Pubdate: Sat, 19 Mar 2016
Source: Lodi News-Sentinel (CA)
Copyright: 2016 Lodi News-Sentinel
Author: Christine Vestal, Stateline.Org


BALTIMORE - A crowd quickly gathers here on one of West Baltimore's 
many drug-infested street corners. But it isn't heroin they're 
seeking. It's a heroin antidote known as naloxone, or Narcan.

Two city health department workers are holding up slim salmon-colored 
boxes and explaining that the medication inside can be used to stop 
someone from dying of a heroin overdose. Most onlookers nod solemnly 
in recognition. They've heard about the drug. They want to know more.

Nationwide, more than 150,000 people received naloxone kits from 
community outreach programs like Baltimore's between 1996 and 2014, 
and more than 26,000 overdoses were reversed using those kits, 
according to a recent survey funded by the U.S. Centers for Disease 
Control and Prevention.

In addition, police, emergency medical technicians and emergency room 
physicians have used the drug to save tens of thousands of lives. 
Baltimore police officers started carrying the kits last year.

But as the opioid epidemic seeps into nearly every small town and 
suburb across the country, state, local and federal officials are 
trying to make the life-saving prescription drug available 
everywhere, particularly at local pharmacies.

To accomplish that, New Mexico last week became the 29th state to 
adopt a law that allows doctors and other prescribers to write a 
naloxone prescription known as a standing order, enabling local 
pharmacists to distribute the overdose rescue drug to anyone who asks for it.

Maryland adopted a similar measure in October. The day after it took 
effect, Baltimore's health commissioner, Dr. Leana Wen, wrote a 
standing order for the entire city, allowing anyone who completed a 
simple naloxone training - like the demonstration offered on the West 
Baltimore corner last week - to walk into a pharmacy, show a 
certificate of completion, and walk out with a kit.

"I like to say I became the prescriber-in-chief," Wen said.

New Mexico's new law updates a 15year-old law that allowed lay people 
to administer naloxone. In addition to allowing standing orders, the 
new measure allows people without a medical license to distribute 
naloxone kits in their communities, a legal provision found only in 
Maryland and 12 other states. This exception allows jails, treatment 
centers, homeless shelters and others to hand out the drug. Even the 
local PTA could offer it.

"It needs to be in everyone's first-aid kit and medicine cabinet," Wen said.

Forty-two states have enacted laws to make naloxone available beyond 
hospitals. New Mexico, which has had one of the highest drug overdose 
rates in the country for more than two decades, was the first to act 
with its 2001 law.

After more than a decade, Massachusetts in 2012 became the second 
state to enact a law. Most other states adopted so-called rescue drug 
measures in 2014 and 2015 after the opioid epidemic began making headlines.

This year, "states are going back and expanding or tweaking their 
laws," said Amber Widgery, who tracks these and other drug-related 
laws at the National Conference of State Legislatures.

Thirty states also have adopted socalled good Samaritan measures, 
which give limited legal immunity to a bystander or friend who calls 
911 to report an overdose. Those laws also need to be expanded, said 
Corey Davis, an attorney who tracks the laws for the Network for 
Public Health Law.

In Maryland, for example, the law only protects overdose bystanders 
from being arrested, charged or prosecuted for possession of a 
controlled substance or use of drug paraphernalia. It does not 
protect them against arrests for open warrants or probation and 
parole violations, which are common among heroin and opioid addicts. 
As a result, residents of West Baltimore or other communities where 
drug use is prevalent may be unwilling to call 911.

In addition to state and local actions, initiatives at the federal 
level are picking up. Last week, the U.S. Senate passed a 
comprehensive opioid addiction and overdose prevention bill that 
would expand the use of naloxone, and the U.S. Department of Health 
and Human Services announced additional funding for naloxone and 
other drug treatment services.

The majority of opioid overdose victims die from lack of oxygen one 
to three hours after they have taken a drug, leaving a substantial 
amount of time for someone to intervene and administer naloxone or 
call for help.

Naloxone, approved by the U.S. Food and Drug Administration in 1971 
in injectable form and widely used as a nasal spray, is a relatively 
cheap generic drug that has been proven safe and effective at 
reversing the deadly lung suppression that can cause a fatal 
overdose. Once the drug is administered, most victims instantly begin 
breathing again; they also experience nausea and other withdrawal symptoms.

But until the late 1990s, naloxone was only used, intravenously, in 
hospital emergency departments and operating rooms. Even emergency 
medical personnel and other first responders did not use it initially.

In 1996, a community group in Chicago that provided clean needles and 
other assistance to drug addicts began handing out naloxone as a 
nasal spray as well. Later, similar pilot programs began cropping up 
in places like San Francisco and New York.

When people began coming back and reporting that they had saved a 
life with naloxone and wanted another kit, researchers took notice. 
Eventually, these and other programs handing out naloxone caught the 
attention of federal and state officials, said Daniel Raymond, policy 
director for the Harm Reduction Coalition, which advocates for the 
greater availability of naloxone and other health care services for 
drug addicts.

In 2006, Massachusetts began using naloxone in public health and 
social service centers. Along with New Mexico, it funded statewide 
distribution of the life-saving medication in communities with large 
numbers of known drug addicts.

But in other parts of the country, naloxone initiatives were limited 
and mainly local. Then in 2012, the FDA, along with the National 
Institutes of Health and the CDC, convened a meeting with state and 
local officials to discuss ways to expand availability of the drug 
nationwide. Initially, some objected to making naloxone widely 
available, arguing that it would simply enable more drug addicts to 
continue shooting up.

Now that more Americans are dying of heroin and prescription 
painkiller overdoses than from homicides - roughly 28,000 people in 
2014 - that argument rarely comes up. Politicians from both parties 
vigorously support the use of naloxone. Along with increased access 
to treatment and safer opioid prescribing, expanding the use of 
naloxone is among the Obama administration's top three weapons 
against the epidemic.
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MAP posted-by: Jay Bergstrom