Guest Column: Are there ways to decrease opiate overdoses?
Have you ever experienced the deep personal satisfaction that flows from saving the life of another human being? Or perhaps you’ve tasted the sorrowful anguish accompanying a mistake that contributed to the death of someone.
Medical staffers, first responders, police personnel and firefighters have likely experienced one or both emotions. Less so the average citizen. Read on and learn how this may be changing.
According to various published reports and government and academic studies, in 2010, some 12 million Americans abused opiates. Emergency room visits due to painkiller abuse totaled 180,000. Drug overdose deaths are now the leading cause of accidental death in the U.S. for the 25-64 age group.
In 2010 there were 38,000 drug overdose deaths, more than for HIV/AIDS or homicide. Some 40 percent of these deaths were from medication prescriptions like oxycontin, Vicodin or Percocet.
These numbers reflect a dramatic rise in the availability of prescription painkillers during the last 10-15 years accompanied by an inexhaustable supply of illegal opiate derivatives.
More recently, in part due to a government crackdown on “pill mills” and, in part, to the relatively cheaper cost of heroin, chronic pain patients who used to get their drugs from pharmacies switched to heroin. It’s estimated that over 50 percent of heroin users switched from legal opiates for just these reasons.
The result? A dramatic escalation of heroin overdose deaths.
In the last several months, heroin usage and heroin-related deaths have made front page news in the Northeast. Massachusetts declared a public health emergency due to a rising tide of heroin overdoses. The governor of Vermont devoted his entire state of the state address to the opiate epidemic in that state.
In our region, Nevada ranks in the top fifth for abuse of prescription pain medications. In Washoe County there were 4,000 emergency room visits in 2010 for prescription overdosage — 70 percent were diagnosed as drug dependent, and 70 percent of those were Caucasian. Overdose deaths have also been recorded in Incline Village, Placer and Nevada counties.
Remarkably, most of these dire outcomes are entirely preventable. How? By a change in medical practice and by a change in social priorities.
There is a safe “antidote” to opiate overdosage. Naloxone, or Narcan, an “opiate antagonist,” reverses the life threatening respiratory depressant effect of opiate overdosage. Unfortunately, the drug is not widely available because conventional wisdom makes it tightly controlled and regulated and generally prescribed only by physicians or their appointed surrogates.
Moreover when social policy emphasizes arresting people for drug possession as opposed to saving lives, lives are lost. How does that happen?
It is estimated that some 85 percent of people overdose in the presence of others. These “others’ usually either don’t know how to gauge a potentially fatal overdose and/or are frightened they will be arrested if they call 911. Indeed, the most common reason for failing to call 911 is the fear of police involvement.
Some jurisdictions have passed “Good Samaritan “ laws to protect the caller and the victim from arrest for drug possession, possession of paraphernalia, and/or being under the influence. California has such a law. Nevada does not.
These policies may soon change, driven partly by publicity about the opiate overdose epidemic, and partly by more enlightened social policy.
Responding at least in part to political pressure,the Federal Drug Administration recently approved an easily injectable form of naloxone.
This could allow family or caregivers to keep this lifesaving medication on hand. Other measures could be adopted in our local communities.
Physicians who regularly prescribe opiates for chronic pain should also prescribe naloxone. Opiate users should tell those nearby to have naloxone on hand. These folks should know about the symptoms of drug overdosage and how to administer naloxone.
Politicians should pass “Good Samaritan Laws.” Pharmacies should have “standing order” prescriptions from physicians or naloxone should be sold over the counter.
Utilizing this public health model of community responsibility, we can dramatically decrease opiate overdose morbidity and mortality.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.