A Life-Saving Lesson

A few nights before the 2021- 22 winter break, ABSN nursing student Katerina Fella Nu’22 was in her West Philadelphia apartment when she heard a commotion outside her door. “I heard someone yell- ing,” she says. Stepping into the hallway, she recognized one of her neighbors lying on the floor, blue and unconscious. A friend of his had dragged him there. Fella’s nascent nursing instincts kicked in. “I took over,” she says. She felt for a pulse; her neighbor was unresponsive. She started chest compressions. The friend, in a panic, revealed that the unresponsive man had overdosed on heroin. Fella ran back into her apartment and grabbed the Narcan nasal spray she had picked up at a local drugstore several weeks earlier, after attending a guest lecture on harm reduction by Penn Nursing assistant professor Shoshana Aronowitz PhD MSHP FNP-BC GR’19 GR’21. Aronowitz, she says, had taught the class how to use naloxone during that lecture. “I shot it into one nostril, waited a minute, continued CPR…then I did the other nostril,” says Fella.

Narcan, brand name for the opioid antagonist naloxone, binds to the same receptors as an opioid, displacing it temporarily and undoing its dangerous effects.
After the two doses of Narcan nasal spray, Fella’s neighbor woke up. His pupils changed from tiny pinpoints to normal, she says. His skin went from blue to pink. “He looked at me and asked what happened,” says Fella. Meanwhile, someone in the building called 911.

Anyone can learn how to use naloxone

About a month later, after Fella returned to Philadelphia from her winter break, her neighbor stopped by her apartment. He told her that he had been clean before the overdose but that he had been battling substance use disorder for a long time. “He’s okay,” she says. “I see him every day.”

After the incident, a shaken Fella emailed Professor Aronowitz to share her story and express her gratitude. “I never thought I would have to use
Narcan,” says Fella, who plans to work in the public health sector after she earns her master’s in women’s health and midwifery at Penn Nursing. “Narcan is amazing,” she says. “Someone on the floor with no pulse goes to standing up and breathing, unaware of what happened! I think everyone should carry it.”

In an interview, Dr. Aronowitz, who earned her PhD from Penn Nursing and completed her postdoctoral fellowship at the National Clinician Scholars Program University of Pennsylvania site agreed that everyone should carry naloxone, not just health care professionals. “Any layperson can learn how to do it,” she says. With minimal training they can save someone’s life. In this case, she says, Katerina didn’t know before the lecture that naloxone was available at no cost. When Aronowitz teaches nursing students about naloxone—typically as a guest lecturer in Psychiatric Nursing 235—she always tells the students that they can get this medication at any pharmacy. “You need to ask the pharmacist. I encourage students to do this. It is a really easy thing to have with you. You can access it easily and carry it with you. You can put it in your bag. It is an easy thing to do that could have a very clear benefit.”
“I learned how far nursing health education can go,” says Fella. “If I hadn’t gone to Shoshana’s lecture that day and didn’t know how to use and access Narcan, I wouldn’t have been prepared.” Today, she says, most of her neighbors carry Narcan with them.

“There is no downside that I can think of,” says Aronowitz. If you suspect that someone has overdosed on opioids, but you are wrong, giving themnaloxone will do no harm. “It is wonderful that I have been asked to give this talk multiple times,” says Aronowitz. “It’s what students and faculty want. This is so relevant to nursing.” And yet, she says, “the nursing curriculum has not caught up to that at every nursing school.”

“Before I came to Penn,” says Fella, who grew up in Haverhill, Massachusetts and earned a BA in biology and history at Assumption College in nearby Worcester, “I had a different perspective” on substance use disorders. While she felt badly about it, “people can read you numbers all day, but when you take away the numbers you realize these are human beings battling something difficult and we as a society haven’t figured it out yet. Before, it was easier to judge because I didn’t know anybody or talk to anybody who has been through it.” The experience with her neighbor, she says, humanized substance use dis- orders for her. And she’ll never go any- where without naloxone again.

Fella is attending Penn Nursing as an Amy Gutmann Leadership Scholar. Selection to the program is based on diversity, academic achievement, first-generation status, leadership potential, and a commitment to make a difference in underserved communities.

“Every month or so all the Gutmann Scholars meet to discuss what we can do to be leaders in fields we are passionate about,” says Fella. “All of us have different backgrounds with different goals as nurses. Mine is to help underserved communities really have access to quality care.” It should come as no surprise then that this young leader is already saving lives.

Where to Find Naloxone

If you have health insurance, it will usually cover the cost of naloxone. “In Pennsylvania there is a standing order so that anyone can go to a pharmacy and get it,” says Aronowitz. But if cost or pharmacy access is a barrier, you can get the medication for free through the mail thanks to a partnership between the national organization Next Distro, the Philadelphia-based harm reduction grassroots organization SOL Collective, and the Philadelphia Department of Public Health. This program prioritizes people who use drugs, their loved ones, and anyone who is likely to encounter an overdose but cannot access the medication elsewhere.

For more information, visit: nextdistro.org/philly phillysolcollective.org