Created on Friday, 04 April 2014 Written by KATIE ZEZIMA, Associated Press
CAMDEN, N.J. (AP) — As deaths from heroin and powerful painkillers skyrocket nationwide, governments and clinics are working to put a drug that can reverse an opiate overdose into the hands of more paramedics, police officers and the people advocates say are the most critical group — people who abuse drugs, and their friends and families.
A kit with naloxone, also known by its brand name Narcan, is displayed at the South Jersey AIDS Alliance in Atlantic City, N.J. on Wednesday, Feb. 19, 2014. An overdose of opiates essentially makes the body forget to breathe. Naloxone works by blocking the brain receptors that opiates latch onto and helping the body "remember" to take in air. (AP Photo/Mel Evans)
Supporters say the opportunity to save potentially thousands of lives outweighs any fears by critics that the promise of a nearby antidote would only encourage drug abuse.
At least 17 states and the District of Columbia allow naloxone — commonly known by the brand name Narcan — to be distributed to the public, said Jeffrey Levi, executive director of Trust for America's Health, a national nonprofit that focuses on preventive health care. And at least 10 of those states allow for third parties, such as a family member or friend of an intravenous drug user, to be prescribed it.
Among them is New Jersey, which passed a law last year that allows members of the public to carry naloxone — administered through a nasal spray or injection into a muscle — after getting training.
About 20 people, most of them related to overdose victims or people who currently abuse heroin, crowded into a clinic in February in Camden, a drug-plagued city across the Delaware River from Philadelphia, to learn about the antidote. Jane Stiuv, whose daughter survived a heroin overdose in 2011, listened as a nurse described the signs of an overdose and when to administer naloxone.
Stiuv, who found her daughter slumped over the side of a bathtub with a needle in her arm hours after her release from prison, said she wanted to learn how to reverse an overdose should it happen again. Each attendee received a kit containing two syringes, a small vial of naloxone, alcohol swabs and a face shield for rescue breathing.
"I was a little shaky. It brings me back to the times she overdosed," Stiuv said of the training. "But it makes me feel better that it can help her and do something about overdose prevention."
Naloxone is regarded within the medical community as highly effective when used properly. A study conducted during a state-supported pilot of naloxone distribution and overdose education in Massachusetts showed it was 98 percent effective in attempts to rescue a person who overdosed.
Police in Quincy, Mass., have been carrying naloxone nasal spray since 2010 and said in July 2013 that they used naloxone 179 times, reversing 170 of those overdoses — a 95 percent success rate.
According to the White House Office of National Drug Control Policy, the number of overdose deaths involving prescription drugs increased 21 percent from 2006 to 2010; the number of overdose deaths involving heroin increased 45 percent. In March, U.S. Attorney General Eric Holder called the increase in heroin-related deaths an "urgent and growing public health crisis" and said first responders should carry Narcan with them.
Bills are pending in at least seven states to increase access to naloxone. In Tennessee and Utah, doctors would be allowed to prescribe it, and civil liability for those who administer it would be dropped. A Wisconsin bill seeks to broaden access to naloxone and, as New Jersey also does, provide legal immunity to drug users reporting an overdose.
Marty Walsh, the new mayor of Boston, in February called for all first responders to carry naloxone. Police in Indianapolis, where heroin overdose deaths have doubled since 2011, have started a pilot program to have officers carry the drug. In Ocean County, N.J., police are being trained in how to use it.
The White House drug policy office is also urging all first responders to have naloxone on hand. And on Thursday, the U.S. Food and Drug Administration approved an easy-to-use device that automatically injects the right dose of naloxone before an ambulance arrives. Doctors could prescribe it for family members or caregivers to keep on hand, in a pocket or a medicine cabinet.
Naloxone is available by prescription in the United Kingdom, but an advisory council has called for over-the-counter distribution. Prescription take-home programs are in place in Australia, Canada, Estonia and Russia. Norway plans to distribute nasal spray kits to drug users in its two largest cities.
But not everyone is sold on the idea of making it more widely available.
In Maine, where heroin overdoses increased fourfold from 2011 to 2012, Gov. Paul LePage opposes a bill that would allow health care professionals to prescribe it to family members and caregivers of addicts and allow more emergency responders to carry the drug.
LePage, who wants to add 14 new drug enforcement agents in the state, cites concerns that it would raise Medicaid costs. He also has said the drug provides "a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby."
"This bill would make it easier for those who have substance abuse problems to push themselves to the edge, or beyond," LePage wrote in a letter last year explaining his veto of a similar bill. "Offering temporary relief without medical or treatment oversight will not combat drug use."
Dr. Marcus Romanello, the chief of the emergency room at Fort Hamilton Hospital in Hamilton, Ohio, said he believes police should carry naloxone but is leery of giving it to the public.
There is no disputing, however, that it works, he said.
"They are pulled back from the jaws of death, as we say, by the Narcan," he said.
An overdose of opiates essentially makes the body forget to breathe. Naloxone works by blocking the brain receptors that opiates latch onto and helping the body "remember" to take in air. The antidote's effects wear off in about a half-hour, and multiple doses may be needed.
The drug's backers say it's crucial to train relatives or friends of addicts because the person overdosing is likely sick or unconscious and unable to self-administer the antidote. It also must be given within a certain window; most overdoses occur within a half-hour to three hours after injecting too much of a drug.
Naloxone wouldn't, therefore, have helped actor Philip Seymour Hoffman, who died Feb. 2 from a combination of heroin, cocaine and other drugs in his New York apartment and is believed to have been alone as he took drugs; he was already dead when discovered.
At the New Jersey workshop, nurse Babette Richter described the signs of an overdose. Observers should watch and listen for raspy breathing and a blue face, signaling a loss of oxygen. Keep a close eye on people who nod off after using, and try to wake them, Richter instructed. If they do not rouse, place them on a floor or other hard surface, give rescue breaths every 10 seconds or so, and administer naloxone.
The most important thing, Richter said, is to call 911 and wait with the person who has overdosed — and to remember that in New Jersey, the caller can't be charged with a crime.
"This is buying us time," Richter said. "It's not a cure."
Associated Press writers Alanna Durkin in Augusta, Maine, and Dan Sewell in Cincinnati contributed to this report.
'Killer heroin' causing fatal overdoses
KATIE ZEZIMA, Associated Press
POINT PLEASANT, N.J. (AP) — On an icy night in January, a man entered a grocery store here, walked past the displays of cake mix and paper towels, and went into the bathroom, where he injected himself with heroin.
Hours later, the man was found dead in the bathroom with a needle still in his arm, authorities said. They believe he was one of more than 80 people across the country who have died after injecting heroin laced with fentanyl, a powerful synthetic opiate.
As the number of people who use, and fatally overdose on, heroin has risen in recent years, authorities are seeing the return of an alarming development: heroin that, often unbeknownst to the user, is spiked with fentanyl.
Fentanyl is a narcotic that is typically administered to people in chronic pain, including end-stage cancer patients. It is also used as an anesthetic. It is considered 80 times more powerful than morphine and can kill by inhibiting breathing.
"The dealers push this as being a super high, which it is, but it's also lethal," said Ellen Unterwald, director of the Center for Substance Abuse Research at the Temple University School of Medicine. Users typically don't know how much fentanyl is mixed in, and she said just a small amount can be fatal because the drug is so potent.
"A very small amount can exert a very significant effect," said Eric Strain, director of the Center for Substance Abuse Treatment and Research at Johns Hopkins University.
In Maryland, at least 37 people have died from the combined drugs, according to the Maryland Department of Health and Mental Hygiene. In western Pennsylvania, authorities said they have caused at least 22 deaths. In Rhode Island, there have been at least 25 fentanyl-related deaths, though health officials are unsure how many of those cases also involved heroin. And in Vermont state police have warned that pure fentanyl is being sold as heroin.
After actor Philip Seymour Hoffman was found dead with a syringe in his arm, investigators in New York tested the heroin found in his apartment for fentanyl but found that it did not include the additive.
With more and more addicts turning to heroin because crackdowns on powerful prescription opiate painkillers have made them more expensive and inaccessible, there is concern that more people may be exposed to fentanyl-laced heroin during this wave than in previous ones, including in 2006 when hundreds of people from Chicago to Philadelphia died after injecting the drugs.
In January the Drug Enforcement Administration put out a bulletin warning local authorities of what it dubbed "killer heroin," a mixture that was up to half fentanyl. It urged first responders to "exercise extreme caution" when coming into contact with any heroin because fentanyl can be absorbed through the skin.
It is unclear where the fentanyl is coming from. It is typically only distributed in hospitals. It can be administered in the form of a patch, a drip or a lollipop, which patients in pain suck on.
Heroin dealers put so-called stamps on the bags that hold their product, allowing users to discern among different batches. Oftentimes they are product logos. Authorities said bags bearing the stamps "Bud Light," ''Theraflu" and "Income Tax" have tested positive for fentanyl.
"A lot of those people thought that Bud Light was really hot, it's really good stuff, it sends you over the edge," said Ocean County, N.J., prosecutor Joseph Coronato. "It's a marketing tool, almost."
Ocean County has been besieged by heroin and prescription drug overdoses in the past two years. In 2012 there were 53 overdoses in the county that hugs the Jersey Shore, and last year there were 112.
"The demand is so high. That's the problem that's out there," Coronato said.
T.J. Smith, a police spokesman in Anne Arundel County, Md., said there have been four cases within the last year of heroin found with fentanyl in it — an "unusually high number," he said. Smith said heroin — both pure and laced with fentanyl — is driving a major increase in property crime. He said the drug has undergone a major change in the past year, with more potentially fatal doses found with fentanyl.
"It's a different heroin now," Smith said. "You can't use that same amount of heroin that you used a year ago, because now it has a fentanyl kick in it."