Source: British Medical Journal (No 7128 Volume 316) 
Author: Kamran Abbasi BMJ 
Pubdate: Saturday, 31 Jan 1998 
Contact: The Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR 
Fax: +44 (0)171 383 6418/6299 
Email: DEATHS FROM HEROIN OVERDOSE ARE PREVENTABLE

A thousand deaths from heroin overdose each year could be prevented in
Britain if emergency resuscitation drugs were supplied to addicts and their
close contacts, according to a report presented to the Royal College of
Psychiatrists' winter meeting last week. 

Professor John Strang, director of the National Addiction Centre at the
Maudsley Hospital in London, suggested that premature deaths from drug
overdoses account for the increased mortality among opiate addicts. A survey
of heroin addicts in south London showed that over half of those undergoing
treatment had overdosed in the past. These overdoses, however, were rarely
suicide attempts. 

Professor Strang's team plans to involve addicts, and a nominated partner,
in therapeutic training programmes, which will teach basic resuscitation
techniques and the correct way of administering naloxone. Up to now, drug
user communities have relied on unproved and potentially dangerous methods
of resuscitation, such as injecting salt, placing the person in a cold bath,
and injecting adrenaline through the breast bone as demonstrated by John
Travolta in the film Pulp Fiction. 

In overdose, opiates cause pinpoint pupils, respiratory depression, and
coma. Doctors in casualty departments regularly use naloxone, a specific
antidote, to reverse the effects of a heroin overdose. As it is short
acting, repeated injections and continuous infusions of naloxone are often
needed. Now that naloxone is available as a nasal spray, Professor Strang's
team hope to distribute it to heroin addicts as part of a pilot study. 

Dr David Best, research coordinator at the National Addiction Centre, said:
"So many overdoses occur in the presence of friends and partners. If
naloxone was available in drug user communities, when somebody overdosed,
friends could place the patient in the recovery position, administer
naloxone, and call for an ambulance."