Pubdate: Thu, 28 Jul 2016
Source: Buffalo News (NY)
Copyright: 2016 The Buffalo News
Author: Katharine Q. Seelye, New York Times


Critics Say Drug Allows Addicts to Take More Risks

PORTLAND, Maine - A woman in her 30s was sitting in a car in a 
parking lot here last month, shooting up heroin, when she overdosed. 
Even after the men she was with injected her with naloxone, the drug 
that reverses opioid overdoses, she remained unconscious. They called 911.

Firefighters arrived and administered oxygen to improve her 
breathing, but her skin had grown gray and her lips had turned blue. 
As she lay on the asphalt, the paramedics slipped a needle into her 
arm and injected another dose of naloxone.

In a moment, her eyes popped open. Her pupils were pinpricks. She was 
woozy and disoriented, but eventually got her bearings as paramedics 
put her on a stretcher and whisked her to a hospital.

Every day across the country, hundreds, if not thousands, of people 
who overdose on opioids are being brought back to life with naloxone. 
Hailed as a miracle drug by many, it carries no health risk; it 
cannot be abused and, if given mistakenly to someone who has not 
overdosed on opioids, does no harm. More likely, it saves a life.

As a virulent opioid epidemic continues to ravage the country, with 
78 people in the United States dying of overdoses every day, 
naloxone's use has increasingly moved out of medical settings, where 
it has been available since the 1970s, and into the homes and hands 
of the general public.

But naloxone, also known by the brand name Narcan, has also had 
unintended consequences. Critics say that it gives drug users a 
safety net, allowing them to take more risks as they seek higher 
highs. Indeed, many users overdose more than once, some multiple 
times, and each time, naloxone brings them back.

Advocates argue that the drug gives people a chance to get into 
treatment and turn their lives around. And, they say, few addicts 
knowingly risk needing to be revived, since naloxone ruins their high 
and can make them violently ill.

With drug overdoses now killing more people than car crashes in most 
states, lawmakers in all but three  Kansas, Montana and Wyoming  have 
passed laws making naloxone easier to obtain. Its near-universal 
availability reflects the relatively humane response to the opioid 
epidemic, which is based largely in the nation's white, middle-class 
suburbs and rural areas - a markedly different response from that of 
previous, urban-based drug epidemics, which prompted a "war on drugs" 
that led to mass incarceration, particularly of blacks and Hispanics.

This more compassionate response has been on display this week at the 
Democratic National Convention in Philadelphia. Speakers there have 
talked about addiction and the need for more accessible treatment, 
and a call by Sen. Jeanne Shaheen of New Hampshire for all emergency 
responders to carry naloxone drew applause from the delegates.

Nonprofit organizations began distributing naloxone to drug users in 
the mid1990s, but most of the state laws making it more accessible 
have been enacted only in the last few years. Between this and 
so-called good Samaritan laws that provide immunity to people who 
call 911 to report an overdose, the chances are much greater now that 
someone who overdoses will be saved and given medical attention 
instead of left for dead or sent to jail.

The federal government still requires a prescription for naloxone, 
but that is under review by the Food and Drug Administration, which 
has also approved a Narcan nasal spray that is easier to administer 
and is growing increasingly popular.

There is no question that the nation's death toll from heroin and 
prescription opioids would be significantly higher without naloxone.

But in Maine this spring, Gov. Paul LePage, a Republican, questioned 
the effectiveness of naloxone and vetoed legislation that would have 
increased access to it.

"Naloxone does not truly save lives; it merely extends them until the 
next overdose," LePage wrote in his veto message in April. "Creating 
a situation where an addict has a heroin needle in one hand and a 
shot of naloxone in the other produces a sense of normalcy and 
security around heroin use that serves only to perpetuate the cycle 
of addiction."

The Maine Legislature easily overrode the governor's veto. According 
to the Network for Public Health Law, Maine is now one of 34 states 
with what is called a standing order, essentially a prescription that 
makes naloxone available to the general public.

Yet most users loathe naloxone's effects. By blocking opiate 
receptors, it plunges them into withdrawal and makes them "dope 
sick," craving more heroin or pills.
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MAP posted-by: Jay Bergstrom