Time to Demand Public Access to the Lifesaving Drug that Can Reverse Opiate Overdose
[Editor's Note: Naloxone is a legal drug that can stop opiate overdose in its tracks with just a few sprays. This week the U.S. Food and Drug Administration (FDA) approved an automated medical device that makes it easy for anyone to dispenses naloxone and potentially save a life. Previously, naloxone was only available in limited amounts to paramedics and some law enforcement agents. Now a movement is on the rise to make the lifesaving drug, and its new dispensing device, more easily accessible for the general public. An article with the details about the importance of public naloxone access is forthcoming.]
The following article first appeared on Substance.com:
Officer Peter Buck opens a nasal Narcan kit and shows me how to put the atomizer (foam tip) on the syringe: “It’s very easy. Open it up, cap off the vial, screw it together, administer it.” Once the atomizer is screwed on, you squirt the syringe—half into each nostril. It sprays out a fine mist that can bring overdose victims “back from the dead,” as the opioid antagonist naloxone binds with the victim’s opioid receptors, preventing opioids from attaching and effectively reversing the OD.
Officer Buck, a sturdy figure in full uniform who drops his “r”s in the typical New England manner, meets with me at the police station in Athol, Massachusetts, a small former industrial town that’s faced economic decline since the 1950s. He is one of a growing number of police officers nationwide who have begun carrying these Narcan kits (the naloxone brand of choice).
Naloxone is news right now like never before—as it should be in a country where overdose is the most common cause of accidental death, with an estimated 16,651 fatalities linked to opioid analgesics in 2010. Last month, Attorney General Eric Holder urged law enforcement agencies to train and equip more officers to carry the lifesaving drug, which is being widely heralded as “truly amazing.” New York State is planning to fund this using confiscated crime proceeds. And just last week, the FDA approved a new naloxone delivery device called Evzio. There’s no doubt that more cops carrying naloxone will save many lives. Their new role could also change the way the police—long feared by drug users—are seen by the public.
Buck had a head start on most of his peers: In addition to serving as a police officer for 17 years, he’s also been an EMT for 20. So he already appreciated Narcan as a lifesaving tool and wanted to get trained. In the EMT setting, he’s seen people passed out, “blue, with a respiratory rate of zero.” Then Narcan is administered and moments later, “they are able to get up and walk out to the ambulance.” He’s also experienced incidents as a policeman when he didn’t have Narcan, when it could have been used, with a chance of saving somebody’s life.
Up until December 2012, Officer Buck says, it was illegal in Massachusetts to possess Narcan without a prescription. Then Governor Deval Patrick altered the language around his state’s “Good Samaritan” law, and practices began to change. Last week, Patrick declaredopioid use in Massachusetts a “public health emergency.” He announced $20 million in funding for prevention, intervention, treatment and recovery programs, and directed all police departments to train with and deploy Narcan, using emergency powers to make the drug available immediately to all first responders. This means that brave officers like Buck, who blazed the trail, can now use Narcan without fear that they could be violating regulations, or be held liable.
Before the changes to Massachusetts’ Good Samaritan law, Buck confirms, people were dying of overdose because friends and family were afraid to call 911 in case of legal repercussions. Now it’s more likely that someone who overdoses could be revived by a first responder like him and taken to the hospital. Then, says Buck, it’s “See you later,” with the hope that “they don’t fall back into the same situation.” As simple as that? “That’s what we’re there for at that time,” he insists. “It’s a medical emergency, not a drug investigation.”
But don’t imagine that things have loosened up that much—there’s still good reason to be wary of the police in other circumstances. If someone reported heroin use, say, but the user turned out not to be overdosing, “That would be possession, that would be a criminal offense,” says Buck, reeling off the relevant code, “94c34.”
Joyce Rescia knows what can happen if first responders don’t carry naloxone. Her son, Matthew, was addicted to heroin. He was living at their home in Massachusetts in 2000, she tells me, while they waited for a bed to open at a detox facility. One day, shortly after he turned 18, she found him passed out in his room. She called 911 immediately and “assumed” that whoever came would have Narcan. When the police arrived first, Matthew was already blue.
Rescia, who had a nursing background and had educated herself about heroin and ways to help her son, pleaded with them: “Where’s your Narcan?” But they didn’t have any. Then the EMTs arrived, but they didn’t have any either. Matthew died.
Rescia says she “had to fight tooth and nail to get Matthew’s death certificate to say ‘opiate overdose.’ Otherwise they just put respiratory failure…they didn’t want the numbers.” After her loss, she founded an organization called “Never Another Death,” dedicated to promoting better access to naloxone. “We do our outreach and education and advocacy in his memory,” says Rescia. “We need to increase education and fight the stigma of addiction…Matthew was one of a large group of young people in the area who died. Now that we have naloxone, there’s no excuse.”
There hasn’t really been any pushback from fellow officers about the new policy, says Officer Buck, although they are concerned about being trained properly. “We have protocols as EMTs—right medicine, right patient, medicine not expired, etc,” he says. “This is asking people with a lower level of training to go out and administer a medication, so it’s a change.”
Buck is a drug recognition officer—one of only 6,000 in the world. That means he’s an expert in identifying a party who is intoxicated or impaired, determining what they are intoxicated or impaired by, and deciding whether it’s enough to arrest them. But some less expert cops worry about what to do with Narcan. I can’t help but wonder, staring at Officer Buck’s big gun, whether people who are so concerned about cops carrying a nasal spray aren’t getting their priorities wrong. Unlike guns, naloxone can’t hurt anyone if used wrongly. It isn’t dangerous even if it’s accidentally administered to someone who isn’t overdosing.
There’s a precedent for medical tools being transitioned into police use: the automatic defibrillator machine. “About 10 or 15 years ago, defibrillators were not out there as much,” says Buck. “There were similar concerns around defibrillator pads, expiration dates, technology to recognize the weight of the person, how many joules to give…people thought, ‘No—that’s medical equipment.’ But now it’s standard procedure; we carry defibrillators in the cruisers. It’s not hard equipment to use.”
Police responders need to carry defibrillators and naloxone, Buck explains, because “Police usually get there before ambulances—75% or more of the time. We’re out and mobile. It’s a far greater potential that we’ll get there first.” This is even more important, he says, in the most rural communities, where ambulances and EMTs have further to travel.
These days, automated defibrillators are available in malls, airports, restaurants, gyms, hotels, sports stadiums and schools. And that’s an important next step for naloxone—getting it into the hands of the public, people who use drugs and their families and friends, in addition to first responders. Joyce Rescia hopes eventually to create “Matthew’s Bill” to ensure that workers in community locations are trained in administering naloxone.
Officer Buck was trained to administer Narcan by Liz Whynott, director of the Tapestry Health Needle Exchange Program—one of only two licensed Narcan distribution sites in Western Mass. Buck’s boss, Athol Chief of Police Timothy Anderson, is on board too, and plans are being made for Whynott to train the whole department.
Getting law enforcement to start using naloxone hasn’t been easy. “When I started it was very hard to convince service providers that it was life-saving, not increasing the risk,” Liz Whynott tells me. “It was common for police to confiscate Narcan, for shelters to take it away. People would be charged with possession; the culture of the police wanted nothing to do with Narcan. There has been a drastic shift in the last year.” Whynott, who grew up in the Athol area, emphasizes that opiates are anything but a new problem, although much media coverage acts as if it is. But it’s good, she concedes, that people are finally paying attention.
Change is now happening “so quickly” all over the US says Dr. Sharon Stancliff, the Medical Director of the Harm Reduction Coalition. When I speak with her, she says that for the past couple of days her phone hasn’t stopped ringing about naloxone and first responders. “New York State is going for it big-time at this point,” she tells me. “They’ve been doing it in Suffolk county for over a year as part of a pilot project, very successfully—they’ve had multiple reversals.” She mentions similar programs in South Carolina and Seattle. Currently, 18 states (NM, NY, IL, WA, CA, RI, CT, MA, NC, OR, CO, VA, KY, MD, VT, NJ, OK and OH) have laws allowing medical professionals to prescribe and dispense naloxone, and lay administrators to use it without fear of legal repercussions.
Why the gathering pace of change? “We’ve been been working on this since 2005,” says Stancliff. “Bits and pieces have led to the momentum. Getting the White House on board was big.” In fact it was the acting drug czar—Michael Botticelli, who is himself in long-term recovery from addiction—who launched Massachusetts’ pilot Narcan program back when he served as director of the state’s Bureau of Substance Abuse Services. “Getting buy-in from the American Medical Association” and from “some more conservative agencies, like the US army” was also important, Stancliff continues. “And of course, every time there’s a celebrity overdose…”
But even with the blaze of publicity that accompanies big-name deaths, not everyone gets the memo. Maine’s Governor Paul LePage vetoed a bill last year to make naloxone available to first responders—and he’s set to veto a new bill that’s being considered right now. According to Adrienne Bennett, Governor LePage’s press secretary, the governor’s office does not release statements on bills that are currently under consideration. But she does tell me that LePage “Does not condone that sort of behavior.”
Is saving someone from dying of an overdose really “condoning” drug use? Science says no; Governor LePage says yes. In his veto letter last year, he wrote: “This bill would make it easier for those with substance abuse problems to push themselves to the edge, or beyond. It provides a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby.”
That’s just not true, say naloxone advocates—including even the federal government. In contrast to LePage’s claim that Naloxone provides a false “safety net” for users, Attorney General Holder said simply, “Naloxone can save lives.”
Studies also contradict the “safety net” argument. According to the American Journal of Public Health, “People who use opioids and who have experienced the acute withdrawal effects that accompany naloxone consistently deny that they are more comfortable using heroin frequently or in higher doses because of naloxone availability. Rather, studies suggest that increasing health awareness through training programs that accompany naloxone distribution actually reduces the use of opioids and increases users’ desire to seek addiction treatment.”
Officer Buck cites statistics from Assistant Chief Glenn Sapp at the Police Department of Quincy, a suburb of Boston, who played a major role in getting nasal Narcan onto the streets. “They used 400 doses,” says Buck. “Of those, only 10 were repeat customers. That was important for people to hear.”
Like all harm-reduction approaches, naloxone distribution is based on an underlying ethical assumption that people who use drugs are still people. Even if a tool did somehow “condone” drug use—which naloxone does not—that would be no kind of reason to choose not to save a person’s life. As Eliza Wheeler, author of a report on naloxone published by the Centers for Disease Control and Prevention, puts it, critics may be confusing rescue with recovery: “Naloxone is not drug treatment. It’s an immediately lifesaving act.