Pubdate: Mon, 25 Jul 2005 Source: Pittsburgh Post-Gazette (PA) Copyright: 2005 PG Publishing Contact: http://www.post-gazette.com/ Details: http://www.mapinc.org/media/341 Author: Joe Fahy Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) Bookmark: http://www.mapinc.org/prison.htm (Incarceration) TEACHING DRUG OVERDOSE SURVIVAL Program Goal: Limit Addicts' Overdose Risk To a group of Allegheny County Jail inmates, Alice Bell gave a detailed presentation aimed at keeping them and others from dying from a drug overdose. Overdoses kill more people locally than traffic accidents or homicides, Bell said before outlining ways to prevent an overdose or to intervene if one occurs. Bell and other staff members and volunteers for Prevention Point Pittsburgh, a local nonprofit, have presented the hour-long training to 3,000 people, 2,000 of them county jail inmates, since 2003. "We hope the 3,000 people we've talked to about this, and the people they've talked to, may have contributed to saving some people's lives," Bell told her audience, noting that drug overdose deaths in Allegheny County declined last year for the first time since 1999. Though other communities have overdose prevention initiatives, the Pittsburgh program is unusual because it targets jail inmates, said Robert Heimer, associate professor of epidemiology and public health at the Yale University School of Medicine. But reaching inmates is important, he said, because they are at high risk for overdosing once they are released. Even a few days in jail can cause inmates to lose some tolerance for the drugs they typically use. Returning to the same level of drug use after their release can be deadly. Many inmates have drug problems, and many overdose soon after leaving jail, Heimer said. In 2002, 68 percent of the nation's jail inmates reported symptoms in the months prior to their incarceration that indicated substance abuse or dependence, according to the Bureau of Justice Statistics. While eliminating drug use is the best way to prevent overdose, "the reality is a lot of people continue to use drugs," Bell told about 75 inmates gathered in a maximum security area for her presentation earlier this month. "There are way too many people dying, and that doesn't need to be happening. So that's why we're here today." Unlike overdose prevention programs in some other cities, Prevention Point does not distribute naloxone to drug users and others who complete overdose prevention training. The nonaddicting drug, whose trade name is Narcan, can quickly reverse the effects of an opiate overdose. But Prevention Point is working to begin a program to distribute naloxone to drug users in conjunction with its syringe exchange program, which provides clean injection equipment, medical testing and information to prevent the spread of HIV and hepatitis C. Marc Cherna, director of the county Department of Human Services, expressed strong support for those programs, saying they help reduce overdoses, disease and health care costs. Dr. Ronald Roth, medical director for Pittsburgh EMS, said distributing naloxone to drug users "certainly has the potential to save lives." While paramedics often administer naloxone in overdose cases, drug users may not call 911 for help. "If you're doing something illegal, you may be reluctant to call," Roth said. Syringe exchange and overdose prevention are known as "harm reduction" programs, which assist drug users in making choices to reduce drug-related harm. Those choices could include drug treatment, abstinence, or other strategies for people unable to stop using drugs. The Surgeon General and many experts have concluded that syringe exchange programs reduce the spread of disease and do not encourage drug use. Whether overdose prevention programs reduce deaths is unclear. The programs are relatively new and have not been rigorously evaluated, though proponents believe they are effective. In Chicago, deaths from opiate overdoses have decreased since the Chicago Recovery Alliance began an overdose education and naloxone distribution program in 2001, said Dan Bigg, the group's director. In New Mexico, which began similar programs the same year, no trend toward fewer deaths has emerged, "but we believe we're having an impact," said Phillip Fiuty, the state health department's harm reduction coordinator. Without those initiatives, even more deaths may have occurred, he said. Both the Chicago and New Mexico programs report many anecdotal accounts of people who have been revived by receiving naloxone or through other interventions. Prevention Point has had similar reports of people helped by the overdose prevention training. One former inmate told Bell that guidance from the training helped him save his girlfriend's life. Another man told her that if he had received the training a year earlier, his daughter might be alive. She had overdosed and he "didn't know what to do," Bell said. In Allegheny County, 205 accidental overdose deaths occurred last year, down from 228 in 2003, according to the Allegheny County coroner's office. Despite the decrease, police and health professionals say local drug activity remains significant. "Heroin's still a major issue," said Stephanie Murtaugh, director of prevention and intervention services for Mercy Behavioral Health. Heimer said the rise in overdose deaths in some communities has been linked, in part, to the greater number of people who began using drugs in the 1960s and '70s. Local experts ascribe some of the increase to purer, more addictive heroin and the greater availability of prescription drugs. Responding to the rising number of deaths, Prevention Point helped to organize an overdose prevention task force in early 2003 that includes police and representatives from the jail, emergency medical services and other human service agencies. That effort led to the overdose prevention effort in the jail, Bell said, noting that Calvin Lightfoot, the former jail warden, was especially supportive. Prevention Point also has presented the trainings, which are funded by grants, at local detox and methadone treatment programs, drop-in centers for homeless people, and other settings. Groups of jail inmates are trained three times a month. Jack Pischke, the jail's inmate program administrator, said he tries to select units where inmates are more likely to be released. "Not using drugs at all is the surest way to prevent an overdose," Bell told inmates during the training earlier this month. "But if you are using, not mixing drugs together goes a long way toward preventing an overdose." Many local overdose deaths, she noted, have been linked to use of more than one drug. She also recommended awareness of factors that could affect drug tolerance, such as illness and periods of drug treatment or incarceration, and suggested that her listeners not be alone when they use drugs. If an overdose occurs, another person present could intervene or summon help. Bell also addressed the common misconception that victims of opiate overdose should be packed in ice, noting that doing so could make the problem worse. "It lowers their body temperature, and their systems are already depressed." If overdose victims are conscious and breathing, walking them around might help, she said. If they're unconscious, she recommended calling 911 and starting rescue breathing, demonstrating the technique with an assistant, Alex Bennett. "The cure for a heroin or other opiate overdose is oxygen," she said. "If you can keep someone breathing, you can keep them alive." Narcan, if available, can be a big help, she said. "It's a pretty miraculous drug. People can be blue and not breathing, then they get an injection of Narcan and they come back." Bell stressed the importance of calling 911, but conceded her listeners may not want to stay until paramedics, and possibly the police, arrive. "Stay as long as you can," she said. Inmates applauded when she finished. One of them, Frederick Tillman, 47, of the Hill District, said he was in jail for a probation violation, had used heroin or other drugs off and on for years and had witnessed two overdoses, one of them resulting in death. "I think everybody needs this training who is in active addiction or knows someone who is," said Tillman, who hoped to get into a drug treatment program. "I learned some things today that may help save a life -- maybe my own life, though my goal is to go out of here and stay clean." - --- MAP posted-by: Beth