By: Marcus J. Hopkins, Blogger
For the past two weeks, HEAL Blog has covered various issues related to Harm Reduction and opioid abuse, but not much attention has been given, on our part, to what happens when using injection drugs goes awry and results in an overdose. This is where two specific Harm Reduction methods – Good Samaritan laws and expanded access to the opioid antagonist, Naloxone – come into play.
Good Samaritan laws are ones that provide legal protection to people who provide reasonable assistance to people who are, or whom they believe to be, injured, ill, in peril, or otherwise incapacitated. As it relates to drug overdoses, Good Samaritan laws allow bystanders, medical professionals, or anyone, really, to treat an overdose victim using reasonable methods – such as the application of Naloxone for opioid overdoses – without fear of being later prosecuted, should the person survive and decide, for whatever reason, to sue the person who performed the life saving measure.
Naloxone, itself, is referred to as an “opioid antagonist” – a drug medication that counteracts life-threatening depression of the central nervous system and respiratory system, allowing the overdose patient to breathe normally. It’s also a nonscheduled (i.e. – non-addictive) prescription medication (Harm Reduction Coalition, n.d.), meaning that there is no chance of becoming addicted to the drug. It can be delivered via injection into the muscle, vein, or under the skin, or, more commonly, by nasal spray. The latter application, under the product name “Narcan,” is the generally preferred method of treating overdose victims.When discussing “expanding access to Naloxone,” we’re speaking of more than simply making it more readily available; we’re also discussing how it can be procured, not only by medical emergency personnel and authority figures, but by minimally trained people, which can include essentially anyone, from family members to neighbors to your local postal worker. In fact, CVS pharmacy locations have made Narcan available without a prescription (over the counter, essentially) in 22 states (Thurston, 2016), allowing virtually anyone to procure the overdose cure with minimal hassle, and minimal cost.
Cost is, of course, an issue that must be dealt with, whenever we speak of medical treatments. While Naloxone is relatively inexpensive – depending on the location, between $20-$40 a shot (and in some cases, $6/dose with rebates) – the increased and increasing demand for the drug has cause some drug manufacturers – Amphastar Pharmaceuticals, in particular – to increase their prices to meet the cost of production, raw materials, and labor. Amphastar makes the naloxone most widely used by health departments and police, and is currently the only manufacturer that makes naloxone in a dosage that can be administered nasally (All Things Considered, 2015).
Naloxone, however, is not a panacea, for all its potential live-saving benefits. While the increased availability of Naloxone does translate into more overdose victims being saved, it may not be able to keep up with the increase in opioid and heroin abuse. In Louisville, KY, for example, 40 people in the metro area have died from a drug overdose as of March 21st, 2016, whereas that number was 31 in 2016 (Mora, 2016). While these numbers will, of course, fluctuate from year to year, Jefferson County (where Louisville is located) has the highest overdose rate in the state; Kentucky, as a whole, has the third highest rate in the nation.
In addition to the concerns about increasing opioid abuse levels, areas that are hardest hit by opioid addiction (and thus require larger amounts of Naloxone) may find themselves unable to keep up with the cost of treating patients. Opioid addiction and overdose rates continue to soar in suburban and rural areas, where financial resources may already be taxed by the basic functions of governance. Rural areas, in particular, face significant issues outside of just the cost of procuring doses – reaching and delivering naloxone to far flung overdose patients requires additional resources, both in terms of human and transportation resources.
While the increased access to Naloxone and Good Samaritan laws protecting those who use it are undoubtedly a good thing, they are only two parts of the Harm Reduction stratagem. Without additional efforts, such as Doctor Shopping Laws, Mandatory Prescription Drug Monitoring Programs, and Federally- and state-funded recovery services, we will continue to struggle with the growing opioid and heroin abuse epidemic. As Louisville city councilman stated, “I don’t think we’ve seen the worst of our heroin or opioid problem; I think we’re still in an upward trajectory” (Mora).
All Things Considered. (2015, September 10). Price Soars For Key Weapon Against Heroin Overdoses. National Public Radio: All Things Considered. Retrieved from: http://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses
Harm Reduction Coaliation. (n.d.). Understanding Naloxone. New York, NY: Harm Reduction Coalition. Retrieved from: http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/
Mora, C. (2016, April 04). Opioid overdose deaths increase, despite naloxone prevalence. Louisville, KY: WLKY News. Retrieved from: http://www.wlky.com/news/opioid-overdose-deaths-increase-despite-naloxone-prevalence/38859616
Thurston, J. (2016, March 31). CVS locations in Vermont to sell naloxone without prescription. Colchester, VT: WPTZ New Channel 5. Retrieved from: http://www.wptz.com/news/cvs-locations-in-vermont-to-sell-naloxone-without-prescription/38762902
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.