City program to let addicts give overdose medication

Heroin users to inject opiate-blocking drug

March 03, 2003|By Joe Nawrozki | Joe Nawrozki,SUN STAFF

Pressed by a staggering number of fatal heroin overdoses, Baltimore health officials will launch a program this spring that will allow addicts to administer Narcan, a drug that can revive a person near death from a heroin overdose.

The plan calls for distribution of vials of Narcan - used by paramedics and hospital personnel to treat opium-based narcotics overdoses - to begin May 1 after a training period for a group of 50 addicts.

Last week, training started for emergency services and health officials who will, in turn, fan out across Baltimore and teach addict-rescuers basic medical protocol with the drug, syringes, resuscitation techniques and other lifesaving methods.

"There is a chronic problem here," said Dr. Peter L. Beilenson, Baltimore health commissioner. "A significant number of people are dying each year from heroin overdoses - in one year, more than the homicide rate - and while this may be viewed as enabling, this is a worthwhile attempt to keep people alive."

In the past four years, more than 1,000 people have died from heroin overdoses in Baltimore, officials said.

Baltimore County's top health officer, Dr. Michelle A. Leverett, said she will be keeping a close watch on the city's Narcan program. "I will be very interested to see what happens in the city. ... Heroin overdose deaths are also going up in the county."

Last year, 109 people died from heroin overdoses in Baltimore County. Other metropolitan counties have problems with heroin use, but none comes close to Baltimore's or Baltimore County's heroin morbidity rates.

Mixed message

While supporters of the Narcan program said lives have been saved in other heroin trouble spots in the nation and world, critics contend the city's plan sends a mixed message to Baltimore's estimated 60,000 addicts: Use as much heroin as desired, anytime, anywhere.

Critics also wonder whether addict-rescuers can retain the necessary information about varying doses of Narcan needed for different overdose scenarios, all involving life-and-death decisions. There are also questions of whether a heroin user, high on the narcotic, can efficiently administer Narcan to a dying member of their shooting party.

Under the program, addict-rescuers will be given vials of Narcan and syringes. After recognizing an unconscious user experiencing difficulty breathing, the addict-rescuer will be expected to fill a syringe with a specific dose of Narcan and properly administer it.

The city started a needle exchange program eight years ago in which nearly 3.8 million syringes have been exchanged in an effort to staunch the spread of HIV and other diseases among addicts sharing needles.

Baltimore Mayor Martin O'Malley declined to comment on the Narcan program.

Tony Tommasello, director of the Office of Substance Abuse at the University of Maryland's School of Pharmacy, said that while caution should be exercised in implementing the Narcan program in Baltimore, the situation requires innovative steps to reduce the high number of heroin deaths.

Tommasello notes a time when families stocked up on syrup of ipecac in their households for poison emergencies. "That saved a lot of lives and prevented emergency room visits," he said.

"Admittedly, we are not dealing with the same mindset here because lots of things could go wrong with naloxone [the generic name of Narcan] in the hands of heroin addicts," he said. "But naloxone is a terrific drug and it has saved countless lives, and while there are lots of questions, the only way to answer them is test it."

Dr. Robert K. Brooner, professor of psychiatry and director of addiction treatment services at the Johns Hopkins medical institutions, said he is "a bit conservative" on the Narcan program. "But we are in a culture that is reluctant to apply the death penalty to serial killers ... and the sins of a drug abuser should certainly not mean a death sentence.

"While there are a number of unanswered `ifs' about such a program, Narcan should limit the number of people who die from heroin overdoses, and I don't think anyone would really argue with that."

Still, the Narcan program concerns others familiar with treatment and the subterranean world of heroin addiction.

The Narcan program "takes the most serious deterrent away from someone considering a life of addiction - that shooting heroin is dangerous and can kill you," said Michael W. Gimbel, former director of Baltimore County's bureau of substance abuse and a former heroin addict.

"The Narcan program sanctions heroin addiction," said Gimbel. "It's like the city has given up."

But city officials say the body count from overdoses is staggering. They contend that the innovative program will save lives and drastically cut the 1,800 emergency calls the Fire Department receives annually to revive overdosed addicts.

`Serious heroin abuse'

The National Drug Intelligence Center of the U.S. Department of Justice said in an August report that Baltimore "has one of the most serious heroin abuse problems in the nation."

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