Tuesday, March 31, 2015

To Save Lives, Give Drug Users the Overdose Antidote

Photo Credit: Photographee.eu / Shutterstock.com
As drug overdose continues as the leading cause of accidental death in the United States, everyone who knows someone struggling with addiction has one word on their mind: naloxone. Also known by its brand name, Narcan, naloxone is a medication that can reverse potentially fatal overdoses from opioids like heroin, methadone or prescription pain relievers.

For decades paramedics have administered naloxone to patients experiencing opioid overdose. About 20 years ago overdose prevention advocates realized that naloxone would save more lives if programs could distribute it to active drug users. The Chicago Recovery Alliance is credited with creating the first organized naloxone distribution program in 1996, but a decade before that, a couple of rogue paramedics in Oakland, California had already launched an initiative of their own. 

During the 1980s, Oakland resident David Sparks became an unwitting participant one of the first experiments in naloxone distribution.  “I used to live next door to an ambulance service,” said Sparks. “One day one of the EMTs was bummed out because there was some bad fentanyl [a synthetic opiate] going around and people were dying. The EMTs knew I was using drugs and as we were talking, they offered to give me a few vials of naloxone and show me how to use it on people who overdosed. I wasn’t sure at first because I didn’t even know what naloxone was.”

Opioid overdose stops a person’s breathing, which can result in brain damage or death. Naloxone works by temporarily blocking the effects of opioids, thereby restoring normal breathing. Before receiving naloxone, Sparks had used rescue breathing, or mouth-to-mouth resuscitation, to get oxygen to people experiencing an overdose. But naloxone, administered through intramuscular injection or intranasal spray, can restore normal breathing patterns much more quickly and easily.

Sparks laughs recalling the first time he used naloxone. “A guy overdosed on heroin in my house just as he was eating a carrot,” he said. “I was grateful not to have to do rescue breathing on him because his mouth was full of chewed food. I injected naloxone into his muscle and it was amazing how fast it worked. By the time I got to my feet, he was up too.”

While people are often hesitant to call the authorities for fear of legal ramifications, the official recommendation is to call 911 to report an overdose even if naloxone is on hand. Because naloxone only temporarily blocks the opioids, the person could overdose again after it wears off and might need followup medical care. Rescue breathing is also recommended until the person can breathe on their own.

After his first naloxone rescue, Sparks reversed overdoses in nearly a dozen other people. He also distributed the antidote to some of his peers, who used it to save lives. The paramedics supplied him with naloxone for two years before the private company went out of business.

“After they left, I went back to rescue breathing [when someone overdosed] because I didn’t know where to get naloxone,” Sparks said.

It would be almost 15 years before someone else realized what those Oakland paramedics knew all along—naloxone is most effective at saving lives when in the hands of active drug users. Today, approximately 250 naloxone distribution sites exist in 28 states. Many have started in just the past four years as communities respond to the burgeoning problem of drug overdose deaths.

Texas launched its first peer naloxone distribution program in Austin last year. Mark Kinzly, a former drug user who is now working with the Austin Harm Reduction Coalition to expand access to overdose prevention services, said the new program has distributed over 2,000 naloxone kits in just a few months.

“I’m alive today because of naloxone,” said Kinzly, who has overdosed twice. “If we are going to make a difference in preventing overdose deaths, we need to get naloxone to the drug user community.”

This summer Georgia will become the newest state to implement a naloxone distribution program. Following the example of 14 other states, Georgians advocated for new legislation to protect medical providers who prescribe naloxone and anyone who administers it to an overdose victim from liability. The law, enacted in April 2014, also protects people who call 911 to report an overdose from arrest for some drug charges, prosecution for underage drinking and parole violations.“We want to make sure naloxone gets into the hands of the very first responder—other drug users,” says Mona Bennett, executive director of the Atlanta Harm Reduction Coalition. 

This July, AHRC plans to introduce a naloxone distribution program modeled after a program at North Carolina Harm Reduction Coalition that has reported 80 overdose reversals by laypeople since August 2013 Thirty years after paramedics gave him his first dose of naloxone, David Sparks is now 10 years drug-free. In his free time he volunteers with one of California’s 17 distribution programs to provide education and naloxone to people at risk for drug overdose.  

“No one should ever die of an [opioid] overdose,” said Sparks. “As long as the antidote exists, there is hope to prevent those deaths. We just need to get naloxone to the right people. I’m glad I was able to help starting doing that.”

To some people, giving active drug users the tool to reverse overdose might be a new or even controversial idea. But as Sparks and countless others illustrate, drug users have been coming up with creative, resourceful ways to keep themselves and their friends safe for a long time. Naloxone programs do more than just distribute an antidote. They also prove that active drug users can and do take responsible actions to save lives.
To find the naloxone distribution program near you, visit the program locator. Or learn more about how to start a naloxone program.