Pubdate: Fri, 07 Feb 2014
Source: New York Times (NY)
Copyright: 2014 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Robert S. Hoffman
Note: Robert S. Hoffman is an emergency physician at NYU Langone 
Medical Center and Bellevue Hospital and the director of the Division 
of Medical Toxicology at the New York University School of Medicine.
Bookmark: http://www.mapinc.org/find?132 (Heroin Overdose)

HOW TO STOP HEROIN DEATHS

PHILIP SEYMOUR HOFFMAN, who died of an apparent heroin overdose on 
Sunday, was just one of hundreds of New Yorkers who fall victim to 
this drug each year. Heroin-related deaths increased 84 percent from 
2010 to 2012 in New York City and occur at a higher rate - 52 percent 
- - than overdose deaths involving any other substance.

I am an emergency physician at NYU Langone Medical Center and 
Bellevue Hospital, but I rarely see victims die of heroin overdose 
because most fatalities occur before patients get to the hospital. 
Overdoses often take place over one to three hours. People just 
slowly stop breathing; often they are assumed to be sleeping deeply, 
or they are alone.

The most frustrating part is that each of these deaths is 
preventable, because there is an antidote to heroin overdose that is 
nearly universally effective. Naloxone, an opioid antidote, is a 
simple compound that has been in clinical use for more than 30 years. 
It can be administered via needle or as a nasal spray, and it works 
by displacing heroin from its receptors in the brain and rapidly 
restoring the overdose victim to consciousness and normal breathing.

An analysis in the Annals of Internal Medicine last year suggested 
that up to 85 percent of users overdose in the presence of others. 
This provides an opportunity for friends, family and other non-health 
care providers to intervene. In New York State, it has been legal to 
distribute naloxone to ordinary citizens since 2006. But the 
distribution has to be done with medical supervision. Naloxone is 
purchased by the city and state health departments, which then 
distribute the antidote through hospitals, harm-reduction programs 
and other outlets at no cost to patients.

Some New York City hospitals are now distributing kits containing 
naloxone to users and their friends and families. For the past three 
years, the New York City Department of Homeless Services has 
administered naloxone in shelters. And a new pilot program on Staten 
Island - which has the highest rate of heroin overdose deaths in New 
York City - is supplying the antidote through the Police Department's 
120th Precinct there.

The city's health department is conducting a large study following 
people who get naloxone to assess how frequently the antidote is used 
to reverse overdose. In 2012, the health department filed a public 
letter to the Food and Drug Administration recommending that the 
F.D.A. approve naloxone for over-the-counter use. The letter stated 
that more than 20,000 kits had been distributed in New York City. It 
also noted that more than 500 overdose reversals had been reported by 
civilians who had administered the antidote.

Some people might argue that the widespread distribution of a safe, 
effective and inexpensive antidote might actually encourage drug use. 
But that's like suggesting that air bags and seatbelts encourage 
unsafe driving. Naloxone is a public-health method of intervening 
when a life is in the balance. Its distribution is endorsed by the 
American Medical Association.

A new bill that would make it easier for users to obtain naloxone was 
introduced in the New York State Legislature just last week, and on 
Tuesday it passed the State Senate Health Committee. It would 
increase access to the antidote by allowing doctors and nurses to 
write standing orders - prescriptions that can be used for anyone - 
and issue them to community-based drug treatment programs. The 
programs would then train people on the signs of overdose and provide 
them with the naloxone kits. This means that the programs would not 
have to have a doctor present to distribute the antidote, overcoming 
one major hurdle that impedes widespread distribution.

This bill empowers a community to protect itself and others. If the 
bill becomes law, it would be one step closer to making naloxone 
available over the counter - as it already is in Italy.

According to the Centers for Disease Control and Prevention, drug 
overdose is now the leading cause of injury-related fatalities in the 
United States, ahead of motor-vehicle collisions and firearms 
accidents. We make cars safer by having speed limits, seatbelts, 
crumple zones and D.W.I. laws. We make it harder to buy a firearm 
with background checks and waiting periods, and we teach gun safety 
and sometimes mandate trigger locks. We can make heroin safer, too, 
by supplying methadone or buprenorphine as medications to treat 
physical dependence, providing clean needles to help prevent the 
spread of hepatitis and H.I.V., and facilitating the wide 
availability of naloxone to counteract overdoses.

While Mr. Hoffman's death was without a doubt a tragedy, it is also 
emblematic of a societal need to take action to prevent the hundreds 
of deaths that otherwise go largely unnoticed. We can't control 
heroin - that's the job of law enforcement - but we can make it safer.
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MAP posted-by: Jay Bergstrom