Fixing the twin public health “epidemics” in this country — abuse of opioid painkillers by addicts and under-treatment of legitimate pain patients who often need those same drugs — will take time, a lot of creative thinking and a willingness to change dysfunctional government policies.
But there is one astonishingly simple step — a no-brainer, actually — that is immediately available and has been shown to reduce deaths from opioid overdoses. In fact, the city of Boston has already implemented this idea and is a model for the country. The utterly frustrating thing is that, so far, only 15 states and the District of Columbia have such programs — a far cry from what is needed.
The idea is what doctors call “harm reduction,” which means not necessarily trying to solve the root problem but to do things that make the problem less likely to be fatal.
Few situations in medicine present such a clear take-home lesson: Naloxone could, and should, be made easily available to opioid abusers.
The worst risk of opioid drugs (formerly called “narcotics”) is, obviously, fatal overdose. Opioids include heroin, oxycodone, methadone, fentanyl, codeine and morphine. Although reasonably safe when used properly, opioids do carry the risk of fatal overdose, whether used by a street addict or a pain patient.
The good news is that an antidote is available — injectable naloxone, which has been used in emergency rooms for years to reverse the potentially fatal breathing problems caused by an opioid overdose. It’s also available as a nasal spray called Narcan.
In both forms, naloxone rapidly knocks heroin and other opioids off opioid receptors. Naloxone brings about an instant, horrible withdrawal — but also saves the person’s life by restoring breathing. It has virtually no abuse potential and is considered very safe.
The chief flaw in the naloxone “rescue” idea is that, for the antidote to work, someone — conscious and functional — must be close by to administer the drug.
In Boston, deaths from overdoses among heroin abusers plunged after the city began distributing free Narcan kits to addicts in 2006, as the Boston Globe reported.
That success prompted the state Department of Public Health to run its own pilot program, which lists a number of places around the state where naloxone is available.
Nationwide, the Centers for Disease Control and Prevention reported in 2012 that community-based programs using naloxone have prevented the overdose deaths of 10,171 people since 1996. As of October 2010, there were at least 188 such programs operating in the U.S.
So encouraging are these results that the Food and Drug Administration is now considering ways to allow wider distribution of naloxone.
Few situations in medicine present such a clear take-home lesson: Naloxone could, and should, be made easily available to opioid abusers. It might also make sense for physicians who write opioid prescriptions for chronic pain patients to prescribe naloxone as well, with proper instructions for its use, so that patients could have an antidote on hand at home in case of overdose.
This might not prevent all opioid overdose deaths. But it would go a long way in the right direction.