Naloxone Access Urged for Increasing U.S. Heroin Users

 Relatives of heroin addicts should be allowed to keep an overdose antidote available as use of the illegal drug surges in the U.S., prompted by increased abuse of prescription painkillers, federal drug officials said.

As the street values of medicine-cabinet pills rise because of federal limits on their access, abusers have turned to drugs such as heroin that cost less, said Gil Kerlikowske, director of the Office of National Drug Control Policy. It’s a “growing national crisis” that must be addressed with a new national focus on prevention and treatment, he said.

Heroin use increased 79 percent in the five years ended in 2012, with 669,000 people in the U.S. reporting they had taken the drug, according to the National Survey on Drug Use and Health last year. Actor Philip Seymour Hoffman died earlier this month from a suspected heroin overdose. Canadian actor Cory Monteith, best known for his role in the television show “Glee,” died in July from a combination of heroin and alcohol.

heroin_small3 Naloxone Access Urged for Increasing U.S. Heroin Users

“It’s clear we’re not going to arrest our way out of this problem,” Kerlikowske said today on a conference call.

Four of five new heroin users previously used prescription drugs non-medically, he said.

“The pathway seems to moving from prescription drugs to heroin, which is a very dangerous development,” Wilson Compton, deputy director of the National Institute on Drug Abuse, said during the call.

Heroin-related deaths jumped 84 percent in New York City in 2012 from 2010, according to the city’s Department of Health and Mental Hygiene. Heroin overdoses in Boston rose 76 percent over the same period, Boston Mayor Martin Walsh said in a statement.

Overdose Antidote

Heroin overdoses can be countered by naloxone, an emergency overdose treatment injected or delivered through a nasal spray. It counteracts the life-threatening depression of the central nervous system and respiratory system that leads to death. Naloxone is also very safe, as it is impossible to overdose on the antidote, says Sharon Stancliff, medical director of the Harm Reduction Coalition in New York.

The antidote has been carried by paramedics and used in hospital emergency departments for years. Now, it is being placed in the hands of law enforcement officials.

The New York Police Department started a pilot program in Staten Island in December, equipping 180 officers with a nasal spray version of naloxone to use in opioid overdose cases. A police officer has already saved the life of a 44-year-old man, Kerlikowske said.

Test Program

Staten Island was targeted as two neighborhoods, Willowbrook and South Beach-Tottenville, were among the five New York City neighborhoods with the highest rate of heroin poisoning deaths, according to the city Department of Health’s report. Walsh said today that distributing naloxone to Boston’s first responders is “a top priority.”

Advocates say the antidote needs to be even more available, such as in the hands of users and their family members, while prescription laws are getting in the way in some states.

In Pennsylvania, laws require doctors to prescribe the drug directly to patients. Alice Bell, overdose prevention project coordinator for Prevention Point, a needle exchange in Pittsburgh, worries about additional overdose deaths after tainted heroin took 22 lives last month.

“If I have a mom call me up and say, ‘I want naloxone for my son,’” she can’t get it, said Bell in a phone interview. A doctor would have to prescribe the spray directly to the son.

New York Proposal

Legislation that would allow non-patient specific prescription in New York is being considered by the state legislature. The bill, co-sponsored by Republican state Senator Kemp Hannon of Nassau County, and Democratic Assemblyman Jeffrey Dinowitz, from the Bronx, would allow doctors to prescribe naloxone to overdose prevention workers, who then can give it to users or their family members after training. Similar laws exist in California, Massachusetts and Chicago.

Kerlikowske commended states that allowed co-prescribing to the user and their relatives or significant others. While the Office of National Drug Control Policy isn’t pursuing national legislation, he encouraged states to make naloxone more readily available.

“Most of the time, medicine is practiced and controlled at the state level and states move faster” to introduce new laws, Kerlikowske said in a telephone interview. “We’re really starting to see this expand in a host of ways at the state level, and we think that is great.”

Friends and family also should be educated about the signs of an overdose. Users “can look like they’re in a heavy sleep when they’re actually in respiratory distress,” he said.

Brain Damage

Taeko Frost, executive director of the Washington Heights Corner Project in New York City, also supports increased availability of naloxone. Even though police and ambulances usually arrive within five minutes of a call, she has seen cases where users overdosing in isolated areas were saved by the antidote before emergency personnel were able to locate them.

“Even when we call the police, any second they’re under they’re at risk of brain damage,” she said.

Frost has used naloxone more than 30 times.

“It’s a pretty incredible thing to see somebody with blue or gray skin go from completely unresponsive to eyes opening and talking in 15 seconds,” she said in a phone interview.

She is hopeful the new legislation in New York will help prevent more overdose deaths, but says treatment availability still has a long way to go.

“We’re operating in a situation where people are dying unnecessarily all the time,” she said. “Until we expand access to everyone, we have a lot of work to do.”