Contents of a naloxone reversal kit distributed by the NC Harm Reduction Coalition.
Contents of a naloxone reversal kit distributed by the NC Harm Reduction Coalition. Photo credit: Rose Hoban

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By Rose Hoban

More than 200 lives across North Carolina have been saved from opiate-related overdose in the past year, since implementation of a new law that allows advocates and doctors to distribute the drug naloxone more freely.

Senate Bill 20, which passed in April 2013, decriminalized the possession and distribution of naloxone, a drug used to reverse the deadly effects of overdose by prescription pain relievers and heroin. The law also exempts someone at the scene from being prosecuted on drug charges if they administer naloxone to a person experiencing an overdose.

In early December, Robert Childs, head of the North Carolina Harm Reduction Coalition, said members of his organization had collected 208 stories of “reversals” from people surveyed at methadone clinics and on the streets and from people who have contacted the coalition. Many of the people who recount stories of giving naloxone to a friend have already lost someone to overdose.

Contents of a naloxone reversal kit distributed by the NC Harm Reduction Coalition. Photo credit: Rose Hoban

“I distribute naloxone because I lived for years with the fear and helplessness of having a loved one at risk for overdose,” said Loftin Wilson, a naloxone distributor in Durham. “Every time I give naloxone to a person living with that same fear, and I see relief and hope in their eyes, it helps me to heal from that time in my life.

“I was at a methadone clinic in Hickory about three months ago,” said Childs. “When I was there, a quarter of the people I talked to had lost someone from overdose.”

Thousands of kits

Members of the Harm Reduction Coalition around the state have given out more than 5,000 reversal “kits” in the past year, Childs said. The kits include several vials of naloxone, a syringe, needles and information on how to use the drug to reverse an overdose.

“Most people won’t say anything, so we set up a system so they can say, ‘It worked. This is the city [where] it happened.’ That’s all,” Childs said. “You can let us know you’ve reversed by email, text, phone, web form or in person.”

Although the group has documented 208 reversals, Childs estimates there have been many more.

“The limitation of our model is that we don’t operate from a fixed site, so we go out to the community to dispense,” he said. “We also do a lot of rural distribution, which is harder to track, and getting to them and hearing back from them is tough.”

[pullquote_left]Is North Carolina Health News part of your daily news diet? Support us by making a year-end donation![/pullquote_left]Childs said his staff find out about the majority of reversals by returning to the sites where they dispensed the kits. He said his organization has relationships with almost every methadone clinic in North Carolina. Many of the people coming into the clinics know people who use opioid drugs, either heroin or prescription pain relievers obtained on the street or prescription drugs given by a physician.

But sometimes, coalition members will receive a tip. That was the case this summer in High Point, when a batch of heroin laced with the powerful opiate fentanyl was making its way around. Fentanyl is commonly used during surgery and can be as much as 100 times more potent than morphine.

When they heard about overdoses from the fentanyl-laced heroin, coalition members fanned out across town to sound a warning.

“We actually had 10 reversals in one night,” Childs said. “We were able to get out information to the people who were using drugs. We sent a crew out on the street to do dispensing of naloxone and did street-based prevention training.

“[We told them,] ‘You need to be really careful, and carry naloxone if you plan on using, and have a friend there to potentially administer it, because something insane is happening here.’”

Childs estimated that naloxone distribution has also saved the health care system thousands, if not millions, in averted emergency department visits and ambulance calls.

Knowledge gap

Trust is still a big issue among people using both prescription drugs and heroin, said Ariana Katz, who worked with the Harm Reduction Coalition last year while a student at UNC’s Gillings School of Global Public Health. And she said there are a lot of drug users out there who don’t know about SB 20 or its companion bill, House Bill 850, which makes it possible for someone carrying a syringe to declare it to a police officer and not risk arrest.

Katz surveyed people at methadone clinics about their knowledge of the two laws, and found that most were unaware of them.

Because of people’s reluctance to tell their stories, she created hypothetical situations that she presented to her subjects of what to do when they saw a friend overdosing.

She found that most people said they would call an ambulance, regardless of the new law. But even though they would make the call, many said they didn’t trust law enforcement figures or first responders not to turn them in.

“One person said, ‘I don’t trust the system; I’m sure the police will find some way around the law,’” Katz recounted.

But she said that once people learned of the laws, they said they wouldn’t hesitate to call for help.

SB 20 also allows physicians to write a “standing order” for naloxone for someone who is taking opioid pain relievers, in case the person takes too much of their medication.

Physicians can also write a prescription to a family member who suspects that a loved one is abusing drugs.

“We just know that if you get naloxone into the right population, like the methadone population and parents of kids who use drugs, it gets used,” Childs said.

According to state statistics, 68 percent of unintentional fatal overdoses in 2012 came from prescription drugs and about 21 percent of overdoses came from heroin. Childs said he expects fewer deaths from overdose as more people learn about the availability of naloxone and get their hands on one of his organization’s kits.

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