Do-It-Yourself Anti-Overdose Kits: Do They Help?

By chillinwill · May 30, 2009 · ·
  1. chillinwill
    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

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  1. H Bomber
    Swim obtained one of those sorts of kits awhile back when he was in manhattan. He sat through a ten minute lesson at the lower east side harm reduction center (also a needle exchange) and was provided with several 1ml vials containing naloxone 2mg/ml. He never had to use it himself, but some of his friends who had been there with him that day ended up having to use some at one point or another. One of them said that one time he was in a where in a situation where medical assistance would never have been able to get to his location in time, the use of a dose of the naloxone provided by the Harm reduction center proved lifesaving for his OD'd friend. Swim feels that, based on anecdotes such as this one and others he has heard, the distribution of naloxone as part of a broader overdose prevention program is invaluable and that greater access to these sorts of programs should be made available to a larger portion of the population.
  2. Birkill
    Good idea this, sorta saved sum1 tutha day, but was in town and ambulence got there quite quick so i dont know if my cpr actually saved him but i would defo cary 1 of these if they were given out in the uk as most other using equip is!!!
  3. sasafrass
    Just in case you ever find someone in needof Narcan, it will really throw them into a tail spin. Its not like day in withdraws. Its instant, and can be scary. But its better than turning blue.
  4. jmunny fo twunny
    as someone who has been in the presence of many overdoses (some ending in death some not) i used to carry (im no longer a user) some packets of salt or, if i had any, suboxone. salt water will bring someone back as well as a suboxone. the salt water must be injected but the suboxone can either be stuck under the tounge (though i recomend crushin it up before you put under the tounge because it can take a while for the narcan to take effect and knock the opiates off the receptors) or crush them up in some water and inject striaght into the blood stream. not much is needed about 2-4 mg but be warned injecting it will cause an instant withdrawl wich can be horrible (trust me, i know!) but its better than being dead!
  5. chillinwill
    How and why does the salt water work? I have never heard of this and am very interested.

    Oh and as far as the naloxone in the Suboxone goes, it is not activated when taken sublingually. The buprenorphine has a higher affinity for the opiate receptors than say heroin or hydrocodone thus kicking off any opiates that are already placed on the receptor sites. The naloxone has nothing to do with that when given sublingually.
  6. Benniboi
    with regards to salt water, it's a common misconception that it can help to revive someone- the safer injecting handbook states that this is a fallacy and it is more efficient to just call 999 or 911 rather than waste time with this. and obviously place the person in the recovery position whilst you're doing so
  7. Spucky
    AW: Do-It-Yourself Anti-Overdose Kits: Do They Help?

    One short Notice from my Dr. Cat (as i told she is very noisy)

    If some People have Nalox. but are not educated how to use:
    "Inject it very, very slowly, always wait and control the Bio-Functions like Heartbeat and Breath, don`t forget that Nalox have a very short affinity to the Receptor.
    (afair. less than 20min.)
    A Overdose with something like Buprenorphin or/and Methadone need more than one Injection. Call the Emergency always as soon as possible"!

    @ Poster above, the Idea with Suboxone is not bad
    but do this only in a case where swiny know the reasons for that OD as well as the Victim (what kind of a User he/she is)!!!
  8. jmunny fo twunny
    Hmm. i sincerely apologize for the salt water thing... i live in the south central pa area and spend a decent amount of time in baltimore and in both places many people seem to think it works. in my experience on 2 different occasions when injected the person came back both times. not instantly but within a minute or so. i guess it was just by coincidence that they came back. but nonetheless thank you all for correcting me on this inaccurate info....

    haha ok im not quite sure what your saying (im a little slow) but what i get from it is that the narcan is not activated when taken under the tounge and that it is the buprenorphine that knocks the opiates off the receptors? (if this isnt what your saying please correct me) and thanks for the help guys!

    jmunny fo twunny added 5 Minutes and 9 Seconds later...

    i did not know that it was possible to OD on beprenorphine? i was told that after 16mg it blocks it self out making any dose higher than that pointless. haha am i wrong on this one too?
  9. Rightnow289
  10. Spucky
    AW: Re: Do-It-Yourself Anti-Overdose Kits: Do They Help?

    There is a misunderstanding, i guess you think about the "Ceiling dose",
    above a Dose of ca.24mg there is no effect`s anymore for Pain-Treatment and/or Substitution Treatment.
    But 24mg. of Buprenorphin is lethal for Opioid-naive People (This do not mean "People who are naive with Opioids", just People "without a Opioide-tolerance"!)

    (Imo. already a Dose of 2mg. brings People with no Tolerance into a very big Danger, spec. if the People use Bupre. via IV. or Nasal!)

    Nalox. kick off the Bupre. from the Receptors but Bupre have a very high affinity, they return prompt to the Receptors like Moskitos return to the Light
    and the Nalox is very short-acting.
    So it`s very important to check up the Victim and use Nalox. again and again.
    AFAIR. every 20min.!

    But again: Nalox. is not unproblematic!
    And it can be only the First big Step to help,
    to call a Ambulance have not to be forgotten!
  11. jmunny fo twunny
    ahh thanks for clearing that up. and so if i understand correctly people with a normal tolerence for opiates can not overdose on suboxone only people with no tolerence at all. and is there a difference between taking suboxone sublingually or snorting it? because swim's sister and her boyfriend both snort it and they swear it takes less than it would under the tounge to get them well. is it just in their heads or what?
  12. Spucky
    AW: Re: Do-It-Yourself Anti-Overdose Kits: Do They Help?

    Hmmmm, Bupre. is a "relative" (!!!) safe for People with a Tolerance,
    but only when the use it without any other Drug!

    There is a difference in the BA.
    Sub-lingual has a ca.30% of BA. (This means ca. 70% do not reach the Receptors)
    Nasal ca. 70% "as far as i remember in my burned Brain"
    IV. ca. 100%.

    This sounds maybe "nice" for some People but do not forget
    that the Subutex Level deplete significant quicker.
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