Pubdate: Sun, 21 Aug 2005
Source: New York Times (NY)
Section: Sec 14, Col 1, Pg 9, The City Weekly Desk
Copyright: 2005 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Maia Szalavitz
Note: Maia Szalavitz is a senior fellow at Stats, a media watchdog group
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

THE SHOT THAT SAVES

IN the last few weeks, at least six people have died of apparent overdoses 
of heroin in Lower Manhattan.

The news seems shocking, but in fact, it's not. According to the most 
recent analysis based on data collected from the city's medical examiner, 
accidental drug overdoses kill more people in New York than homicide or 
suicide, about 900 a year.

In the case of two 18-year-old college students, Maria Pesantez and Mellie 
Nicole Carballo, the deaths are blamed on overdoses of heroin that was 
either ' 'too pure" or was cut with poison and was taken with alcohol and 
cocaine.

No matter what the cause, the sad thing about these deaths is that they 
were preventable with a simple injection. Heroin is an opioid, just like 
methadone, OxyContin and Vicodin, to name a few. Because overdosing kills 
by slowly stopping a person's breathing, there is a short time in which a 
person can be injected with an antidote called naloxone, quickly reversing 
an opioid overdose.

If given early enough, naloxone can prevent damage to the brain caused by 
lack of oxygen and leave the victim unharmed. According to research by Dr. 
Sandro Galea of the Center for Urban Epidemiological Studies at the New 
York Academy of Medicine, at least 75 percent of overdose deaths involve 
multiple drugs, usually mixtures of heroin and other depressants like 
alcohol. Removing the opioid from the mix with naloxone is often enough to 
revive victims.

Naloxone itself is virtually harmless. Its most common side effects are 
withdrawal symptoms like nausea, shakiness and agitation in those who are 
physically dependent on opioids. While uncomfortable, these symptoms are 
not dangerous. Rarely, seizures can occur, but this risk is far lower than 
the risk to those who are not treated. The drug has no effect on those who 
haven't taken opioids.

Pilot programs in Chicago, Baltimore and London that have trained 
needle-exchange users how to administer naloxone are already credited with 
saving dozens of lives. In New York, naloxone has been distributed to 300 
syringe-exchange participants.

In a study conducted by Dr. Galea and his colleagues, 22 New Yorkers were 
provided with naloxone and trained in its use for first aid. Of the 22 
participants, half witnessed an overdose in the three months that they were 
followed. Naloxone was administered 10 times, and all of those given the 
drug lived.

According to a study published in the journal Drug and Alcohol Dependence, 
57 percent of 1,184 hard drug users interviewed had witnessed at least one 
overdose. Medical help was sought in only two-thirds of the instances, and 
this was usually only after efforts to revive the victim by hitting him or 
rubbing him with ice had failed. In the college students' case, their 
companions tried putting one of the women in a tub of cold water before 
dialing 911. But every second is precious when the oxygen supply to the 
brain is interrupted.

More than half of the drug users in the study cited fear of arrest as the 
main reason for delaying or failing to seek help. That was almost certainly 
the case in the deaths of Ms. Pesantez and Ms. Carballo, because at least 
one of their companions had a long history of arrests and convictions for 
carrying and selling drugs. Without witnesses having to debate whether to 
call 911 and potentially face arrest or discovery, almost all overdose 
victims could be saved.

So why not make this antidote available not just at needle exchanges, but 
also in every first aid kit, with every prescription for painkillers like 
OxyContin and at every methadone clinic? Recently, Gov. George E. Pataki 
signed a law allowing doctors to prescribe naloxone on request, but for 
maximum effectiveness, the drug should be available over the counter and 
provided free when doctors prescribe opioids. That way, it would be on hand 
if a child gets into his mother's methadone, or a teenager gets into his 
grandmother's OxyContin, or an addict overdoses at a shooting gallery. What 
mother wouldn't be grateful to have it in her first-aid kit when she finds 
an unconscious child -- even if she'd never had any suspicion of drug use, 
as was the case in the deaths of Ms. Pesantez and Ms. Carballo? And a 
pre-loaded syringe, like the Epi-Pen used to treat people having allergic 
reactions to things like bee stings, would make it easy to administer.

Some will argue that reducing overdose deaths will encourage drug use. But 
Dr. Galea says there's no evidence to support this position in the naloxone 
studies. The same argument was used against needle exchanges, but research 
never found support for it. And I'd imagine that no matter what their other 
feelings about drug policy are, the families and friends of all six 
overdose victims wish naloxone had been on hand in time to save their loved 
ones.
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MAP posted-by: Beth