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.”
By J. DAVID GOODMAN
APRIL 3, 2014
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.”
By JULIE TURKEWITZ
Published: August 21, 2013
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