Doctor demonstrates emergency use of opioid blocking naloxone
Just a few days before his death in Minneapolis, Prince’s private jet made an emergency landing in Moline, Ill.
The purpose: To give an unconscious Prince a shot to counteract the effects of an overdose of a prescription painkiller, sources told the Minneapolis Star-Tribune this week.
The drug naloxone counteracts the effects of a heroin or opiate overdose on the central nervous and respiratory systems, allowing a person to breathe normally within three to five minutes. If administered in time, it can save a life.
“People are put into immediate withdrawal,” said Magni Hamso, a Boise physician.
If Percocet played a role in Prince’s death — prescription painkillers were reportedly found at the scene — he would be the latest and most prominent celebrity caught up in the nation’s wave of opioid overdose deaths, McClatchy’s Tony Pugh noted in a separate report.
Idaho is also part of that wave. Over the past year, health experts and politicians here have worked to broaden access to naloxone, hoping that amid other efforts to confront drug addiction, its use will save lives.
ROLLING OUT THE NEW LAW
Last July, state House Bill 108 took effect, allowing people suffering from a drug use disorder, their friends and family members to obtain naloxone. Under Idaho’s Good Samaritan Law, the naloxone statute shields anyone who administers naloxone from liability if the person calls 911.
The drug, which causes no harm and has no effect if opioids are not present, was first approved by the Food and Drug Administration in 1971, but for decades its use was limited mostly to hospital emergency rooms. The Chicago Recovery Alliance began handing out free naloxone to drug users and family members in 1998. Reports indicate that more than 6,000 people in Chicago have been kept alive after a potentially fatal overdose.
165,000people in U.S. died from opioid overdoses between 1999 and 2014
2,326Idahoans died from opioid overdoses during the same years
It’s hard to know how many doses of naloxone have been used in Idaho since the new law went into effect. The Idaho Board of Pharmacy tracks prescriptions written for opioids and other narcotics, but not naloxone because it is not a controlled substance.
Hamso, who treats patients at Terry Reilly Health Service, supports widespread availability of naloxone.
“It’s not to curb the use of opioids, but it can help save someone’s life,” she said. “I prescribe naloxone to anyone who could benefit from its use.”
Hamso is a native of Norway who came to Boise two summers ago from New York City. She said one-third of her patients are homeless. While methamphetamine use is more prevalent among her patients, she’s seen a recent increase in heroin and street opioid use.
Other physicians have not been as enthusiastic.
“There has been a reluctance by some doctors to go ahead and provide naloxone,” said state Rep. Christy Perry, R-Nampa, who sponsored the bill relaxing the prescription regulations. “They felt like that would encourage drug use.”
Elisha Figueroa is director of the Idaho Office of Drug Policy, which works to reduce drug use and related crime. She said she hasn’t heard that reluctance from health care providers, but has heard the same question from others.
“It is a painful, uncomfortable process to have an overdose reversed, so it’s not an experience people will want to endure repeatedly,” said Figueroa, whose website provides video instruction on how to administer naloxone. “If we can keep people alive, it gives them an opportunity for recovery.”
WHERE CAN YOU GET IT?
Last year, Idaho doctors wrote 1.5 million prescriptions for painkillers, according to the Idaho Board of Pharmacy. That’s nearly one for every Idahoan.
Less than 5 percent of individuals who receive opioid prescriptions abuse them, but the abusers generally account for 32 percent of the opioid prescriptions obtained, according to a national study by Castlight Health, a health care information company.
Figueroa’s office and groups representing Idaho physicians, dentists and nurses are working to get the word out about naloxone. They encourage practitioners to provide it to patients, as well as friends and family members of those who could be vulnerable to an overdose.
The state Board of Pharmacy also has focused on pharmacists. When the new law went into effect, it was sometimes hard to find pharmacies that carried the drug.
“There are some big chains that have begun to carry it in Idaho. Now that they know the law has passed and that it is going to be in more demand, we are seeing many more pharmacies bringing it in and stocking it,” Figueroa said.
The medication can be administered by injection, through a nasal spray or by an auto-injector applied over clothing to the thigh. It costs from about $33 to $100 depending on the formulation, said Ashley Flower, a spokeswoman for Rite-Aid, which stocks naloxone at its Idaho stores.
Fred Meyer also carries naloxone. Employees at the Albertsons store at 16th and State streets and at the Wal-Mart on Overland Road said they do not carry it but could order it.
Walgreens earlier announced it would make naloxone available at stores in 35 states, including Idaho, by the end of the year. A worker at the chain’s Fairview Avenue store said last week it was not available there yet.
More than 40 states have passed laws providing greater access to naloxone. Some insurance plans will cover at least a portion of the cost.
THE QUINCY EXPERIENCE
Quincy, Mass., a working-class town of 100,000 residents that borders Boston, began using the term “epidemic” when its number of drug overdose deaths reached 100 in 2008.
13.7 per 100,000 Idaho’s overall rate of opioid overdose deaths in 2014, triple what it was in 1998
13 per 100,000 That rate for Ada County
11 Death rate for Canyon County
25 Bannock County
24 Bonneville County
It took a major change in police philosophy, Quincy Police Lt. Patrick Glynn said, to stop looking at drug use as a criminal problem and treat it as a medical situation.
“What we did before was arrest. We arrested, we arrested, we arrested,” Glynn said. “It was almost as if we had stock in handcuff companies. We wore out so many handcuffs, it didn’t make sense. So we changed it.”
Naloxone use was part of that change. Officers received training and by 2010 were provided with naloxone kits so they could reverse overdoses they encountered on the streets. They work to get users into treatment centers, where they can get the help they need and return to their community drug-free. They also began looking at those with drug problems in a new light — as people’s sons, daughters, brothers and sisters.
It’s not someone who is lurking in a dark corner with a needle sticking out of their arm.
Quincy, Mass. Lt. Patrick Glynn
To reiterate that point, Quincy holds a yearly candlelight vigil for those who have died from overdoses. Names are read out loud, each followed by the ringing of a ship’s bell.
Quincy’s 220 police officers also had to realize that relapse is part of recovery, Glynn said. He was asked how many times police will work to reverse an overdose by the same person.
His answer: “Every single time that we have (naloxone) with us and it’s called for. We don’t say three strikes and you’re out or that you’ve met your quota. That’s not what we do.”
The department has had stunning success. The first year after officers were provided with naloxone kits, overdose deaths decreased by 66 percent. Overall, the death rate is down 55 percent since 2010. More than 500 overdoses have been reduced in Quincy since police officers began carrying naloxone.
At least some Idaho law enforcement agencies are considering the same thing. The Idaho State Police is working to train its officers and plans to provide naloxone to troopers, detectives and forensic scientists sent to crime scenes, spokeswoman Teresa Baker said.
The Police Services Bureau at the Ada County Sheriff’s Office is scheduled to speak this week with Sheriff Stephen Bartlett on the issue.
Going easier on users does not mean police look the other way on drug crimes, Glynn said.
“We’re not soft on crime. We’re arresting the traffickers and the dealers, so there is a happy balance, so to speak. But we’re treating the people who have the disease,” he said.
John recently attended a weeklong training on the opioid crisis, sponsored by the National Press Foundation. The sources quoted from outside Idaho spoke to the group of 20 journalists selected for a fellowship. He will continue to write on this topic.
Symptoms of an opioid overdose:
▪ Pale skin and/or clammy to the touch
▪ Limp body
▪ Blue or purple cast to lips or fingernails
▪ Vomiting or gurgling sounds made by victim
▪ Patient can’t be aroused
▪ Breathing is very slow or has stopped