Pubdate: Fri, 04 Apr 2014
Source: Asbury Park Press (NJ)
Copyright: 2014 Asbury Park Press


CAMDEN - 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

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 in February 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

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. In March, U.S. Attorney General Eric
Holder called the increase in heroin-related deaths an "urgent and
growing public health crisis" and said first responders should carry
Narcan with them.

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

Marty Walsh, the new mayor of Boston, in February 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. And on Thursday, the U.S. Food and Drug
Administration approved an easy-to-use device that automatically
injects the right dose of naloxone before an ambulance arrives.
Doctors could prescribe it for family members or caregivers to keep on
hand, in a pocket or a medicine cabinet.

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

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 to family members and caregivers of
addicts 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. "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 Feb. 2 from a combination of heroin, cocaine and
other drugs 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, 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 on a floor or other hard
surface, give rescue breaths every 10 seconds or so, and administer

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.

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