Pubdate: Wed, 03 Jul 2002
Source: Portland Press Herald (ME)
Copyright: 2002 Blethen Maine Newspapers Inc.
Author: Josie Huang


Jolted by a spate of drug overdoses, Portland officials will discuss 
whether the controversial and rare practice of supplying addicts with a 
life-saving heroin antidote makes sense for the city.

Paramedics already use Narcan to reverse the effects of heroin and other 
opiates on overdose victims, and the state last week extended the authority 
to specially trained emergency medical technicians.

Now, after more than 200 overdoses in the state's largest city this year - 
including 18 resulting in death - some officials are wondering whether 
Narcan should also be put in the hands of addicts, as is the case in San 
Francisco and New Mexico and countries like Italy and Australia.

"I really want us to brainstorm these things," said Gerald Cayer, director 
of Portland's Health and Human Services Department and organizer of a July 
17 meeting at City Hall.

"How do we feel about users having access to this? Who should have access? 
Should it be only EMS?" Cayer said, referring to emergency medical services.

It's not clear who would make that decision. And officials say it's too 
early to know what kind of program they would consider, how Narcan would be 
distributed, or how drug addicts would be trained to administer it.

What is evident is that the mere idea of take-home Narcan has already 
created divisions among those who work in health care and first- response 
organizations. Some see a program as a low-barrier, harm- reduction tool 
akin to needle exchange programs. Others say it would open up a Pandora's box.

"My fear is that if they give the Narcan out there, the death rate will 
actually go up," said Deputy Fire Chief Terry Walsh, who oversees 
Portland's Medcu unit. Addicts, he said, will "try to self-rectify the 
problem, and I think this will cause a problem."

Walsh said Narcan, the brand name for naloxone, needs to be administered by 
professionals who know how much to give and can monitor the overdose victim 
for potential side effects.

Once they arrive on the scene, paramedics typically inject Narcan into the 
arm of the victim. The drug works almost immediately, by competing with the 
opiate for the same receptor sites and winning out.

But, Walsh said, Narcan's effect wears off before the narcotic does, so 
close medical attention is essential. Addicts, he said, may not know how to 
deal with Narcan's cardiac-related side effects, or may administer it too 
quickly, causing "profuse" vomiting and possible asphyxiation.

Walsh also worried that giving Narcan would "enable" drug addicts, rather 
than encouraging them to seek rehabilitation.

In contrast, Kim Johnson, director of the state Office of Substance Abuse, 
said such a program would help addicts by "just getting (Narcan) into their 
hands so they can save each others' lives."

Distributing Narcan, she said, could be the only alternative for an 
overdose victim whose friends don't call authorities for fear of being 

Johnson dismisses the idea that Narcan helps addicts continue their habits, 
and that it will cause overdoses to rise.

"When they overdose, it's an accident. It's not the goal of taking drugs. 
The goal is to get high," she said.

Johnson said addicts would be educated on administering Narcan - a point, 
she said, that needs to be part of the discussion on July 17. The program, 
she said, could serve as an opportunity to draw addicts into the system and 
the pave the path for rehabilitation, while saving lives.

Those are the same reasons used by leaders promoting Narcan training for 
addicts and their families in New Mexico, a state with one of the highest 
heroin overdose rates. Gov. Gary Johnson, a conservative Republican, has 
supported the months-old program, saying the state's first responsibility 
is to save lives.

In Portland, key decision-makers like Mayor Karen Geraghty, Police Chief 
Michael Chitwood and Fire Chief Fred LaMontagne are expected to attend the 
July 17 meeting. Cayer said the meeting is not intended to be a public 
debate, but a chance for city officials to develop a position as "a city 

"It may be appropriate to have a larger public debate, but I don't think we 
can do that until we have a better understanding," he said.
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