September 14, 2007
DOSE OF COMMON SENSE
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Narcan prevents overdose and saves lives |
When someone accidentally overdoses on heroin or another opioid, chances are pretty slim they’ll be hanging out with a medical professional just right then. In most of the country, that means that no one on the scene could administer Naloxone (Narcan), a prescription medication that reverses an overdose by blocking heroin or other opioids in the brain for 30 to 90 minutes—and which can save the life of someone who’s overdosing.
But New York is one of two states (New Mexico is the other) where ordinary folks— not just medical providers— are allowed to administer Naloxone. Since the law was put into place on April 1, 2006, more than 2,000 people have been certified to provide the treatment and more than 200 reversals have been performed.
New York State's initiative was modeled after a program initiated by Lower East Side Harm Reduction, and has been fully supported by the New York State Health Department. "We realized we had a problem in the state, of people dying due to heroin and other opioid abuse," said Alma Candelas, associate director for the division of HIV prevention at the NYS health department. "We'd like to see the program grow."
Front-line service providers say the program just makes sense. "Supplying Narcan to drug users helps, because think of the people who are around when someone's overdosing. People getting high themselves," said Derek Wyche, a community follow-up worker at Housing Works, who leads an Overdose Prevention class that includes sessions about how to use Naloxone, one of 20 programs sanctioned by New York State to prescribe Naloxone.
The programs can be somewhat expensive to establish and maintain, because a "medical professional" is still needed on staff to prescribe Naloxone. But with "accidental poisonings" being measured at 30,000 a year (the U.S. doesn't track drug overdoses) state and city health departments are looking at strategies to limit overdoses. Overdose prevention classes that include instruction on the administration of Naloxone are a powerful and effective tool to help deal with this serious problem.
New Mexico led the way on overdose prevention policy, allowing anyone with a prescription to administer Naloxone in 2001. Los Angeles, Chicago, Baltimore, Philadelphia, Salt Lake City and a growing number of cities throughout the country have adopted similar laws. But in most states, administering Naloxone is still technically illegal, and programs are not funded by the government. So far, there has been little national effort to reform restrictive regulations and laws limiting who can administer Naloxone.
"Overdose Prevention is not something people think about"
Overdose prevention typically only makes headlines after a tragedy. In May 2006, after dozens of overdose deaths in Chicago, the Drug Policy Alliance (DPA) worked with U.S. Senator Dick Durbin (D-IL) to develop a bill that would make federal money available for state overdose prevention programs and would also require the Center for Disease Control to develop a comprehensive plan for reducing overdose deaths. But the bill stalled when DPA couldn't find any other lead co-sponsors. "We'd love to find a co-sponsor," said Bill Piper, director of the Drug Policy Alliance. "There just aren't a lot of members of Congress who will take the lead. If you know anyone, have them call me!"
"Overdose prevention is just something that people don't think about," Piper continued. "It's not controversial like needle exchange. Policy makers just don't have it on their radars."
Expanding Naloxone administration rules through a federal law might clear up the murky situations many cities and states encounter when they try to make Naloxone more readily available. Can a physician prescribe Naloxone to someone who's not a drug user? Is there criminal liability? But Scott Burris, a professor at Temple University, who has researched barriers to providing Naloxone prescriptions, said that states should overcome these obstacles. "Overdose is an almost fully preventable form of death and it isn't just a problem among illegal drug users," Burris said, noting that prescription opioids account for most accidental overdoses. "Overdose prevention is exactly what we mean when we say harm reduction."
Another great idea that has gained little traction is to make Naloxone available over-the-counter, like it is in Italy. While injectable drugs have previously not been available over-the-counter, Naloxone could be made available nationally OTC as a nasal spray, something already happening in New Mexico. But there has been little movement towards making Naloxone available off-label— partially because there is no drug company that is poised to make money from it. Naloxone is inexpensive and off-patent, so there’s no way for drug companies to strike it rich.
"It's kind of an orphan-drug situation," Burris said. "But there's enough evidence that this might be good for public health that we need to be pushing the FDA to study whether Naloxone should be sold off-label." While it could take up to ten years for FDA approval of off-label use, the time to start is now.
Despite the need for better laws and more tools, Daniel Raymond of the Harm Reduction Coalition said he thinks “overdose prevention is reaching critical mass," noting that the Boston Health Department recently inquired about developing its own program. "We're poised on the edge of something really important here," he said. We couldn’t agree more.
This article is part of Housing Works Harm Reduction Month—look for more stories on harm reduction practice and policy all throughout September.