Preventing Overdose: Obama Administration Drug Czar Calls For Wider Access to Overdose Antidote

For the first time, the drug czar has supported broadening access to naloxone, the life-saving prescription drug that immediately reverses overdoses of heroin and prescription painkillers

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Courtesy of Fred Brason / Project Lazarus

A naloxone kit to reverse overdose.

(Updated) Speaking on Wednesday at a North Carolina overdose-prevention program, the Obama administration’s drug czar Gil Kerlikowske called for increased action to prevent drug overdose deaths. Notably, Kerlikowske urged wider distribution of a medication called naloxone, an antidote to overdoses of opioid drugs, including prescription pain relievers and heroin, saying that “naloxone can be expanded beyond public health officials.”

Currently, naloxone is available only by prescription and is otherwise accessed easily only by health professionals and some law enforcement officers. Kerlikowske’s comments mark the first time the drug czar — who is more formally known as the director of the Office of National Drug Control Policy — has voiced support for broadening access to naloxone by addicted people, pain patients and their families. On Wednesday, he spoke with officials and others involved with Project Lazarus, a North Carolina program that pioneered wider distribution of the medication and is seen as a model prevention program for its comprehensive approach to fighting overdose and prescription drug misuse.

“As valuable as naloxone is, it’s only a small piece of the broad spectrum of drug use prevention,” Kerlikowske stressed, adding, “We’re very serious about removing the legal impediments that can mean the difference between life and death. The odds of surviving an overdose, much like the odds of surviving a heart attack, really depend on how quickly the victim receives treatment.”

To illustrate that point, Kerlikowske recounted the story of a young woman who survived an overdose thanks to the quick administration of naloxone. Her brother, who was enrolled in a drug treatment program participating in Project Lazarus, used the naloxone kit he had received from his treatment provider to save his 26-year-old sister’s life, when he found her “unresponsive and not breathing and her face was blue,” as Kerlikowske put it.

The man had initially called his counselor, who told him to hang up and dial 911 and use the naloxone. Within about a minute or two of receiving the drug, his sister woke up. Four days after “her near death experience,” Kerlikowske said, “she entered treatment. Without naloxone, she wouldn’t have had that choice.”

(MORE: Government Considers Overdose Antidote, Naloxone, to Fight Prescription Drug Misuse)

Naloxone, sold under the brand name Narcan, immediately reverses overdoses of heroin and prescription pain medications like Oxycontin, even if these opioids are combined with alcohol or other sedatives. The medication is non-addictive and does not cause harm if used in error, although it can induce non-life-threatening withdrawal symptoms in people who are dependent on opioids.

This spring, the FDA held a meeting to discuss making naloxone available over the counter, but such a move would require a manufacturer to seek approval to do so, which would in turn require expensive drug testing — that does not appear to be forthcoming. There are other regulatory paths to over-the-counter status that would bypass this hurdle, but it is not clear whether Obama administration officials will pursue them; neither Kerlikowske nor his office provided further specifics.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, has supported broader distribution of the overdose antidote.

Earlier this month, a bill to provide federal grants to expand naloxone programs like Project Lazarus, known as the Stop Overdose Stat (SOS) Act, was introduced in the House by Rep. Mary Bono Mack (R-Calif.) and Rep. Donna Edwards (D-Md.), with bipartisan support from two dozen other members, but its chances of passage and the amount of funding it would receive are also not known.

“I welcome Director Kerlikowske’s announcement today to expand the availability of naloxone, proven to be an effective treatment in reversing drug overdose,” Rep. Edwards said in an email. “This is a critical component of H.R. 6311, the Stop Overdose Stat (SOS) Act.”

(MORE: A Lifesaving Overdose Antidote Should Be Made More Widely Available)

On Wednesday, officials from Project Lazarus, which is based in Wilkes County, N.C., presented information on the program’s effectiveness and its collaborative, cross-disciplinary approach to overdose prevention. In addition to naloxone distribution, the program involves physician and widespread community education, law enforcement efforts to fight illegal prescribing, pill take-back days and use of the state’s prescription drug monitoring program. Unlike other efforts to reduce prescription drug misuse, it actively involves chronic pain patients and those who care for them.

Two years after Project Lazarus began, overdose death rates in Wilkes County dropped 67%, after having risen steadily for years, according to a presentation by Rev. Fred Brason, project director of the program. The program also appeared to reduce problem prescribing without harming legitimate pain patients: in 2008, 80% of overdose death victims had received at least one prescription for their medications from a local prescriber; in 2011, none did.

As a mother who lost her daughter to overdose said at Wednesday’s meeting, crying as she spoke, “If I had known there were things out there like naloxone, I could have helped her. I wouldn’t be here today talking to you all. I could have had my daughter.”

Correction [Aug. 22]: The original version of this post misidentified Rep. Mary Bono Mack as Rep. Connie Bono Mack.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

11 comments
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SMF
SMF

It is my hope that " Project Lazarus" will be enacted in all states. The program makes sense and has had an outstanding effect on reducing the number of overdose deaths in NC. Having Naloxone available to Chronic Pain patients and their care givers would help eliminate accidental overdoses from these much needed medications and would go a long way towards ending the stigma associated with them. I will be pushing for this program to be enacted in my state. It will benefit all.

DonnaRatliff
DonnaRatliff like.author.displayName 1 Like

I support having the antidote available and I feel it should be available over the counter and given to all patients that require pain medicines, FREE. "Project Lazarus" is the best program with common sense in mind  and should enacted in all states. Over 100 million people with chronic pain? There has to be medicine available and having the antidote is the answer to saving lives..

ecstatist
ecstatist

Natural and simply processed opiates (the salts of morphine including "heroin")  are incredibly inexpensive, (single digit cents per dose, even in ampoule packaging.) The (semi) synthetic ones, who primary "advantage" (to the pharmaceutical industry) are "patentability," and to a far lesser degree (for the patient/user) aspects such as activity time, efficiency with oral administration (debatable if viewed in terms of cost as opposed to mass), and aspects such as blood - brain transmission (useful when very large dosing is required.) The cost (unencumbered by the complex logistics of legally required securities) of supplying any "addict" or patient  is less than a dollar per day.

Simple opiates are extremely non toxic in terms of organic harm. They kill by depressing (stopping) the urge to breathe. If respired artificially, the patient suffers no harm even with 1oo's of times the conventional dosage. In environments where the prices are not exorbitantly high (thus without the problems of secondary marketing, as would be the case if there were no legal restrictions,) the simplest, cheapest, most effective "treatment" is lifetime drug supply maintenance. The user would be no different than the average unremarkable (and unproductive) citizen and often is more "truly productive." An unspoken but significant portion of medical professionals are these citizens already!

The global primary cause of street level overdose is due to the unknown concentrations sullied and supplied by the black market. The primary cause of fatalities attributed to opiate overdose  in the USA, is due to liver failure caused by the inclusion of acetaminophen (paracetamol) which the "authorities" feel compelled to include to deter the use of large quantities. (We are going to protect you from the relatively insignificant harm of opiate use (abuse) by including something that will kill you more surely.) This practice is beginning to change despite the "moralistic mewling" of the "loving and caring" religious sector of society.

We need more science, not emotion driving and driven politics.       

theskeptic2
theskeptic2

Why is 'big pharma' not being prosecuted?

In 2009, 26,000 deaths from prescription medicines.

Deaths caused by marijuana...not a single one in recorded history.

Several years ago, I had surgery on my right shoulder. Pain medication was

prescribed..."take one capsule every 4 hours."

I took one capsule.  

I was down for over 20 hours. When I came to, I

felt like I had been hit by a truck. The next time I felt discomfort, I smoked a

small amount of marijuana ...pain gone, no after effects.

I threw the pills out.

Then I wrote: Shoulda Robbed a Bank

My contribution to helping point out just how ludicrous our pot laws truly

are.

Bailey Hirschburg
Bailey Hirschburg

This is actually quite relevant. Time's talked about it recently.

http://healthland.time.com/201...

Criminalizing addiction has dehumanized serious abusers and mis-labled casual users and wasted police time and money. Decriminalize use and possession and work to control drug markets either through existing sales/prescriptions, or controlled by hospital, research, and treatment facilities.

www.drugpolicy.org

HarryObrian
HarryObrian

Yes, let's enable drug users even further. Where's all the taxpayer money for the 'war on drugs' being wasted now?? Absurd pensions?? Overtime?? Where??

Seems like this socialist drug czar is more concerned with job security and keeping drug dealers employed then solving any problem.

quickiB
quickiB like.author.displayName 1 Like

This is exactly the kind of idiotic, right-wing thinking that keeps this so-called Drug War (A.K.A War on Drug Users) going with no end in sight. If your own child or best friend overdosed when something as cheap and effective as Nalaxone could save them, would you be worrying about the economy and how an unproductive member of society is no longer a burden, or that person's life. Anybody should be able to buy this at any corner store and have it on hand for people they know or emergencies. The same principle applies to Good Samaritan exceptions. People should not have to let their friend or someone else overdose for fear of self-incrimination. It's time to adopt a more sensible and socially-conscientous approach to drug use and harm-reduction.

Starshiprarity
Starshiprarity

The point is to keep them alive long enough to recieve treatment for their addiction. It doesn't promote drug use any more than condoms promote prostitution.

Amy Smith
Amy Smith

2,000 assault rifles and other firearms were sold to suspected traffickers for the Mexican drug cartels. It was intended as an intelligence-gathering ploy, but U.S. agents lost track of most of these weapons. ...

 

By early October 2011, there were calls for a special prosecutor to investigate whether Holder had perjured himself during testimony before Congress. Right-wing pundits described the scandal as “Obama’s Watergate.

Andrew Kamadulski
Andrew Kamadulski

So those guns were loaded with narcan? Or are you just some goofy wingnut ranting off-topic?