Addicts Treat Own ODs in Controversial Drug Program

Tuesday, November 20, 2012

Adam Joseph Drici, GoLocalWorcester Contributor

A pilot program from the state's Department of Public Health (DPH) distributes drugs to combat opioid overdoeses to at-risk individuals, but opponents say the program goes too far and promotes more dangerous behavior.

The Opioid Overdose Prevention and Reversal Project is administered through the DPH's Bureau of Substance Abuse Services and offers the drug naloxone, commonly referred to by its brand name Narcan, to individuals over the age of 18 who are either currently active users of opiates or likely to come across a friend or loved one experiencing an opioid overdose. It is administered through a special intra-nasal spray.

During an overdose, opioids can slow breathing to the point of death. Nasal naloxone blocks the opioids and restores normal breathing when sprayed into the nose of someone who has overdosed. It is safe, easy to administer, and has no potential for abuse.

Since its launch in November 2007, the pilot program has made naloxone available to individuals in a number of cities throughout the Commonwealth, including Boston, Cambridge, Fall River, Lowell, New Bedford, Northampton and Springfield.

As of September 2012, the program has resulted in 1,700 documented nasal Narcan reversals in Massachusetts.

Worcester's Battle with Heroin

In Worcester, where heroin use has been recorded at nearly twice the national average, the program has been administered since November 2011 by AIDS Project Worcester. Director of Prevention and Education Jesse Pack said that over 300 individuals have enrolled in the program locally. Those enrollments have resulted in about 30 documented overdose reversals in Worcester in the past 12 months.

"That's potentially 30 folks that might not be with us that have been helped out and saved with the medication," Pack said.

However, the Main South Alliance for Public Safety has voiced concerns about distributing the drug for administration by drug users or their caretakers rather than by trained medical professionals.

"This is still a prescription drug and it shouldn't be dispensed," said William Breault of the Main South Alliance for Public Safety.

The public safety group argued that providing drug addicts with the medication to reverse overdoses risks giving them a sense of confidence that they can take their drug use to the point of overdose and still be able to come back down safely.

Breault and his colleagues have petitioned the Worcester City Council requesting that the City Manager work with the Police Chief and the Fire Chief to amend their department protocols to include the use of Narcan when first responders treat individuals experiencing a heroin overdose. UMass Memorial's EMS Medical Services currently follows such protocols.

In order to receive the free doses on naloxone, which cost around $16 per dose, individuals must participate in an education and counseling session where they learn the most common causes for fatal opiate overdose, what an overdose looks like, what to do in case of an overdose, how to perform rescue breathing, how to safely administer the Narcan, and what is required for follow-up care.

"It's not like we're standing on the street corner handing it out to anybody that comes by," said Pack, adding that many of the program's enrollees are currently in treatment themselves but seek out the program because people they know are still using and at risk.

Having spent a decade working with public health and intervention programs, Pack said the Opioid Overdose Prevention and Reversal Project has been very successful judging by the number of people actively enrolling and the number of documented reversals, which is likely lower than the actual number of people whose lives have been saved by the program in Worcester.

"This is actully an intervention that people come and find us to get because they don't want to see a friend die or a loved one die," Pack said.

"It's unfortunate that the situation wth opiate abuse and addiction in Worcester is so great that it's warranted."

Fighting Back With Outreach and Education

The City's Division of Public Health, in its "Health of Worcester Report," found that 4.9 percent of high school-aged children in and around Worcester reported using heroin at least once in their lives. Nearly half of the City's 4,821 rehab admissions in 2010 were opioid-related, and the Worcester Police Department responded to 94 overdose 911 calls in 2011.

Opioid overdoses accounted for an estimated 29 deaths in Worcester in 2008.

The Division of Public Health has launched several initiatives to combat these numbers by engaging directly with the City's youth through the Worcester Youth Substance Abuse Task Force, the Worcester Cares About Recovery Walk & Celebration and numerous prescription drug take back days.

Worcester's Public Health Division is currently in the process of developing the City's Community Health Improvement Plan, which has identified behavioral health and substance abuse as the second-highest priority to be addressed as the City moves forward. Over 100 community partners, including the Division of Public Health, Common Pathways and UMass Memorial, will develop strategies to decrease the abuse and diversion of prescription drugs and other opiates among youth through education, awareness and ongoing disposal efforts.

Individuals struggling with their own opiate abuse or that of a friend or loved one can call the Bureau of Substance Abuse Services Helpline at 1-800-327-5050.