As heroin problems surge, states expand access to overdose reversal drug

Bills to expand access to naloxone passed in two state Senates this week, in what appears to be a national effort to put the drug into the hands of those most likely to reach a person overdosing on heroin first.

Bills to expand access to a drug reversing heroin overdoses passed in two state Senates this week, in what appears to be a national rush to tackle a heroin addiction problem whose abysmal toll on communities, from sleepy New England villages to high-octane cities alike, has become apparent.

In Ohio, the Senate on Wednesday unanimously passed a bill to allow physicians to prescribe the overdose reversal dug, called naloxone, to friends and family of drug addicts. And in Wisconsin, four bills related to tackling heroin addiction, one of which would equip all EMTs with naloxone, cleared the Senate 33-0 a day earlier. Both bills are now before the states’ governors.

The two unanimous votes come amid pushes around the country to meet head-on what has increasingly been seen as a preventable spate of heroin overdose deaths. Chief among those efforts is putting naloxone into the hands of the people most likely to reach an overdosing person first, be it the police, his or her parents, or close friends.

In all 50 states, health-care professionals can prescribe naloxone, an FDA-approved drug, to opiate addicts, and the antidote is stocked in all ambulances and emergency rooms.

But if naloxone is available, it is not nearly as available as it could and should be, advocates say. Not all heroin addicts can or will see a doctor for a naloxone prescription. And ambulance crews are not always the first to reach overdosing victims, especially in out-of-the-way communities like rural Ohio, where the average ambulance response time is about 17 minutes, says Erin Winstanley, a professor at the University of Cincinnati who works in heroin addiction outreach in the state.

“That 17 minutes could be the difference between life and death,” she says.

So far, 17 states and the District of Columbia have laws on the books that expand access to naloxone, according to figures from LawAtlas, which tracks naloxone laws.

But that number appears set to grow – and soon. Of the 18 jurisdictions with naloxone expansion laws, 10 of them adopted their laws in 2013, according to LawAtlas. Ohio and Wisconsin appear poised to join that roster, as does Tennessee, whose Senate also last week unanimously passed a bill to expand naloxone access. Similar bills are being weighed in other states, including one before the House in Georgia.

Though naloxone expansion laws differ in each state, the laws on the whole remove barriers to getting the reversal drug to the people most likely to encounter overdosing addicts before anyone else.

“Any layperson can administer this medication,” says Fred Brason, executive director of Project Lazarus, an advocacy group based in Moravian Falls, N.C.

Municipalities in states with legislation have in recent weeks been aggressively making good on the opportunities that those laws afford. In Massachusetts, which has a naloxone law, Boston Mayor Martin Walsh announced last Friday that all city police officers and firefighters will soon be required to carry naloxone. He cited a problem of epidemic proportions in the state capital, with a 76 percent increase in heroin overdose deaths from 2010 to 2012.

“The first people that arrive at a scene play a really key role in survival chances,” says Nick Martin, director of communications for the Boston Public Health Commission, “and naloxone is truly a lifesaving tool.”

Mayor Walsh’s announcement paid homage to the success of a similar program run since October 2010 in Quincy, Mass., which put naloxone in police officers’ possession. Rhode Island State Police also announced this month that all state troopers would keep the antidote in their cruisers. Gil Kerlikowske, director of the Office of National Drug Control Policy, last week stamped such measures with the Obama administration’s approval, urging more local communities to outfit their police and fire departments with the drug.

Altogether, states and municipalities seem to be “playing catch-up” to handle an issue that some communities are coming to see as their problem, not someone else’s problem, says Daniel Raymond, policy director at Harm Reduction Coalition, an advocacy group in New York City.

“There used to be a perception that it was a big-city problem, but it’s not just the New Yorks’ and the Baltimores’ problem anymore,” says Mr. Raymond, referring to heroin’s surge in suburbs and rural communities. “And in all these other places, the drug epidemic has really taken them by surprise.”

“But the tide is turning,” he says.

Even states without legislation have made progress on the issue. In Ohio, in advance of legislation, a pilot program through the Ohio Department of Health, called Project DAWN (Deaths Avoided With Naloxone), has provided training and supplies to patients across the state for the past two years. The program is credited with distributing 168 naloxone kits and saving four people’s lives at its Cincinnati outpost over the past year, Dr. Winstanley says. Also, in December, the state’s Emergency Medical Services board said it would allow all EMTs to administer nasal naloxone.

Still, not all states are on board. Maine Gov. Paul LePage (R) has indicated that he does not support a bill that would widen naloxone access. He vetoed a similar bill last year, on the grounds that easing barriers to getting naloxone to at-risk populations would reduce heroin addicts’ incentive to quit. 

His opposition is in keeping with the cadence of his State of the State speech this month, in which he outlined an antidrug policy that addressed drug abuse with measures to boost arrest and prosecution rates for narcotics offenses, not with treatment initiatives.

But there is little evidence to back up the governor’s position on naloxone, says Jack Stein, director of the Office of Science Policy and Communications at the National Institute on Drug Abuse.

“No studies suggest any increases in risky behavior when naloxone is made available,” he says in an e-mail to the Monitor. “Naloxone administered by trained nonmedical personnel (e.g., family and friends) has been shown to be cost-effective and save lives.”