If there's anything more empowering than bringing someone back to life, Dan Bigg wouldn't know. He has personally resuscitated five people who were unconscious from drug overdoses, and the organization he co-founded in 1991, Chicago Recovery Alliance, has helped save hundreds of others from accidental drug-related death.
The organization's strategy is a simple one: Help people help themselves. Since 2001, Chicago Recovery Alliance has distributed more than 11,000 anti-overdose kits to drug users at needle-exchange programs and other sites in Chicago. The kits, which include vials of the drug naloxone (brand name Narcan), commonly used in hospitals and ambulances to reverse opiate overdose, have led to at least 1,000 successful overdose reversals in the city since 2001, according to Bigg. They are now part of a growing nationwide effort to stem the increasing rate of accidental drug-related fatalities.
Overdoses kill some 22,000 Americans each year — more than homicide and, in some states, like Utah, more than car accidents. Most overdose deaths happen accidentally, and most involve a combination of an opioid — either prescription painkillers, like methadone or OxyContin, or street drugs like heroin — and other depressant drugs, such as alcohol or Xanax. (Such deadly cocktails were responsible for the deaths of actor Heath Ledger in 2008 and former Playboy Playmate Anna Nicole Smith in 2007.) Typically, people who overdose on prescription drugs have a history of addiction, and they end up either taking more than their prescribed dose or mixing painkillers with other substances.
In North Carolina, a program called Project Lazarus, which is slated to launch this summer, will target that very group of at-risk patients, who are not often included in other initiatives. Project Lazarus will hand out naloxone kits and offer training, including instruction on rescue breathing, to patients who are starting methadone treatment for pain — methadone is stronger and lasts longer than other painkillers, which puts users at a higher risk of overdose — and those beginning treatment for addiction with the anti-addiction drug buprenorphine, who are by definition at high risk for drug relapse and overdose.
To date, at least 17 states, along with city health departments in New York City, Baltimore, Boston and San Francisco, now have in place programs similar to that of Chicago Recovery Alliance. But not all officials agree that they are a viable part of any solution to the country's drug problem. Critics argue that arming drug addicts with an overdose remedy only encourages more drug use; they also say naloxone should be administered only by medical professionals to protect against side effects and potentially dangerous misuse. The deputy director of former President Bush's Office of National Drug Control Policy called naloxone programs "not good public-health policy," since they are not overseen by doctors or EMTs.
But curiously, there has not been the same political outcry over naloxone distribution as there has been against other public programs, such as needle exchange, for addicts. So far, there have been no attempts to ban or limit funding for naloxone programs. Says Bigg, who once helped convince a skeptical doctor of their value in a radio debate: "I think people who study it up close realize that you could not have a purer case of a chance for life versus the risk of death."
A recent study published in the journal Addiction found that after naloxone training, addicts did just as well as medical professionals at recognizing the symptoms of overdose and determining when to use the medication. And addiction experts say the experience of coming back from an overdose is frightening enough — not to mention often accompanied by severe withdrawal symptoms — that few addicts would consider using naloxone as an insurance policy to justify taking more drugs.
Advocates also note that the drug, which has been used for decades in emergency rooms and ambulances, is safe. Naloxone reverses a high by blocking the brain's opioid receptors, where drugs like heroin and narcotic painkillers bind. According to Daliah Heller, an assistant commissioner of the New York City Department of Health, who is involved with the city's naloxone program, serious side effects from the drug (aside from triggering withdrawal symptoms in addicts) are extremely rare. But they're not unheard of: in rare instances, high doses of naloxone have caused seizures, but, says Heller, "It's much more deadly for [overdose victims] not to have the naloxone."
In part, that's because few overdose victims get immediate medical treatment. While most overdoses take place in the presence of other people (surveys of heroin users suggest that 58% to 86% were not alone when an overdose occurred), many bystanders don't call the authorities for help, usually because they're high themselves. Naloxone kits can be crucial in these circumstances.
That was the precisely the situation that Bigg walked into about two years ago, when he found a clammy, unconscious 25-year-old man sprawled out on a La-Z-Boy in a chic Chicago townhouse. He had overdosed on heroin and GHB (a party drug that is also used as a date-rape drug), according to his two panicked friends. The friends were high too, and afraid to call 911, so they called Bigg instead, whom they knew from Chicago Recovery Alliance's needle-exchange program.
Bigg tried unsuccessfully to rouse the young man. He moved him onto a bed to help him breathe. Still no response. But about a minute after Bigg administered a 1-cc dose of naloxone, the young man's color improved and he began to come around. "He was like someone trying to go back to sleep, with his mother waking him," says Bigg.
While dramatic tales are many, it's still not clear how effective naloxone programs are overall. Research on their impact has only just begun. One study, published in the Journal of Addictive Diseases in 2006, found that after increasing for years, heroin-overdose deaths in Chicago dropped 20% in 2001, the year Bigg's program began, and fell an additional 10% the following year. So far, addiction researchers say no significant problems have been reported with naloxone use, but they concede that much more studying needs to be done.
"We've got a medication that is incredibly effective at reversing overdoses," says Dr. Wilson Compton, director of the Division of Epidemiological Services and Prevention Research for the National Institute on Drug Abuse. "It makes good logical sense. I wish we had a rigorous evaluation of the benefits and potential risks."
By Maia Szalavitz
Friday, May. 29, 2009