for all of us as society members, the key here is thinking about these substances in the same way we think about other risky constructs. So peak car crash deaths were in 1972. That's when we lost the most Americans to car crash fatalities. Think about all the things that have happened since then. We've put in airbags, and we've put in the brake lights. I think they're referred to as Dole lights. We have campaigns about getting people to drive smarter, Click It or Ticket, Arrive Alive, zero fatalities. We have a lot more cars on the road and a lot more people driving cars, but we have decreased those deaths.

We need to start thinking about opioid substances the same way. How do we make ourselves safer and smarter around them? How do we limit our exposure to the riskiness of them? And how do we be prepared for worst-case scenario? Which, I think, every time that we have a new way of looking at this crisis, and every one of them is horrifying, they come out and our life expectancy is going down. We're losing now 72,000 people in 2017 in the United States to opioid overdose deaths. That's 197 people every day. That's a 737 falling out of the sky every single day. Right?

Interviewer: Wow, all right. All right.

Dr. Plumb: I mean, it's enormous. And so we have to be thinking about these substances in ways that I don't want everyone to think, you know, I'm calling fire in a theater. I'm actually really asking be smart. If you do have these in your world, be prepared. What does an overdose look like? How do I respond to an overdose? What if that overdose was in my child? What if that overdose was somebody else around me? And then, if I'm going to allow these substances into my world, do I need them?

So, if you have a physician, a clinician, a prescriber wanting to put opioids in your home, in your life, ask a few things. Is this really necessary immediately? Do we need narcotics? Tylenol and ibuprofen are great options. Physical therapy, occupational therapy, mindfulness, acupuncture, acupressure, yoga, all of these have been shown to really help with pain. Should we look at those strategies first? Okay, we think we might still need those. I have a brother who died of a heroin overdose. Does the fact that addiction is in my family make us any more concerned about bringing narcotics into the home? Have that dialogue.

Then, finally have the dialogue, if it really does seem like they think that's the next big strategy, what's your plan to get me off of this in five days? Because in seven days, you can start having a dependence risk. In seven days, you can start developing that physical dependence on a substance that means that maybe in seven months you won't be able to stop.

Interviewer: Yeah. Or I've heard like if it's a 28-day supply, and 28 days coming off that could be just as hard as coming off if you were on illegal narcotics.

Dr. Plumb: Absolutely the same, exact withdraw, absolutely. So, as consumers and as health care consumers and individuals, we need to take that active role as well in having that dialogue with our team.

Interviewer: Yeah, especially with such dangerous substances. And I think one of the traps that we might fall into is, "Oh, I have a prescription for these drugs. I'm not an illegal drug user. So it's somehow safer." But as you said earlier, you got to judge the substance. The substance is the same regardless of how or why you're taking it.

Dr. Plumb: Right.

Interviewer: And now it's in your world, so what are you going to do to be safe about that? So I think that's a great point you bring up. Talk to your physician if they're going to recommend those, if you have a procedure coming up or whatever. Ask those questions that you asked. If you have somebody in your world that's a drug user, then you should also have naloxone around, because even if they're off now, they could relapse.

Dr. Plumb: Absolutely.

Interviewer: Or even if you just have the prescription opioid pills, have naloxone. It comes back to the substance again.

Dr. Plumb: Absolutely. And it is just like, to me, it really is just like a fire extinguisher. You have a kitchen. That means there's heat. That means there could be fire. Having a fire extinguisher is smart. It's safe, it's okay. Same thing, you have opioids in your world, whether it's for yourself or someone around you, you should have naloxone as well. Be prepared for that just-in-case scenario.

Interviewer: I hope that the big takeaway after somebody is done listening to this conversation is that these are serious substances that need to be treated seriously, and the data shows that a lot of people accidentally die from them.

Dr. Plumb: They do and that they perhaps are not perceiving just how risky they are. Be educated. Be aware. Be prepared.

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Interviewer: What would you do if a child or a grandchild accidentally got into your opioid pain pills? It can be a deadly scenario. Dr. Jennifer Plumb, what's your advice?

Dr. Plumb: I say the best strategy is to be prepared for the possibility. Even the most careful and prepared homes have incidents where children get into their pills. Kids get into everything. They get into cat litter, and they get into cosmetics. They also get into pills, which oftentimes look like candy. Being prepared with a naloxone rescue kit, which is the antidote to an opioid overdose, can absolutely save the life of a child.

Interviewer: And how do you, as a parent, get one of these kits?

Dr. Plumb: They can get a kit by talking to their physician to get a prescription. There are also several participating pharmacies where you can acquire a kit without a prescription and also local organizations who can help get you a kit if you need one.

updated: November 9, 2021
originally published: September 18, 2017

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Interviewer: You may have heard recently of a drug called Naloxone. What it does is it reverses opioid-based overdoses. So if you have an opioid-based pain pill or if somebody has a drug overdose that's based on opioids, it can actually reverse it and save their lives. Dr. Jennifer Plumb is one of the founders of UtahNaloxone.org, is also in pediatric emergency medicine here at University of Utah Healthcare, and Sam Plumb is the program's manager at UtahNaloxone.org.

I wanted to ask you both, why is this important to you? I've gone to the website. I see that you've put a lot of work into it. I see on my Facebook feed a lot of times you're trying to increase awareness. Dr. Plumb, why?

Dr. Plumb: We are in this position, I think, at a position of passion, but also at a position of a true desire that we can bring awareness to the epidemic that's gripping our state with opioid overdoses. We are fourth in the nation, which is a distinction that certainly nobody wants. We're not talking about it a whole lot, and I think that there are a lot of people out there who have at-risk family members.

We unfortunately lost our brother in 1996 to a heroin overdose, and since that time the situation has just gotten worse and worse. Naloxone was not legal to have in the home setting when Andy died, and it is legal now. So I think that we both feel very passionately that if one family can be spared what we went through, it's all worth it.

Interviewer: It would've saved his life you believe?

Dr. Plumb: Absolutely, I believe it would've saved his life. It would've saved his life.

Interviewer: So when you say we have opioid-based overdoses, are you talking about pain pill overdoses, intentional, accidental? I mean, what are we talking about here, people abusing?

Dr. Plumb: When the figures all come out, the Health Department puts them together and the CDC also puts them together, and they do look at all of those categories. They look at intentional or suicides. They look at accidental or poisonings. We are seeing in this state that we have continued accidental overdose increases. So what do these look like from an opioid perspective? Most of these poisonings and overdose deaths in Utah are from opioid substances.

There are some others, cocaine, methamphetamine, alcohol, that can also kill people, and unfortunately does kill people. But the majority are from the opioid-based substances. Of those, the majority probably still is prescribed pain medications. So the pain pills, OxyContins, Percocets, codeines, these medications that we all have heard about in different incarnations in our lives, but heroin is another big one.

The CDC just this year basically released data and released recommendations calling it an epidemic. It's truly an epidemic what's happening. Since 2000, I believe, we're almost up 400% for heroin overdoses nationwide. It's everywhere.

Interviewer: Not a problem here, though, right? Not in Utah.

Dr. Plumb: You certainly wouldn't think so.

Interviewer: But it is.

Dr. Plumb: It absolutely is. It's really challenging, because I get that people don't want to talk about it. There's a lot of stigma around it. But to me, it really is just another medical problem, a critical one and one that will kill someone if it's not dealt with, and if we don't get people help. But we don't talk about it. You're exactly right. It doesn't exist if we don't talk about it. We don't see billboards about it. We don't see PSAs. We need to. We need to start encouraging conversations surrounding these substances so other families don't go through what we have gone through.

Interviewer: Sam, you're also involved in UtahNaloxone.org. You're the program's manager, and I understand you do a lot of outreach to people that have a drug addiction problem. Talk about that a little bit, and how Naloxone can change things.

Sam: Well, I think it could potentially have a drug addiction problem. When you're doing community street outreach, you're dealing with a population that they obviously aren't in a good place. If they themselves aren't active users, they could know people who are at risk of an overdose, for instance. So the idea is these are people that are typically missed by other realms of the medical field.

They don't typically go to the doctor. They don't have access to the pharmacy. They don't often have insurance. So for that reason, these people are most at risk for having an overdose and not having the access to Naloxone, which can save them.

Interviewer: You actually make these available to those at-risk individuals.

Sam: Yes. We go out to different areas, and you start to have an understanding of more at-risk areas of the city. For instance, I know Pioneer Park is one that people typically think of. The Road Home, places where there are typically going to be people that are living outside or don't have the means to often take care of themselves, or provide themselves the shelter. We will go out and we will educate each and every person that gets a kit so that they know everything that they need to do should they witness an overdose, or should they themselves have an overdose.

Then, we distribute the kits, and we've really had a great response for that matter from that group of people, and they're very willing to be honest about it. If you ask them if they're using, they will tell you frankly, "Yes, I am." When you tell them that you're willing to help them, to say that they're gracious is an understatement.

Interviewer: I'm going to be cynical here for a moment and say, what do you say to individuals that would say, "Well, they have a drug addiction, that's their own problem?"

Sam: I mean, that is probably what we hear the most frequently about that population. But these are people that do not have the typical resources that even somebody of no means may have, for instance family, support, friends, a place to stay, any type of income. Without some type of help, that doesn't mean that they should just die as a result. For these people, you can't recover if you're dead. So Naloxone gives them that chance to actually recover from a potentially fatal overdose, and then also have the opportunity to seek some type of treatment or go into recovery.

It's really surprising, and I think that if you have a doctor or an EMS responder, they revive you, well that person is just doing their job. But if you have a friend, or a mother, a father, actually revive you, I think that that has more of an impact on your future usage as well.

Dr. Plumb: We've seen that too. We've seen firsthand, as well as anecdotal reports from other states. But we've seen firsthand, if someone is revived by their mom, and they wake up and their mom is begging them not to die, there's a different lightbulb that goes off. There is a realization that, "Wow. Somebody really wants me to be alive. I need to be here for myself. I need to be here for them. My life does matter to them." It's been reported in the literature too that actually bystander-administered Naloxone is a much more powerful tool to get people to have that realization that their rock bottom has come.

Interviewer: So that very much near death experience is actually the thing that will help turn them around and perhaps get them unaddicted, or more willing to seek treatment?

Dr. Plumb: On a healthier path, basically.

Interviewer: Yeah.

Dr. Plumb: Just to have that realization that, "Wow. I actually need to be here. Someone else sees that I need to be here, not just someone whose job it was to save me. Someone else made the conscious decision to save my life. They're not medical. They just care about me."

Sam: It also is very important to mention that the experience of having Naloxone administered to you, especially if you are an active user, an addict, it is something that is terribly painful. It kicks them into instant withdrawals. Some of the people that we've spoken to have said, "I'd rather be tazed or shot before I get that Naloxone again." You're like, "Well, would you rather be dead?" "No. Well, if I'm going to die, then yes you can give it to me." But other than that, I mean, it's a terribly painful experience. So it's not something that people would use or to . . .

Interviewer: Yeah. Because I was going to ask, I was going to say, now I've got my safety net so, woo, party's on. Right?

Dr. Plumb: Your parachute, kind of. We hear people say, "Oh, you're providing a parachute to people," and that's just not the reality.

Sam: Because if you think about it too, these people who are active users, number one, nobody wants to overdose, nobody wants to be an addict, and beyond that they don't want to waste their last fix. So if you give them Naloxone and they've overdosed, they've just lost their last high. So it's another way to think about it.

Dr. Plumb: Yeah. We do get questions about that, though. "Well, aren't you just enabling use? Aren't you just enabling riskier use? Aren't you just basically telling people you're okay with this choice that they make?" The reality of it is, no, we're not. What we're telling them is, "Hey, listen. We want you to get to a healthier place. We want you to get to a place where your life is not so encompassed by your addiction. But we can't get you there and you can't get yourself there if you're not alive." Naloxone will get you basically breathing again if you've overdosed. That's all it does.

Interviewer: So I know that you're an advocate for having the conversation. It's not just for people that are homeless or at The Road Home. There are plenty of other people that have drug addictions, that have families and live in homes. What would you say to a person that's in that situation that's listening?

Dr. Plumb: Well, I think probably the best way to speak to them would be to provide some examples of folks that have reached out to us. Sam and I can both give you examples of different conversations that we've had with people. I think one of the most powerful ones for me thus far, since we have embarked on this, has come from a mom who desperately reached out to us to get Naloxone. She had asked multiple providers, her physician, other physicians, emergency department physicians, addiction physicians.

She'd asked for a prescription for Naloxone for her son, who was a heroin addict, and at the time he was clean. We all know that one of the times that you're most at risk of overdosing is when you've had a period of sobriety. So your body is not at all accustomed to opiates, even as short as a period of three days and you go back to using what you used before, and you can overdose. So this mom reached out to us and in desperation said, "Can you please help me get Naloxone?"

She came up to Primary Children's and met with me. I educated her on how to use that. I was willing to write her a prescription. She was so uncomfortable getting it from the pharmacy that I ended up just giving her a free kit, which we have the ability to do. She didn't want that on her record. She didn't want that anywhere in the medical record.

Despite the fact that it's completely legal, insurance companies cover it, that it's been done for two decades now in the U.S., she had that stigmatization worry. She got the kit, and within a week she had to use it to save her son. I mean, it gives me chills even now thinking about it, because whether it was her motherly sixth sense or her experiences from the past, but she knew, and she almost didn't have that opportunity to save her son's life. Sam took a call today from a gentleman . . .

Sam: He has some type of chronic back disorder and he's in tremendous pain, and surprisingly he told me that his prescription for pain relief is morphine. He's receiving six doses of morphine throughout one single day of 60 milligrams each dose. Typically, 100 milligrams is something where you start to think of somebody as very high risk, or is a very high dosage, and he's taking 360 milligrams a day.

He's bedridden, he can't work, but he made the effort to call out to get Naloxone, because he said, "I fear for my life with the amount of medication that I am being prescribed, and I worry that my doctor may prescribe more. I want my family to be able to save me if I overdose."

This is a similar story that we hear from other people as well. These aren't just people that are down on their luck. These are people who are taking their medication as prescribed.

Dr. Plumb: And are still just at risk, because at the bottom line, end of the day, these are risky substances. It isn't about a risky person. It isn't about a moral character judgment. It's about these are risky substances, and they are everywhere in our society. I think all of us should take a little thought about, "Do I have these in my home? Do I have these in my home for a legitimate reason, or what may be an illegitimate reason?"

It doesn't matter to me. If they're in the home, they don't discriminate. They can absolutely cause an overdose and a death, and being prepared is really just not only smart, but it's appropriate. It's not asking for anything wrong by asking to be able to keep yourself or the people that you love alive.

Interviewer: It's like having a fire extinguisher or a first-aid kit, or an EpiPen, or an inhaler, or any of those things that you would use.

Dr. Plumb: Absolutely. Although, interestingly, an EpiPen which is absolutely vital for people who have anaphylaxis or allergic reactions to things, an EpiPen can actually hurt you. It's epinephrine, adrenaline. That can cause heart arrhythmias. That can actually hurt you. Naloxone can't hurt you. So I mean, even a level beyond it, I absolutely advocate for EpiPens and think they should be everywhere we know where they should be, but Naloxone is even safer. But it is very much the same thinking, that if there were to be that worst case scenario, you'd be prepared.

Sam: I think that's something that is particularly salient here in Utah, because we have our own culture here and it is a very stigmatized issue, whether it's an opioid pain medication or if it's an illicit substance. But we do hear from people that call us to talk about Naloxone after it's too late. Oftentimes in Utah, unfortunately, the conversation starts too late, when somebody has already been lost and there's nothing that can be done. So given how simple it is and how safe it is, it just makes complete sense to have it.

Interviewer: That's right. This can be that conversation.

Dr. Plumb: Right. Absolutely.

Interviewer: Right?

Dr. Plumb: Think about it.

Interviewer: This is the conversation and now go out and get . . . So do you just, prescription from your physician?

Dr. Plumb: Yeah. Your physician can absolutely prescribe it there. It's 100% legal for them to do so. Some physicians are a little uncomfortable with it, and I think that this will come in time. The law is pretty fresh still. I think physicians will become more comfortable with it.

But if you do run into a conversation where your physician states they're not comfortable, reach out to us. I can absolutely call in a prescription statewide, and we have done so from St. George to Brigham City and Wendover to Vernal, statewide. It's absolutely legal for me to call in a prescription for anyone who's either at risk of an overdose or at risk of witnessing an overdose.

Sam: For more information or to view our training videos, or even for other resources such as treatment and medication-assisted treatment, we have all of that listed at www.UtahNaloxone.org.

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Interviewer: Every house has different things around in case there is an emergency. Like you might have a first aid kit, a fire extinguisher, maybe even an EpiPen if you have somebody with allergies. There's one more thing you should add to that list. It's called a naloxone kit. Dr. Jennifer Plumb is one of the founders of UtahNaloxone.org. You're also in pediatric emergency medicine. So I was wondering if you could start with a story, perhaps, about having a naloxone kit in your house could change the outcome of an otherwise tragic situation.

Dr. Plumb: We see all kinds of scenarios of children overdosed on opioid medications as well as narcotics. One that comes to mind of a grandparent who was being treated for cancer on a chemotherapy regiment and also needed pain medications. And the grandchild, unfortunately, got a hold of one of the pills and overdosed on it.

Just as an example of how frequently these are seen, I personally saw a four-week period with four children on my shifts who came in overdosed on medications that they came into contact with either in their home or in the home of somebody else. And those were all kids under the age of eight. The reality of it is as just about any scenario that you can think of that a kid can get into trouble with a medication, they can get into with opiates. And unlike other medications that they can get into and take, these medications can kill them. One pill can actually kill them.

Interviewer: So let's back up for a bit here. naloxone, what exactly is it?

Dr. Plumb: So naloxone is an antidote. It's a very pure substance. All it does is reverse an opiate overdose. It doesn't relieve pain, it doesn't get someone high, it's not addictive, you can't overdose on it. So it is just purely an antidote to opioids. So what are opioids? Opioids are OxyContin. The medication in that is actually oxycodone. You can also see that in Percocet and other medication. It's methadone, it's morphine, it's fentanyl, it's codeine. These are medications that we've all periodically had in our homes after surgical procedures or traumas. It also is an antidote for heroin and all of those substances are very, very similar biochemically. Very, very similar.

Interviewer: So get a little geeky for me here. How does it work exactly? So what causes an opioid overdose and then how does naloxone reverse that?

Dr. Plumb: Absolutely. We know you physician types like that nerdy stuff.

Interviewer: And I like hearing these types of stories because it fascinates me.

Dr. Plumb: And it is really simple. I think of receptors in the brain as like a golf tee. They have a little cup and you have substances that trigger those receptors. We have all different kinds of receptors in our brain. A receptor that's triggered by opiate medications or opioid medications is exactly that, an opiate receptor. So if you picture the opioid coming to sit on that tee like a golf ball, it gets on there, it does what it's supposed to do. It relieves pain, provides analgesia, provides comfort.

Unfortunately, if too many of those receptors are filled by the opiate medication, it causes an overdose. And an overdose of an opiate medication causes respiratory depression. So when you overdose on one of these substances you stop breathing. They look blue or gray if they're darker skinned because they're not getting oxygen. They're not breathing. They also get these really tiny pupils, almost looks just like a fleck of pepper. So these are the things we tell people to look for when they overdose or when they see someone they think is overdosed and that is the cue. "Holy moly, we need to call 911. We need to get naloxone into this person."

Traditionally, paramedics, EMTs, ER doctors were the only ones that could provide that antidote. Fortunately, it's now legal for people to have in their home so that if they find someone overdosed, they can start the reversal of the overdose before the EMS personnel even arrive. We always tell folks, "Call 911. Give them naloxone." And that way, hopefully, ideally, by the time EMS is there, your loved one's breathing again and you've bought those extra minutes that are so important and so crucial of oxygen to the brain.

Interviewer: So you say it's legal for now for anybody to own. What changed?

Dr. Plumb: In 2014, a bill was passed here that made it legal for a physician to prescribe naloxone to anyone. And this is unique. Anyone who's either at risk of an opioid overdose or at risk of witnessing an overdose. So traditionally, if I write you a prescription, I write it for you. It also made it legal that it could be prescribed without a physician-patient relationship, which is unique.

Normally, I have to have a relationship with you, as a patient, if I'm giving you a medication. Well, in this case, if I have, say, a 16-year-old who overdosed on heroin and their parents are desperate to have coverage in the home just in case, I can absolutely write a prescription to that mom, to that dad, to that significant other. And that's unique in the law, but it's very important that it's in the law.

Interviewer: Is it dangerous on its own?

Dr. Plumb: Absolutely not.

Interviewer: No danger to have it in the home?

Dr. Plumb: No. If I gave it to you right now you would feel the little prickle from the injection. You would have no effect from it whatsoever. You can't overdose on it. We have people sometimes say, "Well, what if it's not an overdose and I give them the naloxone? What if?" And the reality of it is if you had a heart attack, if you're having a stroke, if you've had a brain injury, if it's related to a diabetes problem, it won't do a thing. It won't hurt them, it won't help them, but when your EMS providers get there because you've called 911, they're going to also know this person that's down didn't respond to that Narcan. We need to start thinking about other things as well as the additional medical care. So it really is about as safe as any medication that we know of out there.

Interviewer: There are a lot of resources. Is it Utahnaloxon.org?

Dr. Plumb: It is.

Interviewer: I've noticed you have all sorts of resources on how to use it, what's going on when you use it, where to get it. Do you have any final thoughts as we wrap up this conversation?

Dr. Plumb: I think that the thing I would really like to get into people's heads is that this epidemic, and it really is an epidemic, the CDC has called the crisis we're having in this country with opioid overdose as an epidemic, is it's really okay to talk about. It's really okay to think about. It's really okay to look at what's going on in your own personal home and say, "You know what? We don't really want to tell people about this, but we need to be prepared and we need to be willing to have this conversation."

Have the conversation with your physician. Have that conversation with your therapists. Have the conversation with people who are involved in your healthcare. If you're not getting anywhere with that, have the conversation with us. We can be called 24/7 and we can get naloxone into people's homes. It's just more important to us that lives are saved. These are unnecessary losses of life.

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