In this 2014 file photograph, a small bottle of the opiate overdose treatment drug, naloxone, also known by its brand name Narcan, is displayed at the South Jersey AIDS Alliance in Atlantic City, N.J.

For years, Colorado leaders and health care providers have worked to improve access to naloxone, the nasal spray that can stop opioid overdoses.

Those efforts included giving pharmacists the ability to dole out the antidote, and doctors and providers can write prescriptions for naloxone.

Grant funding has worked to give the medicine to needle exchanges and other services that regularly deal with addicts.

Those strategies have their own issues, said addiction and emergency medicine physician Don Stader.

Grant funding can dry up. The stigma surrounding opioid addiction or misuse can deter those struggling from filling naloxone scripts. Stader said the prescription fill rate is "abysmal" and is as low as 5%.

So he has launched his own effort, the Colorado Naloxone Project, to more efficiently and effectively get the antidote to those who need it.

Through this project, providers can give a naloxone kit — a plastic bag with the spray, rehab information and various instructions — to patients in the emergency room who might be misusing opioids. The kits could also be distributed to patients given a new opioid prescription.

The goal, he said, is to keep patients alive while educating them about the dangers of opioid misuse and giving them resources on how to get help.

Over the past year, as the focus of the medical and public health community has been trained on the pandemic, the opioid epidemic "has spread like a malignant cancer," Stader said.

The need for this program is as great now as it's been at any other point.

"The opioid crisis has worsened significantly in the face of COVID," Stader said. "Not only is the drug supply more dangerous, but the drug use and really substance use across the board is so much higher in our country because of all the stress, the anxiety, the loss of employment and jobs, and the chemical coping that’s oftentimes an unhealthy way that people deal with these stressors."

Stader's project, he said, is the first of its kind in the United States.

Holly Monatt, the director of clinical pharmacy services for HealthOne, said she first heard about it in late 2018 or early 2019, when Swedish Medical Center, where Stader is based, piloted it.

At first, they'd either give a kit or a prescription for one, depending on the patient's ability to access a pharmacy.

But they realized the fill rate of those scripts was poor, so they switched to just handing it out. Still, 85 kits were distributed from Swedish between December 2018 and March 31 of this year.

Stader began looking beyond Swedish. He partnered with various medical and hospital organizations to form the Colorado Naloxone Project.

The long-term goal is to recruit hospitals across the state to participate. So far, HealthOne and Centura have signed on. 

Since April 1, 20 kits have been distributed, Monatt said. Hospital data indicates the need is even greater than that.

According to numbers Monatt provided, there were roughly 800 patients in 2020 identified with an opioid use disorder or opioid overdose in HealthOne's emergency rooms.

The company that makes naloxone donated some of the medicine to the program, Stader said, and he's working on securing "a much larger donation from the Colorado Office of Behavioral Health, which oftentimes makes bulk purchases of naloxone."

Previous state legislation requires insurance providers reimburse hospitals for the opioid antidotes, and Stader said the next legislative goal is making Medicaid do the same.

"The biggest innovation that this program is really trying to implement is we are trying to — instead of making this grant-based or instead of making this based on the good will of hospitals who have the funds to afford giving naloxone out, to make this part of the actual medical system," he said.

"This is part of insurance, and this is part of what all hospitals should be doing and not expected to be doing just based on grant funding or based on their own willingness to give things away for free."