By: Maria Sorbera, PharmD Candidate c/o 2013 at AMSCOP (LIU)
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Author William S. Burroughs states in his novel, “The question is frequently asked: Why does a man become a drug addict? The answer is that he usually does not intend to become an addict. You don’t wake up one morning and decide to be a drug addict.”1 Addiction does not form over night; it consists of a timeline of events that cannot be reversed. Creating a tight grasp, an addiction makes it extremely difficult for an individual to find freedom. A quick snap of the fingers cannot reverse months or years of abuse. Unfortunately, this country is in the midst of a prescription drug abuse crisis leaving many people wishing that they can simply “snap their fingers” and be lifted from rock bottom. Although the battle against prescription drug abuse presents a difficult road ahead, it has opened numerous doors for healthcare professionals. Medical teams can aid in this crisis by taking a stand. Such positions have already been made by New York in this growing crisis with the Naloxone Pilot Program in Suffolk County and the passing of the Internet System for Tracking Over-Prescribing Act, I-STOP.
Here are the statics: in 2008, there were a reported 36,000 deaths from drug overdoses in the United States. Since 1990, the death rate from drug abuse has more than tripled. Hospital admissions from drug abuse have increased by 60% from 2007 to 2010.In addition, admissions due to oxycodone have exponentially increased by a frightening 160%. It is clear that prescription drug abuse is rapidly spreading with New York directly feeling many of the effects.2 Both Nassau and Suffolk County have been experiencing increases in opioid hospital admissions. The majority of deaths due to prescription opioids are caused by oxycodone. From 2008 to 2010, oxycodone prescriptions have increased by 42% in Nassau County and 23% in Suffolk County.3 It’s hard to remain blind to the situation. Recent news reports are filled with overdoses, pharmacy robberies, and physician misconduct. A recent instance was with Dr. William Conway in Baldwin who was charged with illegally distributing medication that resulted in patient harm and/or death. The severity of this ongoing crisis reveals the need for continued interventions such as the expansion of the Narcan Pilot Program.
Recently, Suffolk County has initiated the Narcan Pilot Program. Through this program more than 300 police officers have been trained regarding the use of intranasal Narcan, a drug that can be used to treat overdoses. Positive outcomes have already been displayed as the drug has been administered three times since August 1st in what would have been three potentially fatal overdoses4. With the increase in opioid abuse, it is completely reasonable and valid for police officers and EMS workers to carry this life-saving emergency medication. Deaths resulting from overdoses usually occur within 1 to 3 hours of ingestion. The time frame between when the patient overdoses to the arrival of EMS greatly varies with each situation. More often than none, opioid overdoses are in the presence of others.5 This raises the question, if people are present why is it that 911 calls are sometimes delayed? Unfortunately, the presence of others does not always mean that a 911 call will happen immediately.
In many cases, individuals who are present during an overdose try to revive the person themselves using techniques such as emerging the person in a cold bath or injecting them with stimulants. Being that the individuals present might be drug users as well, it is common for them to become frightened of the legal implications once 911 is called. Even with the Good Samaritan Law passed in 2011, which gives the individual who overdosed and the individual who calls 911 legal amnesty, some are still hesitant to seek medical help.5 Due to the various ineffective interventions by peers, medical care can be greatly delayed. This delay needs to be minimized. In an overdose, the longer one waits before an antidote or measures is taken to rid the drug of the body, the more likely the person is to lose his or her life. The need for police officers and EMS to have the Narcan Emergency Kit is essential in overdose situations; however, can this benefit expand even further if users themselves had access to the emergency kit?
Currently, the state of New York has Naloxone Distribution Programs which allow users and non-users to obtain naloxone with a valid prescription and proper training regarding the use of the drug. Some people might argue this is promoting drug abuse. Yes, it very well might be; however, what type of message does the distribution of condoms or Plan B send out to the public? Or the ability for people to obtain syringes due to the public health concerns about users sharing needles? Are they not promoting behavior that some people might also argue unethical? There is a fine line between life and death during an overdose and no value can be placed on an individual’s life. Granted there are still several concerns with allowing the distribution of naloxone: such as people having misconceptions that medical attention is not required once the drug is administered and another concern that with administration of naloxone, more opioids can now be ingested safely. With proper training these concerns can be significantly minimized.
Intranasal naloxone has an onset of action of 8 to 13 minutes and a relatively short half-life. Once the drug wears off, the individual can have recurrent respiratory depression. Medical attention is absolutely necessary during an overdose regardless if naloxone is administered. During training, this is a crucial concept that must be instilled in the individuals. Other concerns consist of users possibly readministrating more opioids. Currently, there are no documented cases in which narcan distribution programs have had problems with the readministration of opioids following naloxone administration.5 It is absolutely necessity that healthcare professionals counsel patients and assess their understanding of the drug in order to avoid any negative consequences from distributing naloxone.
Prescription drug abuse has been casting a shadow over America for years causing deaths, broken families, and economic hardships. It is an issue that must be faced head on and presents a time for health care professionals to take a stand on saving lives. Providing comprehensive counseling and training if needed are key ways that health care professionals can become involved. On Long Island, there have been steps made to combat this crisis in order to save lives. The three lives saved this past summer since the initiation of the Narcan Pilot Program in Suffolk County are not just three lives, they are individuals with families and friends who are forever thankful to those police officers. The distribution of naloxone is a way to prevent overdose victims from crossing that fine line between life and death, and hopefully seeing it as a wake-up call. Take a stand and give patients their lives back. Everybody deserves a second chance.
SOURCES:
- Burroughs WS. Junky. New York: Penguin Books; 1977.
- Centers for Disease Control. Policy Impact: Prescription Painkiller Overdoses. December 19th, 2011. Available at: http://www.cdc.gov/homeandrecreationalsafety/rxbrief/. Accessed October 20th,2012.
- New York State Office of Attorney General. Internet System for Tracking Over-Prescribing (I-Stop): A Proposal Addressing New York’s Prescription Drug Abuse and Drug Diversion Epidemic. 2011. Available at:http://www.ag.ny.gov/sites/default/files/press-releases/2012/ISTOP%20REPORT%20FINAL%201.10.12.pdf. Accessed on October 20th, 2012.
- Newsday: Suffolk officer saves life through Narcan pilot program. August 2nd, 2012. Available at: http://www.news12.com/archive/articleDetail.jsp?articleId=329227&position=1&news_type=news. Accessed October 20th, 2012.
- Kim D, Irwin KS, Khoshnood K. Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality. Am J Public Health;March 2009: 99(3).
