Hope Seen in Overdose Drug

Back in 2007, a teenage girl was in the right place at the right time, the parking lot of a New Haven drug treatment facility, when she overdosed on drugs. Staffers saved her with an antidote called Narcan. New data from Yale researchers show that the antidote could have saved more than three-quarters of those who’ve died from accidental drug overdoses.

Researchers at the Yale School of Epidemiology and Public Health analyzed data from the office of the state’s Chief Medical Examiner showing that 77 percent of the 2,900 drug-involved accidental/undetermined intoxication deaths in Connecticut from 1997 to 2007 involved opioids. The number of deaths annually has increased substantially, from 211 in 1997 to 327 in 2007.

Many drugs — both illegal and legal — contain opioids, such as heroin, methadone and oxycodone (a category of drugs of which Oxycontin in the best known). If someone overdoses, the opioid will cause breathing to stop, so it’s critical to intervene immediately.

The researchers also discovered that, while overdose from the opioid heroin causes more deaths than overdose from opioid prescription drugs, the former is declining while the latter is rising.

The story of the girl in the parking lot comes from Doug Bruce (pictured), the medical director of SCRC (South Central Rehabilitation Center) and a consultant to the APT Foundation. APT, a drug treatment and research facility in New Haven, is spearheading the use of Narcan (naloxone), the antidote that saved her life.

The story has a happy ending: The young woman is in drug treatment and has turned her life around.

Now Bruce wants to get the word out — that if Narcan is prescribed for more overdose patients, there can be more happy endings.

“It’s really easy to reverse an opioid overdose with Narcan,” he said. “Most of the patients we have are poly-drug users; they use lots of different drugs in overdose. Narcan only reverses opioids, but because it’s involved in most overdoses we think it’s really effective in saving lives.”

Bruce added that Narcan is not “divertible,” meaning it has no street value because it can’t make a person high. It’s so safe that if it were given by mistake to a person who’s not suffering from an opioid-related overdose, it would have no effect at all, he said.

A researcher at Yale, said the data she helped analyze for Connecticut are consistent with drug intoxication deaths from other states. She said the big news is that many of the deaths can be prevented if Narcan is administered more often. She pointed to the increase in prescription opioid-involved deaths, including methadone, as one of the most interesting findings.

In analyzing causes of death, her team decided to exclude drug-involved car accidents, where the direct cause of death was blunt trauma, “although drugs may have contributed to those deaths,” she said. Most of those who died from accidental drug overdoses had a combination of drugs in their system, including opioids.

Among 17 to 24 year-olds, 562 in Connecticut died from 1997 through 2007 from motor vehicle accidents, which included some in which drugs were a contributing factor. The number of deaths attributed specifically to drug overdoses (not vehicle crashes) in that age group was 304. The age group with by far the highest death toll from drug overdoses was 35-to- 44-year-olds.

Narcan has been used for decades by EMTs coming on the scene of a suspected opioid drug overdose. Bruce said it needs to get into the hands of other medical providers as well as substance abusers and their partners. He said he’s the only physician he knows of in the state who prescribes the drug. He helps conduct weekly trainings at sites around New Haven, and newly trained individuals can “graduate” with a kit from the pharmacist at the APT Foundation. “It contains everything you need to safely give an injection — latex gloves, alcohol swabs, intra-muscular syringe, plastic barrier for rescue breathing, Narcan and written instructions” that serve as a refresher course.

“The goal,” Bruce said, “is to improve people’s outcomes by giving them the tools necessary to reverse overdose as fast as possible. Now, we do educate people to call 911, to do rescue breathing, but Narcan’s the biggest piece because it reverses the problem itself.”

Bruce said that Narcan programs in New York City, Chicago and on the West Coast have been “wildly successful.”

New Havener Mark Kinzly is a trainer for the National Harm Reduction Coalition, based in New York City. He does trainings around the country on using Narcan to reverse overdoses. Chicago has had more than 700 reversals of potentially fatal overdoses, New York City, almost as many, and Massachusetts has had 225 reversals in the past year, he said. So far Connecticut has had nine, “but we don’t have an official program,” he said.

Those are impressive numbers, but Kinzly shared an even more impressive number — the 1,100 people who died in just three cities in 2007 from overdosing on fentanyl, a chemical derivative of the poppy (and therefore an opioid). He said it occurred at the same time as an e coli contamination of fresh spinach, which made headlines for weeks — and which ultimately killed five people.

“Here’s 1,100 drug users that died, and we never heard about it,” he said. He attributes that silence to the stigma attached to drug use. The harm reduction movement tackles that stigma head-on, promoting actions that can save lives, even though they might be technically illegal. The best-known harm reduction practice is probably needle exchange to prevent the spread of HIV through addicts sharing syringes. (New Haven ran the state’s first needle exchange pilot program in the early 1990. Follow-up by Yale researchers showed that it cut HIV transmission 45 percent after two years.)

Opponents of that and other harm reduction techniques worry that such actions will increase illicit drug use. In the case of Narcan, that theory goes, addicts might become complacent about overdoses if they know there’s a cheap, easy way to reverse them. (An injection of Narcan costs about $2.50, Kinzly said, while an intranasal spray costs between $6 and $9 per application.)

He said a model program in North Carolina is the Lazarus Project, in which doctors who give a prescription for an opioid to control pain also give a prescription for Narcan. He said that Oxycontin, because it is a time-release medication, becomes particularly lethal when someone using the drug not as prescribed takes off the time-release covering.

Kinzly said making Narcan available and training people how to use it is a priority for the National Harm Reduction Coalition. He said as a result of the fentanyl deaths, activists from the coalition hold a conference call every two weeks with reps from an alphabet soup of federal agencies: SAMHSA, DEA, FDA (Substance Abuse and Mental Health Services Administration, Drug Enforcement Agency, Food and Drug Administration) to discuss their concerns. He said that batch of fentanyl came from a clandestine lab in Mexico.

In addition to working with drug abuse programs, Kinzly also does trainings with parents around the state. “The face of opioid addiction has changed,” he said. “We always had that mindset of the guy who’s strung out in the street with the needle sticking out of his arm, and the reality of it is that the fastest growing population is white, middle class suburban kids.” He said the ONDCP (Office of National Drug Control Policy) recently released data that teens can get opioids easier than marijuana — much of it pain meds that a family member is prescribed but doesn’t end up taking all the pills. “It’s the easiest way for kids to get these drugs. They don’t have to go to the street — they go to the medicine cabinet. And then after a while, when they can’t get it from the medicine cabinet, that’s when they turn to street narcotics.”

Dr. Bruce had a final word of warning about this life-saving intervention: “Narcan works for about an hour, and people could overdose later once it wears off, so they must get to a hospital right away.” He said harm reduction proponents are encouraging pharmacies to carry Narcan. “Most don’t carry it because it’s not something people would ask for.” He hopes that changes as people realize the value of having it available.

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Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine.

Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine