There’s new indications that administering the drug naloxone to halt an opioid overdose is the best strategy, advocates of naloxone distribution said.
It’s an important conversation to have, the advocates and drug abuse experts say, because deaths from opioid overdose have been climbing across the country since the close of the century. From 1999 to 2011, drug overdose death rates rose 118 percent, the Centers for Disease Control and Prevention reported. No one knows exactly how many of those are teenagers and young adults, but experts say use of heroin and prescription painkillers among youth have become epidemic.
Opioids are pain-relieving medications, such as hydrocodone, oxycodone, morphine and codeine. Heroin is synthesized from morphine.
A recent report that more than 200 lives were saved in North Carolina in one year by naloxone has added to the discussion. That number is one-tenth the number of lives it’s estimated naloxone saved over five years, according to Students for a Sensible Drug Policy, based in Washington, D.C.
“We’re really excited about this [report],” said Robert Childs, executive director of the North Carolina Harm Reduction Coalition (NCHRC). “We heard this all the time, ‘If I’d had this, he would still be alive.’ It’s really been great to hear instead, ‘I had this, and he’s still alive.’”
NCHRC, a statewide nonprofit group that aims to reduce deaths from opioid overdose, was one of the strongest proponents of a bill passed in April 2013 that allowed naloxone to be distributed to the public via standing orders. That allows a North Carolina physician to write a prescription for naloxone and have it ready to be distributed to those who would need it should they overdose.
That can include those who are prescribed narcotics for pain or those who use heroin or narcotics without a prescription. In addition to North Carolina, 23 other states have passed such bills. Fifteen plus the District of Columbia have passed bills that would allow a bystander to an overdose to call 911 and not be charged.
The two types of approaches are known in the drug treatment community as harm reduction efforts, because the emphasis is on saving lives rather than prosecuting a person for possession or even immediately getting the person into treatment. North Carolina has one of the most active harm reduction programs in the country, in large part because communities in Appalachia have been devastated by opioid abuse.
Since August 2013, NCHRC has distributed more than 5,100 overdose prevention kits, which include naloxone. A wide range of people get them, including heroin addicts and people who have been prescribed opiates to treat intense pain, Childs said. The number of saved lives — 209 — indicates what he and others suspected all along: access to naloxone saves lives, he said.
No one knows how many of those 209 were young people, but heroin usage and prescription opioid usage have risen dramatically among teens and adults in the past 15 years.
More than half — 22,810 — of the 41,340 drug overdose deaths in 2011 were from prescription drugs, CDC figures show. The majority of those deaths — 75 percent — were from opioid pain killers.
The number of people in the United States treated inpatient for heroin and opioid abuse was second only to the number of those treated for alcohol abuse, according to the National Institute on Drug Abuse in 2008. A recent CDC report says rates from heroin overdoses increased by less than 50 percent from 2009 to 2011. Many of those deaths occurred among teenagers and young adults.
Heroin could only be injected for years. Its appeal was limited because of a negative association with needles and syringes. But as newer, sometimes more potent types were produced, the drug could be inhaled or snorted and became cheaper. Kids looking for an easy high found the drug very appealing, not recognizing that one in four people who flirt with heroin became its slave.
Parents, friends and those who work with youth were grief-stricken and alarmed as they saw the young die from overdoses of drugs whose effects can be halted. When naloxone is administered to someone who has overdosed they feel an unpleasant reaction, but they typically survive.
Betty Aldworth, executive director of Students for Sensible Drug Policy, said 2,500 lives have been saved since naloxone laws went into effect. The kits containing naloxone cost about $40, she said.
Proponents of laws that protect a witness to an overdose or even the person who has overdosed from being prosecuted for possession, “Good Sam” laws, believe they have saved many lives, although no one knows an exact number.
Still, not everyone agrees the harm reduction approach to drug abuse and overdose is completely positive.
“We only see using naloxone as a part of the solution,” said Robert Lubran, director of the office of opioid treatment programs at the Substance Abuse and Mental Health Services Administration in Washington. It is important to focus on the person taking an opiate and try to get him or her the help they need, he said.
“I think this is one issue that needs continued information,” he said. SAMHSA addresses several different aspects of drug abuse, including the prescription of the drugs, the communities in which people live and the people who have overdosed.
"I think it's a valid argument," said James Sizemore, pastor of Radiant Church near Fayetteville, N.C., which ministers to the homeless, those who are HIV positive and those with addiction issues.
"We believe in a holistic approach, and we do try to plug people into rehab and to let them know that resources are available to help them," he said.
Childs said he agrees that drug abuse needs to be addressed more effectively, but that a person cannot make it into a rehabilitation program if he or she is dead.
“With naloxone, they live to see another day,” he said. “Families are able to stay together, and people can get another chance.”