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Heroin Overdose Kits: The Debate Goes On

Posted Aug 26 2008 12:35pm

More states back naloxone programs, but Feds aren’t convinced.

Since the first trial run in Chicago several years ago, efforts to provide heroin addicts with naloxone overdose kits has gained ground in Baltimore, New York, Boston, and several other cities and states. As reported here at Addiction Inbox last month, Dr. Peter Moyer, medical director of Boston’s fire, police and emergency services, applauded the recent Massachusetts decision to expand the Boston program to the entire state and offer Massachusetts heroin addicts the overdose reversal kit. Approved by the Food and Drug Administration (FDA) 35 years ago, Naloxone, or Narcan, is the standard emergency room treatment for heroin overdose. Naloxone instantly reverses life-threatening overdoses by crowding out heroin molecules at the brain receptor sites where they bind.

Predictably, the Office of National Drug Control Policy in the White House does not support the Massachusetts program. Drug Policy officials do not like the idea of addicts medically treating other addicts and have argued repeatedly against distribution of the naloxone kits, claiming that distributing the Narcan antidote will only encourage heroin use and delay treatment.

But the move among states and cities for direct naloxone distribution to addicts continues to gain momentum. In Baltimore, assistant commissioner of health Richard W. Matens maintains that the direct-to-addicts model had been “extremely successful” in his city. Death by heroin overdose reached its lowest level in a decade in 2005, and Matens says the naloxone distribution program played an important role in that reduction.

At the New York State Health Department, which oversees 20 naloxone distribution programs in New York City, Dan O’Connell told the New York Times (reg. required) that from a public health perspective, heroin overdose kits were “a no-brainer.” O’Connell, director of the department’s H.I.V. prevention division, said: “For someone who is experiencing an overdose, naloxone can be the difference between life and death.”

Wisconsin, Minnesota, Connecticut, New Mexico, Rhode Island, and several other states are also embarking on naloxone distribution programs. Thousands of lives are likely to be saved if the idea continues to gain ground.

So what could be the worm in the apple?

“It is not based on good scientific data,” contends Dr. Bertha Madras, deputy director with the White House Office of National Drug Control Policy , which continues its steadfast opposition to such programs. “It’s based on what some people would consider the right thing to do. But the studies supporting it are so sparse it’s painful.” As evidence, Madras and other federal substance abuse officials point to a survey of San Francisco drug addicts done in 2003, the year San Francisco first began funding naloxone distribution. About one-third of the addicts in the survey said they might use more heroin if they had naloxone to protect against overdose. “In the absence of scientific evidence,” Madras told the Times, “we don’t engage in policies that would bring more harm than benefit.”

However, a more recent survey of San Francisco addicts casts major doubt on those findings. In 2005, when the city began a trial program giving out two free needles loaded with naloxone, local officials claimed that fatal overdoses began to fall markedly, and city officials were soon claiming that heroin overdose deaths were at their lowest mark in ten years. California programs train addicts in the use and administration of naloxone. “I’m glad they’re showing us this stuff,” one addict said. “I don’t want to just sit there if someone ends up in a bad situation.”

According to figures reported by the Harm Reduction Coalition , 3,691 California drug users died of overdose in 2003, the latest year of official records. This represents an increase of 42 per cent since 1998, resulting in an annual death rate greater than that from firearms, homicides, and A.I.D.S.

But so far, states are on their own, as Federal drug policy officials continue to maintain that naloxone should only be prescribed and administered by doctors. And yet, many doctors refuse to treat heroin addicts, on the grounds that there is nothing that can be done for them, or that they are recalcitrant patients.

Dan Bigg, director of the Chicago Recovery Alliance, told the New York Times he has seen firsthand that such overdose kits are effective. “What we have here is an antidote to the problem [of heroin overdose],” Bigg said. “Now we just have to convince people it’s worth it.”

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