In its first 12 months, the Colorado Naloxone Project has successfully enrolled 86% of the state’s hospitals and emergency departments to dole out an overdose reversal medication for free to patients with opioid-use disorders. 

The success is “remarkable,” said Don Stader, the emergency and addiction medicine physician who started the effort. The goal is to get Naloxone into the hands of people at risk of overdosing from an opioid, like fentanyl or heroin, or to their loved ones. Through the 104 enrolled hospitals and emergency departments, the program has distributed more than 3,300 doses of Naloxone so far, and Stader said the project’s now branching out further into the health care system and beyond Colorado.

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As Colorado leaders grapple with how to address the state’s spiraling overdose crisis, a recurring theme is the importance of getting more Naloxone into the hands of organizations and people who need them most. A sweeping piece of legislation introduced last week sets aside $20 million to buy more of the medication.

The Colorado Naloxone Project started at Swedish Medical Center in Englewood, where Stader’s based. Fifty hospitals and emergency departments quickly signed up, he said, with more enrolling after the state’s Office of Behavioral Health provided additional Naloxone kits.

“I think the first year went extremely, extremely well,” Stader said in an interview Tuesday, ahead of a one-year anniversary news conference Wednesday that featured Attorney General Phil Weiser, submitted videos from three legislators and from providers. “I couldn’t be more happy with the reception we got from hospitals, emergency departments, clinicians and patients. Being able to get to over 100 hospitals (and emergency departments) committed to dispensing Naloxone … in the context and in the face of worldwide pandemic has been nothing short of remarkable.”

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Ramnik Dhaliwal, an emergency medicine physician involved with the project, said that when Naloxone is prescribed to patients – meaning a provider writes a prescription for a person to go fill at a pharmacy – it’s filled at a pharmacy, at best, 20% to 30% of the time. He and Stader attributed that to shame and stigma among people with substance-use disorders; that population, advocates and experts have said, is particular wary of the health care system.

But distributing Naloxone directly to patients in a judgment-free manner, providers said, is vital. 

“Within the emergency department, we have a touchpoint where a lot of people come when they have an overdose,” Dhaliwal said. “To be able to provide them a life-saving medication at their point of bottoming is huge.”

Stader described a young man who came into the emergency department at Swedish recently. The patient “was very unstable, he didn’t want treatment, and his mom brought him in,” Stader said. “We sent that family home with Naloxone. They were home 48 hours later, that patient had an overdose, and his mom was able to reverse him.

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“That young man has another chance of considering recovery. His family has more time with him, and we hope that’s a learning moment for that patient because oftentimes, you do see patients who overdose, sometimes they do have that moment of clarity where they think, ‘Wow, this is something I’m going to die or could die from.'”

It’s a vital part of harm-reduction services: providing users with support and resources to safely use while continually giving them opportunities to enter treatment when they’re ready. 

Of the 14% of the state’s hospitals that have yet to sign up for the Colorado Naloxone Project, Stader said all of them are rural hospitals with limited staffing. He said none had rejected him outright or said the idea was bad; those who haven’t enrolled said they couldn’t handle the adjustment now.

Fresh off its first-year successes, the project has begun issuing Naloxone in labor and delivery departments; three hospitals have signed on for the pilot program. Between 2014 and 2016, the second-leading cause of maternal deaths were overdoses, according to a July 2020 report issued by the state Department of Public Health and Environment. 

Stader said Naloxone given to at-risk mothers or families can ensure “that child, once they’re born, might have an opportunity to group in a house where one of their parents hasn’t been lost to overdose.”

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Moreover, he said, Naloxone should be available at all points of entry within the health system to people who need it. To that end, he announced Wednesday that the program will now expand to California, Tennessee, Wisconsin and Virginia. He told supporters and reporters during the news conference that he wanted “to commit to teaching other hospitals to do what we’ve accomplished here.”

As he looks to move beyond Colorado, Stader told The Denver Gazette on Tuesday that the program’s broad success wasn’t what surprised him most after its first 12 months.

“I thought it was about the Naloxone,” he said. “But it’s not. It’s about the relationship.”

When providers in hospitals or emergency rooms give patients Naloxone, Stader said, those patients “get the sense for the first time that the medical system actually cares about them.” 

Talking to supporters Wednesday, Stader became emotional describing how many young people are dying needlessly from drug overdoses, when opioid-use disorders “are so damn treatable.” He said he tells every patient he sees that “I’m worried about you, your life matters, you’re worth recovery.”

“I always end it (with): ‘On the day you’re ready to stop or quit, come back here so we can help you to get you into treatment,'” he said. “It opens that door in a much more concrete way.”