Pubdate: Sun, 15 Nov 2015
Source: Alaska Dispatch News (AK)
Copyright: 2015 Alaska Dispatch Publishing
Contact:  http://www.adn.com/
Details: http://www.mapinc.org/media/18
Note: Anchorage Daily News until July '14
Author: Michelle Theriault Boots

WITH HEROIN OVERDOSES RISING, A CALL FOR WIDER ACCESS TO THE DRUG 
THAT CAN HALT THEM

Part of an occasional series

In emergency medicine, naloxone is as close to a miracle drug as they come.

Usually sold under the name Narcan, the medication can instantly yank 
a person near death out of an opiate overdose.

Paramedics around Alaska use it almost daily to revive overdose 
patients they encounter slumped in cars, on couches or in public 
bathrooms. In Anchorage alone, firefighters administered 352 doses last year.

Some in Alaska think the medication should be in the hands of more 
people, so families and friends of addicts are equipped to quickly 
stop overdoses themselves. They envision a world where Narcan could 
be picked up at the drugstore and stored in a heroin addict's 
bathroom cabinet, the way the family of someone suffering from a 
severe peanut allergy might keep an EpiPen around.

In the midst of a heroin crisis that has killed at least 29 people in 
Alaska this year, a person shouldn't have to call 911 for a 
lifesaving drug like Narcan, they say.

State and national public health officials agree.

In August, the state Division of Public Health recommended the state 
"broaden access" to naloxone to reduce heroin-related deaths, echoing 
the national Centers for Disease Control's advice on the subject.

A bill under consideration by the state Legislature could put Narcan 
in the hands of more Alaskans.

Senate Bill 23, introduced during the last session by Sen. Johnny 
Ellis, an Anchorage Democrat, found broad bipartisan support in the 
Senate, passing by a vote of 19-1. The bill would protect doctors who 
prescribe Narcan from civil liability, an important first step to 
getting the medication to more people, Ellis said.

If it passes the House and is signed into law next year, Alaska would 
join a growing number of states that have expanded Narcan access in 
recent years as a resurgence of heroin has led to spiking numbers of 
fatal overdoses nationwide.

Over-the-counter in 14 states

Some 30 states have programs that distribute Narcan to people other 
than trained medical professionals, according to the Centers for 
Disease Control.

And in September, drugstore giant CVS announced it would sell Narcan 
over the counter in 14 states, including California, Minnesota and Wisconsin.

Ellis said he took on the Narcan legislation because he saw it as a 
solvable piece of a complex, frustrating puzzle of how to rein in 
heroin addiction and deaths.

"I knew treatment was woefully inadequate and woefully underfunded," he said.

In the state's current fiscal situation, tackling that sprawling, 
thorny issue is unrealistic, he said.

Narcan won't solve Alaska's smoldering heroin crisis, Ellis said. But 
it could give addicts another chance at life.

"When your son or daughter is overdosing, you need access to this 
lifesaving drug," he said.

But some of the emergency medical professionals who use Narcan the 
most say there are risks that can't be ignored.

'One of our most frequently used medications'

Data from public health authorities and paramedics show that a lot of 
people are overdosing on opiates in Alaska and Narcan is bringing 
hundreds of them back from the brink of death.

In 2014, emergency medics reporting into a state database said they 
used 490 doses of the drug -- up from 289 the year before, according 
to a July special public health bulletin on heroin and opiate use in Alaska.

The bulk of those cases happened in Anchorage.

Last year, firefighters in the city administered 352 doses of Narcan 
to 285 overdosing patients, said Erich Scheunemann, an assistant 
chief with the Anchorage Fire Department.

Other Southcentral emergency medical response departments say Narcan 
is an essential and frequently used tool, too.

In the Matanuska-Susitna Borough, medics end up administering the 
drug 3 or 4 times a week, said Lisa Behrens of the borough's 
Department of Emergency Services. During spikes in drug usage, it 
might be used multiple times a day.

"It's one of our most frequently used medications," she said.

On the more sparsely populated Kenai Peninsula, the medication is 
administered by emergency crews at least monthly.

"In December or January, we might use it on a weekly basis," said 
Jaye Peterson of Kenai's Central Emergency Services.

Witnessing Narcan at work is startling: A slack, unconscious patient 
barely breathing or not breathing at all is given the drug nasally 
and seconds later awakens, sometimes fighting mad. Eyes pop open. 
People sit straight up.

"It's almost instantaneous," said Peterson.

It can be administered by either a syringe or a nasal spray.

Giving the right dose and monitoring the patient for other problems 
does take some finesse, paramedics say.

In bringing a patient back from an overdose, it also kills the high, 
which can lead to combative patients.

"I've had people pull a breathing tube out and try to hit us with 
it," said Mike Crotty, AFD's EMS battalion chief.

'OK if we play with heroin'

There are other dangers: In some cases, a dose of Narcan can trigger 
opiate withdrawal, causing seizures or worse.

Crotty says when someone calls 911 in Anchorage to report a drug 
overdose, response times are so quick he doesn't see a clear need for 
friends and family of addicts to administer Narcan themselves.

"There are some risks and downsides to arming the populace with it," 
he said. "When you balance that with our ability to quickly respond, 
I don't think it's a good decision to do it."

Crotty also worries about what he calls the "It's OK if we play with 
heroin because we have Narcan" scenario.

"That is, I think, an incredibly dangerous philosophy. Unfortunately, 
that's what's going to happen," he said.

He emphasized he was speaking only for himself, not on behalf of the 
department.

The paramedics agree training and education would be an essential 
part of broadened access. Medics themselves, said Behrens, spend 
about eight hours of instruction learning how to properly use it.

Correction: An earlier version of this story misstated a quote from 
AFD's Mike Crotty about an interaction with a patient.
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MAP posted-by: Jay Bergstrom