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NY To Push for All Law Enforcement to Carry Naloxone for Heroin and Opiate ODs

By Calliope, Apr 3, 2014 | Updated: Apr 11, 2014 | | |
Rating:
4/5,
  1. Calliope
    View attachment 38262 With deaths from heroin and opioid prescription pills soaring, Attorney General Eric T. Schneiderman on Thursday is expected to announce a push to have law enforcement officers across the state carry a drug that is effectively an antidote to overdose.

    The program, to be funded primarily from $5 million in criminal and civil seizures from drug dealers, would help provide a kit with the drug, naloxone, and the training to use it to every state and local officer in New York, the attorney general’s office said.

    The authorities have increasingly seen naloxone, also known under its brand name Narcan, as a potent weapon against a national surge in drug overdoses. Last month, the Justice Department encouraged emergency medical workers across the country to begin carrying the drug.

    The move to broaden access in New York is the latest tactic employed by state officials to combat abuse of pills and the rising specter of heroin use. Last year, the state Health Department began more closely tracking prescriptions that are written for the most frequently abused drugs. Early data from the program show a decrease in so-called doctor shoppers, or those who move among many prescribers to get steady access to addictive pills.

    But the prescription monitoring program does not catch heroin users, and increasingly New Yorkers are dying. In New York City, there was an 84 percent jump in heroin overdose deaths between 2010 and 2012, according to the city’s Department of Health and Mental Hygiene. “Heroin is destroying our communities,” Mr. Schneiderman said in a statement ahead of Thursday’s announcement. “Naloxone is stunningly effective at stopping an overdose in its tracks.”

    The drug, which has been available for decades in emergency rooms, works on the opiate molecules that attach to the brain and, during an overdose, will fatally slow a person’s breathing. Naloxone effectively bumps them away, restoring breathing in minutes and giving medical workers time to get to a hospital.

    For years, only paramedics carried the drug. In 2012, a pilot program in Suffolk County trained emergency medical technicians and half the police officers to administer the drug. [see NYTimes story below]

    “The first week we had five saves,” said Dr. Scott S. Coyne, the chief surgeon and medical director for the Suffolk County Police Department. It proved so effective at bringing back users in the throes of an overdose that the program quickly expanded to the entire department, he said. To date, police officers there have halted 184 overdoses, Dr. Coyne said.

    Late last year, the New York Police Department trained some 180 officers to use the drug on Staten Island, which has seen the city’s most acute problem with heroin and pill overdoses, saving three people in the first three months. The department is currently looking to expand the program across the borough and around the city.

    The state’s Good Samaritan law protects those who call the police during an overdose, even if they too were using illegal drugs. Those who administer naloxone are also protected from liability. The drug, which is not habit forming and gives no high to an overdosing user, is nontoxic.

    Teri Kroll, an advocate for drug awareness who lost her son Timothy to heroin overdose in 2009, was an early adopter of naloxone on Long Island. She has carried it with her since she was trained to use it in 2010. (Those who are not emergency medical workers must get a doctor’s prescription and training from the Health Department.)

    So when Ms. Kroll came upon a young man overdosing in his car last June, she had a dose of naloxone — and a responding police officer did not.

    “I put the needle together and asked, ‘Do you want me to do it?’ and he said, ‘yes,’ ” she recalled. “It’s absolutely amazing that when you inject somebody, within seconds it reverses it. Within seconds, he was talking to the police officer.”

    NYTimes
    By J. DAVID GOODMAN
    APRIL 3, 2014

    http://www.nytimes.com/2014/04/03/n...elp-police-get-a-kit-to-combat-overdoses.html

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~

    Coffin PO, Sullivan SD. Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal (2013) Annals of Internal Medicine. 2013;158:1-9. [also attached to this post]

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~

    An Effort to Expand Access to a Drug That Could Save Victims of Overdoses

    View attachment 38260 Samantha Dittmeier was the youngest of Karen Allar’s four children. “She was very loving, very compassionate,” said Ms. Allar, 51, an employment counselor who lives on Long Island. “Unfortunately, the addiction got to her.”

    Ms. Dittmeier, 23, died of a heroin overdose in January, leaving behind her 3-year-old son, Aiden. Ms. Allar is haunted, she said, not just by her daughter’s tumble into addiction, but also by the circumstances of her death. She wonders if her life might have been saved if the emergency workers who treated her had been armed with naloxone, a powerful drug that can reverse the effects of an overdose.

    “You start to get that sick feeling again,” Ms. Allar said, recounting a frantic race to the hospital just before Ms. Dittmeier’s death. “I’m back at work. I’m trying to think positive about such a horrible situation.”

    On Long Island and across New York State, drug overdoses are taking an increasing toll. The most common killers are opioids, a class of painkillers that includes prescription drugs like Vicodin, OxyContin and Percocet, as well as illegal narcotics like heroin.

    In Suffolk and Nassau Counties, the two that make up Long Island, 338 people died of opioid overdoses in 2012, up from 275 in 2008, according to county records. Statewide, opioid overdoses killed 2,051 people in 2011, more than twice the number that they killed in 2004.

    The spate of deaths is spurred, in part, by the easy access to prescription drugs. As a result, the state has begun several efforts to stem access to prescription drugs. A new law aims to stop addicts from gaining access to multiple rounds of medication by requiring doctors to consult an Internet database that tracks prescriptions.

    Law enforcement authorities have also cracked down on physicians who dispense painkillers illegally. New York City early this year took the unusual step of limiting access to pain medication in emergency rooms.

    Some public health experts and antidrug advocates, however, are offering another way to prevent overdose deaths: naloxone, an easy-to-administer, inexpensive drug that is sprayed into the nose or injected into the body. The more people who carry it, they say, the better.

    The Food and Drug Administration approved the drug to treat overdoses in 1971, and since then it has been widely used in hospitals. Now, it is slowly getting into the hands of nonmedical personnel across New York State.

    “I wish I’d known about this beforehand,” said Kelly O’Neill, 46, of Nassau County, whose son Billy died of a heroin overdose in 2011 at age 25. “It’s kind of like, ‘Thank God it’s here,’ but it’s taken so long for them to get it here.”

    Opioids function in the body by attaching to specific proteins, called opioid receptors. When opioids attach, the body relaxes and breathing slows. But too much of an opioid can cause respiration to slow to a lethal level.

    Naloxone acts by competing with opioids for the receptor sites, essentially pushing the opioids out of the way and reversing the effects of the drugs.

    The timing is critical. Depending on the dosage taken and the conditions of a user, a person can die within minutes of taking an opioid, so naloxone must be administered quickly. The drug is used not just to save substance users, but also children who accidentally wander into a parent’s medicine cabinet.

    Until recently, though, the only emergency personnel in New York trained to use naloxone were the state’s 7,500 paramedics, who have advanced training but are often not the first to arrive at the scene of an overdose.

    Now, a pilot program in Suffolk, Nassau and four other New York regions is training emergency medical technicians — who have less training but are more likely to be the first to reach an overdose victim — how to use naloxone. There are 42,000 E.M.T.’s in New York, many of them also police officers and firefighters. The two-year pilot program is scheduled to end in 2014, when the State Department of Health will decide if all state E.M.T.’s should be trained. Since spring 2012, newly trained E.M.T.’s have administered naloxone to 197 people who overdosed.

    A second statewide effort is aimed at getting naloxone into the hands of people without medical training, an effort spurred by a 2006 New York law that made it legal for community organizations and health departments to deliver naloxone training. Similar laws exist in at least a dozen cities and states, including New Jersey and Connecticut. People who might seek training could include parents of addicts or a volunteer who works with substance abusers.

    A list of organizations that provide naloxone training is available on the State Health Department’s Web site. [http://www.health.ny.gov/diseases/aids/consumers/prevention/opioidprevention/index.htm] The training takes 10 minutes to one hour, and graduates are given small blue bags containing two doses of the drug.

    The recent addition of a nasal version of naloxone has made it easier for people without medical backgrounds to administer the drug. Still, some people caution against its widespread distribution.

    Paul A. Werfel, who oversees the E.M.T. and paramedic training program at Stony Brook University on Long Island, said drug users can become combative after they are given naloxone. “The average E.M.T. in Suffolk may not necessarily have the tools to handle that,” he said.

    Others, however, say that the drug’s lifesaving potential outweighs such concerns. A growing body of research about the drug’s effectiveness has turned many skeptics into advocates, said Dr. Sharon Stancliff, the medical director at the Harm Reduction Coalition, a national nonprofit group.

    A study published in the Annals of Internal Medicine in 2012 found that one life could be saved for every 227 naloxone kits distributed to heroin users and those close to them.

    “Public health moves slow,” Dr. Stancliff said. “This is really an extremely safe, safe medication.”

    NYTimes

    By JULIE TURKEWITZ
    Published: August 21, 2013

    http://www.nytimes.com/2013/08/22/nyregion/training-to-apply-a-drug-is-urged-in-overdose-cases.html

Comments

  1. Calliope
    USA - Hand-Held Treatment for Overdoses Is Approved

    [IMGL="white"]http://www.drugs-forum.com/forum/attachment.php?attachmentid=38259&stc=1&d=1397141348[/IMGL]Federal health regulators approved a drug overdose treatment device on Thursday that experts say will provide a powerful lifesaving tool in the midst of a surging epidemic of prescription drug abuse. Similar to an EpiPen used to stop allergic reactions to bee stings, the easy-to-use injector — small enough to tuck into a pocket or a medicine cabinet — can be used by the relatives or friends of people who have overdosed.

    The hand-held device, called Evzio, delivers a single dose of naloxone, a medication that reverses the effects of an overdose, and will be used on those who have stopped breathing or lost consciousness from an opioid drug overdose. Naloxone is the standard treatment in such circumstances, but until now, has been available mostly in hospitals and other medical settings, when it is often used too late to save the patient.

    The decision to quickly approve the new treatment, which is expected to be available this summer, comes as deaths from opioids continue to mount, including an increase in those from heroin, which contributed to the death of the actor Philip Seymour Hoffman in February. Federal health officials, facing criticism for failing to slow the rising death toll, are under pressure to act, experts say.

    “This is a big deal, and I hope gets wide attention,” said Dr. Carl R. Sullivan III, director of the addictions program at West Virginia University. “It’s pretty simple: Having these things in the hands of people around drug addicts just makes sense because you’re going to prevent unnecessary mortality.”

    The scourge of drug abuse has battered states across the country, with deaths from overdoses now outstripping those from traffic crashes. Prescription drugs alone now account for more than half of all drug overdose deaths, and one major category of them, opioids, or painkillers, take the lives of more Americans than heroin and cocaine combined. Deaths from opioids have quadrupled in 10 years to more than 16,500 in 2010, according to federal data.

    [IMGR="white"]http://www.drugs-forum.com/forum/attachment.php?attachmentid=38258&stc=1&d=1397141348[/IMGR]Once turned on, the new instruments will give verbal instruction about how to deliver the medication, similar to automated defibrillators that hang in public buildings. Food and Drug Administration officials said they speedily approved the device in just 15 weeks because it is critical to prevent deaths.

    Experts applauded the F.D.A.’s decision, saying it could lead to the broad dissemination of the drug, which has rarely been available to the families and friends of drug abusers, who are often the first to find them when they have overdosed.

    Dr. Nathaniel Katz, assistant professor of anesthesia at Tufts University School of Medicine in Boston, whose company, Analgesic Solutions, develops treatments for pain, said the approval would “catalyze the adoption of this treatment.” “We have 17,000 fatal opioid overdoses every year,” he said. “You can potentially prevent a chunk of them with this technique.”

    Deaths have climbed despite efforts by states and the federal government. In January 2013, an expert panel convened by the F.D.A. recommended tightening prescription practices. In September, the F.D.A. changed labeling requirements to indicate that the opioids only be used in patients with no other treatment options for their pain.

    The agency’s critics said it was drawing attention to its approval of the new device — the conference call for reporters included Kathleen Sebelius, the health and human services secretary — because it was defensive about its record on opioids.

    The F.D.A. has been under pressure since last fall when it approved Zohydro, a new hydrocodone drug, a prescription opioid, against the advice of an expert panel.

    The drug differs from other painkillers in that it is a pure form of hydrocodone, without acetaminophen, in an extended release form, and the agency contended that it would help patients who needed longer-term treatment for pain and wanted to avoid the risks of liver problems from acetaminophen, the active ingredient in Tylenol.

    But health officials who deal with abuse of opioids strongly objected to the approval, saying the drug was an unnecessary addition to the long list of pain drugs on the market. In December, attorneys general from 28 states wrote the agency’s commissioner, Dr. Margaret A. Hamburg, asking her to reconsider the approval. Massachusetts announced a ban on the drug last week, and last month, Senator Joe Manchin III, Democrat of West Virginia, submitted a bill to require the F.D.A. to reverse its decision.

    Dr. Katz of Tufts University said the federal government could be doing more to combat the drug epidemic, for example requiring doctors who prescribe highly addictive opioids to get training in how to do it properly. Such training is now voluntary, though Dr. Hamburg said on a conference call on Thursday that she believed it should be mandatory.

    Dr. Katz said of the agency’s approval of Evzio, “They’re plucking the low- lying fruit, but the hard things haven’t been done.”

    But Dr. Hamburg defended the agency’s record. “Tackling the opioid epidemic is a high priority for the F.D.A.,” she said, adding that the device is “an extremely important innovation that will save lives.”

    Some states have already taken steps to make naloxone more broadly available, though mostly through a patchwork of pilot programs. In Massachusetts and Maryland, police departments have a standing order from health departments to allow emergency medical workers to use naloxone. In New Jersey and Ohio, there are laws allowing people who may witness an overdose to administer naloxone.

    But Dr. Eric Edwards, chief medical officer of Kaléo, the pharmaceutical company that produces Evzio, said naloxone treatment used outside hospitals today involved injectable formulations with glass vials, syringes and, in about half the cases, attachments requiring assembly to create a nasal spray. The new device is the shape of a credit card, the thickness of a cellphone, and has a contractible needle the user never even sees.

    The company said they had not yet finalized the price.

    Some voiced concerns that the device might create new problems.

    “I’m worried that there will be a false sense of security” among drug users,
    said James Rathmell, chief of the division of pain medicine at Massachusetts General Hospital. “Like, ‘O.K., I’ve got a naloxone pen, we can party all we want, no one is going to die.’ ”

    Dr. Sullivan, of West Virginia, disagreed. “This is going to help way more than it is going to hurt,” he said.
    David Hufferd, 31, a former addict in Portsmouth, Ohio, whose wife died of an overdose of OxyContin in 2010, said he would buy one of the devices to have on hand in case one of his friends or family members who still actively abuse drugs needed help.

    “You never know who is going to show up at your doorstep,” he said.

    NYTimes
    By SABRINA TAVERNISE
    April 3, 2014

    http://www.nytimes.com/2014/04/04/health/fda-approves-portable-drug-overdose-treatment.html

    -----------------------------------------------------------------------------------
    FDA News Release April 3, 2014

    FDA approves new hand-held auto-injector to reverse opioid overdose
    First naloxone treatment specifically designed to be given by family members or caregivers

    The U.S. Food and Drug Administration today approved a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Evzio (naloxone hydrochloride injection) rapidly delivers a single dose of the drug naloxone via a hand-held auto-injector that can be carried in a pocket or stored in a medicine cabinet.
    It is intended for the emergency treatment of known or suspected opioid overdose, characterized by decreased breathing or heart rates, or loss of consciousness.

    Drug overdose deaths, driven largely by prescription drug overdose deaths, are now the leading cause of injury death in the United States – surpassing motor vehicle crashes. In 2013, the Centers for Disease Control and Prevention reported the number of drug overdose deaths had steadily increased for more than a decade.

    Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for overdose. However, existing naloxone drugs require administration via syringe and are most commonly used by trained medical personnel in emergency departments and ambulances.

    “Overdose and death resulting from misuse and abuse of both prescription and illicit opioids has become a major public health concern in the United States,” said Bob Rappaport, M.D., director of the Division of Anesthesia, Analgesia, and Addiction Products in the FDA’s Center for Drug Evaluation and Research. “Evzio is the first combination drug-device product designed to deliver a dose of naloxone for administration outside of a health care setting. Making this product available could save lives by facilitating earlier use of the drug in emergency situations.”

    Evzio is injected into the muscle (intramuscular) or under the skin (subcutaneous). Once turned on, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators. Family members or caregivers should become familiar with all instructions for use before administering to known or suspected persons to have had an opioid overdose. Family members or caregivers should also become familiar with the steps for using Evzio and practice with the trainer device, which is included along with the delivery device, before it is needed.

    Because naloxone may not work as long as opioids, repeat doses may be needed. Evzio is not a substitute for immediate medical care, and the person administering Evzio should seek further, immediate medical attention on the patient’s behalf.

    In one pharmacokinetic study of 30 patients, a single Evzio injection provided equivalent naloxone compared to a single dose of naloxone injection using a standard syringe. The use of Evzio in patients who are opioid dependent may result in severe opioid withdrawal. Abrupt reversal of opioid depression may result in nausea, vomiting, sweating, accelerated heart rate (tachycardia), increased blood pressure, uncontrollable trembling (tremulousness), seizures and cardiac arrest.

    The FDA reviewed Evzio under the agency’s priority review program, which provides for an expedited review of drugs that appear to provide safe and effective therapy when no satisfactory alternative therapy exists, or offer significant improvement compared to marketed products. The product was granted a fast-track designation, a process designed to facilitate the development, and expedite the review of drugs to treat serious conditions and fill an unmet medical need.

    Evzio is being approved ahead of the product’s prescription drug user fee goal date of June 20, 2014, the date the agency was originally scheduled to complete review of the drug application.

    Evzio’s approval is also the result of efforts by several federal agencies. Naloxone has been a part of the White House’s Office of National Drug Control Policy’s National Drug Control Strategy since 2012. The FDA co-chairs an HHS inter-departmental working group on naloxone, which helped coordinate an April 12, 2012, meeting regarding access to naloxone products.

    Evzio is manufactured for kaléo, Inc., of Richmond, Va.
  2. Calliope
    Another move on this front:

    In Effort to Fight Overdoses, Staten Island Officers Will Soon Carry Heroin Antidote

    Police officers across Staten Island will soon be equipped with and trained to use a nasal spray that reverses the effects of a heroin or opioid pill overdose, the authorities said on Thursday.

    The move, expanding a pilot program in the borough, is part of a broad national push to get the lifesaving medication, naloxone, into the hands of emergency workers amid what federal authorities have called an epidemic of opioid overdoses.

    New York City paramedics, who have advanced training, have carried the drug for four decades. Now emergency medical technicians and firefighters, who, along with the police, are often the first to be dispatched to medical calls, will also carry the drug, the Fire Department said.

    In recent years, the city has seen surges in the amount of heroin seized and in fatal overdoses from the drug. On Monday, the authorities seized 44 pounds of heroin, worth approximately $12 million, from two apartments in the Washington Heights neighborhood of Manhattan serving as stash houses. Deaths from heroin increased 84 percent between 2010 and 2012, and followed alarming rises in overdoses from prescription pain medications citywide in recent years.

    The expansion of the pilot program into a regular part of police work on Staten Island underscored the scope of the crisis in the borough, which has seen the city’s highest rates of fatal overdoses from both heroin and prescription opioid abuse. In the past few months, officers in one police precinct in northern Staten Island used naloxone to save three people in the throes of an overdose. (Because the medication only works on heroin like drugs, a person overdosing from a nonopiate drug died despite receiving naloxone from officers.)

    “The victim was snoring very loudly, what’s called a death rattle,” said Officer Daniel Keating, recalling his experience in February administering the drug with two other officers. After two doses, Officer Keating said, “he came to, and then the E.M.S. took over, and he survived.”

    At a news conference in the Richmond County district attorney’s office, the police commissioner, William J. Bratton, thanked the officers for the example they provided to the borough’s three other precincts. All Staten Island officers will be trained to use the drug by the end of next month, he said.

    Mr. Bratton, in his first public comments addressing the city’s resurgent market for heroin, said it stemmed from Mexican drug cartels “pushing it quite aggressively,” not only in New York but around the country.

    “Part of that is in response to success in starting to deal with the illegal prescription issue, making it more and more difficult — not just here but around the country — to get these drugs,” Mr. Bratton added, referring to efforts to rein in abuse of prescription pills that give the user a similar high to heroin. “Now they are going back to the traditional buying in the street, with all the inherent dangers there.”

    The district attorney, Daniel M. Donovan Jr., said he helped to secure $50,000 in federal funds to give the Police Department roughly 1,000 doses of naloxone for use on Staten Island.

    Naloxone, also known by its brand name, Narcan, counteracts the effects of an overdose within minutes, restoring breathing that an opiate drug can fatally slow. Paramedics have saved 42 people on Staten Island using the drug so far this year, the Fire Department said.

    The fire commissioner, Salvatore J. Cassano, said his department would now train all its emergency medical responders citywide, including firefighters in engine companies, to administer the drug. Such training is already given to all new firefighters at the academy.

    Community groups in New York also help to provide training to administer naloxone, which requires a prescription and must be obtained through the state Health Department. Relatives of opiate drug users, along with relatives of those who have succumbed to overdose, have sought out the training.

    The effort follows a program announced this month by the state attorney general’s office to put the medication into the hands of law enforcement officers across the state, using $5 million in criminal and civil seizures from drug dealers. Mr. Bratton said the Police Department is looking to draw from those funds to provide naloxone in precincts beyond Staten Island.

    The training to use the nasal spray form of the drug is not complicated, Mr. Bratton said, and he predicted a fast rollout once the money becomes available. “We can do it at a roll call,” he said.


    NYTimes
    By J. DAVID GOODMAN
    APRIL 17, 2014

    http://www.nytimes.com/2014/04/18/nyregion/staten-island-officers-will-carry-heroin-antidote.html
  3. berry13
    I think this is fantastic, it's about damn time law enforcement has at least the power to save somebody's life when they really need it and no other emergency service is immediately nearby. This should be made nationwide or at least states/counties affected by it who choose to have it!
  4. polio vaccine
    beautiful.... reminding the police they are here "to protect and serve" the people, and that yes, junkies are people. if anyone needs reminding of these two basic tenets, it's the NY fucking PD

    then again, with their gleeful propensity for stalling a junky's case going through/putting off fingerprinting/doing anything to make you sweat it out sick an extra 12 hours, giving them narcan to administer at will might basically turn a lot of peoples' experiences with the holding cells into experience with torture chambers. i can absolutely see certain NYPD detoxing people who aren't ODing, just "for your own good," i.e. for their own amusement..... the attitude is admirable, but hopefully it won't wind up being abused...
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