On August 1, 2013, the North Carolina Harm Reduction Coalition’s (NCHRC) Overdose Prevention Project (OPP) began dispensing naloxone in North Carolina as part of community-based overdose prevention training program. This program has been made possible under SB20, otherwise known as the “911 Good Samaritan/Naloxone Access” law. By this law, the NCHRC Medical Director, Dr. Logan Graddy, under a standing order, provides naloxone and supplies to administer the medications for patients or families of patients at high risk for overdose who have completed a NCHRC community-based overdose prevention training program.
Dr. Graddy completed his residency in Psychiatry and a Fellowship in Forensic Psychiatry. He is double-boarded in Psychiatry and Addiction Medicine. He works as a psychiatrist for the North Carolina Physician’s Health Program in Raleigh and also has a private practice in Durham.
Q: How did you become interested in harm reduction?
LG: I’ve had an interest in harm reduction since I first learned about it while in my psychiatry residency at Duke. Public health harm reduction strategies like encouraging people to wear seat belts to reduce fatalities from motor vehicle crashes just made sense to me.
As I have grown as a clinician, I have found that using harm reduction strategies in my practice can really help engage patients with an addiction. If you help people start to think about how to use drugs in a safer manner, you can then use that conversation to pivot and ask whether they have ever thought about stopping using altogether. What are their goals in life? Is what they are doing now consistent with where they want to be?
You can see the light switch come on when they see that you care about them and have their best interest in mind. I’m not saying this is easy-- it’s challenging to meet people where they are. I admit at times I’ve struggled with fully embracing a harm reduction approach because I’ve had trouble accepting some of the choices people are making.
But what I’ve come to realize that I have to accept and honor where people are in order for them to trust me to help motivate and encourage them to change their behaviors. I have had the experience that most people, over time, with support and encouragement, will naturally start working towards a healthier life. Our shared goal becomes more stability for them, more balance, and then, hopefully, I can help them imagine, and then realize a life completely abstinent from addictive substances.
Q: NCHRC has spoken to quite a few medical prescribers about prescribing Naloxone to their patients. Why do you think some prescribers are hesitant?
LG: I think when you ask many prescribers to consider prescribing naloxone to patients at risk for an overdose they have an immediate concern about being sued. One thing I learned before I decided to prescribe naloxone that may reassure others is that no prescriber, ever, has ever been sued for prescribing naloxone for overdose prevention.
I think other prescribers may have a knee jerk negative reaction to the harm reduction aspect of this program. Again, I can understand this because I’ve had my own struggles with harm reduction at times. But I think when you understand the overdose epidemic we have in North Carolina, literally over a thousand people dead from this last year, you realize how important it is for the medical community to respond to this crisis. We all need to do our part. And we know that naloxone distribution programs are an evidence-based harm reduction strategy that is going to save lives in our state.
I believe in our program because we are going above and beyond for our patients to try to save lives. It shows that we care, regardless of whether they have health insurance, their immigration status, even if they are on probation or were just incarcerated. I think this kind of outreach makes it easier for people to seek help further down the road and not throw just their life away with drugs. We should not be writing people off because they are using drugs, or thinking somehow that in order to stop using drugs people need to learn a lesson by almost dying.
I believe that every person’s life is of value and we need to all do what we can to save these lives at risk. These folks are our neighbors, our friends and our families. Substance abuse doesn’t discriminate by class or color.
Q: Besides trying to do your part, what reassures you that you are doing the right thing in prescribing Naloxone by standing order?
LG: Well, first I feel reassured because of the wording of SB20. This law states clearly it provides civil and criminal immunity to a provider prescribing Naloxone in good faith under a standing order to a person at risk of experiencing an opiate-related overdose, their family member, or friend.
I also feel reassured because the North Carolina Medical Board (NCMB) has made several statements of support specifically supporting Naloxone prescription through a program like ours. In March 2013 the NCMB said that they encouraged licensees to cooperate with programs in their efforts to make opioid antagonists available to persons at risk of suffering an opioid overdose. In May 2013 the NCMB specifically supported the use of standing orders by prescribers to provide Naloxone prescriptions.
I think it’s pretty clear that the leaders in our State are encouraging prescribers to participate in these kinds of programs and I applaud them for their foresight and support. As I said earlier, I think we all need to do our part in trying to prevent overdose deaths in North Carolina and I think this is my role to play right now.