Lessons from Bon Jovi’s Daughter’s Overdose

Stephanie Bongiovi's case makes the argument for broader Good Samaritan laws and wider use of the overdose antidote naloxone

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Chris Pizzello / AP

Stephanie Bongiovi, daughter of rocker Jon Bon Jovi, attends a pre-Grammy party in Beverly Hills, Calif., on Jan. 30, 2010

The case of Stephanie Bongiovi makes the argument for broader Good Samaritan laws and the wider use of the overdose antidote naloxone.

On Nov. 14, a 911 call alerted medics that an unresponsive female student at Hamilton College in upstate New York had apparently overdosed on heroin. The victim turned out to be rocker Jon Bon Jovi’s 19-year-old daughter, and according to New York State law, overdose victims and the people who aid them can’t be prosecuted for possession of small amounts of illegal drugs.

Known as the Good Samaritan law, the legislation was first passed in New Mexico in 2007 and is now law in nine states, including New York, to help overdose victims get medical care as soon as possible without fear of criminal repercussions. Research shows that most overdose deaths are witnessed and occur within one to three hours after the last ingestion or injection, but only 10% to 56% of witnesses call for medical help, primarily because they fear being arrested.

Bongiovi’s overdose (for his band, Bon Jovi changed the spelling of his name) is a case in point. Both Bongiovi and the student who allegedly dialed 911, Ian Grant, were arrested on charges of possession of heroin and marijuana — exactly what the law was supposed to prevent.

Citing the legislation, prosecutors dropped those charges the following day. But the confusion highlights the need for expanded understanding and enforcement of Good Samaritan laws as well as greater access to the antidotes for overdose from heroin or prescription painkillers.

About 16,000 people die annually of opioid overdose. Most of these deaths are preventable, however, if treated quickly with a drug called naloxone (Narcan). Unfortunately, awareness of Good Samaritan laws is still low, and despite recent statements of support from the U.S. drug czar’s office and from the American Medical Association, naloxone is not always available when it is needed. The drug is most effective when used just before the overdose victim has stopped breathing, to prevent oxygen-deprived damage to the brain.

In the current issue of the Journal of the American Medical Association (JAMA), researchers call for wider adoption of Good Samaritan laws and federal action to facilitate the distribution of naloxone to treat victims of heroin or prescription-painkiller overdoses.

(MORE: Preventing Overdose: Obama Administration Drug Czar Calls for Wider Access to Overdose Antidote)

As Bongiovi’s case highlights, however, the authors say there are still significant barriers to this strategy. “Right now the message is that if you call for help, you’ll get arrested,” says Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition and a frequent prescriber of naloxone for overdose prevention. “A huge amount of damage has been done simply by arresting them in the first place.”

But it’s not simply the legal ramifications that are thwarting efforts to change overdose treatment. Naloxone’s cost and prescription-only status may also keep it from being used more widely. It is currently a prescription drug that is only approved by the U.S. Food and Drug Administration in its injectable form, and since injectable medications need to be sterile, they are generally more expensive to make and buy. Shortages in these drugs are also a growing problem. “The production process for ‘sterile injectables’ like naloxone is prone to any number of problems — of which the recent meningitis-contamination horror story is an extreme example,” explains Leo Beletsky, lead author of the study and assistant professor of law and health sciences at Northeastern University.

“To deal with quality issues, drugmakers may reduce or discontinue making the specific medication, causing a shortage,” he says. “Predictably, in these situations, the production of generic off-patent medications like naloxone is the last priority because they are the least profitable. This makes such drugs more likely to be in shortage and also jacks up their price.”

About 188 community-based programs currently distribute naloxone in 15 states, and at least 10,000 successful overdose reversals have been reported since the programs began in 1996. But such programs still do not meet the national need — there are 16,000 such deaths every year — in part because most programs cannot afford to buy the expensive drug and its use is not covered by insurance.

Regulatory barriers also contribute to the problem. In April the FDA held a meeting to consider making naloxone available over the counter. An intranasal form of the drug exists and is being used in the U.S. by some of the community-based programs, based on small studies that show that it works. But the makers of the intranasal form have not submitted its version for approval by the FDA, and injectable versions of drugs are typically not sold over the counter.

In the JAMA article Beletsky and his co-authors suggest ways of easing the bottleneck in naloxone distribution. Shortages in manufacturing, for example, might be alleviated if the FDA allowed foreign-made naloxone to be imported into the U.S. “Naloxone is a cheap drug to make, and it is abundantly available in Europe and Asia, as well as elsewhere, at a fraction of the cost,” he says. “Given the U.S. shortage, the exorbitantly high prices and existing production lines, there are foreign drugmakers eager to enter the market.”

Further research to support approval of an over-the-counter product could also help, as will awareness campaigns to educate the public of the dangers of overdose, and the need to seek medical help as soon as possible.

After all, it’s not only rock stars and their daughters who are at risk: it could be your child or sister or brother or partner.

MORE: Naloxone Debate: FDA Hears Testimony About Making an Overdose Antidote Nonprescription

15 comments
NicoletaSteliana
NicoletaSteliana

We all have a right to live, regadless of the bad decisions we may have taken at one point or another.

imskeptical
imskeptical

We should allow the foreign drug companies into the U.S. market to supply this and all other drugs.  We should make the antidote available OTC in pills and suppositories as well as injectable form, to help the maximum number of people and save lives.  And, of course, all drugs should be decriminalized.  Need to break up the criminal enterprises that make money off of crime, AND the legal monopolies (private prisons, etc.) and their lobbyists that drain our economy and corrupt our political process due to criminalization of stuff that should be legalized.

Shadow_041
Shadow_041

If they're dumb enough to take substances that they know could potentially kill them, then let them die.  It improves the global gene pool.  The world has enough stupidity in it to worry about those that want to purposely harm themselves.

UrsulaWhite
UrsulaWhite

aww, why do rock stars and their significant others have to be associated with substance abuse and OD? ... oh FYI found a great article on Sex, Drugs, and Rock and Roll: http://maryszela01.blogspot.com/

Paulpot
Paulpot like.author.displayName like.author.displayName 2 Like

You cannot OD from smoking opium. If the herbal pharmacopoeia were completely legal, people would have access to safer options than the currently concentrated potions forced on the market by the economics of prohibition.This case also highlights the central paradox of prohibition that it makes victims of the victims. How are you helping someone in need by putting them in prison?The natural drugs are far safer and far cheaper than the current industrial offerings. Our health system is burdened by the cost of them and robbed of perfectly good drugs doctors had prescribed for centuries.The problem is prohibition.End the drug war.

FosterRight
FosterRight

"Hey, kids, let's do heroin! No worries, I have naloxone. Shoot away!" Only a liberal would think the only problem with using heroin is that it might kill you.

sucorazon20101
sucorazon20101 like.author.displayName like.author.displayName 2 Like

@FosterRight , really fummy.,considering that most dope users and internet porn users are from the red states.

hollis
hollis like.author.displayName like.author.displayName 2 Like

Just like the National choice to highlight bullying, the media should overflow their outlets with the information.  give a person the opportunity, without prosecution, to save a life!! Too many people are already in US jails for small amounts of Marijuana and cost all of us a hugh amount of money to lock up and feed!

Martian_14
Martian_14

And the liberals, postmodern "geniuses" want to decriminalize this scourge...

They want to use drugs, but do not want to pay the price for it. It is very easy to be a liberal, right? They want to have fun while the rest of the  population has to pay for their stupidity. I guess that's why Obamacare is so popular

The "new normal" is to be a moron...

ToeHead
ToeHead like.author.displayName like.author.displayName 2 Like

@Martian_14 Well I guess Obamacare isn't THAT unpopular considering he was reelected. I know. You're still nursing your sad little wounds.  People who actually work with people suffering with addiction aren't going to argue that you should just do drugs and have this drug available so you don't die.  No one is denying the fact that drug use causes multiple health problems and often death.  A lot of people also believe that addicts shouldn't be simply left to die. Much the same as if you develop lung cancer from smoking cigarettes or type 2 diabetes from a poor diet, we don't just leave you to die. Is that a hard concept for you to accept? Apparently so because you lack any sort of empathy or compassion which makes you a pretty disgusting human being indeed.

Hadrewsky
Hadrewsky like.author.displayName like.author.displayName like.author.displayName like.author.displayName 4 Like

@Martian_14 And criminalization has worked real well for the US hasnt it? The war on drugs has been a complete success at filling up prisons to the point out per capita prison population is right up there with Saudi Arabia,

Criminalization does not work nor will it ever work and you seem to be willing to keep up a strategy that costs us more than decriminalization ever would... Supporting legal costs and prison costs far more than getting people treatment/// 

So i would suggest growing a damned brain.

treatdiaries
treatdiaries

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pmenzies
pmenzies

St Louis is devastated by heroin addiction and some estimates put the deaths around 2000 in the last five years. Many of the deaths could have been avoided if we had Good Samaritan Laws and the availability of Narcan which instantly reverse an overdose and safe lives. Heroin addiction is one of the most stigmatized of all addictions and many heroin users self-stigmatize themselves. It is very different from using marijuana or alcohol. Heroin users fall out of their normal 'social orbit' and forced into groups and relationship associated with heroin use. These young people are more likely to heed the advice of the street pharmacologists than treatment professionals. Some of them may try to kick the habit by buying or trading drugs like buprenorphine (Suboxone) but the vast majority have not heard about all the treatment options. The most under-utilized medication is naltrexone and the monthly injection of naltrexone - Vivitrol. Naltrexone is not for everyone so are all the other medications including methadone and buprenorphine. Using naltrexone is a lot of work but the rewards are equally good. The State of Missouri has done the right thing by offering naltrexone to patients in state-funded programs and not just for the well-to-do patients and results are impressive. We have to make every effort to encourage heroin addicts to seek treatment and more importantly encourage treatment professional to become familiar with all treatment options.