Nursing Students Are Ready to Reverse Opiod Overdose with Narcan

UC Nursing students, faculty and staff prepared in late spring to take on one of the worst public health disasters in United States history.

About 50 people volunteered to participate in a training offered by the college in partnership with Hamilton County Public Health and Harm Reduction

Ohio on the signs that a person is experiencing an opioid overdose and how to administer six brands of the opioid overdose reversal drug naloxone, including Narcan. The county’s public health department also provided participants with Narcan nasal spray and fentanyl test strips.

“Overdose deaths continue to rise across the country and in Ohio. We need people to carry naloxone and be prepared to use it in case of an emergency because anyone can save a life with naloxone,” says Tasha Turner-Bicknell, DNP, RN, CPH, who co-led the training and serves as director of UC’s Public Health Nursing Doctor of Nursing Practice (DNP) and post-bachelor’s certificate programs.

Drug overdose deaths skyrocketed across the U.S. in 2021, increasing 30% over the previous year, driven by synthetic opioids like illegally made fentanyl, which are highly potent and hard to detect without a test. Fentanyl has made its way into stimulants like cocaine, crack cocaine, meth and counterfeit Xanax, oxycodone and Adderall. That is why, Turner-Bicknell says, even people who use stimulants should know they could experience an opioid overdose. She shared that drug overdose deaths from the opioid heroin have declined during the past decade as methamphetamines and cocaine deaths have spiked. In 2021, only 180 deaths in Ohio were attributed to heroin, compared to 2,750 from cocaine and meth. To make matters worse, an animal tranquilizer called xylazine has been increasingly found in combination with fentanyl and linked to overdose deaths across the nation.

In response to the increase in drug overdose deaths, the U.S. Food and Drug Administration approved Narcan nasal spray for sale over the counter, meaning people can purchase naloxone without a prescription. Turner-Bicknell says many people who use drugs cannot afford to purchase Narcan, but others around them can now more easily access it.

“You never know who’s using drugs or when someone could overdose in your home or in a restaurant,” she says. “I keep one in my car and on my person. I’ve used mine in a bar.”

Ben Greenwell, a fourth-year UC Bachelor of Science in Nursing student who attended the training, says he witnessed providers administering Narcan during his co-op at Cincinnati Children’s, “Obviously, you don’t want to have to use it at any point, but if a situation arises, it’s a great thing to know how to use,” he says.

Amanda Lynn Reese, director of programming for Harm Reduction Ohio, who led the second half of the training, emphasized naloxone’s safety. The medication, which works by blocking opioid receptors in the brain, does not cause any significant side effects. An opioid-dependent person, however, may experience withdrawal symptoms after receiving naloxone. That is why it is important to treat people who use drugs with compassion and respect, Reese says. “Your interaction with this person can validate or negate relationships that other health professionals have been building,” she says.

In fact, harm reduction is all about building relationships with people who use drugs. Within this framework, public health nurses and other professionals work directly with drug-dependent individuals, providing them with health care access and resources that empower them to take control of their health.

Turner-Bicknell, a Harm Reduction Ohio board member, says, “The reality is that people use drugs — not just a little but a lot. My goal is to meet them where they are, just as they are, and offer them the services they need today.”

The collaboration with local agencies to offer the training supports the college’s commitment to strengthen partnerships with local and global organizations, as well as UC’s urban impact agenda, which is part of its Next Lives Here strategic plan.

The reality is that people use drugs — not just a little but a lot. My goal is to meet them where they are, just as they are, and offer them the services they need today.”
— Tasha Turner-Bicknell, DNP, RN, CPH

By: Laura Toerner

Tasha Turner-Bicknell’s Public Health Journey

I started working in harm reduction in 2014. Like many people, I had lost friends and loved ones to opioid overdoses. Coming from a working-class Appalachian family, I was particularly concerned with the devastation we were seeing in those communities. So, as a nurse, I searched for and found a strong body of evidence-based interventions that weren’t being implemented widely in our area.

I began volunteering with Cincinnati’s first syringe service program, and after waiting a few months for my first shift, I worked directly with program participants every week for the next three years. Around that period, I started a Doctor of Nursing Practice (DNP) and developed a DNP project focused on quality improvement for syringe distribution models based on a recommendation for needs-based syringe distribution from the CDC that was not being implemented in our area.

After graduating from the program, I continued to work in harm reduction and overdose prevention. I was asked to join the Board of Directors for Harm Reduction Ohio, on which I still serve. I have worked as a naloxone train-the-trainer to provide community members and lay persons with the knowledge, skills and abilities to train people in their own community on how to use naloxone. Today, we have an incredible group of grassroots leaders and community members who provide training and distribute naloxone across the state.

In 2021, I partnered with Caracole to bring the first harm reduction vending machine to the Midwest, which made Ohio the second state in the country to leverage this technology. Through the vending machine, people have access to naloxone, safer sex supplies, safer smoking supplies and safer injection supplies, among other harm reduction items. Our initiative brought hundreds of requests from other states for information and mentoring in setting up machines.

Currently, I collaborate with community partners to increase access to wound care for people who use drugs to keep them out of hospitals. As more street drugs are altered by suppliers to include other harmful ingredients, more people who use drugs are experiencing wounds that frontline harm reduction workers cannot address, so they end up in emergency rooms which is not an appropriate place to treat nonemergent conditions.

I also serve as a subject matter expert and consultant for organizations looking to increase their capacity for harm reduction services through training and education. I hope we can increase engagement with communities not currently being served, increase access to health care by embedding medical services in syringe programs and continue working across sectors with diverse partners to monitor and mitigate the flow of dangerous substances into the drug supply, which is the known leading cause of overdose death.

INTERESTED IN LEARNING MORE about our Public Health Nursing Doctor of Nursing Practice or graduate certificate? Contact Tasha Turner-Bicknell at turnerta@ucmail.uc.edu.