Initial results from evaluation of Washington State's "911 Good Samaritan Law"

Washington State passed an overdose bill granting immunity from drug possession charges for those who witness or experience an overdose if help is sought AND granting legal and professional immunity to those who prescribe, dispense, purchase, possess, administer, or use naloxone with the intent to reverse opioid overdose.

Dr Caleb Banta-Green, of the University of Washington Alcohol and Drug Abuse Institute, headed up an evaluation of this law, with an emphasis on the "Good Samaritan" component that protects from drug charges. The study is funded by a grant from the Robert Wood Johnson Foundation to look at the law's legal intent, implementation, and outcomes. This is the first such evaluation of this type of law in the United States.

The study will ultimately include evaluations of behavior change among drug users, police, and paramedics during heroin overdoses, the legal intent of the law through document reviews and interviews with legislators and other stakeholders, and changes in the rates of opioid overdose (fatal and non-fatal), 911 overdose call volume and severity, and naloxone administration by lay persons and medical professionals.

Dr Banta-Green has released a preliminary report including legal intent and baseline beliefs, knowledge, and behaviors.

Disclaimer: I am one of the co-investigators on this study.

Pubmed November 2011 Update

Some good stuff this month...

1) Vital signs: overdoses of prescription opioid pain relievers --- United States, 1999--2008

MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60:1487-92.

Comment: This report summarizes the impressive outbreak of death from opioid analgesics (around 15,000 in 2008) in the United States - providing a helpful state-by-state breakdown.

2) Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia

Marasovic Susnjara I, Definis Gojanovic M, Vodopija D, Capkun V, Smoljanovic A.

Croat Med J. 2011 Oct 15;52(5):629-36.

Comment: Authors developed an interesting association of war and post-war periods with increased overdose deaths, the majority of which were due to heroin and half of which involved multiple drugs. Authors hypothesize that the reason for this increase is due to social instability and increased drug supply.

3) Pilot scheme shows that giving naloxone to families of drug users would save lives

Hurley R.

BMJ. 2011 Aug 25;343:d5445. doi: 10.1136/bmj.d5445. No abstract available.

Comment: A brief summary of the pilot program at drug treatment programs in England. 495 "carers" (generally family members) were trained and a subgroup (number not in the text) were also given naloxone in 2009 and 2010. Twenty ODs were witnessed and naloxone was given in 18 of those; all survived. These are important results, particularly in two settings: 1) regions where drug users frequently live with family, and 2) settings such as abstinence-based treatment or youth programs where there might be reluctance to provide a drug user with naloxone.

4) Naloxone pro-drug rescues morphine induced respiratory depression in Sprague-Dawley rats.

Wallisch M, El Rody NM, Huang B, Koop DR, Baker JR Jr, Olsen GD.

Respir Physiol Neurobiol. 2011 Oct 19.

Comment: I don't usually include animal studies, but this was intriguing. Authors developed a depot pro-drug of naloxone that is released in the setting of hypoxemia - that is, when there's a low-level of oxygen in the blood naloxone is released, reversing the (presumed) opiate effect.

5) A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death.

Paulozzi LJ, Kilbourne EM, Shah NG, Nolte KB, Desai HA, Landen MG, Harvey W, Loring LD.

Pain Med. 2011 Oct 25. doi: 10.1111/j.1526-4637.2011.01260.x.

Comment: Our understanding of opioid analgesic deaths is so poor for many reasons - most notably it is hard to study this population because they are hidden. The authors here used a case-control design (I can't access the full article and their methods are not so well-described in the abstract) to identify risk factors for death. They found receipt of prescriptions for selected opioids and >40mg morphine equivalents daily to be substantial risk factors for overdose death. This is consistent with earlier studies.

News: Toronto now distributing naloxone kits (with bad instructions?)

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.