Monday, April 28, 2014
Posted: Saturday, April 26, 2014
The so-called “Killer Heroin,” which is blamed for a string of recent overdoses in Bucks County, may contain little — if any — actual heroin.
Instead, it could be all fentanyl, posing a greater risk for users since the powerful painkiller used in street heroin isn’t manufactured by pharmaceutical companies, experts say. The black market fentanyl acts like pure heroin but it’s cheaper, so dealers are more likely to use higher amounts as a cutting agent, significantly escalating the overdose risk.
The popularity of fentanyl-heroin combinations also reflects another trend, which is how modern drug dealers are tailoring their products to match customer demand, according to David Fialko, a prevention specialist with the Drug and Alcohol Council of Southeast Pennsylvania.
And with street heroin, death is a selling point.
“Dealers are, in fact, using a person’s overdose/death as a form of marketing,” Fialko said.
The popularity of the fentanyl-laced heroin also appears to be prompting counterfeit brand-stamps. Ambitious dealers will use the counterfeit stamps to imitate best-selling heroin brands, Fialko said.
The Pennsylvania State Police Drug Law Unit is aware of recent cases where street fentanyl has been marketed as heroin, state police spokesman Adam Reed said.
Two overdose deaths in Bucks County this year, which police initially linked to the popular brand “Bad News” — a fentanyl-tainted heroin — turned out to be the result of “pure” fentanyl, according to the county coroner.
And Coroner Dr. Joseph Campbell said none of the nine confirmed fatal heroin overdoses so far this year have involved the combination, just one or the other.
At least four nonfatal overdoses reported locally in February and March also were linked to the “Bad News” brand, but law enforcement officials haven’t said whether it was the original fentanyl-tainted heroin or a counterfeit brand with 100 percent fentanyl.
As of late March, a Bensalem lab confirmed 45 instances of fentanyl-laced heroin over a four-day period, according to Fialko. The results came from hospitals and drug treatment programs in areas between Camden, N.J., and Reading. Urine samples were sent for comprehensive opioid screening after initially testing positive for heroin.
Last year, heroin was listed as the cause of death in 38 accidental overdose deaths and fentanyl was listed as the cause in four accidental fatal overdoses, according to the annual county coroner’s report. One death was blamed on a fentanyl-heroin combination, the report said.
Fentanyl-tainted heroin returned to the public consciousness after it was suspected in at least 50 fatal overdoses in Pennsylvania, Michigan and Maryland since January, according to news reports. Vermont state police are now warning pure fentanyl is being sold as heroin, and police in Lorain, Ohio, confirmed that black market fentanyl was responsible for 23 overdoses and two deaths in November.
The federal Drug Enforcement Administration recently issued a warning to law enforcement about a circulating heroin brand that contains up to half fentanyl. The DEA is also urging first responders to use “extreme caution” when dealing with street heroin since fentanyl can sicken them if it’s absorbed through the skin.
FAUX HEROIN, REAL RISK
Fentanyl is a narcotic that is typically administered to people in chronic pain, including end-stage cancer patients. It’s also used as an anesthetic. The drug is a synthetic opioid, meaning it contains a chemical that resembles the natural morphine — or opiate — found in the opium poppy.
Opioid and opiate drugs react the same way in the brain, and they kill the same way, by suppressing breathing. Pure fentanyl is 50 to 100 times more powerful than most street heroin, which typically has a 20 percent to 60 percent purity level, Fialko said.
Chemically, the black market and pharmaceutical-manufactured drugs are identical, but that’s where the similarities end, drug experts said.
The street version comes in a powder form, but the legitimate version is manufactured only in gel patches and liquid designed for a slow release. The black market fentanyl is one-tenth the cost to manufacture as pure heroin, Fialko said.
Black market fentanyl is made outside a regulated, sterile medical lab, which means it could be contaminated and its potency level is unknown, said pharmacist Ken Dickinson. He’s a co-founder of SARPH Pa., a substance abuse recovery program for pharmacists and pharmacy students and a marketing director for Gaudenzia, a nonprofit drug treatment center.
To understand why a potentially deadly kind of heroin would attract users, it’s important to understand how the addiction manifests, drug counselors explained. The body builds a tolerance to opiates, meaning that, over time, it takes larger amounts of the drug to achieve a high or prevent painful withdrawal symptoms.
Once an opiate user starts injecting heroin, the addiction accelerates, said Ellen Unterwald, a professor of pharmacology and director of the Center for Substance Abuse Research at the Temple University School of Medicine.
“The reason that fentanyl is preferred over other opioids is because it is very potent and has a very rapid onset of action after IV administration. The more rapid the onset, the faster and more intense the high,” Unterwald said.
But that extra kick also creates extra danger, experts said.
Heroin users base a purchase on tolerance levels, and if a person usually takes a one-bag shot, but that bag is laced with fentanyl, then “they actually are doing a 10- or 20-bag shot at once,” increasing the risk of overdose, said Fialko, the prevention specialist.
Heroin dealers know their street reputations and sales are based on the product. To promote their brand stamp, dealers include one so-called “hot bag” containing fentanyl or pure heroin in every 50 or 100 bags of heroin, said Fialko. Opiate users, particularly heavy users, seek brand stamps associated with overdoses looking for the “prize” or next “great” high.
UNDER THE RADAR
There were 1,013 fentanyl-associated deaths in six states among heroin users between April 2005 and March 2007, according to the U.S. Centers for Disease Control and Prevention. In Bucks County, fentanyl-related deaths spiked to 18 in 2006, then dropped to nine the next year. At least six deaths were attributed to a fentanyl-heroin combination in 2006, according to the coroner.
The monthly death rate dropped to zero after federal agents closed an illegal fentanyl lab in Mexico in 2005, and the DEA started regulating access to a chemical used to make non-pharmaceutical versions of the drug, according to a 2013 CDC report.
At the time, the perception among drug treatment centers and law enforcement was that the deadly drug combination had disappeared, said Shane Moes, director of specialty programs at Livengrin Foundation, a Bensalem substance treatment center. But what more likely happened is that drug dealers made their product less lethal; users adjusted how much heroin they used to avoid an overdose; and/or more people were using prescription opioid drugs instead of heroin, which drug treatment centers didn’t track in admissions until recent years, Moes said.
“We were watching heroin use going down and thought that was great,” Moes added. “(Prescription painkillers weren’t) on the radar.”
One reason it likely took treatment centers so long to recognize the prescription opioid abuse phenomenon is how patients were typically assessed, Fialko and others said. Treatment providers relied on patients self-reporting their drug use and used blood toxicology screens only to confirm the presence of opiates.
And while standard drug screening tests confirm the presence of opiates, they don’t distinguish between synthetics or natural sources, pharmacist Dickinson said.
Until a few years ago, most standard drug tests for opiates checked only for morphine or codeine, Dickinson said. Consequently, a death or overdose would be listed as heroin, when it could have involved fentanyl or another synthetic opioid, which mimic morphine overdoses.
More sophisticated screening tests that looked for a large group of synthetic opiates were available, but most medical professionals didn’t seek them because of the cost, Dickinson and others said. However, with the attention on prescription drug abuse and overdose deaths, detailed toxicology tests have become more standard in recent years.
But Dickinson doesn’t believe that the surge in heroin is dropping anytime soon.
“The trend is not something that (has) peaked yet,” he said.
Posted: Friday, April 25, 2014
A convicted Bristol Township sex offender missing for nearly four years has been arrested in Montgomery County for allegedly raping a 15-year-old girl there while he was noncompliant with Megan’s Law.
|Samuel Lovelace IV as he appears today|
Norristown police arrested Samuel Lovelace IV, 29, who listed his address as Hamilton, N.J., on April 1 for multiple counts of forcible rape, false imprisonment, indecent assault on a person under age 16 and other offenses. He was sent to Montgomery County jail in lieu of $250,000 cash bail.
Bristol Township police had been looking for Lovelace since July for allegedly failing to update his sex offender registration information with state police. Lovelace had been considered noncompliant with the Megan’s Law since 2010, according to state registry records.
Lovelace is a Tier 2 sex offender, which means the state considers him a moderate risk for re-offending. He was required to appear in person at a state police registration station to update personal information, including home and work addresses, and be photographed twice a year or when he moved or changed jobs.
But the Norristown police affidavit of probable cause does not mention that Lovelace is a registered sex offender.
|Samuel Lovelace in 2010|
In the Norristown complaint — filed in September 2012 — the 15-year-old alleges that Lovelace raped and molested her four times at her home between August 2011 and February 2012, according to court records. The alleged crimes occurred when Lovelace was considered noncompliant with Megan’s Law but before an arrest warrant was filed for alleged violations.
One month after Lovelace allegedly started raping the teen, the Pennsylvania Megan’s Law Unit notified Bristol Township police that Lovelace failed to register as a sex offender, according to a probable cause affidavit filed by Bristol Township police.
When a detective went to the address Lovelace listed on his registration, he talked to his grandmother. The grandmother said he was living there, but experiencing "mental issues that would make it nearly impossible" for him to respond to the registration request.
Township police were notified again in last May that Lovelace failed to update his registration information. When a detective went to the same address, they found out he had moved.
Posted: Tuesday, April 22, 2014
Zachary Gonzalez was 3 when a drunken driver killed his dad. At the age of 9, he lost his mother to leukemia.
The Pennsbury High School freshman died Jan. 19, three days after he turned 15, when his bike was struck by a 60-year-old Bristol man who allegedly was driving under the influence of cocaine and prescription medications.
|Zachary Gonzalez on his 15th birthday|
But Brian Patterson isn’t being charged in the teen’s death. Instead, he’s facing charges of driving under the influence of a controlled substance and related offenses, according to court documents filed Tuesday. Patterson will receive a summons in the mail detailing his charges.
On Tuesday, Kelli Donlen, Zachary’s aunt and legal guardian, expressed frustration that Patterson was not charged in her nephew’s death.
“A tragic accident is one thing, but a tragic accident with drugs in your system is another thing,” she said. “That is the thing I can’t wrap my head around.”
Law enforcement referred questions on the charges to Bucks County Assistant District Attorney Matt Hoover who referred to the probable cause affidavit.
Tullytown police and the Bucks County District Attorney’s Homicide by Vehicle Task Force conducted an extensive reconstruction, but did not find Patterson at fault for the accident, according to the affidavit.
“As a result of the investigation, no chargeable violations (were) found in relation to crash causation,” the affidavit said.
Donlen said she was told by police that Patterson did not have enough time to stop before he struck Zachary, who was crossing the highway on his bike. But she is skeptical.
Zachary and two friends were riding bikes along southbound Route 13 in a construction zone around 4:30 p.m. when Zachary was struck by Patterson’s Volkswagen just below the Mill Creek Road exit, authorities said.
Zachary sustained significant head trauma and was pronounced dead at the scene, a second unidentified boy was injured and taken to St. Mary Medical Center for treatment. The third boy was not injured.
Patterson stopped his car and cooperated with police. Court documents state that Patterson had slow, slurred speech and was hard to understand when he explained to police how the accident happened. He also exhibited other signs of impairment, police said. He agreed to have blood drawn at Lower Bucks Hospital in Bristol Township for chemical testing.
When police frisked Patterson, they said they found a small, empty pill bottle that was prescribed to someone else. Patterson allegedly told police his “perc 10s” were kept in the bottle, referring to the prescription opiate painkiller Percocet.
Police executed a search warrant on his car and found “multiple pills” and five pipe-like items, according to the affidavit. A lab analysis of the items found cocaine residue on the pipe and the pills tested positive for oxycodone and zolpidem, a prescription sedative.
Police allege Patterson, while at police headquarters, repeatedly requested to return to his car to get his “oxys.” But when they asked if Patterson had a prescription for the pain drugs, he reportedly told them he didn’t.
Blood test results found that Patterson had diazepam, nordiazepam, cocaine and benzoylecgonine in his system at the time of the accident, according to the affidavit.
Zachery’s 47-year-old father, Reinaldo “Ray” Gonzalez, was struck and killed by a 32-year-old Philadelphia man who was intoxicated along State Road in Philadelphia in 2002.
Six years later, death visited Zachary again, when his mother, Joanne Donlen Gonzalez, was admitted to the hospital with suspected pneumonia, but was soon diagnosed with leukemia. She died three days later, Kelli Donlen said.
“He was only 9 years old and his mom was his best friend,” Donlen said. “He was very close to his mom. That is what gives me peace. I know he’s with his parents.”
After his mom’s death, Zach went to live with Donlen and her husband — Joanne Gonzalez’s brother — in their Falls home. She said he was a work in progress, still reeling from losing both parents before turning 10.
“Zach was very quiet and reserved in the beginning, but the last year he came out of his shell,” Donlen said.
He had many friends — more than 300 people attended his funeral. He loved wrestling, and he was a member of Pennsbury’s junior varsity wrestling team. Zach loved riding his long board, video games and science.
He was a voracious reader who loved the “Divergent” and “Game of Throne” series, Donlen said, adding she donated 60 books from Zach’s collection to the Gift of Life organ transplant program. Zach was also looking forward to becoming an uncle, she said.
“He was truly a good kid. He had so much to offer,” Donlen added. “He touched a lot of lives in good ways.”
The day before he was killed, Zachary returned from a Disneyworld trip to celebrate his 15th birthday. Kelli Donlen took him and a friend for the four-day adventure, where they rode all the theme park rides, hung out at the pool, and experienced Disney Quest on his Jan. 16 birthday.
About a week after Zach’s death, Donlen said she found a rough draft of a school project in his bedroom. It was his autobiography. In reading it, Donlen found out many things she didn’t know about her nephew.
He expressed an interest in pursuing a career in the health care field, said Donlen, who is a nurse. She also learned just how much her shy nephew really appreciated and loved his family. Among his long-term goals was buying his first house at age 23, and starting a family at age 24.
He listed his values as education, achievements, wealth and family, she said.
While she is still in mourning, Donlen vows to attend every one of Patterson’s court appearances.
“This man can look me in the face and see what he has taken from me. I have a lot of questions,” she said. “This man needs to be responsible. That will always nag at my brain if he hadn’t been impaired would he have seen Zach.”
Monday, April 21, 2014
Posted: Monday, April 21, 2014
More than a year after being involved in a fatal one-car accident, a 51-year-old Bristol man was charged with homicide while driving under the influence.
Wyckoff never made it to the bar, though. Police say his Hyundai hit a concrete barrier, jumped a guardrail along southbound Route 13 near the Tyburn Road exit and flipped several times before landing in Martins Creek around 11:30 a.m.
Wyckoff’s front seat passenger, Steven Carroll, 57, of Trenton, was fatally injured and pronounced dead later that day.
One witness told police she first noticed Wyckoff’s car as she yielded onto southbound Route 13 from the northbound Route 1 exit. His car was changing lanes, slowing down and then speeding up, she said in the affidavit.
Through her rearview mirror, she saw the car strike the concrete barrier, court records show.
After striking the barrier and then hitting the guardrail, the car went airborne, the witness claimed. The Hyundai then landed nose down and flipped over two or three times before stopping on the opposite side of the creek, partially submerged in the water, according to court documents.
Another witness traveling south on Route 13 reported that Wyckoff’s car was traveling “too slow” for the highway, estimating its speed as under 50 mph, the affidavit said. The second witness also said he saw Wyckoff’s car in his rearview mirror shoot across the highway from the right to the left lane and strike the concrete barrier, police said.
After striking the barrier, the witness said the car returned to the right lane at a high rate of speed and passed his car, coming within feet of hitting it, court documents said. Wyckoff’s car then hit the guardrail and went over it, police said.
At the time of the accident, Wyckoff had told police that he was cut off while traveling south on Route 13, police said.
Wyckoff showed signs of possible intoxication after the accident and submitted to blood tests, which showed his blood alcohol level was .153, almost twice the legal limit for drivers, police added. He also had marijuana metabolites in his system, they said.
Wyckoff was arraigned late Sunday night on charges of homicide by vehicle while under the influence, homicide by vehicle, driving under the influence and related misdemeanor and summary traffic violations. He was sent to Bucks County prison in lieu of 10 percent of $50,000.
Posted: Sunday, April 20, 2014
The search for a boater who slipped below the surface of the Delaware River on Friday afternoon is now considered a recovery mission, with the U.S. Coast Guard is joining marine units from Bucks, New Jersey and Philadelphia.
John J. Poltonowicz, 49, of Bristol, reportedly fell overboard around 1 p.m. not far from the Second Avenue boat ramp at Neshaminy State Park in the Croydon section of Bristol Township. New Jersey State Police identified the man Saturday night.
Witnesses say Poltonowicz was jumping wakes caused by a northbound tugboat when he lost his balance and fell from the boat into the murky water, Bristol Township police’s acting Chief John Godzieba said.
Croydon Fire Co. Chief Tom Tryon said Saturday his firefighters and boats from Croydon and several other companies spent three hours searching for Poltonowicz.
|Marine units search for missing boater on Delaware|
“We called it off about 5:30 p.m. Friday and went out early Saturday. The state police were using sonar to assist us,” the chief said.
Trooper Jeffrey Flynn of the New Jersey State Police said authorities will not resume using sonar or undertake any further dive missions to locate Poltonowicz.
He said patrols will continue to look for the man on their routine patrols of the river.
Tryon added firefighters were scheduled to go out Saturday night, but will not search on Easter Sunday.
Witnesses said the man was not wearing a personal flotation device. No one else was on the boat.
The unmanned motorboat circled in the river for about 20 minutes before it ran out of gas, Godzieba said. The New Jersey State Police Marine Unit took custody of the boat, he said.
Marine rescue and recovery units from Lower Southampton, Croydon and Philadelphia participated in the search, but divers were not put into the water because of swift currents.
The search area was described as spanning the river between the Second and Fourth avenue boat ramps in the state park.
The area of the river where Poltonowicz is believed to have gone overboard is near a channel that is 45-feet deep, Godzieba said.
Witnesses who were fishing nearby described the missing man as white, about 250 pounds and wearing tan shorts, Godzieba said.
Posted: Thursday, April 17, 2014
The burglary suspect who broke into a Bensalem home in November didn’t leave police much to work with. The only evidence was the blood droplets near a broken window.
The case appeared unsolvable — that is until the blood sample collected at the scene was run through the Bensalem Township Police Department’s burgeoning DNA database.
The sample matched the DNA of Croydon resident John Sobolewski, who Bensalem had arrested two months earlier on an outstanding warrant. Bensalem had taken a sample of Sobolewski’s DNA when he was in custody and entered it into its private DNA database. He is now awaiting trial in the burglary in Bucks County Court.
Sobolewski is what police call a “blind hit,” when a suspect is developed based solely on DNA. He was among six "blind hit" criminal suspects Bensalem was able to connect with unsolved crimes last year while piloting a first-of-a-kind initiative that generates DNA results in 90 minutes.
“Anytime you can stop a criminal from committing a crime that much earlier is a good day in law enforcement,” Bensalem Director of Public Safety Fred Harran said Wednesday.
While fingerprints once were the gold standard for crime-solving, law enforcement has added routine DNA testing to its arsenal. Police enter biological samples taken from crime scenes into a DNA database. If it generates a matching profile, an individual cannot be ruled out as a suspect. But police still need a DNA sample from the individual to test and confirm a match.
The Bensalem Police Department was the first in Bucks County to contract with a private lab to generate a local DNA database in 2010, but now 15 Bucks police departments are poised to join them soon.
“We’re jumping on their coattails and following them right in,” said Warminster police Chief James Donnelly Jr., whose department is among those participating.
The towns, which represent about 25 percent of Bucks’ 48 police departments, formed the Central Bucks County Special Response Team consortium to defray the costs of the private lab DNA analysis, Donnelly said. The consortium has contracted with Bode Technology, the same private Virginia forensic lab Bensalem Township Police Department uses. The DNA samples collected will be added and compared to Bensalem’s DNA database, which has more than 7,000 samples.
Police officers in the participating departments are undergoing training on DNA collection at crime scenes, and Donnelly anticipates that as soon as May 1 the first consortium DNA samples could be sent for processing.
“We would love this to be a county initiative in conjunction with the (District Attorney’s) office,” Donnelly added. “The same people who do property crime in Warminster do the same type of crime no matter where they go.”
The Bensalem Township Police Department added nearly 600 new DNA samples — as many as 56 samples a day — to the database started in 2010 during a 30-day DNA testing program through Bode. Bensalem was the first U.S. local law enforcement agency to participate in the Bode pilot.
The 587 samples analyzed during the month-long pilot broke down to 342 samples taken from crime scene evidence and 245 reference samples from people, Harran said. The samples assisted in 15 criminal investigations that were cleared to arrest, Harran said, adding that one investigation could involve multiple crimes.
Eight suspects arrested were connected to multiple unsolved crimes dating back to early 2012, Harran added.
A unique aspect of the rapid DNA program is that it can test DNA directly from crime scene evidence while other available rapid tests can process only reference samples from an individual.
While Harran is calling the rapid 90-minute DNA testing program a success, for now the township will stick with its 30-day turnaround program through Bode. He added that the department is evaluating and researching potential funding to implement the 90-minute turnaround model.
In November, Harran estimated the cost of creating a testing lab in Bensalem headquarters, where samples could be processed and analyzed, at $100,000 for equipment and $100 per sample to process.
The 30-day turnaround time is still far faster than DNA tests run by state labs, which can take a year or longer to process results involving minor crimes, such as burglary or theft.
State forensic labs put a priority on processing samples involving violent crimes such as rape and murder. Property crimes such as theft and vandalism are considered low-priority, though they are far more prevalent than violent crimes in most communities.
State police use the Combined DNA Index System, better known as CODIS, a type of a national DNA database. More than 11 million DNA profiles are in CODIS including 300,000 in Pennsylvania alone, according to the Pennsylvania State Police.
In Bensalem, DNA has played a role in more than 150 criminal investigations, most involving drug or property crimes. Since the township initiated its more aggressive DNA testing program, property crime has steadily declined, including a 47 percent drop in burglaries between 2012 and 2013, Harran said.
Monday, April 14, 2014
Posted: Saturday, April 12, 2014
Did You Know?
Some people call it a resurrection drug, able to reverse a heroin or other opiate overdose almost immediately. Others describe it as an enabling drug, which encourages addicts to continue using dangerous legal and illegal painkillers.
The drug is Naloxone — better known by the brand name Narcan — which binds to the opioid receptors in the brain and reverses the drug’s effect within minutes, stopping a potentially fatal overdose.
Narcan is described as a cheap, effective, safe drug with no abuse potential and easy to use, though in Pennsylvania only paramedics and registered nurses can administer it.
But a bill now on House floor would expand access of the prescription drug to first-responders, as well as opioid users and their family and friends.
A push is underway to improve emergency medical access to Narcan, as opiate overdose deaths continue to climb in the state and nation. But questions remain about training and liability, as well as a part of the legislation that would provide limited legal immunity for people who seek medical attention for a suspected drug overdose.
Lower Makefield police Chief Ken Coluzzi organized a meeting Thursday with local emergency medical responders, department officers and a representative for state Rep. Steven Santarsiero, D-31, to discuss the bill. Coluzzi supports expanding availability of the drug.
|Paramedic Dennis Wallace demonstrates Narcan|
“This is more than a public safety issue. It’s a public health crisis,” Coluzzi said. “It’s frustrating to have family members tugging on you to do something. In this day and age, why wouldn’t tools like this be available to us?”
The rate of fatal overdoses in the U.S. has tripled since 1991, and opioid-related drugs, particularly painkillers, account for most of the increase, according to a National Association of State Alcohol and Drug Abuse Directors' report released last year.
The Centers for Disease Control and Prevention in Atlanta estimates that U.S. programs for drug users and their caregivers that prescribe take-home doses of Naloxone and provide training on how to use it have prevented 10,000 opioid overdose deaths.
In 2001, New Mexico became the first state to change its laws to make it easier for medical professionals to prescribe and dispense Naloxone and for non-medical personnel to use it without fear of repercussions. As of last month, 17 other states, including New Jersey, and the District of Columbia have made similar changes.
In 2009, Massachusetts' fire and police departments participated in a department of health pilot program that distributed Naloxone to friends and family of opiate addicts. Since then, one study found that police intervention reversed 239 or 250 overdoses using Narcan.
Another recent evaluation of a Massachusetts' program, which trained more than 2,900 potential overdose bystanders, reported that opioid overdose death rates were significantly reduced in communities that had the program compared to those without it, according to NASADAD.
Under Pennsylvania’s House Bill 2090, doctors and pharmacists would be authorized to prescribe and dispense the drug to law enforcement personnel, firefighters, and persons at risk, along with their friends, family members and others in a position to help them. It would also expand the EMS providers access to the drug.
Educational materials and mandatory training would also be provided on how to identify an overdose, administer the drug and seek further medical help.
Pennsylvania prescribers who dispense Naloxone in good faith would be immune from civil, criminal and professional disciplinary liability, and people seeking medical help for someone experiencing an opioid overdose would also be immune from criminal liability.
Generally, opiate-related overdoses can take hours as opioids gradually depress respiration until a person stops breathing, according to the NASADAD. What Naloxone does is immediately tell the brain to tell the body to start breathing again.
The drug can be injected intravenously for fastest results — within a minute, but a nasal atomizer is more commonly found outside medical settings. The nasal spray, which works within minutes, is what community first responders and the general public typically use.
Dennis Wallace, deputy chief of the Yardley-Makefield Emergency Unit, says paramedics in his squad use Narcan less than a dozen times a month, but when they do the effects are fast and successful. The cost is relatively inexpensive: $25 for a one-dose kit.
|Nasal mist form of Narcan is most commonly used|
But the drug has limitations. It should be administered only to an unconscious person and it doesn’t stop the effects of non-opioid drugs such as cocaine and crystal methamphetamine, Wallace and others said.
The effects are also temporary. Once administered Naloxone lasts only 30 to 90 minutes so a possibility exists that it could wear off before the opioid, triggering another overdose.
Generally, Naloxone has few side effects with the most common being vomiting, which means airway management is critical to prevent aspiration or choking, Wallace said.
Another potential drawback is that patients can become combative once the overdose is reversed, especially if they have other drugs in their system and their effects are enhanced once the opiate is ineffective, said Scott Bahner, chief of the Bucks County Rescue Squad, which serves Bristol Township and Bristol. He estimates his paramedics respond to five to 10 overdose calls a month, and at least half are opiate-related.
For Bahner, the biggest issue with wider availability of the drug is not how it’s administered, but how police and others would get access to the drug and making sure it is properly stored. Improper storage of the drug renders it useless.
Lower Makefield Detective John Campbell, also a trained paramedic who attended the Coluzzi meeting, pointed out that Narcan would be especially helpful with a more potent heroin cut with the prescription painkiller Fentanyl, which has recently appeared in the area.
“You just stick it in their nose and squeeze,” he added. “It’s almost idiot proof.”
Generally, House Bill 2090 has broad support among Pennsylvania lawmakers, but what has stalled the legislation is its Good Samaritan provision, said Rosemary Wuenschel, chief of staff for Santarsiero.
Some representatives fear that the immunity clause makes them appear soft on drug enforcement, she said.
The Good Samaritan laws provide immunity for overdose victims and witnesses who “act in good faith” to seek medical assistance and they generally cover only minor drug offenses discovered as a result of a person seeking medical assistance. Currently 14 states and Washington, D.C., have Good Samaritan laws in place.
New Jersey amended its law last year to expand availability of Naloxone and protect individuals who in “good faith” summon help from arrest or prosecution of minor drug offenses, including possession, use or obtaining a controlled substance.
The law also protects the individual who overdosed, but it does not provide immunity to drug dealers, or from prosecution for drug-induced death or driving while under the influence.
Initial evidence from states that have enacted such a law suggests an increase in reporting of suspected overdoses. Washington State, which amended its law in 2010, found 88 percent of drug users surveyed said that they would be more likely to summon emergency personnel during an overdose as a result of the change.
Among local first responders, support for the expanded use of the drug is mixed.
“Anything we can do to help save lives,” Northampton police Chief Michael Clark said, adding he is investigating how much training would be required. “It sounds like a life-saving asset.”
Bristol Township police's acting Chief John Godzieba said he’s seen Narcan in action and calls it a “tremendous lifesaver.” He added that Bristol Township police are trained and equipped with other lifesaving devices such as automatic defibrillators.
“As police officers, we’re often the first part of the emergency response chain to arrive on scene and having a vital tool to save a life is important,” Godzieba said. “With the right tools and the right training, we can continue to save lives.”
Northampton Fire Department Chief Adam Selisker, too, has seen Narcan save lives. He agreed that providing the drug to firefighters sounds like a good idea, as long as there is proper training, but he was more lukewarm on giving non-first responders access.
Newtown Emergency Management Coordinator Glenn Forsyth sees the benefit in expanding access to EMS workers and firefighters, but is hesitant about the idea of saddling police with more work.
“I kind of have mixed feelings telling the cops this is another job they have to do,” said Forsyth, a former Newtown Township police officer.
Upper Southampton police Chief Ron MacPherson is among those who believe expanding access to the drug sends the wrong message to drug abusers. “It is giving them a false sense of security that if you overdose, Narcan will be more accessible to first responders who might be able to save you.”
Bensalem Director of Public Safety Fred Harran is investigating the feasibility of providing Naloxone and recently attended a doctor presentation on its use. His department responds to at least one to two dozen drug overdoses a month, nearly all of them opiate-related.
Harran said his reluctance about the law involves potential liability issues, especially since it only temporarily reverses overdoses.
“My concerns are, what happens when a person who refuses medical attention and they’re in police custody and we put them in a cell and they die a half hour later,” he said. “There are some unanswered questions.”
States that have expanded availability of Naloxone*
New Mexico, New York, Illinois, Washington, California, Rhodes Island, Connecticut, Massachusetts, North Carolina, Colorado, Oregon, Virginia, Kentucky, Maryland, Vermont, New Jersey, Oklahoma, Ohio, and the District of Columbia
States with Good Samaritan laws providing limited immunity for seeking medical attention for drug overdoses*
New Mexico, Washington, New Jersey, New York, Connecticut, Illinois, Rhode Island, California, Massachusetts, California, North Carolina, Vermont, Colorado, Florida, Delaware and the District of Columbia
*As of March 15, 2014
Source: National Association of State Alcohol and Drug Abuse Directors