Itâ€™s an addictâ€™s worst nightmare. Someone youâ€™ve been shooting up with nods out and you realize theyâ€™ve overdosed. Panic sets in. Heroin is illegal, so taking your friend to the emergency room and signing in is not an option. Some drop off the victim and run. Thereâ€™s always a trip to the bathtub with cold water that may help. Sometimes, everybody just leaves and the victim is found later, dead.
This could be preventable. The solution? Allow addicts access to Naloxone, a drug used to treat opioid overdoses if administered within three hours of the overdose. Then thereâ€™s no fear of jail, or parents, or oneâ€™s boss finding out. Just something to be administered at the time of the overdose to save a life.
One would like to think this would not be controversial, but that would be wrong. Drug overdoses are the leading cause of accidental deaths – even more than those caused by traffic accidents in the last two years. The past has shown, however, that when it comes to some things – like heroin addiction – the problem is best swept under the rug, as archaic as that is. Any type of â€˜practicalâ€™ intervention for opiate addicts has met with negative responses from the public at large. Needle Exchanges, aimed at preventing the spread of AIDS and hepatitis in the 1980s, were met with skepticism and outright hostility. Methadone Maintenance programs are considered by some as just another way to keep opiate addicts addicted, so therefore of questionable help. Newer drugs in the arsenal to help heroin addicts get clean, like Suboxone, are also criticized as ineffective and are considered by some a means of replacing one drug with another. Itâ€™s been said Suboxone itself has made it to the streets!
Those who have lived through, or watched a loved one live through, opiate withdrawal know that anything to help subdue the agony could at least make the addict more amenable to trying – an argument in favor of using methadone or suboxone. Heroin withdrawal may not be fatal, but those going through it may feel like it is! Be that as it may, a means of preventing death should, in good conscience, absolutely be made available.
Our country is in the midst of an opioid epidemic, caused in part by the over prescribing of opioids for pain. Increasing restrictions on these drugs, in turn, has fueled a resurgence of heroin addiction, as it became the cheaper alternative to black market opioids like oxycodone. On the streets, improved quality and price make heroin an attractive alternative. The increased purity means the drug may be snorted to get a high similar to that found by injecting the drug.
Currently, Naloxone, the overdose antidote, is only available by prescription. Itâ€™s chemically related to opioids and works by displacing the heroin, oxycontin or related drug from the opioid receptors in the brain at the respiratory control center, thereby reversing the overdose. Thatâ€™s great for those who make it to the emergency room. Not for those who donâ€™t. Naloxone is not a comfortable relief, either, since the overdose victim wakes up in a state of withdrawal after itâ€™s administered.
Some communities, like several in North Carolina that had a huge problem with opiate addiction, have successfully implemented change by using naloxone rescue kits. The state went from having an 82 percent overdose death rate down to a 29 percent rate, thanks to the Naloxone. The drug is only available to outreach programs, though, with trained personnel doing the dosing.
Some believe that giving naloxone to addicts may be interpreted as a sort of â€œinsuranceâ€ that may reinforce addictive behavior, actually creating more overdoses. Echoes of earlier needle exchange opposition?
And giving the drugs to addicts, rather than to just outreach programs, is one of the challenges in using this solution. Can addicts be counted on to properly administer the drug? It doesnâ€™t work orally – and canâ€™t be given to someone unconscious – so it has to be given intravenously or injected intramuscularly. An intranasal (inhaled) preparation is now becoming available, but the cost is much higher than that of the inject able form – $50 as compared to $8.
A specialty pharmaceutical company, AntiOp, is developing a branded intranasal product it hopes to market by March, 2015.
Currently there are more than 188 locations across the country that make Naloxone available to addictâ€™s family members, training them in how to administer the drug and what to expect. There was a workshop held earlier this month to gauge public opinion on whether to make the drug more widely available. Response ranged from those who thought it should be available over the counter to those who thought only police and emergency personnel should have access to it. One opponent pointed out that an unconscious addict cannot administer the drug to himselfâ€¦
Not much chance of that. Whether this life-saving intervention becomes more accessible remains to be seen. â€œAccommodating anti-social behaviorâ€ by providing overdose intervention (as another opponent pointed out), may be seen by some as a deterrent to seeking treatment. I say, suspend judgment; thereâ€™s no treatment necessary for the dead, so letâ€™s do what we can to provide better outcomes to this serious problem.
B. Lenz, Intervention Services