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Home > Topics > Drugs
March 04, 2014

Narcan: Who gets to carry it?

At least 17 states and the District of Columbia can publicly administer the heroin overdose antidote, and at least 10 allow for prescriptions to family or friends of drug users

The Associated Press

CAMDEN, N.J. — As deaths from heroin and powerful painkillers skyrocket nationwide, governments and clinics are working to put a drug that can reverse an opiate overdose into the hands of more paramedics, police officers and the people advocates say are the most critical group — people who abuse drugs, and their friends and families.

Supporters say the opportunity to save potentially thousands of lives outweighs any fears by critics that the promise of a nearby antidote would only encourage drug abuse.

At least 17 states and the District of Columbia allow naloxone — commonly known by the brand name Narcan— to be distributed to the public, said Jeffrey Levi, executive director of Trust for America's Health, a national nonprofit that focuses on preventive health care. And at least 10 of those states allow for third parties, such as a family member or friend of an intravenous drug user, to be prescribed it.

Among them is New Jersey, which passed a law last year that allows members of the public to carry naloxone — administered through a nasal spray or injection into a muscle — after getting training.

About 20 people, most of them related to overdose victims or people who currently abuse heroin, crowded into a clinic last weekend in Camden, a drug-plagued city across the Delaware River from Philadelphia, to learn about the antidote. Jane Stiuv, whose daughter survived a heroin overdose in 2011, listened as a nurse described the signs of an overdose and when to administer naloxone.

Stiuv, who found her daughter slumped over the side of a bathtub with a needle in her arm hours after her release from prison, said she wanted to learn how to reverse an overdose should it happen again. Each attendee received a kit containing two syringes, a small vial of naloxone, alcohol swabs and a face shield for rescue breathing.

"I was a little shaky. It brings me back to the times she overdosed," Stiuv said of the training. "But it makes me feel better that it can help her and do something about overdose prevention."

Naloxone is regarded within the medical community as highly effective when used properly. A study conducted during a state-supported pilot of naloxone distribution and overdose education in Massachusetts showed it was 98 percent effective in attempts to rescue a person who overdosed.

Police in Quincy, Mass., have been carrying naloxone nasal spray since 2010 and said in July 2013 that they used naloxone 179 times, reversing 170 of those overdoses — a 95 percent success rate.

According to the White House Office of National Drug Control Policy, the number of overdose deaths involving prescription drugs increased 21 percent from 2006 to 2010; the number of overdose deaths involving heroin increased 45 percent.

Bills are pending in at least seven states to increase access to naloxone. In Tennessee and Utah, doctors would be allowed to prescribe it, and civil liability for those who administer it would be dropped. A Wisconsin bill seeks to broaden access to naloxone and, as New Jersey also does, provide legal immunity to drug users reporting an overdose.

Marty Walsh, the new mayor of Boston, this month called for all first responders to carry naloxone. Police in Indianapolis, where heroin overdose deaths have doubled since 2011, have started a pilot program to have officers carry the drug. In Ocean County, N.J., police are being trained in how to use it.

The White House drug policy office is also urging all first responders to have naloxone on hand. In 2012, the Food and Drug Administration held hearings on making naloxone available over the counter, but it has not yet done so.

Naloxone is available by prescription in the United Kingdom, but an advisory council has called for over-the-counter distribution. Prescription take-home programs are in place in Australia, Canada, Estonia and Russia. Norway plans to distribute nasal spray kits to drug users in its two largest cities.

But not everyone is sold on the idea of making it more widely available.

In Maine, where heroin overdoses increased fourfold from 2011 to 2012, Gov. Paul LePage opposes a bill that would allow health care professionals to prescribe it and allow more emergency responders to carry the drug.

LePage, who wants to add 14 new drug enforcement agents in the state, cites concerns that it would raise Medicaid costs. He also has said the drug provides "a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby."

"This bill would make it easier for those who have substance abuse problems to push themselves to the edge, or beyond," LePage wrote in a letter last year explaining his veto of a similar bill designed to expand access to naloxone. "Offering temporary relief without medical or treatment oversight will not combat drug use."

Dr. Marcus Romanello, the chief of the emergency room at Fort Hamilton Hospital in Hamilton, Ohio, said he believes police should carry naloxone but is leery of giving it to the public.

There is no disputing, however, that it works, he said.

"They are pulled back from the jaws of death, as we say, by the Narcan," he said.

An overdose of opiates essentially makes the body forget to breathe. Naloxone works by blocking the brain receptors that opiates latch onto and helping the body "remember" to take in air. The antidote's effects wear off in about a half hour, and multiple doses may be needed.

The drug's backers say it's crucial to train relatives or friends of addicts because the person overdosing is likely sick or unconscious and unable to self-administer the antidote. It also must be given within a certain window; most overdoses occur within a half-hour to three hours after injecting too much of a drug.

Naloxone wouldn't, therefore, have helped actor Philip Seymour Hoffman, who died of an apparent heroin overdose this month in his New York apartment and is believed to have been alone as he took drugs; he was already dead when discovered.

At the New Jersey workshop on Saturday, nurse Babette Richter described the signs of an overdose. Observers should watch and listen for raspy breathing and a blue face, signaling a loss of oxygen.

Keep a close eye on people who nod off after using, and try to wake them, Richter instructed. If they do not rouse, place them a floor or other hard surface, give rescue breaths every 10 seconds or so, and administer naloxone.

The most important thing, Richter said, is to call 911 and wait with the person who has overdosed — and to remember that in New Jersey, the caller can't be charged with a crime.

Associated PressCopyright 2013 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

"This is buying us time," Richter said. "It's not a cure."

Comments
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David Kase David Kase Tuesday, March 04, 2014 7:21:03 PM Why would our gov. want to encourage drug use by giving narcan to every tom,dick,and harry walking. I see this as an encouragement for the drug pushers to sell more drugs because they can now offer an overdose solution. This gives the drug user a false sence of security that they can do a little more and have something there if it was too much. Why don't we just get rid of paramedics all together and just put med bags on every street corner and let everyone just take care of themselves??... Giving Narcan to the public is giving them a false sence of security that they can take drugs with no consequences. I've been in the Fire/EMS field for over 20 years and can say this is the most ridiculous false solution to a public problem politicians have came up with to date.
Seth Wood Seth Wood Wednesday, March 05, 2014 1:28:54 AM This is just a bad idea...
Adriyn Grey Adriyn Grey Wednesday, March 05, 2014 1:32:38 PM So there should be no solution to overdosing? "Drug pushers" don't care one way or another if their clientele o.d's, I know first hand. They know that the client base is a renewable resource. Making this available to (former) Tom, Dick, and/or Harry's like me ensures that we live to see the light of another day and hopefully come out of the clutches of our addiction. Dope Soap saved my ass on two separate occasions, one of them would have been fatal. Having this sold over-the-counter would not be beneficial just to street junkies, but to Gramma in her hospice bed as well. Think of those who take insane amount of pain meds. People overdose on THEM, too!! Yet, no one shows those that use THEM the same disdain!! Even those who ABUSE them!! The only difference between a heroin addict and a pillpopper is the venue and the route of administration, and sometimes even THAT is the same!!! Bottom line, Naloxone saves lives. Opioids are a fact of life. Needlessly withholding from the public is a form of manslaughter.
Emmitt Tucker Emmitt Tucker Wednesday, March 05, 2014 1:59:38 PM I don't think allowing the general public to use Narcan is a good Idea but I can see allowing EMTs to push Narcan. In Montana only a AEMT or Higher can administer Narcan. but I can see training the Basic EMTs to use it but not the General Public
David Kase David Kase Wednesday, March 05, 2014 7:42:12 PM Adriyn Grey there is a solution to overdosing, whether it be someone on pain meds or illegal substances, its called EMS!!! I have had friends that have overdosed and survived, not because narcan was sold over the counter to them, yet because 911 was called and EMS did what we do. Next are we going to give Ramazacon OTC for those taking barbituates????? People have to understand that they are either taking an illegally obtained drug, whether it be heroin or obtained Opiods not prescibed to them, or they are not following the prescribed dosing given to them. Whatever the case may be. The only way to fix a problem is to know about the problem. If you sell narcan OTC, then there is no system in place to help those with an addiction. If EMS gets called there is a trackable record, without trackable records these politicians will have no reason to allocate monies to help those with addictions. This is just a way for the government to say to the public, look it worked because the addiction rates are down. Not that they helped anyone, just that there is no recordable number of overdoses. This in turn will give a false sence to the public that there is no reason to fund addiction programs, because there are decreased numbers of overdoses. Its simple math, if there is no recordable way to give a number to an overdose, then there is no overdose that is recordable. This is way to make a politician look good to the public, yet blinding the public to a true problem that is in our society. If the public doesn't see a problem due to reported statistics then they will believe there isn't a problem, and those addicted will not have access to the help they need.
Adriyn Grey Adriyn Grey Wednesday, March 05, 2014 9:46:43 PM David Kase As the article has stated, it as been available to patients in several states for years, including the state of the city of one of my former stomping grounds, the infamously drug-saturated San Francisco. Which ALSO has in place a very well-established and funded network of treatment programs....given that it is hard to keep utilities running in San Francisco. As a first responder, you should know that it is an incredibly lofty and even unrealistic ideal to place sole responsibility to paramedics given how thinly spread they are even in well-staffed departments. I myself WAS an ER Tech before I became strung out and I saw numerous (if I had to average it out, one a week) opiate overdoses that had to be given norepi and/or be defibbed in addition to being narcanned because they were that far gone. this was before the laws changed. in the months following the formulary access to paramedics and limited patient access, I saw all but TWO before I left. I don't think that many people are BLIND to this problem. In fact, I think if anything, the fact that people are pushing to further legalize this life-saving drug for an ever-growing epidemic shows growing awareness. I can't go a week without some type of news article that is drug addiction related. You can't be everywhere as a paramedic, David. Drugs, especially those derived from poppies, yeast, and cannabis, are going nowhere. Historical fact. Opioids, even when used as prescribed, CAN pose an overdose risk (unlikely, but there ARE scenarios I have heard of). THIS is ONE more way to ensure that this risk is mitigated. Isn't the BEST thing you can HOPE for in your job is NOT to do it???
Tim Suggs Tim Suggs Friday, March 07, 2014 5:47:30 AM Adriyn Grey did you get clean by using narcan or by getting to the root cause that started you onto drugs in the first place. We should be focusing of the root causes and help people prevent drug use, instead of enabling every person who wants to try herion.
Tim Suggs Tim Suggs Friday, March 07, 2014 5:49:05 AM lets give a 4 hr class on brain surgery and have everyone be a brain surgeon.
Adriyn Grey Adriyn Grey Friday, March 07, 2014 4:09:45 PM Tim Suggs I am clean in part because I survived another day due to having had a Narcan kit handy in my buddies adjacent bedroom. Thanks to California law and San Francisco's implementation of it. I am clean NOW because I decided that I was tired of surviving another day. I wanted to start living. What I am TRYYYYYYYYYYYYYYYYING to say is that HARM REDUCTION is a VIABLE resource that, if used in CONJUNCTION with other modalities, DOES get people clean. And minimally, paramedics and cops CANNOT be everywhere at once. You are not GOING to prevent heroin use, no matter how many obstacles are put up. I can tell you first hand. As I have ALSO stated, this would be a valuable tool for those who use a large amount of pain medications, as well, as even those who take them as prescribed run the risk of overdose. Harm Reduction is not just for the addict. In fact, it really is most NOT for the addict. The harm reduced is for society as a whole. Needle exchanges take contaminated syringes off the street and additionally, lower numbers of infected individuals that can infect other people. Naloxone, handed out BY these exchanges, would drastically reduce the taxation on EMS systems and more importantly, SAVE LIVES!! Contrary to what you might think, Narcan is NOT an innocuous experience. It is incredibly jarring and anyone with an IQ over 85 will be left with a sore sense of contemplation over what just happened.
Adriyn Grey Adriyn Grey Saturday, March 08, 2014 6:02:09 PM comparing -giving availability of an otherwise relatively benign drug (it is not abusable and often comes in predosed syringes....and even if not, it's rather safe) just out of an irrational fear that it is going to enable a problem that will be there whether or not an antidote is made present to the layman to. and that already has been available in numerous states for years with wild success rates and a correlated INCREASE in people seeking treatment (note i said nothing of CAUSATION!) -a highly complex medical procedure on natures most mysterious and sophisticated organ that even those trained to do it can EASILY botch is at BEST an asinine statement. think before you speak (type), dude.

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