Amid crisis, states expand access to opioid rescue drug

With drug overdoses skyrocketing across the USA, a growing number of states are expanding access to a fast-acting rescue drug called naloxone, which can revive a dying addict in minutes.

But while these new laws have broad support in the public health community, some doctors and drug-treatment professionals say they are just Band-Aids for an overwhelming addiction problem requiring a much broader solution.

Thirty states and the District of Columbia have enacted laws or developed pilot programs to widen access to naloxone, according to the National Conference of State Legislatures. These include Minnesota, where a law passed last year allows doctors to prescribe the drug to families and friends of opioid abusers so they can save the lives of loved ones.

Minnesota's legislation was authored by State Sen. Chris Eaton, whose 23-year-old daughter died of a heroin overdose in 2007 after shooting up in a car parked outside a Burger King. Eaton says Ariel Eaton-Willson might be alive today if someone had immediately injected her with the opioid antidote.

"By the time the ambulance got to the scene with naloxone," Eaton says, "it was too late." She says her personal tragedy reflects a national epidemic, and she supports efforts by states with naloxone laws already on the books to expand access even further.

Ohio, for one, began with a yearlong pilot program in a single county that allowed trained emergency responders to use naloxone, then last year passed a statewide law allowing medical professionals to distribute it and family and friends of addicts to use it on overdose victims without fear of prosecution. And Kentucky lawmakers are now considering whether to allow doctors to prescribe not only to addicts, as under current law, but to family, friends, police and firefighters as well.

"This is a strategy that's sweeping the nation," says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. "It's a proven way to save lives."

Expanded access laws are in line with a recent recommendation from the World Health Organization, and come in response to a rising scourge. Fatal drug overdoses have risen more than sixfold in the past three decades, according to the Network for Public Health Law; government figures show they now claim the lives of about 120 people each day in the United States. Overdoses were the leading cause of injury death in 2012, killing more 25- to 64-year-olds than motor vehicle crashes.

Opioids, which include heroin as well as prescription drugs such as oxycodone, kill by depressing respiration until breathing stops. Naloxone reverses this. Eric Fulcher, an emergency room physician at Sts. Mary & Elizabeth Hospital in Louisville, Ky., says the drug knocks opioid chemicals off the brain's receptors, reviving patients almost instantly. He likens it to an Epi-Pen, which can stop an allergic reaction in its tracks.

Fulcher says he generally supports giving greater access to naloxone, which at one point his ER administered so often doctors felt like they were running a drive-through OD clinic. But he says new laws "totally ignore" the overall problem of addiction and may communicate an underlying acceptance of intravenous heroin use. "Politicians will feel like they've dealt with the problem," Fulcher says.

Karyn Hascal, president of a Louisville recovery center called The Healing Place, says she would love to see all first responders gain easy access to naloxone. But she worries allowing family and friends to have it may give addicts a false sense of security, making them think they can keep shooting up opioids because the medication will revive them if they overdose. "We've had a number of people here who have been revived several times by naloxone," which may show they viewed it as a sort of safety net, she says.

Client April Lyman, a former nurse from Northern Kentucky, agrees. She overdosed on heroin on her grandmother's bathroom floor nearly two years ago — and says she's alive only because ambulance workers gave her naloxone that day.

"In some ways I think it's a good idea (to expand access) because it does save lives," says Lyman, 34. "But it's also saying you can still use heroin."

And there are other concerns. While naloxone is generally considered safe, some in the drug-treatment world worry that addicts will take more opioids to counteract the withdrawal they experience after being injected — leading to a second overdose. But research shows this isn't a significant problem, according to a 2009 study in the American Journal of Public Health.

Drug-control officials also point to growing frustration with the price of naloxone, which almost doubled last fall – from $20 to $35 or more for a dose. States are starting to seek relief from the financial burden. In New York, Attorney General Eric Schneiderman announced an agreement with drugmaker Amphastar Pharmaceuticals in February for a $6-per-dose rebate.

States also face challenges getting the word out about their laws to addicts, families and the general public to let them know how to get the drug if they need it. Eaton says she'd eventually like to see the federal government allow people to buy naloxone without a prescription.

Eaton acknowledges that naloxone doesn't treat substance abuse or address its root causes. She considers it more like an emergency measure amid a national crisis, which down the road may lead to more comprehensive solutions like expanded drug treatment.

"Yes, we are working backwards," she says. "But it's hard to treat someone who's dead."