As the opioid crisis continues to grip Massachusetts, anyone could encounter a person who has collapsed and may be dying from an overdose. It happens in public parks, restaurant bathrooms, and — increasingly — workplaces. And many bystanders have no idea what to do.
In response, a movement is gradually taking hold to make overdose response a routine component of safety training, alongside first aid and CPR — for first responders and laypeople alike. In the latest such effort, Blue Cross Blue Shield of Massachusetts is announcing Thursday a pilot program to provide the overdose-reversing drug Narcan to three employers and a union, and to train employees in its use.
“We want to communicate to employees that [addiction] is not a ‘we-they’ thing. This is a human thing,” said Ken Duckworth, Blue Cross’s medical director for behavioral health. “This is something that we should be able to talk about. This is part of the human condition.”
Blue Cross’s project comes as data show a startling jump in the number of overdoses occurring in the workplace. According to the federal Bureau of Labor Statistics, nationwide 217 people died from overdoses while at work in 2016, up from 165 the previous year.
In Massachusetts the number went from six workplace overdose deaths in 2015 to 25 in 2016, with 29 documented so far in 2017, according to the Massachusetts Coalition for Occupational Safety and Health, an advocacy group for workers. The 25 workplace deaths in 2016 represent a tiny proportion of the more than 2,000 opioid-related overdose deaths in Massachusetts that year, but the numbers show a fourfold increase in just one year.
With the powerful synthetic fentanyl now prevalent in the illicit drug supply, people die quickly when they overdose, said Dr. Scott G. Weiner, an emergency medicine physician at Brigham and Women’s Hospital and director of the Brigham Comprehensive Opioid Response and Education Program. That makes a fast response especially critical, he said.
Administration of naloxone, the chemical name for Narcan, is now part of the basic life-support training that emergency medical technicians undergo, Weiner said. But he also gets requests from laypeople; Weiner and two other Brigham physicians recently provided naloxone training to nonmedical staff at the Massachusetts Medical Society and to the administrative staff in their office building.
The Brigham doctors are also taking it a step further, developing a naloxone lockbox that could be placed in public places. Bystanders who witness an overdose would call 911 to receive a code that unlocks the box, which would contain the medication and instructions on administering it. In an experiment last year in Cambridge, the researchers found that most people were willing to help strangers in such a situation and nearly all could correctly administer the drug.
In April, Surgeon General Jerome M. Adams issued an advisory urging more Americans to carry naloxone. And Massachusetts health officials have worked for years to make naloxone widely available. Today police and fire departments throughout the state carry the medication and anyone can buy a naloxone kit at a Massachusetts pharmacy.
But a recent survey of Massachusetts residents found that a majority did not know they could obtain naloxone without a prescription.
The survey, commissioned by Blue Cross and conducted in September, also found that 70 percent of Massachusetts residents believe naloxone should be widely available in workplaces and that a little over half are confident they could administer it properly.
This readiness may arise from another finding in the survey: More than half of Massachusetts residents know someone who has been addicted to opioids, and four in 10 know someone who has overdosed — similar to previous findings.
The participants in the naloxone pilot are companies whose employees are covered by Blue Cross health insurance. Two of them — Shawmut Design and Construction and the New England Regional Council of Carpenters, a union — are involved in an industry particularly hard hit by the opioid epidemic. A Massachusetts study found that construction workers were six times more likely to die of overdoses than other workers.
The other two participants — the town of Ware and the city of Brockton — have workers who may encounter overdose victims in public parks and libraries.
In addition to those four participants, Blue Cross is testing out the program among its own 3,700 employees, to see if it’s helpful in an office environment.
Participants will receive tool kits containing two doses of Narcan nasal spray, a surgical mask and gloves, and instructions on administering the medication. Blue Cross will also provide training and has created an online resource center with information on opioid use disorder and treatment. The Department of Public Health is providing “master trainers” to teach others how to provide naloxone training.
Duckworth did not have an estimate of Blue Cross’s spending on the project, but said each kit costs about $130, and the insurer has 800 ready for distribution. After a few months, a survey of participants will help ascertain whether the project should be expanded to other employers.
Bert Durand, communications director for the carpenters union, said the claims filed through the union’s health plan showed a high use of opioids, because of on-the-job injuries and pain from bodily wear and tear. The union, which represents 28,000 workers throughout New England and upstate New York, plans to place the naloxone kits at training centers and the health fund office.
In Ware, town manager Stuart Beckley said the main concern was employees’ ability to respond to people who overdose in public places. Through the pilot, he hopes to train many of the town’s 300 employees and place naloxone kits at a dozen town facilities, including Town Hall, parks, the library, schools, the pool, and the senior center.
Shaun Carvalho, Shawmut’s safety director, said there has never been an opioid overdose on a Shawmut job site — and the goal is to never have a need to use Narcan. But, he said, “We try to be prepared for everything. It’s not unlike having fire extinguishers on the project.”