There’s a growing epidemic of accidental and preventable deaths from overdoses of narcotic pain medication in Hawaii and the other 49 states.
So what are we going to do about it?
Does the social stigma of drug use make us less likely to care about saving the lives of addicts?
Statistics from the Hawaii Department of Health Injury Prevention Program indicate that from 2009 to 2013, there were 773 recorded deaths from drug poisoning in Hawaii. This tops the 618 people who died in motor vehicle accidents over the same five-year period.
Based on trends apparent in this data, the annual numbers of overdoses are likely to continue to rise in the next few years. Despite an increased awareness of the dangers, there is still a huge black market for prescription pain pills, which account for a significant number of the overdoses seen in the last few years.
When people overdose, whether intentionally or accidentally, the first people on the scene are often friends or family members. If they find a loved one within minutes of an overdose, they are — or could be — in a unique position to save them.
Narcan, also known by its chemical name naloxone, has been used by emergency personnel in ambulances and in the ER to pharmacologically reverse the effects of opoids on the body. (Opoids are psychoactive chemicals with similarities to morphine and other pain medicines.) Narcan can reverse the respiratory depression that sometimes happens when narcotic pain medication is taken in excess, meaning that it can save lives.
Seventeen states — but not Hawaii — have enacted laws to allow the distribution of Narcan to friends and relatives of those who might be at risk of an opoid overdose. The American Medical Association and the American Public Health Association both have policies supporting this.
Here in Hawaii, legislation to provide protection for those who help someone who is suffering an overdose has failed in the past, but it deserves another look.
Here is why: In case of an emergency, the people who are most likely to discover someone who has overdosed are in the best position to take action if they find a heroin addict or, say, an elderly person who uses a fentanyl patch that turns out to be too strong (particularly if their body stops metabolizing the medication well).
Paramedic Marie Hathaway has seen Narcan work so well that one addict who was overdosing “woke up, then stood up and walked away.”
Narcan is currently available in all Honolulu EMS ambulances, and has been since 1972. According to Shayne Enright, public information officer for the City and County Emergency Medical Services Division, in 2013 a total of 1,004 doses of Narcan were used, which averages out to 2.75 a day.
Paramedic Marie Hathaway said Narcan is one of her favorite medications to administer on the job.
“If it’s going to work, it does so right away, and we can quickly bring someone back who is otherwise blue or not breathing.”
She’s seen it work so well that one addict “woke up, then stood up and walked away.”
This all leads to a question: Shouldn’t Narcan — and the training on how to use it — be available for non-medical personnel here in the islands?
After all, 24 states and the District of Columbia have developed programs to make it easier for medical professionals to prescribe and dispense Narcan, and for laypeople to administer it without fear of legal repercussions.
According to the Network for Public Health Law (www.networkforphl.org) making Narcan more widely available will save the lives of thousands of people who overdose.
Their research showed that as of 2010, 188 community-based overdose prevention programs have provided training to more than 50,000 people, and have been responsible for 10,000 overdose reversals.
One program in Massachusetts reported significant reductions in death rates from overdoses in communities where the program was implemented, compared to those where it was not available.
Given the latest statistics showing the rising number of drug overdoses in Hawaii, the state could be in a position to save hundreds of lives.
So why haven’t we made this more widely available?
Dr. William Lee, an emergency room doctor at Straub Hospital, sees benefits of Narcan, but expressed caution about whether it can be administered by non-professionals. “I don’t think the average layperson would be able to handle giving this on his or her own.”
Although this may be true about the injectable form of the medication, the intranasal spray is relatively easy to use.
Roland Crawford, a former addict who has been clean since 2011, says he stopped using drugs because he felt it was slowly killing him.
He recalls losing a friend from high school who was the star of the football team until he overdosed on heroin.
Would Crawford have tried to save his friend with Narcan, if it had been had been available?
“Any chance I have to help someone else,” he said, “I would take.”
Crawford says he’s known other people who have overdosed, especially when mixing injected drugs such as heroin, crystal meth and cocaine in something called a “speedball.”
Such a combination of drugs has been blamed for taking the lives of many well-known entertainers, including comedians John Belushi and Chris Farley, the original Red Hot Chili Peppers guitarist Hillel Slovak and actor River Phoenix.
Dr. Jerald Garcia, a pain management specialist, sees dangers in letting laypeople handle Narcan, noting that it is not like an epinephrine pen (injectable life-saving medicine) used by people with severe allergies.
“Some people take a combination of medications that could cause a change in their level of consciousness, and unless someone is 100-percent sure, they should not use it or administer it to anyone else, particularly if they haven’t been trained on how to use it properly.”
That said, Narcan is relatively safe. By itself, it has no side effects, no risk of abuse and, if someone is not experiencing a narcotic overdose, it does not have any effect on the body at all.
The only potential adverse reaction is a sudden withdrawal from the narcotic’s effects, which can be minimized by using the low-dose protocol currently advised by the Department of Health. In their manual of procedures, any EMS personnel can administer Narcan — even without waiting for a doctor’s order — so that no time is lost when it matters most.
Hathaway, the paramedic who has often used Narcan with positive results, has rarely seen its downside. “If someone responds too quickly, they might start becoming combative when they are awakened fully, or may even projectile vomit.”
She prefers administering it nasally to patients because it’s easier, and finding intravenous access in the IV drug abuser population is often difficult given damage to most veins that paramedics might want to inject Narcan into.
The latest administration procedures from the DOH have been amended to use a small dose first to minimize any sudden reactions and better control the reversal process.
But not all doctors agree on the safety of its use in the general public.
Dr. Lee says that people should really administer Narcan in a medical setting where they can handle the potential side effects of the reversal process, and also to treat any other medical conditions that might arise.
This issue isn’t an easy one. On one side, there is the ideal context in which Narcan should be administered. On the other side, there are the less-than-perfect realities when it comes to overdoses.
But when someone isn’t breathing, and is suffering from an overdose, every second can count.
If you want to know more, go to stopoverdose.org, prescribetoprevent.org or odprevention.org.
