Monday, December 12, 2011
Monday, December 5, 2011
That’s why a promising state pilot program that gets a life-saving overdose-reversal drug called naloxone into the hands of friends and relatives of opioid addicts should be expanded to more communities. At the same time, more first responders should carry the drug, often known by the brand name Narcan, and state and federal authorities should relax the restrictions preventing wider public access.
Since 2007, the naloxone pilot program at eight sites across the Commonwealth is credited with reversing more than 1,100 overdoses. The drug, which is squirted into the nose of overdose victims, revives them for 30 to 90 minutes, long enough to get them to an emergency room.
Naloxone is not a new drug, but had previously been confined mostly to hospitals. When the state’s program started, critics worried it would be difficult for nonprofessionals to administer naloxone - or worse, that providing it would be tantamount to official acceptance of drug abuse. But the results speak for themselves:
In Lynn, one of the pilot sites, the number of reported deaths from accidental opioid overdose fell from 22 in 2006 to only 8 in 2008. In four years, according to state statistics, naloxone distributed in Lynn was used to reverse 166 overdoses. Statewide, the program cost only $170,000 this year.
The success of a program that relies on non-professionals - and of similar programs launched in other states over the last decade - ought to prod state and federal authorities to ease some of the needless restrictions on access to the drug, which is not addictive and has no potential for abuse itself. A bill introduced this year in the Massachusetts Senate would allow doctors to write prescriptions to friends or family members of addicts; it deserves the Legislature’s support. On the federal level, the Food and Drug Administration should study whether naloxone could safely be sold over the counter, as it is in Italy.
Meanwhile, as the results of naloxone programs become clear, grass-roots pressure is growing to find other ways to get more of the drug on the streets. Last year, for instance, a group of mothers of opioid addicts pushed Quincy police to carry naloxone, leading to 45 overdose reversals since June 2010. But few other first responders carry naloxone. This makes little sense. Opioid overdoses rank with car crashes as the leading causes of accidental death in the state. There is no reason why front-line public safety officers shouldn’t be fully equipped for them.
Even if more first responders carry naloxone, the reality is that the person squirting naloxone will often be a fellow drug user. Too often, though, fellow users fear arrest and don’t take the critical next step after administering the dose - calling 911. (After the effects of naloxone wear off, a person can go back into overdose if they don’t get help.) New Mexico, New York, and Washington have all passed good Samaritan bills that would protect people who call 911 to report drug overdoses; similar legislation has been introduced in both the Massachusetts House and Senate, and should be approved.
The families of addicts often carry a heavy load, boxed in by stigma and shame, and shadowed by the constant fear that a loved one could die with the next stronger-than expected bag of heroin. Naloxone isn’t a miracle drug, and it doesn’t eliminate addiction. But greater access to naloxone would empower families, provide hope - and save lives.
Saturday, December 3, 2011
Thursday, November 24, 2011
Tuesday, November 8, 2011
Monday, November 7, 2011
|A Toronto overdose kit|
Good news from the great city of Toronto, where the city launched an overdose education and naloxone distribution program in October. Here's the full story from the CBC. As Toronto harm reduction pioneer Raffi Balian says in the article, "to have this product, which can reverse an overdose right away, is an amazing thing. I know it works because I have brought people back from overdoses at least three times and one person twice."
A couple things stuck out from the article though. First, have a look at the photo, which appears to show the contents of kits distributed by the city. The instructions on the pocket card are a little questionable, including direction to do chest compressions and no mention of airway management or rescue breathing. Second, the article has Shaun Hopkins, a Toronto needle exchange manager, saying that naloxone costs the city $8 a dose. Producers have been jacking up prices far and wide over the past couple years, but is Toronto getting ripped off? Comments and clarification from OPA's Toronto readers will be very welcome.
Thursday, October 20, 2011
The whole issue is worth reading. It starts off with an article by OPA's own Dan Bigg on overdose as a fundamental, uniting issue in harm reduction. Other pieces present an overview of what we know about overdose in a region that stretches from the Afghan border to the heart of Europe, stories by people who have been saved from overdose by naloxone or used it on others, a story about a great overdose project in Tomsk, Russia, and much more.
Monday, October 17, 2011
Friday, October 7, 2011
So the whole thing is worth a read, but on OPA we'd like to highlight the report's findings related to overdose. Among people interviewed for the report - all current methadone patients - 10% had experienced overdose themselves in the past 2 years, 20% had been with someone who had overdosed, but 70% of them had no overdose education or naloxone access through their methadone program.
This is changing. Not long ago I spoke with some folks from the Beth Israel Medical Center methadone program (New York's largest methadone provider), who had recently started ramping up overdose education and prescribing naloxone. But VOCAL's report is an important reminder that programs need to move, and now.
Wednesday, October 5, 2011
Feedback-regulated Naloxone Delivery Device to Prevent Opiate Overdose Deaths
(Fast-Track proposals will be accepted)
Number of Anticipated Awards: 1
Budget (total costs): Phase I: $150,000 for 6 months; Phase II: $1,000,000 for 2 years
It is strongly suggested that proposals adhere to the above budget amounts and project periods. Proposals with budgets exceeding the above amounts and project periods may not be funded.
Drug overdose is currently the second leading cause of unintentional death in the United States, second only to motor vehicles crashes. The population at risk for opioid overdose is diverse and includes, for example, more than 3% of U.S. adults currently receiving long-term opioid therapy for chronic noncancer pain, in addition to drug/substance abusing population. Opioids are now more often being prescribed for patients with moderate to severe pain.
Thus, effective measures that would prevent/avert opioid overdoses are needed as overdoses and death often occur inadvertently in private settings where no one is present to offer assistance. Furthermore, patients with opioid addiction are prone to overdose on injected opiates or on excessive oral doses of opioid medications. These overdoses also often happen when no help is available and patient’s lives are at risk.
The objective of this project is to develop an automated device that would administer standard doses of naloxone to a patient in overdose, thus reversing the effects of excess opiate. Naloxone has been used for decades in medical settings to avert opioid overdose, and recent pilot programs demonstrated the feasibility of proper use of naloxone by non-medical personnel. Patients expressing physiologic signals of opiate overdose (e.g. hypoxia, respiratory rate below a critical threshold for a critical period of time, etc.) could be administered an appropriate dose of naloxone even if unconscious. Due to the short duration of action of naloxone, the unit should be capable of repeating the injection after resetting itself and detecting another set of critical information.
There are more than 300,000 heroin users, nearly 5 million prescription opiate users, plus millions of chronic pain patients receiving end-of-life opiate analgesic pain care. The number of poisoning deaths and the percentage of these deaths involving opioid analgesics increase each year. From 1999 through 2006, the number of fatal poisonings involving opioid analgesics more than tripled from 4,000 to 13,800 deaths. Potentially, everyone who has been prescribed opioids, for pain or addiction, and heroin users, could be offered this device by their treatment provider who may be an addiction specialist, primary care physician or pain doctor. There is a crucial need to provide this device to these populations to prevent unintended overdose and deaths and to address public health need.
Phase I Activities and Expected Deliverables
Design the prediction algorithm for opioid overdose requiring the intervention and establish the endpoints for algorithm development
Design and assemble a prototype of detectors, injector and supporting hardware
Propose a strategy to prevent un-indicated use, such as in a person who is unresponsive due to the reasons other than an opioid overdose
Field-test the prototype with focus group participants.
Phase II Activities and Expected Deliverables
Conduct the initial clinical testing in appropriate user population which is sufficiently powered to adequately inform Phase II
Develop detailed plans for initial production model with cost projections
Plan regulatory approval strategy
Establish an FDA-compliant system
Conduct clinical testing necessary for FDA approval.