How Naloxone Can Help Save Lives: Meet Pat Aussem

Naloxone can be a life-saving drug for someone in an overdose situation from opiates.

Pat Aussem has helped families in New Jersey by creating a much-needed naloxone training. If your child is having a hard time with opioids, be sure to get trained and have a naloxone kit on hand. 

I’m delighted to share Pat’s interview! She provides information on naloxone as well as the CRAFT approach.

Please welcome Pat Aussem!

For people who don’t know you, could you briefly tell a little bit about yourself and how you became involved with families who have substance abuse issues?

Sure, about 15 years ago or so, my son was struggling with depression. He was diagnosed with ADHD and was having some difficulties with school. My husband and I realized that he was very depressed, so we started taking him to therapy.

It wasn’t long after that before I realized he was also smoking pot. His use escalated. So did our treatment protocol. We went from individual therapy to an outpatient program. He then attended a residential treatment program where he spent almost four months.

When he was discharged, we realized that we had to help him change so many aspects of his life to sustain his recovery. We worked hard at finding a different school, different friends for him to socialize with, and different activities. For a 16-year-old that is hard to do.

There was the prom, the weekend parties, the football games. They would have been toxic for him. I didn’t know anything about addiction at the time, or what recovery entails. I spent a lot of time getting educated about it.

As families learned about our experiences they began to call me, much like they call you Cathy, asking, “What did you do? How did you do it? Where did you go for treatment? How did you know what to look for in a treatment program?” and all those sorts of questions.

I started trying to answer them but felt like I didn’t have the training and the knowledge that I needed to do that effectively, or to the degree that I wanted to.

So in 2007, I went back to school and got a Masters in Counseling Psychology. After graduating, I spent the next four years or so working at a psychiatric hospital here in New Jersey. I worked in the detox, rehab, co-occurring disorders, and adolescent units.

My time was spent learning more about substance use and other mental health disorders. I had the intent of trying to help families in particular. That is my passion–helping families. There is so much stigma associated with substance use disorders. Families need support figuring out what to do to get the best treatment available.

I ran into families that could not afford treatment without taking out second mortgages on their homes. Or they were taking money from 401K plans to pay for treatment. If a child had cancer everybody would be doing bake sales. You say “substance abuse” and others give you the cold shoulder.

This has to be different. We have to reduce the stigma and get more funding for research and better treatment. That is why I got into the field.

It is amazing that you have put together a naloxone training for your county which has now spread to other counties in New Jersey. Can you explain what is involved with the training?

It started off as a county program. Now, the program has blossomed to five different counties at this point in the state of New Jersey.

I had been to a county-wide task force meeting dealing with the opiate epidemic. The meeting was all about the actions our county had taken to address the crisis. Our county is actually pretty progressive. They had passed the Good Samaritan Law and the Overdose Prevention Act. Our first responders, our police, and our EMTs would be able to carry naloxone.

I left that meeting thinking “this is great news! The first responders are going to be equipped.” Later, I found out that half of the police departments weren’t carrying it. Of the 63 emergency rescue squads, six of them had it on board, and seven of them were planning on it. The rest weren’t going to for a variety of reasons.

They were concerned about keeping the medication temperature controlled. There was the worry that if someone had overdosed, and if they were revived with naloxone, they would be combative; just all different kinds of reasons. I didn’t think most of them were particularly great.

In any event, it occurred to me that this meant there were a lot of families who were going to be out of luck if their child overdosed.

The family is often the first one there anyway. A friend of mine, Denise Mariano and I set about to create an overdose prevention program with the funding we received from a woman who lost her child to an overdose and the support of the Partnership for Drug-Free Kids.

The program included many different elements. Included was an understanding of addiction, what happens in an overdose, how to recognize the signs, how to administer naloxone, what to do after someone is revived and how a family can help get their loved one into treatment. We also provided families with information on resources including treatment options, funding, and support groups.

How can people become more involved with naloxone training in their state? What are the benefits? Are there any negative outcomes to be aware of when administering naloxone?

There are a couple of different ways to get it. In many states where there is a CVS or Walgreens, you can actually go in and ask for naloxone and get a kit without a prescription. It is over the counter.

Some of them do training, yet it is kind of spotty. My recommendation for families is to go to a site called Get Naloxone Now. They have a wonderful animated training program on how to recognize the differences between an overdose and someone who is high. They explain all the steps that are involved in administering Narcan (the brand name) or naloxone.

It takes you through rescue breathing, what the rescue position is, when to call 911, how to put the nasal spray together, how to use the nasal spray, and the importance of getting emergency help. There is a possibility that the Narcan can wear off and the person can go back into an overdose state.

There is another website called Hope and Recovery. They have a zip code locator for finding naloxone training. Many organizations around the country have put their information into that website.  You can search and find something close by.

Failing that, I would either call a substance abuse treatment center in the local area or the county mental health administration to ask them if they are aware of any training in the area. Often there are licensed addiction counselors as well who might be aware of training. The important thing is to get the training. It is very straightforward, and anybody can learn how to do it.

In fact, there are some newer products on the market. You don’t even have to put the nasal spray together; it comes in an all-in-one piece by Adapt Pharma.

There is also the auto-injector called Evzio. It is like an EpiPen version of naloxone. There are lots of advancements going on in this field on overdose reversals.  But again the most important part is having naloxone and making sure you know how to administer it. Checking the expiration date, as the medication expires after a period of time.

I want to underscore how important it is to get the training for anyone who is dealing with opiates. You will have accurate information about what naloxone can and cannot do. In some of the training sessions that I ran, there were people who thought that naloxone was only for heroin.

It is important to realize it can help in an overdose of OxyContin, Vicodin, Percocet — all opioids. It will not help if another drug causes the overdose.

Since naloxone brings people out of the overdose quickly, is there anything parents need to be aware of? 

The first thing I would say is if I gave you a dose of naloxone right now, all you would have is a wet runny nose, and need a tissue.  So even if you saw someone who was not doing well, and you gave them naloxone, but say they had passed out from alcohol, it is not going to hurt them. This is a very benign drug and there are no apparent side effects in that regard.

In determining that your loved one is overdosing, you want to look for blue lips and fingertips. You want to check for a really depressed breathing rate like less than one breath every five seconds, or a death gargle, and you can’t arouse them. 

If you try to give them a sternum rub with your knuckles on the breastbone or under the nose and they are not responding, you know you have a problem on your hands. An overdose can take a couple of hours to happen, so you may check on somebody and think they are fine, but as time goes by something more dangerous happens. 

The biggest issue in my mind is that naloxone only lasts for 30-90 minutes, so that is the reason a family has to call 911. There is the possibility the person could go back into respiratory arrest. They may need to be hospitalized and need more treatment, so that is something to think about. 

Another consideration is that sometimes a person may need more than one dose. With the naloxone nasal sprays that were provided in our community, families were instructed to give one dose and then wait two to four minutes. If the person was not revived, a second dose was given. 

My understanding is that with fentanyl that is hitting the market, there are instances where you need even more than two doses, so fentanyl can be kind of tricky in terms of how potent it is as a drug. 

Families should know that when a person is revived using Narcan or naloxone, he or she is immediately in withdrawal. They are going to cramp, feel like they’ve got the flu, or like someone hit them over the head with a hammer.  They are going to feel miserable, and sometimes say “I’ve got more heroin or pills over there, get them for me.” You don’t want to do that obviously. 

I would encourage every family to have Narcan on hand regardless of whether opiates are being used as prescribed or abused in their household. There are parts of the country where people get a naloxone kit even if their doctor just prescribed Percocet for back pain or something like that, just to make sure if there is a problem, overdose treatment is readily available.

Once someone has been revived, my concern shifts to thinking about how to help that person get into treatment, because we know if someone overdoses once, their risk level for a second overdose seems to go up tremendously. Getting them to treatment is really important.

That brings me to my next question. I know you are an advocate of the CRAFT approach. How does CRAFT benefit teens or young adults and their families in the short and long-term? How can it help them get their child into treatment?

Many families that I have come across sort of dismiss early substance use as typical teen experimentation, although what we are learning about the teenage brain is that it is so critical not to introduce toxic substances until the brain is fully developed, which really doesn’t happen until someone is in their mid-20s. 

I think parents often try to discipline their way out of the problem and when that doesn’t work, they get lots of advice. The advice goes along the lines of letting them hit bottom. “Why don’t you just detach from them and let them figure it out?” “They have to want it.” and “Why are you wasting your time?”

Even when I didn’t know much about this topic, “detach and let them hit bottom” did not resonate with me. I was watching my son struggle tremendously and I felt there had to be a better way. Through my work at The Partnership for Drug-Free Kids and The Center for Motivation and Change, I learned about CRAFT — Community Reinforcement and Family Training. 

Not only is it an evidence-based approach, it gives parents the sort of tools that they can use to influence their child in a positive way. It helps with engagement in positive behaviors, so instead of just letting your child fall apart in front of your eyes, and then try to pick up the pieces, it advocates intervening and using the influence that you do have in a strategic way.

Using positive reinforcement to try to engage your child in behaviors that you want to see more of is an example of one of the CRAFT tools. I know in so many households, parents that I talk to are focused on everything negative that the kid is doing. They didn’t show up and do their chores. He was late to work. She was smoking last night.  They were disrespectful.

They don’t focus in any way on what the child is doing right. 

It becomes this kind of nagging, pleading and lecturing situation, hoping you can give them one piece, or nugget of information, so they might stop using, and it doesn’t work. 

The beauty of CRAFT is that there are tools that can help you figure out how to get your child engaged in activities that compete with their drug use. It helps in ways to figure out how to collaborate with your partner if you are not on the same page. It allows other people to be the teacher of life lessons to your child instead of you, meaning letting natural consequences play out.  If they get a ticket from the police, you are not trying to minimize that ticket by saying, “Well, I’ll pay for it this time, but don’t do it again.” Instead, you let them learn that lesson. Let them feel the pain of paying the ticket.

All of it is surrounded by what I refer to as “background music,” which are the communication strategies that you can use. The first strategy is really being open to listening to what the benefits of drug use are, which probably sounds strange.

What is your child getting out of using? Is it helping with their boredom, anxiety, or desire to fit in socially? Maybe it gives them a thrill or some sort of excitement. 

It is trying to understand why a child is using drugs and alcohol, and the only way to get at that is to really listen to what your child has to say, instead of nagging and lecturing them. 

Just using different ways to present information, and to recognize and validate how they are feeling, can change the whole dynamic in the family. It increases family cohesion, and in most cases, there is either a reduction of drug use or the person gets into treatment.

The underpinning of all of it is the family’s own self-care and recognizing that if you don’t take care of yourself, it is really hard to engage in this. Sometimes this journey lasts decades, and you need those resiliency muscles to be really strong to do this and it helps to appreciate your own life and other people in your life instead of solely focusing on your child’s problems. 

CRAFT is a blessing. I’ve met Bob Myers who created it. I know you have too, and I think it’s just a remarkable way to approach someone you love and care about to address a disease, as opposed to thinking this is a moral failing on your loved one’s part. 

In many treatment centers, families are told that they are enabling, they are codependent, and they are contributing to their child’s problem. They are not really letting parents know what else they could be doing other than perhaps going to a support group. On the other hand, CRAFT is a very clear way to use the influence that you have as a parent to address your child’s substance use.

It is interesting because some parents think, “Well you know, now that they are a teenager, or especially if they are over the age of 18, I don’t have any influence.”

But they do.

It needs to be used in a strategic way so that you recognize and reinforce the things that the child is doing right, let natural consequences play out, use problem solving and collaboration, and make requests in a positive way — all of these tools and more are part of the CRAFT package.

CRAFT makes a tremendous difference. 

The changes in the family and in the individual parents are really quite remarkable. As you probably know or have encountered, there are so many parents who say, “I don’t see my friends anymore because I am sitting at home waiting for the next shoe to drop,” and that is just a horrible place to be.  You feel so isolated and you wonder what you could have done differently.  “I must be a terrible parent. I can’t figure this out.”

CRAFT is a great way to give parents something that is concrete and constructive and actually gets results instead of feeling shame and isolating. 

Finally, what advice do you have for parents who are struggling with their child’s substance abuse?

A couple of things. One is really doing your homework on what your child is using, what the signs of use are, what the side effects are, and things like that so you really know what this particular drug is doing to affect your child. That is really important. 

It is interesting to me that in many cases for parents if their child had a cancer diagnosis, they would be learning everything there is to know about cancer, but with substance misuse or abuse often there is a sort of apathy or a lack of really digging in and learning about what this does to the brain. What is it doing to their body on a physical level and on an emotional level?

Understand why your child is using and get a sense of why it is important to them. Intervene early and as often as you can because in many cases, it is so much easier for someone to build a life where they have friends, a job, they are in school, or they have their house rather than waiting for all of that to dissipate and then saying, “We are just going to start from scratch.”

Looking for ways to engage your child in activities that will compete with their drug use is important.

Also getting help from people with addiction credentials is important. I know in my early attempts at trying to help my son I didn’t realize that substance use was part of the picture so when we were turning to therapists and psychiatrists I wasn’t looking for someone that had an addictions background. I now know that this is critical. 

If they are using opiates, definitely get overdose prevention training. Also, I would suggest learning about medication-assisted treatment like the use of Vivitrol, which is a once-monthly injection; and Suboxone, which you can take on a daily basis to help with cravings and to help with preventing overdoses.

The last thing I would say is to really work on your own self-care and social support as well as finding support groups like yours, because I think you learn so much from your peers who are struggling with this as well. You can get a lot of useful information and feel like you are not alone in this.

No parent should be left behind when it comes to a child struggling with drugs and alcohol because there is help out there if you just ask.

Patricia Aussem, LPC, MAC, provides counseling services to treat substance use and other mental health disorders based on the CRAFT model. As a consultant to the Partnership for Drug-Free Kids, she provides clinical oversight, workshops, and training materials for the Parent Support Network, a peer-to-peer coaching service for families negatively impacted by a loved one using substances. For more resources, contact the Partnership or the helpline: 1-855-DRUGFREE.

What are your thoughts about naloxone? How can we train more families to be first responders? Would the CRAFT approach help your family? Let us know in the comments.

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