MAR basics

Nelson says a person addicted to things like painkillers (prescribed) or an illegal drug might be a candidate for MAR. The main drug providers use to treat is suboxone. Methadone is also used, but it’s less common, Nelson says.

Suboxone would be prescribed by a professional with training for this area of medicine. It’s then taken in a controlled manner to help with the person’s addiction. Over time, you step down your use. It’s similar to using a nicotine patch to wean yourself off cigarettes, Nelson says.

There might be side effects to suboxone use, Nelson advises, like teeth damage. That’s why it’s important to take it as directed. And, she says, it beats the alternative.

“You’re not buying it on the street. You’re not getting toxic level of things that can kill you,” Nelson says, comparing everyday drug use to MAR.

Nelson also points out that people who try to quit opioids “cold turkey” can suffer painful withdrawal symptoms. MAR seeks to lessen that.

MAR would also go alongside therapy with someone like Nelson.

“There are a lot of people in recovery who have a history of traumatic life experiences. We might deal with that. We might change the way they think about things using cognitive behavioral therapy,” Nelson explains. “So they have the medication to ease their withdrawal. And they have the therapy piece to learn new skills to live a productive life.

“It all really helps,” she says.

Changing attitudes

Nelson says MAR isn’t new, but she’s seen more health care providers consider it for their patients. For some of those patients, Nelson says it’s a “last hope” after they’ve exhausted other treatments. And when there are success stories, it’s gratifying to people like Nelson.

“I would see people going back to work, reuniting with family members who had to cut them out of their lives, getting married and having families of their own,” she says.

If you think you or your loved one could benefit from MAR, talk to a member of your health care team. If someone is deep in addiction and not seeing their doctor regularly or is resistant to help, Nelson points out that some hospital emergency departments can fast track someone into a recovery program.

Learn more

Read more about healthy thoughts and behaviors on the OSF HealthCare website. If your addiction has reached a crisis where you are thinking about harming yourself or others, talk to a trusted adult or mental health professional or go the emergency department right away. There are also hotlines and other resources available: The 988 Suicide & Crisis Lifeline, the Illinois Helpline for substance abuse and a treatment hub webpage from the state of Michigan.

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When talking about the opioid crisis in America, you don’t have to explain much to Howard Marsh.

A first responder for nearly a half century, Marsh has gone on numerous ambulance calls for a suspected overdose.

“It breaks my heart,” says the Advanced Medical Transport paramedic. “I just can’t believe people do this to their bodies.”

New federal data show nearly 108,000 people died of an overdose in 2022. That's up slightly from 2021. It’s a time to know the facts and misconceptions about overdoses, their causes and ways to reverse the deadly effects. One such way is naloxone, known under the brand name Narcan, a medication that has become more available in recent years to both first responders and everyday citizens.

“It’s really a good drug to have around,” Marsh says.

Narcan basics

Les Mennenga is lead educator for East Central Illinois Emergency Medical Services (EMS), an OSF HealthCare organization that trains ambulance workers. He describes Narcan as an opioid antagonist that helps reverse the effects of dangerous drugs like fentanyl, morphine, heroin and Tramadol.

“If we get too much of those medications in our system, they’ll bind with receptor sites in our brain. They’ll slow our breathing and pulse rate down,” Mennenga says. “They can actually stop the signal to our diaphragm and make us stop breathing.”

Conversely, he says, “Narcan gets to those receptor sites, competes with the opioid and will knock it off. It will help the person restore their breathing.”

Mennenga says Narcan does not work with methamphetamine, cocaine and other non-opioids.

At the scene of a suspected overdose, typically the first bits of information come from friends or family of the ailing person. Those people likely know if the person has a history with a certain drug, for example. First responders will also look for drug paraphernalia like needles. Mennenga says if the person is still alert and breathing, they would not qualify for Narcan.

“The only time we should be administering Narcan is if they’re having difficulty breathing,” Mennenga says. “They’ll be unresponsive, snoring-like respirations or not breathing at all.”

Blue lips are another sign, Marsh says.

There are three ways to give Narcan: through a shot into the muscle; intravenous therapy, commonly known as an IV; and the most common and simple way, Mennenga says, is a nasal spray. Mennenga adds that Narcan may be combined with cardiopulmonary resuscitation (CPR) or a bag valve mask to help restore breathing.

Mennenga says once the person comes to, they might experience withdrawal symptoms like nausea, vomiting or, in rare cases, a seizure or heart issues. First responders will provide more care as needed.

“Go to the hospital and get checked out,” Marsh advises. “We prefer we take you in case something happens in route.”

What you should know

East Central Illinois EMS has rolled out a Narcan leave behind program. The agency provides kits for first responders to leave with friends, family and others after responding to an overdose. The program serves as a reminder that this is an important issue. Experts say survivors are at high risk for repeated overdoses, and Narcan may be the only chance to save their life.

“Overdoses are quite common, unfortunately,” Mennenga says. “Nobody’s immune to the opioid crisis.”

He says if you want a supply of Narcan at home, contact your local health department for options.

Mennenga also says Narcan, shockingly, has some detractors. He says some people think opioid users need to learn the consequences the hard way. But Mennenga, a veteran of the EMS world, says many people who suffer overdoses aren’t your stereotypical drug user. Their use might have started with an injury, leading to pain medication. Or older adults often mix up pills and take too many.

“If they really want to get some help, we can give them resources like their public health department or the state public health department,” Mennenga says.

Learn more

Websites for the U.S. Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Illinois Department of Public Health and the Michigan Department of Health and Human Services all have information on opioid addiction, treatment and recovery. If you are in crisis, the national Suicide and Crisis Lifeline is 9-8-8.

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Iowa was the only state where opioid-related deaths did not increase last year. The American Medical Association says more than 105,000 opioid overdose deaths were reported in the United States between December 2021 and December 2022.

Federal health officials blame the steep increase in opioid overdose deaths, in part, to the rapid growth of highly potent and often deadly fentanyl that can be added to look-alike opioid drugs. The surgeon general recommends more individuals, including family, friends and those personally at risk for opioid overdose, keep on hand and know how to use naloxone, a safe antidote to a suspected overdose.  When given in time, naloxone can save a life.

Scott Barrows, director of the OSF Innovation Design Lab at Jump Trading Simulation & Education Center, is working on an Illinois Innovation Network-funded education project called Virtual Reality Embedded Naloxone Training (VENT). It includes researchers at Illinois State University (ISU) in Normal and Southern Illinois University (SIU) in Carbondale, Illinois. The work centers around developing mixed-use or augmented reality education for an immersive, engaging approach to train people on how to give someone naloxone, often sold as a nasal spray under the name Narcan.

Barrows says the research will make use of cutting-edge technology, which blends the virtual and physical worlds.

“The mixed-reality portion of this being physical and virtual, will combine the actual spray device and a manikin so that people can practice the actual physical spraying with a manikin as well as having this virtual world that is valuable at the same time.”

The opioid epidemic is affecting all demographics, but Barrows points out underserved populations have the least access to resources for prevention, education and treatment. So, the training will be designed with input from a variety of stakeholders.

Keeping it simple and realistic

“It has to be simple. It has to be easy to use. It has to be intuitive, but it also needs to be sensitive to the community experience whether it's rural, urban, suburban, no matter what age, so that's going to be the trick of the design process," Barrows stresses.

The U.S. Food and Drug Administration made naloxone nasal spray available over the counter in March. It’s part of a strategy that includes harm reduction through innovation and education.

Joanna Willett, MSN, RN, a certified nurse educator who directs the nursing simulation lab at ISU’s Mennonite College of Nursing, believes research and development of innovative training can result in education that an average citizen, using a virtual reality headset, could use fairly easily.

“I've seen dozens of adults of all ages, parents, grandparents, sim lab visitors, etc. navigate our current nursing VR software without issue, and without nurses’ training, take lifesaving steps to save a patient with respiratory distress,” Willett says.  “I personally have no doubt that the intended audience of non-medical adults of all ages will benefit from this experience.”  

Virtual reality training has an advantage because it can be easily accessible and repeatable without significant setup or cost.  Willett believes once it is developed, the simulation training will be easy to maintain as an educational program. A prototype will be field-tested in community settings and at the Illinois State University simulation lab using 15 average citizens and five experts with diverse backgrounds.

Roy Magnuson, an assistant professor of Creative Technologies at ISU, will work with graduate students to design a prototype and make adjustments based on feedback. Magnuson has already developed music composition and conducting software for virtual reality. He’ll work with graduate students to create an immersive world, swapping out medical variables for ones he’s used for his other software development.

Magnuson is thrilled to take on the challenge.

Barrows believes the more immersive training will help people recall important best practices while in a high-stress, opioid overdose situation in real life.

“Providing as realistic a situation as possible, we think is more effective than certainly a classroom situation or watching a video or something that doesn’t really provide that as-close-to-reality experience that we think we’re doing.”

The second phase of research would seek additional funding to conduct a randomized, controlled trial to determine if VENT is more effective than traditional education approaches, in addition to examining whether the training is easier to use and accessible to the target audience.

But during the initial development phase, Wasantha Jayawardene, MD, PhD, will tap resources at the Social Perception Lab at SIU to assess the degree to which an individual’s subconscious bias against people with drug addiction influences how they would respond when someone suffers an overdose. Individuals trying the new education prototype will be given an evaluation called an Implicit Association Test (IAT) that can reveal their implicit bias before they test-drive the VENT prototype.

According to Jayawardene, “Based on the IAT results, the VENT will include a model that addresses implicit bias, which can help the layperson responders to become more conscious of their own biases and their potential impact on helping a victim in a real-life scenario.”

There is $54 billion available in lawsuit settlement money tied to companies for their role in fueling the opioid crisis through actions such as downplaying the risks of prescription opioids and promoting the use of the drugs. States are required to spend 85% of settlement funds on opioid remediation and Barrows hopes to explore the potential of tapping that source in the future to make training available using VENT. 

Video Interview Clips, Scott Barrows