Additional resources to check out:

• April 22nd FREE Webinar (Noon-1pm CT) Registration: Naloxone Training: Responding to Opioid Overdose
• SAMHSA's Overdose Prevention and Response Toolkit (see page 8 for common Opioid Overdose Reversal Medications available to the public, and page 18 for Appendix 1 and page 19 for Appendix 2)
• What is Naloxone? from the National Institute of Health
• Recent drug overdose data - Drug Overdose Deaths in the United States, 2003–2023 from the CDC's National Center for Health Statistics
• Prevent & Protect - This website is a free resource for opioid safety and opioid overdose prevention developed by public health and addiction medicine experts.
• The National Harm Reduction Coalition's Naloxone Finder - Harm reduction is a movement to reduce drug-related deaths and harmful consequences of drug use.

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If you are interested in QPR training, visit: https://www.agrisafe.org/QPR/

Sign up for the AgriSafe newsletter: https://www.agrisafe.org/newsletter/

View upcoming webinars: https://www.agrisafe.org/events/

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Directed by Laura Siegel

Hosted by Linda Emanuel

Edited by Joel Sharpton for ProPodcastingServices.com

Special Guest: Dr. Tara Haskins

Welcome to Talking Total Farmer Health. I'm your host, Linda Emanuel. Today we're going to dive into the topic of naloxone, what it is, why it's important, and so much more. I'm excited to welcome back Dr. Tara Haskins to the show. She is AgriSafe’s Total Farmer Health Director and a nurse with over 38 years of experience. Thank you for joining us today, Tara.

Oh, thanks for having me, Linda. Good to be back.

It is always good to see each other. So, after this episode, if you're interested to learn more about naloxone and how to give it, join our free webinar on April 22nd. Check the show notes for the link to sign up, and if you miss it, you can view the recording after the date in our AgriSafe Learning Lab. So now let's get this conversation started. Tara - share with us just what is naloxone and why is it important?

Yeah. So naloxone is not a new drug. It's been around for a very long time, and we've used it in healthcare. I'm sure Linda and I have both used it when we worked in hospitals. But think of naloxone as a reversal agent for opioids. And it does that reversal action by going in and sort of kicking opioids off of that opioid receptor. And it sits on that receptor and prevents the opioids from activating it, from getting that effect from opioids. Some of the challenges with that, though, is that naloxone is very short lived, and many times those opioids can stay around a long time in our system. So we have to be ready for emergency services. Even in the hospital, we understand that we have to be ready for additional supports, like for breathing. But in the communities, individuals need to understand that if naloxone is used in an emergency situation, that's the first step. And they're going to need to call 911 and get some additional medical attention and support for that individual.

We, we know that it can help be helpful in a crisis, but that's also the point of or the topic to talk about. “What do we do next? What do we do next?” So yes, calling 911 is, is of course the, the desired step. So let's talk about who is at risk of opioid overdose. And possibly let's talk about those misunderstandings that may be out there.

Sure. Well, I mean short answer is anybody that is using opioids can be at risk for overdose. Whether those overdoses are intentional or unintentional. And, you know, this could be anything from somebody that's using pain medication to manage their pain that may be also taking other medications that may get sort of an enhanced effect on the opioids. Or it could be your grandmother who has maybe a hard time remembering whether they took their medication or not and going to go back and make sure they get that dose in. So it can, it can run the gamut from anybody that is just trying to genuinely manage their medical condition. may have other health issues that may compound, the risk for opioid overdose all the way up to those individuals that may be considering, taking their life by the use of opioids. And that would be more of an intentional overdose.

So it really, opioid overdose cuts through all demographics and socioeconomic groups. and I think sometimes in our community there might be the misunderstanding that, opioids are, only people that have made the choice to be addicted or are using it, in a non-healthy way. Most individuals that are introduced to opioids have been prescribed that for an actual medical condition and have made, may find themselves caught in a situation where they're just really trying to manage their medical pain. And the use of the opioids just sort of gets away with them. And so there can be a lot of embarrassment and stigma not wanting to reach out for help. So that's why it's really important as a community, that we see this as an opportunity to help an individual, regardless of what the original intent of the use of opioids were.

Great explanation. I think that'll be very helpful to our farmer listeners. And when we think about an opioid overdose, you know, what does it look like? And how do you know as, as a layperson, how do you know when to give naloxone?

Yeah, so in terms of like, the symptoms of an opioid overdose, um there's, they call this thing sort of the triad symptoms. So there's the effects it has on your pupils. And so when someone is- got a lot of opioids in their system, their pupils are very tiny. We call them pinpoint. They can have effects on their respiratory system. opioids tend to slow the respiratory rate. And that's oftentimes what can cause death because it suppresses the respiratory function. And they may have certainly a decreased level of consciousness. So they may look sleepy. They may look, not being able to pay attention. They may be, if they lose consciousness, they may appear like they can't hold their mouth, you know, and their airway open like they need to.

So it can be a combination of symptoms. And that can be really tricky because I'm sure the community is wondering, “what is this? What do we do?” Right. If you're questioning whether an individual may have used opioids and that's what you're looking at, the use of naloxone can certainly be of help and is not going to hurt that situation. And in fact, it may be the only thing to save their life. If it's not related to an opioid overdose. It's not going to make the situation worse. It actually kind of helps, emergency responders to determine, okay, this may not be what this is, but I think for the general community, just kind of having a general idea of what that might look like. And “where is naloxone, where can I use it and know how to use it when they need to?”

Right, exactly. And, and I feel like all of us that work in agriculture, especially for farmers and ranchers that aren't used to dealing with the human element every day. Right? They know how to treat livestock, they know how to take care of crop diseases. But when it comes to humans, there's a little bit of hesitancy. And, and of course, it's always good to learn more. So again, that training is scheduled for April 22nd, and we will have all the appropriate links in the show notes to that training, where Tara will take a deeper dive in and expand a little bit on, on some of these conversation points. So thinking about the farmer and his or her family, their, why should they have naloxone on the farm?

Well, I mean, farms and ranches are places of employment, so I really see them no differently as than someone working in an office. But there are certainly some challenges with using naloxone on the farm. I mean, there's a lot of distance, you know, where do you keep it so that you have it readily available and that you can also keep it at the right temperatures, so there's a lot of things to consider. And, um you know, for a farmer or rancher that is also an employer, you may have employees, but you may not know exactly all the things that they're, you know, struggling with, or they may have pain conditions that they're trying to treat that you may not be aware of. So, you know, you won't always know necessarily who might need naloxone, but to have it available, it would be no different than if you would take action for somebody that might be having a heart attack. So think of this sort of like as CPR. But we are really directing our efforts at trying to keep someone alive so we can get them the emergency help they need because of their reaction to the opioids.

Correct. I think about, on our farm specifically, we have a lot of agronomists and our ag marketing folks that come through the tractor Are implement technicians that help. So you just you don't know what everyone is dealing with. And so quite possibly it's, do you think that it's - this is a question for you. Is it good to just have naloxone available, even if you don't know of someone that may be taking opioids?

Sure. I mean, I think in most, particularly in farms, there's probably always a kit, like a first aid kit that you're going to have for those emergencies. Having naloxone available and thinking about, you know, where we could keep it, whether it's in the pickup truck or it's in the office. thinking about how you're going to access that, there's certainly no harm in doing that. And if you need it, you know, you'll have it. And I would also ask, Linda, that there are probably certain times during the year where you may have people come onto the farm to help with additional help that you wouldn't have necessarily year round, maybe seasonal type, additional help that, you know, you may pull from community or people that, you know, want to, or seeking employment for those periods of time where you need additional help. So it’s not just necessarily your regular employees, but also your family members that work with you, alongside you. And, for those additional individuals that you may find on your farm.

Exactly. Good. Great point. And in thinking about this reversal agent, do we need to think about when it expires or what's the appropriate way to store it?

Oh, sure. And look, it's a drug that has an expiration date just like any of your other medications. So, you know, ideally, you never want anything that's expired. That's really important to make a note of whenever, if you're going to be storing it somewhere. And, and there are some particular issues dealing with exposures to extreme Temperatures. I go into that a lot more in the training. It can impact you whether you live down here in the steamy South, like I do, Linda, or you're up in Nebraska where you've got, like, some really long, cold days and freezing weather. So both of those extreme temperatures can impact the effectiveness of naloxone. And you know, where you should store it, I really think that needs to be an employer choice of where, where would it be easily accessible by the majority of people. And if you're going to have a centralized place for it, just like in like a first aid kit or something, everybody needs to know where that is. Everybody needs to know how to use it because the, the main employer may not be the person there, at the time on the farm. So educating everybody that's on the farm as to how to use it can be really important.

Yeah. So pull all of those people on your farm into this webinar, right? So you can have this discussion and, and together strategize, “Where do we keep it and and how do we know when to use it?” So the conversation is active. So how do you know when to give someone naloxone and how do I administer it.

Yeah. Well, you know, I covered a few of the symptoms that you might see if in doubt, if you think that's what it is, it's appropriate to use naloxone. If that is not the cause of what you're seeing in emergency care, it's not going to hurt them. And certainly you're always going to call 911, you know, when you're trying, you know, to get that into place, to get someone out there to help you with emergency services. Administering it, for the most part, there's, there's two ways that it's delivered. There are some injectable forms, but for most of the communities, we find that the nasal spray is really the easiest to use. If you've used saline drops, you know, during the winter or Afrin or something, it has a little easy deployable pump system that's in there. So it's no, no different than using a nasal spray that you perhaps have used yourself on yourself. The nice thing about it is when you get it, it has all those instructions printed on the box. It goes over all that. What to expect to, you know, feel whenever you're administering it. So it's, it's really a pretty easy administration. The key though, is, and we go over this in the training, is “do I need to give a second dose. When do I need to give a second dose.” All of those kind of decisions, of course, while 911 is in route.

All the more reason come into this training, you're going to know the details and just feels that much more confident. So, if we go to a scenario where someone has come onto the farm, or an employee looks like they're struggling with an opioid overdose, right? They're not responsive. They're having trouble, their, their breathing is labored. We give them naloxone. What should we expect next?

Well, if the if the issue is opioids, then that individual is going to start waking up and will start waking up fairly quickly. Probably within a few seconds, you're going to notice them become more alert, awake. For some individuals that take opioids for pain management, and maybe they just took too much at that time, an individual might complain about significant increased pain. That's not really a reason to withhold naloxone because this is obviously, you know, a life-threatening situation. And some people can wake up a little quickly, you know, kind of rapidly, almost. I know that there's a lot out there in, in social media and stuff about how people come to, and they might be combative, but that's not always really the case. And, you know, the thing to remember is that, that unless we give it this individual is not going to get better if opioids are the issue. It's not going to be harmful if opioids are not the problem. And, you know, it could have been maybe a combination of medications, but if we give them naloxone and it impacts the opioids that are on board, we might actually get a result for that individual.

Right, amen, that's what we're after. It's, we need to do to change the current situation. So, you know, as a community, what can we do if we're worried about someone who might have an opioid disorders and talk to us about the resources?

Sure. So, oh gosh, there are so many resources. AgriSafe, we have a lot of resources. We have a lot of resources. Because, Linda, I'm sure you're aware. I mean, farmers have a lot of pain conditions. They do a lot of backbreaking work. They could be dealing with old injuries that can cause a lot of chronic pain. And so we know that managing pain in this occupation, you know, it can be challenging also, while trying to maintain a sense of safety around equipment and livestock and things like that.

So AgriSafe has resources that are specific to farmers. SAMHSA has a lot of resources about maybe the use of naloxone. You know, “how I, how can I find naloxone? Where can I find naloxone?” That's gotten a lot easier now because we have access across all 50 states, over the counter naloxone, which you and I can talk about a little bit. And I think it's really important to talk about this in our communities. Have naloxone available even if you're not on the farm, but, you know, having naloxone available in your purse in case someone you know is struggling, maybe in the community, maybe, in the grocery store. I know there are some libraries that find that individuals have been saved within naloxone in, in those more public areas. So I think having conversations about the importance of having naloxone, and if you have a family member that that is getting medical care and gets a prescription for opioids, it's really recommended now that anybody that has a prescription for opioids is offered, you know, to talk about the importance of having naloxone as an emergency measure. So it's really nice that we're starting to change that conversation up front before someone, gets in trouble. To get the education that they need to know where they can get it. And perhaps prescriptions can maybe curb some of the cost. Of course, that's going to vary probably from state to state and depending on your health care coverage.

Exactly. You know, preventative medicine is always good. And just to ask the curious questions, that's always helpful to be more informed. And, and so as we wrap up this discussion, are there any other resources that you'd like to share?

Other than locating naloxone can be pretty easy, you can call your local pharmacy. Many of them have it over the counter. The charge may be slightly different depending on where you live. For some individuals, they may use their health insurance to help cover some of the cost of over-the-counter naloxone. If you do have that in your home, make sure everybody in your home knows how to use it. And it's as, like I said, it's, it's an easy delivery system. and the more people that know about how to use it, the more opportunities you might, have in order to help someone, especially a loved one that may be in your home that either you know, maybe prescribed opioids for pain, or maybe struggling with an opioid use disorder.

Yeah. Well said. It's so important we just take care of each other. Well, Tara, this has been a great informative conversation. I think our listeners are going to find great benefit to, to listening in and learning more about naloxone as well as opioid overdose. And I will plug again to check in to the show notes and you'll find the access to our webinar. You can also get on our website which is www.agrisafe.org. And in the events calendar you will find this training and again easy to access. And, and it is free. So Tara, thank you for your time today. Always a pleasure to have a conversation with you.

Thank you Linda so much.

You're welcome.

Okay folks, that’s another great conversation and a wrap. Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. We are always open to new ideas or stories to share on this podcast. So, feel free to connect with us by email at info@agrisafe.org, and title that email “TTFH Podcast.” You can also get our attention by using the hashtag "TTFHpod" on Twitter! To see more from AgriSafe, including webinars and our newsletter, visit www.agrisafe.org.

This episode was created by AgriSafe Network, directed by Laura Siegel, hosted by me, Linda Emanuel, edited by Joel Sharpton for ProPodcastingServices.com, with guest Tara Haskins.