Trying to prevent heroin deaths one shot at a time

New program trains addicts, their families, police in using overdose-reversing drug

  • Dr. Bethany DiPaula, a pharmacist with the Howard County Health Department, demonstrates how to put together a syringe of Naloxone at an opiate overdose response training session which is being held at the Howard County Health Department.
Dr. Bethany DiPaula, a pharmacist with the Howard County Health… (Barbara Haddock Taylor…)
September 06, 2014|Jean Marbella, The Baltimore Sun

Robert Taylor Jr., and Camille Haviland thought they were being safe — within the bounds of their dangerous heroin habit, that is.

Having bought from a new dealer, Taylor tried just one capsule instead of his usual three or four. Haviland left on an errand; when she returned 15 minutes later, she found him collapsed on the ground, bluish and not breathing.

She started CPR. When paramedics arrived, they injected Taylor with the overdose-reversing drug, naloxone.

"At the time, I would have liked to have had this," Haviland said recently after she and Taylor were trained and certified to administer the drug themselves. "I've had a lot of friends die because people just left them."

Maryland health officials, desperate to stem an 88 percent rise in heroin overdose deaths from 2011 to 2013, have launched an initiative to put naloxone into the hands of addicts, their families, police and other nonmedical personnel.

Heroin in particular is taking a toll: Of the 848 people in Maryland who died of drug or alcohol intoxication last year, 464 overdosed on heroin. The grim trend continues this year: In the first three months, the most recent for which statistics are available, 148 of the 252 who died had used heroin.

The city and region have struggled for decades with high rates of heroin addiction, but fatalities are on the rise here, as elsewhere in the country, as purer forms of the drug, or formulations that include another potent opioid, fentanyl, become more widely available, health officials say.

As a result, states increasingly are turning to naloxone, also known by its brand name, Narcan, which reverses overdoses of heroin and other opioids such as oxycodone, but not of cocaine and other drugs. In 2012, then-federal drug czar Gil Kerlikowske called for broadening naloxone's availability, saying that for some addicts it could be "the difference between life and death."

During the 2013 Maryland legislative session, families of addicts who had died of heroin overdoses pleaded their case to lawmakers and won unanimous approval for a measure allowing nonmedical personnel to be trained to administer the drug and receive a prescription for it.

Taylor and Haviland are two of the roughly 2,200 people who have been certified to use naloxone since health departments and other groups began offering classes in March.

Still, the measure remains controversial in some quarters.

Critics say the new program, like those that distribute clean needles, encourages heroin addicts to continue using by reducing the consequences.

"It exacerbates the problem because people think they can overdose [and] 'someone can bring me around,' " said Israel Cason, the former heroin addict who has run the treatment program I Can't We Can in Park Heights for 17 years. "They're only treating the symptoms. They're not dealing with the problem."

But Maryland Health Secretary Dr. Joshua M. Sharfstein said naloxone is an important component of a larger strategy to cope with the flood of more powerful heroin, often mixed with fentanyl, that has sent the rate of fatal overdoses skyrocketing.

There is no evidence in existing research, Sharfstein said, that making the antidote available increases drug use.

"People use for all sorts of reasons," he said. "The fact that they have naloxone available is not a contributing factor.

"Heroin just destroys people's lives completely. What keeps them in recovery is not just the fear of death, it's losing their family, their house, everything."

Taylor and Haviland, who attended a class at the Howard County Health Department in Columbia last month, started methadone programs during the winter and say they are committed to their recovery. They say having naloxone in their apartment in Laurel gives them a sense of security in case of an emergency.

"I hope I never have to use it," Haviland said. "We both have a lot of goals now. We're just tired of getting high. We want a life, we want something better."

Naloxone works by attaching itself to the same parts of the brain that receive heroin and other opioids, and reversing the effects of the drugs.

At the class, Bethany DiPaula, an associate professor at the University of Maryland School of Pharmacy, demonstrated how to use the device that vaporizes the naloxone into a nasal spray. Naloxone can also be injected into a muscle.

DiPaula has also trained prison inmates near release so that they can take the antidote home with them. Having naloxone available, she believes, does not encourage drug use.

"Naloxone puts them in withdrawal. They're not going to want to do that," she said. "It saves people's lives. For people who have an overdose, it's so traumatic, it can lead them to treatment."

While some in the class work with addicts or were addicts themselves, others simply wanted to learn a new skill.

"It's a wonderful thing to know you're not helpless," said Dorothy Keener, the health assistant in the county's school system.

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