A Way to Reduce Drug Overdoses?

Naloxone kits at a harm reduction facility in Manhattan help opioid users recover from overdoses. They can be distributed with a prescription from a doctor. If the bill passes, all New York care providers will be able to hand them out. (Lucia De Stefani/NY City Lens)

Naloxone kits at a harm reduction facility in Manhattan help opioid users recover from overdoses. They can be distributed with a prescription from a doctor. If the bill passes, all New York care providers will be able to hand them out. (Lucia De Stefani/NY City Lens)

New York State legislators will soon vote on a bill that aims to decrease drug overdose fatalities by increasing distribution of naloxone, an opioid overdose antidote. Currently prescribed only by medical doctors and authorized practitioners, naloxone might become available in New York local communities centers if the bill becomes law, broadening the drug’s availability.

Drug overdoses are the leading cause of accidental death in the United States, surpassing motor vehicle crash deaths, according to a 2010 report by the Center for Disease Control and Prevention. In New York State, overdose deaths related to prescription painkillers increased 233 percent between 2000 and 2012, reports the New York State Health Department. Heroin-related overdose deaths increased 84 percent between 2010 and 2012 in New York City, after declining for four years.

The bill, authored by New York Senator Kemp Hannon (R-Nassau) and Assemblyman Jeffrey Dinowitz (D-Bronx) could represent a first step aiming to stop the death toll, broadening the distribution of naloxone and making the antidote easily accessible. “The recent unfortunate death of actor Philip Seymour Hoffman brought back to life the fact that the drug problem seems to be getting worse again,” Assemblyman Dinowitz said.

The bill was passed by the Senate’s Health Committee on January 28th and is heading now to the New York State Senate for further approval.

“It would change the whole game,” said Williams Matthews, a physician assistant at Harm Reduction Coalition, a national advocacy organization with a mission to reduce drug-related harm. Matthews visits several harm reduction centers each month to issue prescriptions and hand out naloxone kits after providing a brief training. During a two-hour visit recently at Washington Heights Corner Project, he handed out a dozen of kits. If the bill is passed, said Williams, “I wouldn’t need to be here, writing prescriptions and giving out [naloxone] kits to people who need to wait for me.”

Seventeen states have already expanded access to naloxone, according to the Network for Public Health Law. In New York, health care providers, harm reduction groups and non-medical personnel would be able to distribute the naloxone under doctors’ “standing orders” instead of specific prescriptions. Caregivers will also receive a training on how to administer the antidote.

Naloxone has been proved to be crucial in successfully reversing opioid overdose from drugs like heroin, oxycodone, morphine, or methadone, and it has been used for more than ten years. The antidote plugs up receptors preventing the opioids from taking effect and restoring a person’s breathing, nervous system and heart rate to normal levels.

Since most overdoses are witnessed, having the kit on hand could be life saving for heroin addicts, according to Vocal-NY, one of the most active advocacy organizations. The real challenge, however, is to get other opioid users who receive painkillers by prescriptions, to have access to the kits as well.

Heroin users seek out help, says Chance Krempasky, a nurse practitioner at Washington Heights Corner Project, but “other victims of overdoses, middle class or working class that don’t necessarily fit in our demographic, don’t generally come here.”

Moreover naloxone won’t necessarily lead prescription opioid abusers to a full recovery, experts say. And even when participants seek help from rehabs or clinics, the risk of relapsing remain high.

The antidote, despite its proven safety, puts abusers in a state of severe withdrawal as they recover consciousness. Its effect also vanishes after the first half hour. And about 90 percent of patients who are detoxed from opioids resume opioid use within the first one or two months, explains Maria Sullivan, an associate professor of clinical psychiatry at Columbia University. And naloxone, despite its potent action in inverting opioids’ effects immediately, may not be able to help stop that.

“The question is not ‘Should you offer medication?’ but ‘Which medication?” Sullivan says. “Naloxone saves life but it doesn’t prevent relapse. But if a patient refused medication as a treatment, then naloxone is at least a safety measure.”

Patients and family members need to be educated about the heightened risks for unintentional fatal overdose that exist in the four weeks after discharge. It is fundamental, says Sullivan, to have a nurse or a physician talk to the patients and their families before they leave a detox clinic. As academic studies have demonstrated, the combination of long term medication and intensive psychosocial treatment is efficacious, and should be added to the treatment options available for individuals who are dependent on opioids.