I WANT A NEW DRUG
If only John Travolta had known. Instead of piercing Uma Thurman's chest with a needle and stabbing her in the heart with an adrenaline shot in "Pulp Fiction," Travolta's Vincent Vega could have saved her from a heroin overdose by simply filling the syringe with naloxone and sticking it in her backside. Of course, such a move would have robbed the 1994 film of one of its most talked-about scenes. But even with far less edge-of-your-seat suspense, it would have accomplished the same thing: The life of Thurman's character, Mia Wallace, would have been saved.
Compared to Vincent Vega's option, the choice of naloxone seems like a simple solution to a growing problem - make it available to heroin users and more deadly overdoses would be avoided. But resuscitating an overdose victim is hardly a casual affair, and the use of naloxone by laypeople is still very much open for debate.
In fact, in Massachusetts and in all but one of the other 49 states, it is illegal to possess naloxone without a prescription. Naloxone, an anti-overdose drug also known by the brand name Narcan, reverses the effects of opiates such as heroin and OxyContin. The drug restores an overdose victim to full consciousness within minutes, as Essex County Sheriff Frank Cousins Jr. can attest.
A few years ago in his hometown of Newburyport, he watched as a paramedic used naloxone to save the life of a person overdosed on heroin. Without it, he says, there's no question that person would have died. But that doesn't mean the veteran law-enforcement official and Springfield College graduate wants to see the drug passed out on every street corner on the North Shore.
Cousins, like many in his field, believes the idea of providing naloxone to the injection-drug-using community as a cure for overdoses would be misleading and ill conceived.
But they all agree it works, in the right hands. They even admit that without this fairly new drug the number of overdose deaths in this country would be much higher.
"It's a miracle drug in the hands of trained professionals," says Essex County District Attorney Jonathan Blodgett. "People who were blue lining are jumping off the table."
To keep more heroin and opiate abusers from not being so lucky, however, drug counselors and others in the health-care field believe naloxone should be in the hands of those who need it most, or at least in the hands of their family members and friends.
"I have no problems with Narcan being made more available," says Dr.
Michael Levy, director of clinical treatment services at CAB Health and Recovery in Peabody. "These people are using needles anyway ... they're shooting heroin." But don't expect Bay State lawmakers to approve the public distribution of naloxone anytime soon, especially since Massachusetts is one of only four states - the others being California, Delaware and New Jersey - that doesn't allow the purchase of hypodermic needles without a prescription. There haven't even been any concrete talks about Narcan on Beacon Hill, and here on the North Shore, both Blodgett and Cousins, at least, are against such a distribution program. Word on the street Naloxone has no street value, but law-enforcement officials fear its availability would remove some of the deterrent from injecting heroin. They believe it is a dangerous mistake to offer access to this drug as an alternative to professional emergency care. They say drug users armed with naloxone may be less likely to call 911 in case of an emergency - a particular concern to officials who question the ability of someone high on heroin to identify an overdose and give required emergency care.
"It's a good option for medical people," says Cousins of Narcan, which first got FDA approval in the early 1970s. "It can save a life. It's another tool first-responders and paramedics can use in our fight against heroin. But nobody wants to see non-medical personnel administering Narcan." Well, not exactly. Since the drug has proven so effective, some communities outside Massachusetts have made naloxone available to outreach workers and drug users.
In 2001, New Mexico became the first, and is still the only, state to legalize the distribution of Narcan to addicts and their relatives. The law was adopted in an attempt to lower the state's overdose death rate, which is among the highest in the country. The program has curbed the number of fatal overdoses slightly.
Chicago, San Francisco and Baltimore all have sanctioned similar programs to distribute the antidote. Australia also allows the distribution of Narcan to the public.
Revere resident Gary Langis is working to do the same here. He is drafting a proposal he hopes will one day make it legal for needle exchanges to distribute naloxone in Massachusetts.
In the meantime, the board president of the New England Prevention Alliance will continue to help heroin, OxyContin and other opiate users gain access to naloxone in Boston's north suburbs.
"Narcan can't be abused. It can't get you high," says Langis, noting there are underground programs in Massachusetts that dispense Narcan and train people how to use it. "Where's the danger? It's a harmless drug that reverses the effect of an overdose ... By the time an EMT gets there, it's often too late." Langis says he does not know how many referrals he has made for heroin users seeking access to naloxone. But he notes that he is aware of at least 200 reported cases in Cambridge in which laypeople have reversed overdoses using naloxone, since underground programs began making referrals there in 2001. The drug is easy for a layperson to administer, because it can be injected into muscle, rather than into veins or under the skin. Naloxone also gives users who are unwilling to call 911 or afraid to bring a drugged-up friend to the hospital an alternative that could save lives, Langis says.
However, critics argue that users suffering from a heroin overdose immediately become unable to help themselves. Unlike diabetics, who make insulin injections part of their daily routine, or people with bee-sting allergies, who remain conscious after they are stung and identify the problem themselves, Narcan needs to be administered by another person. This fact creates another layer of questions and concerns, according to opponents of Narcan distribution. Narcan, they say, does not cure heroin overdoses. The true cure - oxygen, breathing support and airway control - gets lost in any naloxone discussion, they say. "I don't like the idea of Narcan being in the hands of people who are not medical professionals,"
Opponents of the drug's widespread availability also note that opiate addicts can become combative after receiving Narcan, because it kills their high. Dr. Levy, for one, doesn't see that as a roadblock to making Narcan more available. "Opiate withdrawal is not a life-threatening illness," he says. "It's a much better option than dying."
Unwanted smack down Ever since a 2003 federal report claimed heroin-related deaths in Massachusetts had risen 76 percent since the start of the 21st century, Bay State lawmakers and law-enforcement officials have been calling for more state and federal resources to win the war against drugs.
That White House Office of National Drug Control Policy survey found that Massachusetts had one of the highest rates of illegal drug use in the country, with heroin use reaching epidemic rates.
The same year that report came out, the Essex County Drug Task Force made 300 heroin-related busts, and seized more than 21,000 single-dose bags of heroin and 2,172 grams of pure heroin, enough for more than 65,000 additional single-dose bags.
Massachusetts law-enforcement officials say the street price of heroin has dropped to an average of about $4 per bag, down from about $40 per bag in the 1990s. The drug also is becoming more popular among affluent people and those who live in the suburbs, according to Blodgett and others. "There's a stigma that only junkies, thieves and the homeless are using these drugs,"
says Langis. "But our sons and daughters are using. Kids that should be hanging out at the Gap."
The aforementioned facts and figures have Langis believing naloxone use will become more prevalent.
Just last September, in a Melrose elementary school parking lot, police found a sandwich bag containing a syringe and a bottle of naloxone. The bag also included detailed instructions showing a layperson how to respond to a heroin or OxyContin overdose using naloxone.
Police believe the kit belonged to a drug user. Langis is hardly surprised.
"We can't arrest this problem away," says Langis, whose organization teaches users to call 911 first and not to just "dump" those suffering from an overdose at the hospital and then take off. "Narcan alone isn't the solution either, but it would bridge the gap and it would give us another tool for engaging these people. They do want to change their lives. Nobody wants to be strung out on heroin."