Stories written by Jo Ciavaglia, award-winning multimedia newspaper reporter at the Bucks County Courier Times in Bucks County, a suburb of Philadelphia, Pa.
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Monday, April 14, 2014
Push is on to expand use of overdose drug
Posted: Saturday, April 12, 2014
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