Helping heroin users: New York police to carry overdose antidote

All local and state police officers in New York are to begin carrying an antidote drug for heroin overdoses, the state’s attorney general announced Thursday. It is the latest effort to address a heroin problem blistering communities across the United States, including New York’s urban juggernauts and tidy hamlets alike.

Attorney General Eric Schneiderman said the state’s law enforcement officers are to be provided with kits containing both a syringe and an inhaler version of naloxone, the standard antidote drug for opiate drug overdoses, including those from heroin. Police officers are often the first responders to an overdose victim, and advocates have urged officials to equip police to act as the lifesavers they are positioned to be in such situations.

The kits, each costing about $60, are to be funded in large part with about $5 million in seizures from drug crimes, the attorney general said.

"Putting this powerful antidote in the hands of every law-enforcement agent in the state will save countless lives," said Mr. Schneiderman in a statement. “It’s particularly fitting that these efforts will be funded by money seized from drug dealers.”

In a separate announcement, also on Thursday, the US Food and Drug Administration said it had approved a hand-held device that delivers a single dose of naloxone and can be prescribed for use outside medical settings.

That device, called Evzio, works much like an EpiPen and also gives audio instructions when in use, much as do defibrillators. Federal health officials said that the device was reviewed under the FDA’s “priority review program,” allowing it to get clearance more than two months earlier than expected.

The FDA has already approved naloxone for injection using a syringe, and laypeople often administer the antidote that way. But federal officials said they expect the new device to make it even easier for the public to administer the reversal drug. The administration has not yet vetted naloxone nasal sprays, though the sprays are also widely used, including by laypeople.

The two measures come as communities across the US confront an increasingly acknowledged, but still worsening, heroin problem.

In New York City, heroin-involved deaths jumped by 71 percent from 2010 to 2012, according to the city’s Department of Health and Mental Hygiene. The illegal drug has also spread outward from its old, urban haunts to upstate New York, known more for its farms and hiking trails than as a burgeoning heroin den.

Opioid overdoses, including those from heroin, killed more than 2,000 New Yorkers in 2011, double the number who died in 2004, according to the attorney general’s office. In the past five years, the emergency department at Albany Medical Center has seen an increase of between 80 and 100 percent in treatment for heroin overdoses, says Michael Dailey, an emergency room physician at the medical center and the regional EMS medical director.

Paramount among efforts to curb a heroin crisis have been initiatives to make naloxone more available.

“Each time we save someone from an overdose, it’s a chance to help them get their lives back together,” says Dr. Dailey.

Though the antidote is available in all 50 states to addicts who get a prescription, as well as stocked in ambulances and emergency rooms, efforts are under way to provide access to more people who might reach overdose victims first, including police officers and addicts’ relatives and friends.

So far, 17 states, plus the District of Columbia, have laws that expand access to naloxone, including provisions that allow the antidote to be distributed to members of the public.

Some police departments in those states – including the Suffolk County Police Department in New York, where police and EMTs reversed 563 overdoses last year – have already introduced programs to outfit their police forces with naloxone. Last month, Gil Kerlikowske, director of the Office of National Drug Control Policy, called on more local police departments to do so, and several cities, including Boston, have recently announced such plans.

But New York will be the first state in which all officers – from local police to state troopers – will be provided with the antidote.

“This is such an important step forward,” says Whitney Englander, government relations manager at the Harm Reduction Coalition.

“There are very practical and logistical reasons for police officers to carry naloxone,” she says. “And it can really change the relationship between police officers and communities, when they can be seen as sources of help and as life-savers.”

Ms. Englander also called the FDA’s approval of Evzio a “step in the right direction,” though she cautioned that the cost of the device – expected to be between $200 and $300 – would be a prohibitive factor in making it widely available. A cheaper device would be even better, she says.

Still, the FDA’s announcement did explicitly state that the device is intended not just for medical providers, but for laypeople, says Alex Walley, a faculty member at Boston University School of Medicine and medical director of the Massachusetts Department of Public Health’s Opioid Overdose Prevention Program.

“It’s a big acknowledgment that community bystanders are a big solution to this problem,” he says, adding that such an acknowledgment could portend more action to involve the public in overdose prevention.

Not everyone supports putting naloxone in more hands. Maine Gov. Paul LePage (R) has said he does not support a bill that would expand naloxone distribution, arguing that giving addicts more access to the antidote will reduce the pressure to get off heroin.

Experts say such a concern is scientifically unsubstantiated, with studies showing no change in drug use when barriers to getting naloxone are reduced.

“What this drug does is stop overdoses,” says Dr. Walley, “so that people can live and get treatment.”

Meanwhile, Massachusetts Gov. Deval Patrick last week declared a public health emergency in response to what he called “an epidemic of opiate abuse,” including heroin use. In a speech, he introduced measures to tackle the problem, including easing barriers to distributing naloxone to all first responders, including police, firefighters, and EMTs.