Heroin Hassles: Overdose Antidote Out of Reach

Valerie S. was getting high in her Brooklyn apartment when a friend "went out." She says, "I wasn't really close to the guy. He was a neophyte, a married, college-educated professional, about 30. I made connections for him and he sampled the product at my house.

"It happened in stages. I was nodding also, but I looked back and I saw that his legs were in a weird position, spread on the floor. Something got my attention, maybe the syringe falling. The first thing I saw when I looked closely was that he was on the floor and blue.

"There wasn't time to think," she says. "I tried mouth-to-mouth, I tried CPR, but I realized, 'Wow, he's going.' By the time I realized I should have called [an ambulance], it was too late. I had the naloxone in the house, so I found a vein and injected him. He took a sharp inhalation of breath and sat up."

Valerie's experience using naloxone, a prescription drug, to save a fellow user from opiate poisoning makes a strong case for training others to do the same and making the antidote more widely available.

Unfortunately, the need for naloxone is growing. Nationwide, according to statistics from the U.S. government's Substance Abuse and Mental Health Services Administration, there were 217,868 admissions to treatment facilities for heroin addiction in 1997, up 24 percent from 1992. Between 1988 and 1997, heroin-related emergency room visits nearly doubled, from 18,100 to 36,000, according to the government-funded surveillance study Drug Abuse Warning Network (DAWN). In New York, DAWN trends are confounded by the HIV epidemic, but approximately 700 people die from opiate overdose annually, according to the study's figures, which are compiled by local medical examiners.

With heroin use up, inevitably, the incidence of overdosing rises. Among those who take heroin, an overdose experience is the rule, not the exception. Valerie has overdosed at least three times over the last several years. Research studies from several countries consistently show that about two-thirds of long-term heroin addicts report that they've overdosed at least once. Nearly 80 percent have seen someone else do it. At least one overdose a week is reported to New York's Positive Health Project needle exchange. Though most overdose episodes aren't deadly, they can be.

It is impossible to overdose on naloxone, and there is no potential for abuse. The drug can, however, produce unpleasant withdrawal symptoms if given to an opiate addict in high doses. These symptoms are not life-threatening. The medication is far more likely to cause dysphoria than euphoria.

While conceivably adrenaline, cocaine, or speed could be used to treat overdoses, each of these drugs has a significant chance of doing more harm than good. About two-thirds of opiate overdoses involve a mixture of drugs, according to DAWN, so adding a stimulant is risky because an "up" drug like cocaine might be the real cause of the overdose. Unlike stimulants, however, naloxone isn't likely to do harm. And if heroin is one of a cocktail of "downs," removing the opiate effect alone is usually enough to save the person's life.

So why aren't service providers handing out naloxone at needle exchanges and training addicts in CPR and other aspects of overdose treatment? One obstacle, according to naloxone advocates, is that the medical profession is wary of allowing those with no medical training to treat overdoses. Although naloxone generally is not dangerous, it's certainly medically more prudent to take anyone who is unconscious and not breathing to a hospital where doctors can deal with any complications.

In ordinary circumstances, if the poison weren't an illegal drug, almost no one would disagree with such a recommendation. But expecting addicts to risk arrest and the contempt often meted out to them by medical professionals is naive, according to Dr. Karl Sporer, an emergency room physician at San Francisco General Hospital.