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Naloxone can reverse a heroin overdose, but only if it's available

A shot in the dark

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It's become increasingly evident that North Carolina is in the throes of a heroin crisis that's intensifying each day.

It's an epidemic that can't be ignored, and fortunately our state doesn't intend to turn a blind eye. In the past two years, North Carolina has passed meaningful laws to prevent opiate overdose deaths. These include expanding access to naloxone and enacting "911 Good Samaritan" legislation that protects both the victim and caller from prosecution during an overdose emergency.

All too often, first responders aren't called to an overdose scene as it's happening because those who witness it fear criminal prosecution. That's where the 911 Good Samaritan law comes in. It states individuals who experience a drug overdose or witness one and seek help for the victim cannot be prosecuted for the following offenses: possession of small amounts of most drugs, possession of drug paraphernalia, underage drinking or possession of alcohol, parole or probation violation.

The law is intended to remove the fear of legal repercussions for calling 911 to report an overdose, and instead focus on getting help for the victim. In order to qualify for the immunity from prosecution, the caller must give their name to law enforcement.

The law also removes criminal and civil liabilities from doctors who prescribe naloxone and bystanders who administer it. Naloxone is a medication used to reverse the effects of an opioid overdose. It is the same idea as the adrenaline shot used in the infamous Pulp Fiction scene, but actually operates much differently. Usually, naloxone is injected into a muscle on the arm or thigh.

By law, anyone in North Carolina who uses naloxone to reverse an overdose is immune from civil and criminal liability. The law allows some community-based organizations to dispense the drug under the guidance of a medical provider. Some provide overdose reversal kits for addicts and their loved ones that include naloxone vials, syringes, rescue breathing masks and alcohol pads.

Police are often the first responders on the scene of an overdose. Having the ability to reverse the overdose and fight off death in those crucial minutes is a game-changer. In March, Greenville police reversed four overdoses within a 24-hour period.

As of June, 16 police departments across the state were carrying naloxone and another 26 were developing programs to carry this antidote for opiate overdose.

While equipping law enforcement and first responders with naloxone and making it widely available to those at risk of an overdose may seem like a no-brainer to some, others think it may not be such a good idea. Some EMTs have publicly questioned whether or not police have enough training to recognize an overdose. They say they fear untrained police may use naloxone when it's unnecessary.

In actual cases of overdose where naloxone is administered, the rapid withdrawal from opiates can make the victim react irrationally – sometimes violently – and police are likely to respond with force.

Others who oppose widely-accessible naloxone are critics who say increasing access to it will encourage drug users to go harder, knowing they have this life-saving trump card in their back pocket at all times. Of course, there's no data to suggest this is true.

"Folks get a lot of hell for providing these kits," said Heather Alexander, a recovering addict who is helping organize an awareness concert called Heroin Kills on Dec. 11. "Yes, there are people who take advantage of it. Yes, there are people who continue to OD, but the ones that do get a second chance at life and then start recovery, that's what its all about."

What could end up being the biggest barrier to naloxone accessibility is cost. As the heroin epidemic continues to wreak havoc in the U.S. and across the western world, demand for the overdose antidote has increased exponentially, driving up the price.

Pharmaceutical companies that manufacture naloxone initially made donations of it to select police departments and treatment centers. To continue its use by police and other community first responders, it must become a budgetary line item. That's according to the NC Harm Reduction Coalition, which issued a report on the use of naloxone for the FDA. It highlighted budget efforts by the State of New York, which allocated five million dollars in civil asset forfeiture funds to purchase naloxone and fund training for 150 departments.

The report, released in June, surveyed police officers across North Carolina and found that 90 percent of respondents were willing to carry naloxone on the job and nearly 89 percent thought all fellow law enforcement officers should.

Presumably, the most likely cause of such high support among officers is the thought of being the first to arrive on the scene of an overdose without a supply of the antidote and having to watch the victim die, knowing it was possible to save their life, if only they'd been given the tool to do so.

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