Dr. Joan Papp unzips a bright cobalt bag and begins taking out its contents. The medical director of MetroHealth Medical Center’s Office of Opioid Safety pulls out an airway mask to use while giving rescue breathing, a reference guide listing the signs of an opioid overdose, a brochure detailing resources for treating addiction and a plastic spray containing two 4-milligram doses of naloxone hydrochloride, better known by the brand-name Narcan — the lifesaving antidote for an opioid overdose.
The $75 kit is distributed free of charge to opioid users, their family members and friends. In 2012, Papp approached the Ohio Department of Health about expanding Project DAWN, a pilot opioid overdose education and naloxone distribution program in southern Ohio, to Cuyahoga County. Today, Cuyahoga County’s Project DAWN program is the largest in the state, distributing kits at Circle Health Services, the Cleveland Department of Public Health’s Thomas F. McCafferty Health Center, Cleveland Emergency Medical Service and Hispanic UMADAOP, plus the Cuyahoga County Board of Health in Parma. Funding is provided by the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, MetroHealth System, Ohio Department of Health, Ohio Mental Health and Addiction Services and U.S. Substance Abuse and Mental Health Services Administration.
“Since we started our program [in 2013], we’ve given out about 10,000 kits …and we’ve had 1,700 of our patients tell us that they’ve used the kit to save somebody’s life,” Papp says.
Vince Caraffi, a Cuyahoga County Board of Health supervisor who chaired the Opiate Task Force, notes Papp’s advocacy for laws providing access to naloxone to third-party consumers.
“When we first started dealing with this, the only individual that could get a naloxone kit was an individual who was diagnosed with an opioid disorder,” he says. “Well, it’s very difficult to administer Narcan on yourself if you’re ODing.”
Papp was motivated by what she saw in MetroHealth Medical Center’s emergency room. Beginning in the 1990s, doctors across the country began writing more scripts for extended-release opioids such as OxyContin, believing they were less addictive than immediate-release Percocet and Vicodin. As those claims proved to be false, doctors wrote fewer prescriptions. Patients turned to street heroin, then synthetic fentanyl. Patients were looking for narcotics to relieve chronic pain, suffering from overdoses or in full withdrawal.
“We really didn’t have anything to offer,” she admits.
Papp changed that. Patients admitted to MetroHealth Medical Center or who stop by a MetroHealth retail pharmacy can go home with a Project DAWN kit billed to their insurance. A nurse practitioner arranges appropriate treatment for emergency room patients, including starting them on suboxone, a medication that eases withdrawal symptoms and cravings but requires a special license to prescribe. Independent company Ascent ED provides peer recovery coaches — state licensees in long-term recovery — offering support and resources to get those patients directly into treatment. Her latest project: establishing the Alternative to Incarceration Project that connects jail inmates with treatment via a chemical-dependency counselor.
“What Joan has done, and what Metro has done, is really take a step forward in looking at dealing with this disease as they would others,” Caraffi says.