By: Mahdieh Danesh Yazdi, Associate Student Editor, with Special Thanks to Dr. Tomasz Jodlowski for his contributions to this article
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In the 1990s, major urban and rural areas across the United States grappled with a common problem: drug addiction. At that time, the drugs of choice were illicit substances (i.e. heroin). In order to combat the overwhelming number of deaths due to overdose of these drugs, many cities began using naloxone distribution programs. Naloxone (Narcan®) is a short-acting mu receptor antagonist used in cases of opioid overdose. It works by competing with opioids at mu receptors, thus, preventing them from exerting their pharmacological effects, the most dangerous being respiratory depression. Since most abused drugs, whether illicit or prescription, are derived from opioids, naloxone plays a life-saving role for many patients addicted to these drugs. Naloxone (Narcan®) essentially reverses opioid activity and allows the patient to breathe again.
When initiating the program, it was hoped that with these naloxone kits, people near an addict would recognize the onset of symptoms and be able to inject the addict with the life-saving drug. This is a harm-reduction strategy, where a public health organization tries to reduce the consequences of harmful behavior such as drug abuse, as opposed to stopping the behavior itself. Chicago pioneered the movement, and it has since spread to other major cities, including: Milwaukee, Los Angeles, Boston, Baltimore, New York City, New Mexico, and San Francisco. These programs also exist in other countries, such as Canada and Australia.
Such strategies have many opponents. They argue that these programs encourage people to continue their addictive behavior because it gives them a false sense of security about the negative consequences of their behaviors. This, they claim, encourages further drug abuse. The federal government is among these skeptics, and it has openly stated its opposition to the implementation of such programs. Proponents argue that these programs are effective in reducing the number of deaths due to drug abuse and that they do not increase the incidence of addiction.
However, with the current increase in drug abuse, specifically prescription drug abuse, these programs are once again relevant. Prescription drugs recently superseded illicit substances in the number of addicts and deaths related to overdoses. According to the Centers for Disease Control (CDC), in 2007, over 12,000 people died of prescription drug overdoses. In fact, prescription drug abuse accounted for more death than heroin and cocaine combined. This is especially true for rural areas, where people are twice as likely to overdose versus city residents. With less access to immediate medical care, naloxone kits may be the best chance some individuals have to survive.
For example, in Scott County, Indiana, prescription narcotics are the new drugs of choice for abuse. In this small town with a population of 24,000, nine people have died this year alone from prescription drug overdose. Naloxone kits may prevent such deaths, as they have in large cities. A study assessed the naloxone distribution program in New York City. About 82 participants stated that they had used naloxone: 68 overdose patients survived and the fate of 14 others was unknown. This data can help public health officials make the case for implementing and expanding naloxone distribution programs.
Despite promising results, there are limitations to such programs. The cost of the drug, clean syringes, and educating addicts place a burden on organizations responsible for these programs; a burden some may not be able to bear. These concerns are further exacerbated by the current economic climate which puts pressure on state and local municipalities to cut back on all programs. Also, as with any injectable drug, there is always the potential for infection if the medication is not properly used, mandating additional training for all those receiving vials.
It is important to note that the effectiveness data of these programs is not clear-cut. A meta-analysis of medical literature reviewing these programs from 1990 to 2004 revealed that there is not enough evidence to support a decrease in mortality with the use of these medications. Most data on the issue is anecdotal. Further research and experimental studies are required to prove that naloxone distribution programs are actually effective, particularly in terms of the one major endpoint that matters: saving patients’ lives.
SOURCES:
- Baca CT, Grant KJ. Take-home naloxone to reduce heroin death. Addiction. 2005 Dec;100(12):1823-31.
- Centers for Disease Control and Prevention. CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic. Website. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm. Jan 13, 2012. Accessed Apr 23, 2012.
- Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report: Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010. Website. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm. Feb 17, 2012. Accessed May 23, 2012.
- Piper TM, Stancliff S, Rudenstine S, et.al. Evaluation of a naloxone distribution and administration program in New York City. Subst Use Misuse. 2008;43(7):858-70.
- Wisniewski M. Painkiller Opana, new scourge of rural America. Website. Available online: http://www.reuters.com/article/2012/03/27/us-drugs-abuse-opana-idUSBRE82Q04120120327. Mar 27, 2012. Accessed: Apr 25, 2012.
