Dr. Scott Weiner and Suhanee Mitragotri, Harvard University: Naloxone Training

Hector Murrieta, Principal of Sierra High School, hosts a podcast episode 4 on the opioid crisis and naloxone education. Guests Suhanee Mitragotri, a Harvard student, and Dr. Scott Weiner discuss the rise and fall of opioid overdose deaths, with a peak of 80,000 in 2021 and a current rate of 60,000. They highlight the importance of naloxone, now available over the counter, in reversing opioid overdoses. Suhanee's Naloxone Education Initiative trains high school students to recognize and respond to overdoses. They emphasize the need for harm reduction and the importance of integrating naloxone education into school health curricula.

Sounds great. Can you add these links for the show notes:

Harvard Program: https://steppingstrong.bwh.harvard.edu/naloxone-administration-program/#naloxone_education
Training slides: https://docs.google.com/presentation/d/1ZqkVwmt1B7g2dhN7nVaYrN3wQsrgIOIVethsRymrvws/edit?usp=sharingTraining script: https://docs.google.com/document/d/1LVEDB8AeqJJpPis1mz6-4MYRTl2Onwx31sczhSN5pCU/edit?usp=sharing

Local Resources:

San Bernardino County Department of Public Health: https://dph.sbcounty.gov/programs/health-edu/opioid-initiative/

Overdose Youth Safety in the Inland Empire (ODYSIE) Program: https://odysie.org/ 

Where to find the School Health Connection Podcast:
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School-based Health Center information: California School-Based Health Alliance Visit Inland Empire School Health Coalition to join the Coalition Check out past recorded webinars on School-Based Health Centers: 2023-2024 2022-2023.
For more information on Healthy SBCSS, visit www.healthysbcss.net or contact Ms. Farrah Northcott, RD, Director, Healthy SBCSS by calling 909.386.2775 To contact today’s podcast host, please email: hector.murrieta@sbcusd.k12.ca.us If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lif...

Transcript

SPEAKERS

Dr. Scott Weiner, Suhanee Mitagotri, Hector Murrieta

Hector  00:08

Hello and welcome to episode four of the school health connection podcast. My name is Hector Murreta and I am your host. I'm also the proud principal of Sierra High School in the San Bernardino City Unified School District, a deep and heartfelt thank you to the California school based health Alliance and the San Bernardino County Superintendent of Schools for making this podcast possible. Our Inland Empire school based health centers coalition. From now on, coalition has nearly 300 members. The purpose of the coalition is to expand and support the school based health center movement and to facilitate greater engagement investment and proliferation of school health services, all of which equate to greater access for youth. So today we have a very special episode. The topic today we're going to cover is we're going to be addressing the opioid crisis and the critical role of naloxone education and saving lives. But what makes this particularly unique and interesting for us is we're we're doing something different. We're on a zoom call with our guests. Our guests are back east in Boston right now, and they've joined us today to help educate us on these very important topics. Our first guest that I'll introduce is Suhanee Mitragotri. Suhani is an undergraduate student at Harvard University, studying neuroscience and global health policy, and she is a co founder of the Naloxone education initiative. Welcome to Suhanee, yeah.

Suhanee M.  01:42

Thank you so much for having me. Super excited to talk with you today and share more about our work and our initiative.

Hector  01:50

Wonderful. Thank you. Our other guest is Dr Scott Weiner. He's the chair of the Massachusetts Naloxone project, the emergency medicine expert at Brigham and Women's Hospital and a leader in opioid use disorder prevention and treatment. Welcome. Dr Weiner,

Dr. Scott W.  02:09

thank you. It's so wonderful to be here. Really appreciate the opportunity, and I want to go on record that I am a native Californian. Grew up in San Diego, developed my school there, but I've been in Boston for 25 years, and I'm freezing, just to put that out there. 

Hector  02:22

 Well the three of us, then, are native Southern Californians, actually, Doctor Weiner, I'm from San Diego as well. We're going to have to, we're going to have to talk offline here, see if we cross paths at some point. Absolutely.  there's a ton our guests can share. Yeah, I went on, I went on to the the initiatives website, and, yeah, there's, there's a lot that we could read there, but we'll leave it up to our guests. We'll provide links, and they are to our listeners rather. And they could, they could go in and and and check it out. You know, I want to add some levity the conversation real quick, because I don't think anyone, certainly our listeners won't know. And Suhanee, I think I haven't told you, and I should probably be a little embarrassed to admit this, but this episode almost didn't happen, and here's why I was about to send your email to spam. You know, as a principal, I get a lot of unfortunately, I get a lot of spam email. And you know, everyone has the latest and greatest product or program for schools and such. So when I read your email, I thought, and when I saw where you were from, I thought, no, I you know, this has to be spam. But, you know, you mentioned the the podcast by name, The School Health connection Podcast. So I thought, huh, you know. So I kept reading, and then when I saw that your email was was serious. Then I thought, Okay, well, let me, let me test it. So I that's when I responded, and you responded immediately, and it was a serious response. And then that's when I reached out to to Farah and to Sang, or my colleagues in the coalition. And here we are. So to our listeners, I want to encourage you, if you have a story or your organization, your program, can educate a lot of people in the areas of school, wellness, student wellness, please reach out, and I'll do my part to I'll commit to reading your emails. I won't send you to spam because I learned a big lesson today and or in getting to this episode. So we're very, very it's a blessing to have you online. Thank you. I'm glad I read through it. Thank you so much, and I'm really glad to get the opportunity to to talk today.  Yeah. I mean, when I thought about, wow. Our reach. You know, you know, this our fourth episode, and you know, we're now interviewing, you know, both of you from clear across the country, at a out of Harvard and everything. I thought, wow, this is really, really cool. So thank you. But anyways, getting into the topic, you know, just to help our listeners and all of us, I'm really excited to learn more as well, just to understand more about Naloxone and its role in the opioid crisis, I want to ask you, Dr Weiner, if you can to provide just an overview of the opioid crisis in the country, any key statistics the importance of harm reduction strategies, anything you may have that you can provide to our listeners.

Dr. Scott W.  05:44

Yeah, absolutely. So it's a story of tragedy mixed with hopefully a little optimism. The past decade and a half has been, has been, frankly tragic from the numbers of lives that we've lost throughout our country, back around 2015 we hit 30,000 people that died from opiate overdose. And at the time, it was the number one preventable cause of death in the country. It surpassed motor vehicle accidents, gun violence, other trauma. And even then we were, we were just, just dismayed by this, this, this terrible statistic, around 2018 it had reached even higher, a higher level, and then it started to plateau. We said, maybe we're doing things right. Maybe we're increasing access to treatment, we're increasing education, and we're going to be doing a bit better. And then you might recall something happened at the beginning of 2020 a little viral infection that was making the rounds, and it just the COVID just wreaked this terrible havoc on on society, as you know, it led to increased isolationism. It led to really a change in the drug supply as well. We were we were able to kind of cut off importation of heroin into the country. But then that led, or paved the way for fentanyl to come in, which is a really strong opioid that's like really small doses can can be really potent, and it's, it's easily importable, and that has been the driver of death since then. So we hit, we actually hit up to 80,000 people who died from opioid overdose. Was our peak about a year ago. The optimism I mentioned is that we're now down to around 60,000 so this is the rolling 12 months, still completely tragic, completely preventable needs. Needs work to be done, but at least we're seeing a downward trend, and that does give me hope overall. And part of the Hope is what you had alluded to before is this concept of harm reduction, and that is what naloxone is a part of. And we can, we can talk more about this, but harm reduction overall is the idea that and the recognition that people are using drugs like when I was in high school. The the message was just say no, right? It was just say no. And that was, unfortunately, really simplistic and also not realistic, because we know, throughout humanity, throughout millennia, people use drugs, the concept of harm reduction is not to say, it's not to judge. It's not to say no, don't use or we approve of this, or we don't approve it. It's if you're using drugs, we want you to be safe. We don't want you to die. And that's that's really the role that Naloxone will play, and I'm looking forward to delving into that in this conversation.

Hector  08:32

Absolutely yes. Thank you, Dr Weiner, and we are going to get to that for sure. And that's actually a good segue to invite Suhanee to share, you know, what you could share with our listeners about the Naloxone education initiative. You know, how did you share the story? How did that come about your involvement? You know, again, the little I've read about it, it seems like as a fascinating story.

Suhanee M.  09:02

 I've been passionate about adolescent health education for a while, and I'm currently a senior in college. So I was in high school, you know, about four years ago, and I realized that in high school, I mean, I took health class two semesters of it, but I wasn't really taught about opioids, despite how prevalent the opioid crisis is and how many lives it's taken, as Dr Weiner discussed, and so especially in 2023 with Naloxone becoming available over the counter and in the form of the Narcan nasal spray, which really anyone can use, I realized that this could be a very valuable opportunity to teach students about opioids and how diverse an opioid overdose using naloxone. And so I got in touch with Dr Weiner about this, about this gap that existed in high school health education in terms of opioid education. And I said, you know, is there any possibility that maybe we could work together? There to develop a training specifically catered towards high school students that teaches them how to recognize the signs of an opioid overdose and how to respond using naloxone. And yeah, that's exactly what we did. We developed this training program that teaches students the science of opioids and addiction, how to identify and respond to opiate overdose, we delve into Naloxone like what it is, how it works, where people can find it. And we also talk about destigmatizing Naloxone possession. So, you know, opening conversation about it and talking about the importance of also medical amnesty for those who administer Naloxone and save someone's life. So yeah, it kind of just came from this passion for for adolescent health education, from also being recently in high school and then addressing this gap that you know clearly exists in the high school health curriculum.

Hector  10:53

  thank you. I mean, and thanks to both of you and all of your your partners, yeah. I, you know, from a principal standpoint, I, I remember  a student that I had, you know, word was getting around that maybe he was dealing that stuff. And, yeah, I remember calling him in and and kind of like you said, Dr Weiner, I didn't, I didn't place any blame. I told him, Hey, look, you know, I can't, I can't prove or anything that you are. I just, I just want to be very upfront and tell you, you know, people are saying that you are. And I just say, Look, you know that stuff, you know, I don't know if you're aware, but even a tiny amount, and you could kill somebody. I said, so please. I mean, if you are doing it, please just stop, you know, because, one, it's harmful to the other people. But you know, for you to, you know, if you had to live through that where you found out somebody died, because, you know, you distributed it, yeah, it was, I remember vividly the conversation. Thankfully, you know, it didn't come to anything, but yeah, it's definitely out there. So, you know, and you know, being a high school principal, myself and a lot of our listeners either are educators, or they work very closely with educators in schools. If people wanted to tap into this training, the program that you offer, what? How? What could they do? What should they do? How would they go about that? 

Dr. Scott W.  12:26

Yeah, sure, I can address that. And actually wanted to just touch on that point that you just mentioned, because it's it's really important for for the listeners, and also probably to understand what naloxone is. I think some people know what it is, and some people don't. So the first is what you mentioned about the pills and the potency of this fentanyl that's available. And this is another reason why we're so interested in the adolescent population. I mentioned the good news of decreasing deaths, but we're actually seeing increases amongst adolescents. We think the reason is that there's a lot of people that are making illicitly manufactured fentanyl, are pressing it into little pills, and they look just like pills you would get at a pharmacy, but they're not. They're just pure fentanyl, and it truly is one one pill can kill it's that potent. And the reason it works like that is that the fentanyl, it might give someone some euphoria, like they feel good when they first take it, but then it completely shuts down the brain's mechanism to breathe, and so they just stopped breathing. And I was I was struck by a statistic I saw recently that the DEA in 2024 confiscated around 60 million pressed pills. That's just a drop in the bucket. That's just the pills that they were able to get a hold of and confiscate. So if you can imagine all the other pills that are out there. So if I could leave one message with people, it's like, if you see a pill and someone offers you a pill at a party and they say, like, it looks like, oh, it looks like oxycodone or Vicodin or something like that, don't trust it. It's it might be fentanyl, and it could be enough to on it like, honestly, kill someone. The reason Naloxone works is that it's this amazing molecule. It's very safe, and it displaces opioids that are in the system. And so if someone takes Naloxone, which is also known as Narcan, it's the brand name, it will kick off that opioid that's in the system and reverse the overdose. And as Suhani mentioned, it's wonderful. Now it's even over the counter, although you can also get it the pharmacy with the prescription too. But it's, it's, um, the access is really, is really good now, and we really do want people to learn how to use it. The the way to to train is actually really simple. It's about 15 minutes. And maybe I'll pass it to Suhanee just to talk about our training program and the availability.

Suhanee M.  14:40

 yeah. So we developed this training program that's Yes, about 15 to 20 minutes in duration, and teaches students how to recognize a sign's been over to opiate overdose and respond using naloxone. And we've been delivering these trainings across Massachusetts, but we've also been training. Teachers and community organizations to deliver this training to youth in their community. So our goal is really to expand our reach and really get this training to as many people as we can, because we think it's incredibly important, and the more people that we can get you know trained on how to deliver this training as well, like educators, community organizations, partners, that's incredibly important to us. 

Hector  15:29

So because you're based out of Boston, do you have, you know, we're way out here in Southern California, Inland Empire. Do you have affiliates? Or, you know, how, how would somebody out here tap into, you know, these resources and the training and things like that?

Dr. Scott W.  15:49

Yeah, sure. There certainly are a lot of resources within the different counties. And I bet San Bernardino offers it as well too. As far as availability of naloxone, our training is pretty agnostic, meaning, like, there's one slide which is specific to Massachusetts, but everything else is really, is really just kind of generic. And so if anybody is interested in accessing that, just hopefully, we can include some contact information with the podcast, and it's just, we consider it open access, and we want people to be able to use it. We have both the slides themselves, and we also have a script that goes along with it, so like a health feature, for example, can just take the slides, read off the script, and it's pretty easy to administer.

Hector  16:28

 What barriers are you finding to, you know, Naloxone use, or people actually acquiring it. Are you finding some obstacles, and what are they?

Suhanee M.  16:51

  I guess I can touch on a couple. In terms of some barriers we've, at times, faced going into schools. Sometimes we've seen schools being hesitant about having this education in their classrooms, especially schools located in communities in Massachusetts that have seen overall lower overdose rates, they often put forward the argument that because there's very few overdoses in their community, there's really no need for their students to be receiving this education and to that, we've, we've really been saying, you know, this education is it's not just about like teaching students to, you know, be able to respond to an overdose in this specific community, right? Like these are high school students. They may go across the country for college moving forward in life. I mean, these skills, they stay with you forever, and it's about equipping students with those skills to save someone's life. So that's what we've been, you know, emphasizing to a lot of schools, which has been helpful in getting past those barriers, but definitely has required a lot of conversations surrounding that. Dr Weiner, do you have anything to add there?

Dr. Scott W.  18:02

Yeah, I do. I just wanted to add to that too. I think it's so important just to keep this very objective. Again, this is, I view this as a skill of like, CPR, so, you know, and, and you can think about it in an analogous way, like, you know, say someone has a lot of cheeseburgers, right? And now all they eat is cheeseburgers, and they're on a soccer field and they collapse, and they have a cardiac arrest, and there's a defibrillator there. You wouldn't say, I'm not going to defibrillate you, because I don't like the choices you made in your diet, right? This is what it's about. So we're, we're very much like this is just, this is, this is something that's happening in the community. There's three in 10 Americans say that either a friend or family member has addiction. This is affecting all of us, and this is a perfect opportunity for, particularly high school students, to feel connected and feel like they can actually intervene and save someone's life. It's much more than just the drug use question, and so we've tried our hardest just to stick to that message and be really objective about it. 

Hector  19:01

Yeah, Thank you, Dr Weiner, for that analogy that for me, that hit it. You're right. You know, just knowing CPR, knowing, you know, those basic life saving skills.  I had to, I had to use it on one of our teachers this school year. I mean, yeah, you Yeah, but like you say, you don't sit there and question, you know, you should have done this. Should have done that. No, you want to save the person's life. So yeah. So thank you for that. have you seen any best practices that that you can or would like to share that you know in your work at some schools? 

Dr. Scott W.  19:53

If I can, I can start and pass it to Suhanee, if you like. I a best practice. I. And this is really our philosophy, is that every student graduating from high school should have this training period like that. It's again, it's it takes 15 minutes. It just, we want to make sure that everyone knows this is affecting all of our communities. And like Suhanee mentioned before, it might not even be used in in a community like there might not be a lot of opioid use, but that that individual might find themselves in a different neighborhood one day, or different area, and they need to know how to identify an opioid overdose and how to reverse it. So our our suggestion for best practice is that as the health as in the health curriculum, that it's part of it, at least in Massachusetts, our model health curriculum is something like 80 pages, and it mentions the word opioid one time. There's a lot of emphasis on smoking, vaping, marijuana, which is completely appropriate, because those are the substances that tend to be used more commonly in high school. But because of these, the opioids are being used around the community. We believe that is a best practice to add to that too. I would hope that most school nurses do carry it. You never know if someone has an overdose within within the school, and they can intervene before the ambulance gets there. And an aspirational goal would be that everyone just carries it on them, like I have it in my backpack, and if I'm traveling or on the subway or, you know, anywhere public place. I carry it with me because you just never know.

Suhanee M.  21:23

 in terms of, like, where we've been able to deliver trainings, we've been able to go into some health classrooms and, you know, deliver this training to students. We've also done it for some youth programs, some youth orgs in in our area, so we've been really trying to get in wherever we can. But as Dr Weiner said, you know, the ultimate goal is really to make this something that's just part of the health curriculum that health teachers are teaching to students as a part of the school curriculum. 

Hector  21:56

yes, thank you. As I listen to both of you, you know, I have my principal hat on as well. And I'm thinking, you know, this could be a school wide campaign with with peer leaders. I'll speak for Sierra High School. We have what we call our sunshine crew, and they are our peer leaders that are, they're trained in wellness, general wellness, to support their peers. Yeah, this could be a campaign that they embark on or that they offer the entire campus. Oh, yeah. I mean the and, like you said, Dr Weiner and you Suhanee . I mean the information that you've your organization has provided, the resources, they're very accessible. They're there. And, like you said, open source, so anyone listening to us has license, so to speak, to use them  is there anything else that maybe I didn't ask that you're, you're, you'd like to share with our listeners regarding either your program or information you know about Naloxone or opioids or anything that we may have not covered.

Suhanee M.  23:24

 I think, like one thing, I guess I would say, is, like, when we started this, I mean, it really started with us reaching out to principals, reaching out to town boards of health, health teachers. I mean, really getting engaged with communities is so key to this effort and really having these conversations. I think that's the first step for people who want to, you know, get any sort of, you know, new education implemented at the high schools in their area. You know, just first having a conversation and hearing more from the community and engaging that way, I think is so crucial to really, any sort of public health initiative that you you want to do.

Dr. Scott W.  24:07

 yeah, I absolutely agree with that. And just to take a little different direction, people often ask where they that themselves can get naloxone. And so there are a lot of places where they're offered. Now you can, of course, get into the pharmacy, and it's over the counter now too, although the cost is somewhere between like 30 and $40 a lot of times. People, if they have insurance, the insurance will cover it with either minimal or no co pay. So you can just go up and ask the pharmacist if you can get it that way, and then lots of departments of public health will carry it as well. So there's a lot of resources now within the community to be able to get it at no cost. 

Hector  24:39

Yeah, it sounds like we really have no excuse to we, you know, as as public agencies, as schools, as organizations, to not, you know, at least have it available or or accessible to people. Yeah, so yeah, that's that. That's good to know and to an earlier comment or a question that you asked. Dr Weiner, yeah, we'll add links to a lot of this information your site in the show notes, so that our listeners can access them and and reach out to you, your organization, if they want to learn more and and participate more. Yeah, I want to thank you, Suhanee and Dr Weiner, for your time here with us again. Suhanee, I can't stress for reaching out. It started that way. So I want to thank you for that and for taking the time to share your expertise with us and to be with us and to congratulate you for the work that you're doing and and wish you abundant success. You know, we'll do our part here by, you know, sharing this and hopefully again, the message will spread. So any any final thoughts, words of encouragement before we close out?

Suhanee M.  25:58

 I mean, thank you so much for having us. It's wonderful to be able to share our initiative with more people and hopefully empower others to also take on similar work in their areas. So yeah, thank you.

Dr. Scott W.  26:14

I just want to add that I'm so lucky to be able to work with someone like Suhanee that especially their students listening. Just in college, she's taken this on, and we've been able to introduce a bill in our legislature about naloxone. We've been able to talk around the country thanks to opportunities like this. So she's inspirational to me, and I hope she is to other students as well

Hector  26:34

yeah, Suhanee, this is a congratulations to you, and yeah for the work you're doing, and I'm sure it'll continue in your studies and and moving forward. So to you our listeners, I also want to extend an immense Thank you for listening in and joining us and please sharing this with others. We're going to include, like I mentioned earlier, we're going to include pertinent links that were discussed here in the show notes. And lastly, before we close, I just want to put a plug in to our upcoming Inland Empire school based health centers coalition quarterly meeting, which will take place at Sierra High School. I I'll speak for me and for the school. We're really excited that we're going to be hosting this next meeting at in our new Wellness Center, and it'll include a tour for so for attendees, they'll be able to see our new Wellness Center  So thank you once again for joining us, and we'll see you in the next episode of The School Health Connection. Thank you very much.