An occupational hazard

March 20, 2003

OVERDOSE IS the heroin addict's occupational hazard. Last year, 324 died in Baltimore after excessive heroin use so numbed their central nervous systems they couldn't breathe.

Many of these addicts might have been saved if they had received a timely antidote and resuscitation. That's why Baltimore's health department has embarked on a radical experiment: training 50 addicts to inject naloxone, an opiate blocker. As of May, if those so trained find fellow addicts overdosing, they are directed to intervene and attempt resuscitation.

This approach has achieved some success in Chicago, where a private activist organization prevented scores of overdose deaths during the past two years. But Baltimore's health department appears to be the first in the world that is planning to allow addicts to act in lieu of emergency medical personnel.

It's a worthwhile experiment, but one that must be approached with great caution. The program's goal must not be simply to revive overdose victims so they can continue their habit.

From the outset, Baltimore officials should recognize and address the antidote's limitations and pitfalls. Naloxone - and the its brand-name equivalent, Narcan - may perform near-miracles, but it is not a miracle drug. A shot of the antidote wears off long before the effects of heroin do, so overdose victims remain in grave danger, unless they get swift care by trained medical professionals.

Calling for emergency help is not unreasonably burdensome. Even some otherwise unprincipled operators of shooting galleries make the gesture. When a client overdoses, they simply drag the listless body into an alley and call 911. They don't want the added complication of a corpse in their midst.

But addicts mostly avoid calling for help in overdose situations. Naloxone is so popular because it offers the false hope of anonymity for an addict who otherwise might die.

Even if administered with the proper follow-up care, though, the drug has only limited value. It does nothing to change the addict's destructive behavior or treat the addiction.

Baltimore's bold experiment can only be successful if it begins with the understanding that naloxone is an emergency tool. Ideally, no addict will use it more than once - as part of a rescue leading to medical care, addiction treatment and, ultimately, a healthy, drug-free life.

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