Naloxone in Shelter Settings: A Success Story from Michigan

The Robert J. Delonis Center works to prevent overdose deaths in people experiencing homelessness and opioid use disorder in Ann Arbor.

Ann Arbor, Michigan, is known as a college town that is also home to high-tech industries. However, the city is not immune to the nationwide opioid epidemic and the problem of homelessness. The Robert J. Delonis Center provides 50 beds in a year-round residential program, and it expands to provide additional emergency shelter beds during the cold Michigan winter. The emergency shelter program has recently seen a spike in opioid use.

The shelter’s staff was profiled in a news article by MLive Media Group detailing how they have used naloxone to reverse overdoses in the shelter. The SAMHSA Homeless and Housing Resource Network caught up with Ellen Schulmeister to find out more. Ms. Schulmeister is the executive director of the Shelter Association of Washtenaw County, which operates the Delonis Center.

How many times have your staff had to use naloxone?

We have had to use it eight or nine times recently. Staff responded to eight overdoses in the last four and a half months.

That sounds like it is becoming a regular occurrence. What type of training does the staff receive?

We started receiving the training about four years ago, when naloxone was first available to us. The training is done by a nurse practitioner from a local school of nursing who works out of our clinic. It lasts about 90 minutes. After she trained all of us, she branched out and trained the police and sheriff’s department in the county.

It is like a CPR training: you learn about the basics, get a chance to look at the device and have it in your hand, and learn how to do it. We have been using the nasal spray, and we are just now getting the auto-injector.

We offer training several times a year. Our operations specialist position tends to have a lot of turnover because we promote them, and we also have seasonal staff who help with the winter program. Whenever we need a training, we just get in touch with Gina, the nurse practitioner. It is required for all new people, and anyone who has had the training can also go back for refresher training.

A shelter can be a chaotic environment. How do you make sure naloxone is accessible when staff need it?

We have automated external defibrillator (AED) stations, and the naloxone is attached to them. [An AED uses electricity to return a person’s heart to normal activity during cardiac arrest.] The AED stations are centrally located on the first two floors. We have someone who checks the AED and makes sure to replenish it whenever there is an incident.

We also have naloxone on our third and fourth floors, in our operations staff’s desks. There are three to four staff members who have had training in the building at any time, so they can help each other.

You mentioned that people in the 50-bed residential program are subject to drug screening, but what percent of people in the emergency shelter do you think are using opioids?

I can not say for sure, but I would guess that it is at least 50% because heroin and other opioids are so cheap now. People who were not using it are using it now. A gentleman who died recently used to be a crack cocaine user, but he switched to heroin. We usually have a problem with whatever drug is cheap and available.

What is your reaction to people who say that reversing overdoses using naloxone is enabling drug addiction?

First off, if we have evidence that people shot up onsite, we have a 30-day suspension from the shelter. When we save a life with naloxone and people end up in the hospital, at least 2 out of 5 come back to thank us because they are on their way to treatment. It is a scary situation for people. They do not realize they were actually blue and actually dead on the floor, and we had to revive them because of what they shot in their arm. It is a wake-up call. It is one of those “hitting bottom” things. I am a firm believer in the idea that people who are addicted to chemicals have a progressive disease and it changes the brain. We need to have more medical research to counteract the biological changes in people’s brains. The frustration of family members who have tried over and over to get someone clean and sober is probably what is coming out when you hear comments like that about enabling people.

What is the next step? Is there any kind of program to distribute naloxone to opioid users and train them on how to administer it when they are not in the shelter?

We have not done that in the shelter, but that is probably a good idea. The public health agencies do offer training to the public, but I am not clear how well that reaches our population. They do know about naloxone and what it does, though. It saves lives.


Publication Year
2017

Author
Alan Marzilli, Homeless and Housing Resource Network
Last Updated: 09/14/2017