More than 1,200 people have taken the Second Chance Naloxone Program offered through the St. Clair County Health Department since the program started in October 2015.

And each of them has his or her own reasons why they took the free class, which teaches how to administer a potentially lifesaving dose of a medication that stops opiate drug overdoses.

But there's one over-riding reason most share, said Julie Walding, a registered nurse who teaches the class.

"Because it's a way to save the life of someone you love," she said. "The program is not just for people who are opiate users."

The class is about an hour long. Walding teaches community health professionals, first responders and law enforcement officials — she had a session scheduled for Wednesday at the Marlette Police Department — as well as residents.

Most of her students have personal reasons for wanting to learn about naloxone.

"Most of them are either consumers or contacts of someone in the community who is a user," she said.

Learning to administer naloxone "gives them a chance to save a life," she said. "Naloxone isn't the answer. It is a tool that is available in terms of a multi-disciplinary approach to the problem."

Users take the program so they can help friends — and a free kit that comes with two doses of naloxone also has instructions about how to administer the drug and how to bring someone back from the depths of overdose.

"That's why there's a DVD that comes in the kit," Walding said.

The problem

Talk to veteran first responders, and they'll say they've never seen anything like the spate of overdoses due to heroin and other opioid drugs.

"I've been in fire and EMS 35 years and I've never seen it this bad," said Port Huron Battalion Chief Mark Ford

The numbers bear out those impressions: St. Clair County in 2015 had 48 overdose deaths. That's more than double the 18 people who died in traffic crashes in the county the same year.

Three people died in Port Huron from overdoses in fewer than 24 hours at the start of January. Rural Sanilac County had five overdoses in 10 days at the end of the month.

Michigan had 1,980 overdose deaths in 2015; there were 33,091 overdose deaths in the United States that same year.

Paramedics in St. Clair County injected Narcan — a brand name for naloxone — 312 times in 2015, an increase of 94 from 218 in 2014.

"This didn't happen overnight, and it's not going to get fixed overnight," Walding said.

During the Second Chance class, people learn that about 62 percent of the overdose deaths in the U.S. can be attributed to use of some kind of opiate drug, and that drug overdose deaths have more than tripled since 2000.

Walding said she expects the number of overdose fatalities to have quadrupled since 2000 once new data comes out.

She said most heroin is not "clean" and often is laced with powerful opiate drugs such as fentanyl and carfentanil.

Both are Schedule 2 drugs, as are heroin and morphine. That means they have a high potential for abuse and addiction. They both are much more powerful — hundreds of times more powerful — than drugs such as heroin and morphine.

Carfentanil, for example, is about 10,000 times more potent than morphine and, according to Walding, is "used to take down elephants."

She said the drug likely is coming from China.

"Cincinnati, in August, had 174 overdoses in six days," Walding said. "That was the beginning of the carfentinal problem."


Many people who use drugs such as heroin are aware of the risks — that's one of the reasons they take the Second Chance class. It's also, said Walding, why people will use drugs in public restrooms — if they overdose, there's a chance someone will find them and get them to a hospital.

Opiate drugs are depressants. People die because of respiratory arrest — they simply stop breathing. That's different from drugs such as cocaine, amphetamine and methamphetamine, which are stimulants and cause death by cardiac arrest.

Walding said people who overdose on an opiate drug stop breathing within one to three hours after using.

"We have time to intervene," she said. "We have time to do something."

The danger for many users lies in several areas, including not being aware that some medications are opioids. For example, prescription cough syrups and prescription versions of over-the-counter acetaminophen contain codeine, which also is a Schedule 2 drug.

People using heroin laced with more powerful drugs are subject to overdoses because their bodies don't have the tolerance for those drugs. Decreased tolerance also is one of the factors for an overdose, Walding said. That can happen when someone leaves jail or when someone hasn't used in several days.

"They want to use what they typically use," she said. "They often think they can handle it. They're chasing the dragon.

"The No. 1 cause of death for people leaving incarceration isn't violence," she said. "It's overdose."

People also are in danger when they mix drugs — like a speedball cocktail of heroin and cocaine — or use drugs with alcohol, she said.

People who take the Second Chance class learn an acronym — SCARE ME — to remember the steps they should take if they encounter a person who is overdosing. Those steps are:

  • Stimulate by rubbing your knuckles on the person's sternum. "If you do this to someone and they don't sit up and say, 'Stop it,' call 911," Walding said.
  • Call 911: Naloxone wears off in about 30 to 90 minutes so it's important that people get medical help. "This is a tool to use until help arrives," Walding said.
  • Airway: Pull down the person's chin, look inside the mouth and scoop away obstructions.
  • Rescue breathing: The kit includes a rescue breathing mask 
  • Evaluate: After several breaths, determine if the person is responding and breathing on their own.
  • Medicate: Administer the naloxone by spaying half of the vial into one nostril and the other half into the other nostril. The drug takes three to five minutes to work, so continue rescue breathing.
  • Evaluate and support: If the person is not responsive after five minutes, administer the second vial of naloxone. Do not let the victim walk away or use drugs.

Walding said since the program started, she has done more than 104 training sessions, ranging from one-on-one to large groups.

She said she knows of at least eight overdose reversals that have been administered by people who have taken the class — and there are probably at least four more.

"There are more I suspect didn't fill out the paperwork," Walding said.

She said the program should be considered by "anybody who is at risk or anybody who comes into contact with anybody at risk."

Drug abuse cuts across all strata of society, Walding said.

"If someone thinks this doesn't affect them, they are so wrong," she said. "It isn't an us and them scenario.

"Heroin addicts or opioid addicts never walk into this thinking this is going to happen."

The Second Chance program is funded by Region 10 Pre-paid Inpatient Health Plan and the Michigan Department of Health and Human Services.

While the price of one injectable drug containing naloxone has increased by more than 600 percent since 2014, the cost of the product used in the Second Chance program has not changed, said Jennifer Michaluk, health department director of health education and planning, in an email.


Second Chance

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