Advocates of the harm-reduction approach to drug abuse say that since a law went into effect last year, dozens of lives have been saved by administration of the opiate antidote naloxone.
By Rose Hoban
In 2006, Donna Reeves’ daughter Casey overdosed on prescription medication in her bedroom in the basement of Reeves’ Wilkes County home.
On the morning of her death, Reeves’ husband was heading out of the house for the day and went downstairs to check on Casey. He heard her snoring and decided not to disturb her. Within hours, Casey was dead, her snore likely a sign that her breathing was depressed by the amount of opioid medication in her system.
Since then, Reeves and her family have become advocates for wider distribution of naloxone, a drug that dramatically reverses the effects of opiates, from prescription medications like OxyContin to illegal preparations like heroin.
Reeves’ advocacy contributed to the passage of a law in the North Carolina General Assembly that allows for wider distribution of naloxone in the community and immunity for the person who administers the naloxone if they find someone who has likely overdosed.
Advocates for community distribution of naloxone say the new law is already saving lives.
“We’ve reversed 69 overdoses since Aug. 1 that we know about,” said Robert Childs, head of the North Carolina Harm Reduction Coalition. “We know there’s probably a lot more, but people are just afraid to talk to us about it.”
At least 792 people in North Carolina unintentionally overdosed from opioids in 2012, a number that has decreased since a peak death toll of 836 in 2008. Naloxone advocates say distribution of the medication has played a part in that decrease, along with efforts to educate doctors on better prescription habits for opiates and efforts to educate people in the community about naloxone.
The law also allows community-based organizations such as the Harm Reduction Coalition to distribute naloxone, something the group has embraced. Childs said his group has given out more than 1,700 kits.
“People are coming to our street outreach or our education sessions at methadone clinics or community-based organizations or street-based overdose training sessions,” said Childs, who also said his organization is giving kits to people who are leaving jails, the parents of people who use intravenous drugs and others. “Every time we go back to a methadone clinic, we hear that someone has used it.”
Word of mouth
Louise Vincent will tell you she’s an on-again, off-again heroin user. She’ll also tell you that in the 20 years since she started using the drug, she’s raised two children, held down jobs and earned a master’s in public health.
Vincent has also made it a personal mission to provide naloxone education and outreach within the community of heroin users around the state.
“I have, for the last five or six years, been making sure that everyone I know and they know, and everyone we can find, has naloxone. And if they don’t have naloxone, we get it to them,” she said. “I have rushed to people’s houses in the middle of the night, people who don’t want to call the police or ambulance, and I have been with people who have overdosed.”
“She’s reversed more drug ODs by a lay practitioner than anybody I know in the American South,” said Childs.
Vincent also educates heroin users about how to recognize the signs that someone has overdosed.
Usually, she said, when someone uses heroin, they get mellow or sleepy. “But if someone notices that the person is more than just sleepy – they’re not moving, they’re slumped over, they’re turning blue – you put them in the recover position and administer naloxone,” she said.
Vincent said heroin users don’t really want to overdose; it’s something that happens by mistake. People miscalculate the dose they need or they get a batch of drugs that’s stronger than usual. Sometimes, it takes more than one dose of naloxone to reverse the overdose.
Recently, Vincent was in a video that aired on CNN that shows one of her friends, Liz, during an overdose. Vincent and another friend administer several doses of naloxone and deliver rescue breaths to Liz as she comes back around.
Changing the paradigm
For years, the approach to treating people addicted to heroin or prescription opiates is to insist on abstinence from the drug. But the research literature is peppered with data showing that most people relapse in their attempts to abstain. It can take several episodes of relapse and repeated attempts to quit before most people succeed.
“Something like 90 percent of people who are addicted will relapse,” said Maia Szalavitz, a reporter who has been writing about substance abuse for more than 20 years. “If you think about it like dieting, I don’t know anyone who’s a perfect dieter. Most people will say, ‘I’ll have that cookie today.’ They don’t change their behavior overnight.”
Szalavitz explained that researchers have started thinking about addiction as being akin to a learning disorder.
“You learn that the drug solves your problems, and addiction makes that learning more difficult to unlearn,” she said. “It’s way harder to unlearn than if you’d learned right in the first place.”
Advocates say the better approach to treating addiction is to use a “harm-reduction” philosophy – that is, helping people use drugs safely until such time as they’re ready to quit.
“The harm-reduction approach is much kinder, gentler,” said Vincent, who has been in methadone treatment more than once. “It’s kinder to me. I’m also bipolar, and if I’m going through something and I go out and go on a binge, I don’t have to come back and say, ‘I failed.’”
Making naloxone available to addicts is central to the harm-reduction philosophy.
“Dead people can’t find recovery or get their lives together,” Vincent said. “People die because we don’t give them access to lifesaving medication.”
Szalavitz said that over the past two decades, many people have evolved in their thinking.
“Twenty years ago, when a kid overdosed, the parents would line up with the hard-line warriors and ask for people to be locked up,” she said. “Now you have parents of dead kids saying we want a harm-reduction approach to addiction. They want people to have access to naloxone.”
Embracing the new paradigm
One of the people who changed her thinking over time is a short, energetic gray-haired woman named Kay Sanford. A former state epidemiologist, Sanford has spent her retirement hanging out in prisons and jails and drug-treatment programs, teaching people how to keep from dying from opiate overdose. Over time, she’s become one of the state’s strongest advocates for harm reduction.
“It took me many years to learn that it’s more important to put my personal feelings aside and simply to go and do the kind of public-health work that saves lives,” Sanford said.
And that approach seems to be working: Preliminary numbers from the Injury and Violence Prevention Branch of the state Department of Health and Human Services show that deaths from accidental overdose have declined for the past two years.
Sanford said others in the community are embracing the harm-reduction approach.
“We need to turn this paradigm around, not be judgmental, but recognize that particularly with harm reduction we’re looking at a person where they are,” she said. “We have the opportunity to improve the quality of that person’s life so that there is a potential for better outcomes and better decisions later.”
An increasing number of law-enforcement agencies in North Carolina have arrived at the same conclusion. Earlier this month, the sheriff’s department in Pitt County rolled out an initiative to reduce overdose deaths by giving naloxone to all first responders in the agency.
“The purpose is to reduce deaths associated with opioid overdose through administration of nasal Narcan,” the brand name for naloxone, Melissa Larson from the Pitt County Sheriff’s Office wrote in an email.
Childs said his organization has trained about 665 law-enforcement officers in 2014 alone. He said other local law-enforcement agencies, including Carrboro’s, are planning on giving officers naloxone and training them to use it.
“If we make the life of an IV drug user healthier by promoting safety and health, it’ll make law-enforcement officers who encounter them daily healthier,” Childs said.