Opioid-related overdose deaths are a leading cause of mortality across the United States. Naloxone, the drug carried by ambulances to reverse overdoses, is also available in some states to be administered by trained members of the general public who might be present when an overdose occurs. Many lives have been saved by bystanders, and increasingly, notice is being taken of community-based naloxone distribution. The Food and Drug Administration held a public workshop in April, the Substance Abuse and Mental Health Service Administration will soon be distributing an “Overdose Prevention Tool Kit” featuring it and in June, the American Medical Association passed a resolution supporting it.
Naloxone is a safe and effective antidote to opioid overdose, restoring respiration and reversing sedation, though it also precipitates withdrawal in dependent people. It may legally be prescribed to anyone at risk of overdose, and many jurisdictions allow for it to be administered to persons other than the prescription holder. A brief training in naloxone use includes hands-on practice with the naloxone device (either an intramuscular injection or an intranasal spray) and a kit contains two doses. A recent CDC Morbidity and Mortality Weekly Report reported that, as of June 2010, more than 50,000 individuals had received naloxone kits and that more than 10,000 overdoses had been reversed.
Take-home naloxone has a vital role to play in addiction treatment because relapses after treatment are so common, and in the setting of loss of tolerance frequently, it can lead to overdose. The New York State Offices of Alcohol and Substance Abuse Services (NYS OASAS) were early adopters of take-home naloxone and have urged all the programs they license to do the same. Samaritan Village, the first therapeutic community to offer take-home naloxone, provides overdose prevention training during orientation. Patients are assured there will be a place for them if they return after relapse, and naloxone increases the likelihood that they will be able to.
Some say that the introduction of naloxone into treatment sends the wrong message to the patients: “You will fail”. But in fact, it tells them that the program cares about their lives even if they relapse, a very positive message for someone at a low point in life. It also implies that they are important members of the community with the power to save a life. An OASAS patient relapsed following a 28-day rehab and during the relapse reversed his friend’s overdose; this was a profound experience for him, and renewed his commitment to sobriety.
Naloxone programs have been very effective in targeted populations, as has been shown by the 47 percent reduction in heroin overdose death rates in New York City in the first five years of that program, where distribution was mostly through syringe exchange programs. Opioid analgesic users have been much harder to reach, but regularly turn up for treatment. Provision of naloxone should become a standard of care in drug treatment programs. Treatment providers can become powerful advocates for legislation and funding facilitating community-based distribution programs.
Dr. Sharon Stancliff, MD
Harm Reduction Coalition