Pubdate: Thu, 05 Jan 2017
Source: Milwaukee Journal Sentinel (WI)
Copyright: 2017 Journal Sentinel Inc.
Author: Ashley Luthern


A drug that can stop a heroin overdose, and potentially save a life, is
available in Wisconsin. One agency provides the doses at no cost.

But it's against the law for an individual with a prescription for
naloxone, commonly known by its brand name Narcan, to use the drug on a
friend or someone else overdosing on other opiates such as morphine,
oxycodone and methadone.

A recent report from the State Council on Alcohol and Other Drug Abuse has
recommended a 911 Good Samaritan Law to state lawmakers that, among other
provisions, would offer limited immunity in such cases.

Opiate overdoses, including heroin, are increasingly common in Wisconsin,
and experts agree there would be more if not for the use of naloxone.

Last year, heroin overdose deaths surpassed cocaine deaths in Milwaukee
County for the first time, and heroin was present in 32% of fatal
overdoses from mixed drug cocktails. Fatal heroin overdoses also are
rising in Waukesha, Ozaukee, Racine and Washington counties.

Naloxone effectively blocks the central nervous system from the effects of
heroin and other opiates.

Statewide, emergency medical services have seen an increase in naloxone in
the last three years, from 2,915 uses in 2010 to 3,247 in 2011 and 3,730
in 2012. That data is under-reported and inaccuracies are possible because
some ambulance companies do not report into the system, according to the
council's report.

Doctors can write prescriptions that can be filled at any pharmacy, but
many are hesitant to do so because the person to whom it is prescribed
will likely use it on a person without a prescription, which is illegal in
Wisconsin, according to the council's report.

The AIDS Resource Center of Wisconsin is the only agency in the state that
provides free doses of the overdose-reversal drug and training on how to
use it, including recognizing the signs of an overdose, as part of its
needle exchange.

The center's LifePoint Clean Needle Exchange program was founded in 1994
to help prevent the spread of HIV and hepatitis C. The needle exchange
also offers tests for HIV, hepatitis C and other sexually transmitted
infections, and provides addiction treatment resources.

With a connection already made in the IV-drug-using community, staff at
the center thought it was a natural step to offer naloxone in 2005 after
noting a rise in overdoses. A prescription signed by a physician is given
with each dose.

The Lifepoint Fatal Overdose Prevention program has reported 2,158 lives
saved from self-reported use of naloxone from 2005 to 2012.

Offering naloxone freely is not without controversy, and there are often
two schools of thought related to it, said Lou Oppor, a section chief in
the Bureau of Prevention, Treatment and Recovery within the state
Department of Health Services.

"Some say, well, by providing Narcan for free are you actually
contributing toward the continuation of heroin use?" Oppor said.

"If people feel they are able to receive Narcan, then their heroin use may
pose less of a threat of death. From the public health social work
perspective, a life is a life and saving a life is more important," he

It's an argument the AIDS Resource Center has heard before. Some have
claimed the center is enabling, or even legitimizing, drug use by
providing needles; heroin cookers, which also spread disease when shared;
and naloxone.

But the ultimate goal of the center's programming is to get people into
treatment, said Bill Keeton, the center's vice president of public

"At our core, we are based on the belief that there is value in every
life," he said. "Our mission is to save lives. If someone dies from
opiates or HIV, we've just lost the opportunity to help a person get

As a general rule, the state Department of Justice believes naloxone
should be made widely available whenever it is safe to do so, said Dana
Brueck, department spokeswoman.

The department has not done enough analysis to judge whether specific
delivery methods, like needle exchanges, are appropriate, she said.

If or when legislation is proposed related to naloxone distribution, the
department would weigh in with more details, she said.

Lawmakers could use the report from the State Council on Alcohol and Other
Drug Abuse as a basis for future legislation, Opper said.

Once it's edited, the report will be printed and distributed to policy
makers. The report recommended that Wisconsin offer limited immunity in
overdose situations.

The limited immunity would cover only possession of drugs at the scene of
the overdose or use of a drug like naloxone that reverses the overdose.
Thirteen states already have some form of legislation with limited
immunity from arrest or prosecution from people who call 911 during

Last year, the AIDS Resource Center trained more than 700 people statewide
to use naloxone. In 2013, 255 people have been trained and 357 naloxone
refills have been distributed in southeast Wisconsin. In that same time
and region, 275 uses of naloxone were self-reported.

A dose of naloxone costs about 50 to 60 cents. Keeton said the center pays
for the drug and needle exchange supplies using the roughly $2.5 million
it receives annually in private money.

The center has a fleet of vans it uses for mobile needle exchange and
naloxone training in Milwaukee, Kenosha, Green Bay, Madison and elsewhere
in the state. The same service is available at the prevention offices
statewide, including the Milwaukee office at 3716 W. Wisconsin Ave.

Melanie, 21, of Waukesha, has been a heroin addict for five years and
stops by the Wisconsin Ave. location about twice a month for clean
needles. She took the naloxone training last summer. If she sees someone
overdose, she knows how to administer the naloxone, which only treats
opiate overdoses but will not harm someone who, for example, is
experiencing a cocaine overdose.

Her decision was prompted by the overdose deaths of five friends. Melanie
began abusing Oxycontin in high school with a handful of friends. When the
makers of Oxycontin changed the prescription's composition, it became
harder to shoot up. So the group turned to heroin.

"I wanted to save a life," she said of the naloxone training.

"Luckily, I've never had to use it."
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