Michigan increases access to naloxone

hand drowning
We’ve finally increased access to life preservers. Now, how do we get them out of the sea?

It’s official.

The new laws will allow a state resident to obtain a prescription for naloxone, also known by its brand name, Narcan, to immediately reverse the effects of an opiate overdose, whether due to heroin or a prescription drug such as Vicodin or OxyContin. It also requires emergency medical technicians to carry it on the ambulance, something that is already common practice throughout southeast Michigan.

This is very good news.

The next big question is, what comes after the OD?

OD Awareness and both/and approaches

NARCAN-KITYesterday was International Overdose Awareness Day. Where do we stand?

This crisis has brought some good policy changes. Naloxone distribution programs are spreading fast and good Samaritan laws are spreading too. These policy changes will undoubtedly save lives, and that’s important.

There’s also no doubt that there are a lot of deaths that these programs won’t prevent. Consider the death of Phillip Seymour Hoffman. As is common, he appears to have died while using along, which casts doubt on any suggestions that naloxone and good Samaritan laws would have saved him. Even for those they save, they don’t offer a way out of their suffering and a lives that they hate.

fr2plus-overview-main-450x330How are we doing in terms of access to treatment of adequate intensity and duration? We don’t have much in the way of statistics for that, but it’s save to say that we’re not doing so well. We’ve got models that work really well, but we only use them with health professionals, lawyers and pilots.

Too often, we’ve had one faction calling for more treatment and another calling for harm reduction.

Naloxone is not enough. And, even access to quality treatment of adequate duration and intensity were improved, we couldn’t engage and successfully treat everyone.

We need a both/and approach rather than an either/or approach. Let’s increase access to naloxone and make sure that every rescue is followed by the kind of care an addicted health professional would get.

 

 

Addiction research funding focused on “abstinence only”?

Federal grant search for active projects with the terms methadone, buprenorphine and naloxone
Federal grant search for active projects with the terms methadone, buprenorphine and naloxone

DJ Mac picks up on a story that also caught my eye and catches a line moaning about research bias in favor of abstinence-based programs. He pulled this quote.

The gorilla in the room around this question turns out to be the ideology of the decision makers. “There are ideological constraints tied to what gets funded,” says Ethan Nadelmann, founder and executive director of the Drug Policy Alliance in New York City. An example? The tendency to fund “abstinence only” programs and the war on drugs at the expense of drug prevention research. “There is not a lot of evidence of what works because it does not get studied. Today, kids lose their drug virginity before their sexual virginity. What’s the needle exchange of today?”

This struck me as odd, because NIDA seems to be heavily invested in promoting buprenorphine. So, I went to projectreporter.nih.gov and looked up active projects with the search terms “methadone OR buprenorphine OR naloxone”. It’s not a perfect method, but it tells you something, right?

Here’s what I found:

  • 220 active projects
  • $103,152,353 in total funding for these projects
  • These projects have generated 2028 publications that are now part of the evidence-base

“What’s the needle exchange of today?” It’s obviously naloxone, right? If you limit the search to just naloxone, you still get over $35,000,000. A search for “opioid AND abstinence” returns $41,450,238 in funding.

These results are consistent with the articles theme of research being oriented toward PhRMA, but not with Nadelmann’s argument that “abstinence only” rules the playground.

Dead addicts don’t recover, but…

Naloxone (1)
Naloxone (Photo credit: intropin)

This has gotten a lot of press. There’s naloxone distribution doubt this will reduce overdose deaths. However, some pretty important questions remain:

  • What happens after the overdose?
  • What services/interventions might have prevented the overdose in the first place?

The article references placing defibrillators in public places. What happens after someone is saved by one of those defibrillators? An ambulance comes and takes them to receive treatment. (Often treatment that costs tens of thousands of dollars.)

0 = Number of times the word “treatment/treat/treatable” appears in the article

0 = Number of times the word “recovery/recover” appears in the article

So … dead addict don’t recover, but why do we seem to care so little about treating what nearly killed the patient?

Establishing residence in hell

English: Naloxone HCl preparation, pre-filled ...
Image via Wikipedia

Saving lives is good an important, but something about this feels like building an addition on a house in hell.

Naloxone is a medication administered usually by injection which rapidly reverses the effects of opiate-type drugs such as heroin, including the respiratory depression which can cause what are normally referred to as ‘overdose’ deaths. … The 16 pilot projects trained 495 carers (family members, partners and other carers) to respond to an overdose using basic life support techniques, and all but one also trained them to administer naloxone.

Saving lives is a good thing, but what else might be done to prevent overdoses? Why this?

Yesterday’s post asked, “at what cost?” What are the costs of this to the family members?

The best we can do?

“If you want to treat an illness that has no easy cure, first of all, treat them with hope.”—George Vaillant

credit: Franco Folini

This is so heartbreaking. Communities should distribute naloxone to inmates as they leave prison? Really?

I’ve grown so weary of the trite responses like, “You can’t recover if you are dead.”

Of course it’s true, but what are we doing to help them recover?

In the States it’s nearly nothing.

A report released today finds that Michigan’s Prisoner Re-entry Initiative is reducing recidivism among parolees but it almost ended just a few weeks ago. Keep in mind that this program costs $33 million in a corrections budget of $1.88 BILLION. (That’s less than 2%) Also, keep in mind that Michigan is one of 4 states that spends more on corrections than on higher education.

UPDATE: The more I think about this kind of stuff the angrier I get. It’s the equivalent of  finding someone collapsing with a heart attack in the middle of a street, helping them get to a sidewalk,  leaving them there and then congratulating yourself with statements like, “They’d never survive that heart attack if they got hit by a car!”