Overdose Prevention

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Video: How to Prevent Prescription Drug Overdoses

The next video from the International Drug Policy Reform Conference, by our friends from the Hungarian Civil Liberties Union (who were also the conference's official videographers). The video highlights interviews with US-based harm reduction experts on ways to prevent prescription drug overdoses.

Vermont Governor Signs Overdose Prevention Bills

Vermont Gov. Peter Shumlin (D) Wednesday signed into law two bills aimed at reducing the toll of drug overdose deaths in the state. House Bill 65 provides limited legal protection for those who witness or experience a drug or alcohol overdose and summon medical assistance, while House Bill 522 permits prescription of the opiate-antagonist drug Naloxone to third parties and provides limited immunity for such prescription as well as administration of the drug.

"We cannot break our focus on this critical issue, because drug addiction harms not just the individuals ensnared in it but also our families and communities," Shumlin said. "I pledge to continue to work with mayors, law enforcement, medical and mental health experts and legislators to fight this problem, and will be focusing between now and January on the next steps in this battle."

HB 65, the "Good Samaritan" bill is the broadest of its kind. While 13 states and the District of Columbia have enacted such bills, Vermont's is the first to provide protection from arrest or all drug offenses -- not just possession -- as well as protections against asset forfeiture. It also provides protection against the revocation of parole or probation or the violation of restraining orders for people who seek help for overdose victims.

"Criminalization should not be a barrier to calling 911," said Lindsay LaSalle, an attorney with the Drug Policy Alliance. "The Vermont legislature has aptly recognized that saving a life is of paramount importance to the prosecution of any nonviolent drug crime."

HB 522 is the bill that expands access to Naloxone, which is credited with reversing more than 10,000 overdoses nationwide since 1996. The bill also provides immunity from civil or criminal liability for Naloxone providers.

"Implementation of these new laws by public health and law enforcement officials is critical to improving public willingness to immediately seek medical assistance for overdoses involving illegal drugs and alcohol use as well as to administer Naloxone to opioid overdose victims," said LaSalle.

Montpelier, VT
United States

Colorado Harm Reduction Bills Pass

Colorado legislators approved not one, but two measures aimed at reducing the harms of drug use this week. Both a syringe exchange bill and a naloxone provision bill passed the legislature and now head for the governor's desk.

syringe exchange supplies (wikimedia.org)
The first measure, Senate Bill 208, expands on the Clean Syringe Exchange bill passed in 2010, which exempted staff and volunteers -- but not exchange participants -- from drug paraphernalia possession charges. That left actual injection drug users making use of the exchange at risk for being arrested for carrying clean or used syringes.

This year's bill adds participants to the categories of the protected. Now, participants in the state's six syringe exchange programs -- in Denver, Boulder, Grand Junction, and Fort Collins -- will be able to carry clean syringes and return used ones for proper disposal without fear of arrest.

The second bill, Senate Bill 14, authorizes anyone who might witness an opiate overdose to be prescribed and administer the opioid overdose reversal drug Naloxone. Naloxone has been shown repeatedly to safe lives by reducing the number of opioid drug overdose deaths.

Both bills were supported by the Denver-based Harm Reduction Action Center, the state Department of Public Health and Environment, and the Drug Policy Alliance. The syringe exchange bill was also supported by the, Denver Colorado AIDS Project, Boulder County Public Health, and the Colorado Criminal Justice Reform Coalition, while the Naloxone bill was also supported by the Colorado Medical Society, the Colorado Psychiatric Society, the Colorado Provider's Association, the Colorado Behavioral Health Council, and Mental Health America of Colorado.

Denver, CO
United States

Overdose Prevention Deal in New Jersey

Last fall, New Jersey Gov. Chris Christie (R) vetoed the Good Samaritan Emergency Response Act (Assembly Bill 578), which would have provided limited legal protection to people who witness a drug overdose and summon help. But on Tuesday, Christie changed his tune, reaching an agreement with legislative leaders to include Good Samaritan language in another overdose prevention bill that is sitting on his desk.

The legislature had meanwhile passed Assembly Bill 3095 to expand access to the opioid overdose antidote naloxone. Under the agreement with legislators, Christie conditionally vetoed that bill and agreed to add the Good Samaritan language. The legislature then reconvened, passing the amended measure by votes of 24-1 in the Senate and 68-2 in the House.

The Good Samaritan language Christie agreed to is less broad than envisioned in AB 578, but advocates said it still contains the most important protections for an effective Good Samaritan bill -- it would protect individuals from arrest and prosecution for drug possession charges as well as protection from revocation of parole and probation.

"My family and I are so thankful for this compromise," said Patty DiRenzo of Blackwood, whose son Salvatore died of an overdose at age 27. "We, and the other families who have lost loved ones to overdose, look forward to the day that Governor Christie signs this life-saving bill. It's extremely important that we prevent future overdose deaths and spare other families the grief that mine has endured."

 "We are incredibly grateful to the governor and legislative leadership and sponsors of these bills for working so hard to reach an agreement on this life-saving legislation,” said Roseanne Scotti, New Jersey state director for Drug Policy Alliance.

As prescription drug overdose numbers have mounted in the past decade, an increasing number of states have adopted measures such as Good Samaritan laws and widening the availability of naloxone in a bid to reduce the death toll. California, Connecticut, the District of Columbia, Illinois, Massachusetts, New Mexico, New York, North Carolina, Rhode Island, and Washington have all passed both kinds of law, while Colorado and Florida have passed Good Samaritan laws and Virginia has passed a naloxone law.

Trenton, NJ
United States

White House 2013 National Drug Strategy Released

The White House Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its 2013 National Drug Control Strategy Wednesday. The strategy is being billed as a "21st Century Approach" to drug use and trafficking, but despite some rhetorical softening maintains the US hard-line approach to the issue.

"The president has outlined his vision of an America built to last -- where an educated, skilled workforce has the knowledge, energy and expertise to compete in the global marketplace. Yet -- for far too many Americans -- that vision is limited by drug use, which not only diminishes the potential of the individual, but jeopardizes families, communities and neighborhoods," ONDCP wrote on a blog post announcing the strategy's release and touting reductions in cocaine and prescription drug abuse as progress made.

"Today we are releasing a science-driven plan for drug policy reform in America to build upon this progress," ONDCP continued. "This 21st century drug policy outlines a series of evidence-based reforms that treat our nation's drug problem as a public health issue, not just a criminal justice issue. This policy underscores what we all know to be true: we cannot arrest or incarcerate our way out of the drug problem."

The strategy emphasizes treatment and prevention, but despite the rhetoric, the Fiscal Year 2014 federal drug budget it accompanies continues to be imbalanced, with 58% of federal anti-drug spending directed at law enforcement and interdiction efforts. That figure does mark a decline from previous years, but only a marginal one.

And even its emphasis on treatment also includes punitive criminal justice elements, such as its embrace of the drug court system, where drug-addicted people are subjected to legal sanctions for such addiction-related behaviors as failing a drug test or missing an appointment. That has some drug reformers calling foul.

"The administration says drug use is a health issue but then advocates for policies that put people in the criminal justice system," said Bill Piper, director of national affairs for the Drug Policy Alliance. "Until the drug czar says it is time to stop arresting people for drug use, he is not treating drug use as a health issue no matter what he says. I know of no other health issue in which people are thrown in jail if they don't get better."

While much of the strategy is little more than the same old same old, the strategy does call for expanded access to naloxone, a low-cost antidote that can reverse the effects of opioid overdoses. That is in response to the rapid growth in prescription drug overdose deaths in recent years.

"Director Kerlikowske should be applauded for taking steps to reduce drug overdose fatalities, but he's not doing much to reduce drug arrests or the many other problems associated with treating drug use through the criminal justice system," said Piper.

But while the drug strategy shows flexibility in its efforts to deal with fatal drug overdoses, it maintains a staunch opposition to marijuana reform and includes attacking outdoor and indoor marijuana cultivation as one of its key goals.

"The administration's continued opposition to marijuana law reform shows they're not serious about reforming US drug policy," said Piper. "At the very least they should stop getting in the way of states that are trying to improve public health and safety by regulating marijuana like alcohol."

Washington, DC
United States

DC 911 Good Samaritan Drug Overdose Bill Takes Effect

As of Tuesday, there will be limited legal protections for people who witness or experience a drug overdose in the District of Columbia and summon medical assistance. That's because the District's Good Samaritan Overdose Prevention Amendment Act goes into effect then.

Passed last fall by the DC city council, the new is aimed at reducing overdose deaths by removing the threat of arrest from overdose victims and those who might assist or seek help for them. Many overdose deaths do not occur immediately, and medical interventions can save lives, but some drug users and their peers are reluctant to seek help because of fear of arrest and prosecution.

"Criminalization should not be a barrier to calling 911," said Grant Smith, policy manager with the Drug Policy Alliance. "This new law will help encourage District residents who witness an overdose to pick up the phone and help save a life." 

Under the new law:

  • Law enforcement officers who observe small amounts of illegal drugs or paraphernalia at the scene of an overdose should not consider these drug law violations to be crimes for the individual experiencing the overdose and the witness who sought emergency medical services.
  • A minor is provided limited protection from criminal charges for underage possession of alcohol if they experience an overdose or seek emergency medical services for a peer.
  • An adult who is 25 years of age or younger is given limited protection from criminal charges for providing alcohol or other drugs to a minor who is 16 years of age or older if they seek emergency medical services for the minor in need.
  • The possession of naloxone – a medication that rapidly reverses opiate overdoses – and its use by lay persons on individuals experiencing an opiate overdose is decriminalized.

Ten states (California, Connecticut, Colorado, Florida, Illinois, Massachusetts, New Mexico, New York, Rhode Island and Washington State) have already enacted Good Samaritan laws for preventing fatal drug overdoses. Good Samaritan legislation is currently pending in New Hampshire, North Carolina, Missouri and other states. A coalition comprised of the Drug Policy Alliance, Students for Sensible Drug Policy, American Civil Liberties Union of the Nation's Capital, Bread for the City, HIPS, students from the George Washington University School of Public Health and Health Services and GW Law Students for Sensible Drug Policy, parents and advocates supported passage of the Good Samaritan law.

"Implementation of this new law by public health and law enforcement officials is critical to improving public willingness to immediately seek medical assistance for overdoses involving illegal drug and alcohol use," said Smith.

Spurred by the rapid rise in opioid pain medication prescribing and the diversion of pain pills, drug overdose rates nationwide have increased five-fold since 1990 and more than doubled between 2000 and 2010. Heroin and other opiates are the second leading cause of overdose deaths in the District in recent years, following cocaine.

Washington, DC
United States

Norway Government Wants to Decriminalize Heroin Smoking

The Norwegian government said Friday it wants to decriminalize the smoking of heroin as a harm reduction measure, Agence-France Presse reported. Smoking heroin is less dangerous than injecting it, and the move could reduce the number of overdoses, officials said.

heroin smoking image from 1965 UNODC newsletter
"The number of fatal overdoses is too high and I would say it's shameful for Norway," said Health Minister Jonas Gahr Stoere. "The way addicts consume their drugs is central to the question of overdoses. My view is that we should allow people to smoke heroin since injecting it is more dangerous," he said.

According to the Norwegian Institute for Alcohol and Drug Research (SIRUS), heroin overdoses accounted for 30% of 262 fatal overdoses in 2011. By comparison, only 168 people died in traffic accidents that year.

The city of Oslo has opened a supervised injection site in a bid to reduce overdoses, but decriminalizing heroin smoking would also help, said Stoere. Users currently can't smoke at the supervised injection site.

"This isn't about some kind of legalization of heroin but about being realistic," he said. "Those who are in the unfortunate situation of injecting themselves in a drug room should be able to inhale. It is less dangerous, you consume less and the risk of contracting a disease is lower," he added.

"It's a paradox that you can't smoke heroin when you can inject it, since the first method is less dangerous than the second," SIRUS researcher Astrid Skretting told AFP. "But the culture of injecting which provides a more immediate effect than smoking seems deeply rooted in Norway and it's not certain that a decriminalization will lead to a radical change in behavior," she suggested.

The Norwegian government is set to unveil its latest plan for fighting drug addiction next week. Stoere said the heroin smoking decrim plan has the backing of the center-left government.

Oslo
Norway

FDA Panel Wants Tighter Control over Pain Pills

A US Food and Drug Administration advisory panel voted last Friday to recommend that popular pain relievers containing the opioid hydrocodone be moved from Schedule III to Schedule II of the Controlled Substances Act. Popular prescription drugs containing hydrocodone include Vicodin and Lortab.

That would put Lortab and Vicodin in the same schedule as morphine and Oyxcontin, which contains oxycodone.

If the FDA agrees with its advisory panel and reschedules hydrocodone, pain patients using the drug will have to go the doctor's office to get prescriptions written twice as frequently as now. Schedule III drugs can be prescribed for up to six months at a time, while Schedule II drugs can only be prescribed for three months without another visit to the doctor.

The FDA has for years resisted efforts to tighten controls over hydrocodone, saying it could limit patients' access to pain medicine, but as overdose deaths and addiction rates from prescription pain relievers have jumped in recent years, pressure has been mounting on the agency. The agency is acting now after receiving a request from the DEA to consider rescheduling.

The advisory panel's 19-10 vote received mixed reviews from experts consulted by the Milwaukee Journal-Sentinel.

Andrew Kolodny, a psychiatrist and addiction specialist who heads Physicians for Responsible Opiate Prescribing lauded the vote, saying it will lead to fewer people getting addicted to opiates.

"Doctors have had a false sense of security (about prescribing the drugs)," said Kolodny. "This is a clear message that hydrocodone is addictive," he told the Wisconsin newspaper.

"It seemed pretty clear to me that the preponderance of the evidence supported rescheduling," said Peter Kaboli, associate professor at the University of Iowa Carver College of Medicine.

But Jan Chambers, president of the National Fibromyalgia and Chronic Pain Association, said she voted against the proposal because she has heard so much from family members of people who have committed suicide because they are in such pain.

"Millions of people don't have access to the pain specialist or the doctors who can prescribe these Schedule III drugs," she said.

And Lynn Webster, president-elect of the American Academy of Pain Medicine, said putting tighter controls on hydrocodone will reduce prescribing and abuse, but worried about the impact on pain patients.

"I hope chronic pain patients and acute pain patients don't suffer as a result," said Webster, who spoke at the panel hearing but was not a panel member.

The FDA has not said when it will make a final decision on the issue. Now, the FDA and the National Institutes of Health must make a recommendation to the assistant secretary for health, who will make a final recommendation to the DEA.

Washington, DC
United States

Naloxone Anti-Overdose Bill Moving in New Jersey

A bill that would expand access to the overdose-blocking drug naloxone is moving in the New Jersey legislature. The bill, Senate Bill 2082, the Opioid Antidote and Overdose Prevention Act passed the Senate Health, Human Services and Senior Citizens Committee Monday on a unanimous vote and now heads for a Senate floor vote.

A companion measure, Assembly Bill 95, awaits a hearing before the Assembly Health and Senior Services Committee.

Naloxone is an opioid antagonist, meaning it blocks and reverses the effects of opioid drugs, such as heroin, morphine, and Oxycontin. A Centers for Disease Control and Prevention report from last February found that some 50 naloxone programs nationwide had reversed more than 10,000 overdoses.

Naloxone is available only by prescription in New Jersey. The bill would expand access to the drug by providing protection from civil and criminal liability to medical professionals who prescribe the drug and laypersons who administer it.

Advocates applauded the bill's clearing the first hurdle and urged the legislature to finish the job.

"We must have a comprehensive strategy to reduce the huge number of tragic and preventable overdose deaths in New Jersey," said Roseanne Scotti, New Jersey state director for the Drug Policy Alliance. "Expanded access to Naloxone is a key component in that strategy. This bill will save lives and should now be acted on by the legislature with all possible speed. Lives hang in the balance."

"Drug overdose continues to be the leading cause of accidental death in New Jersey," said Sen. Joseph Vitale (D-Woodbridge). "Each year it surpasses the number of deaths caused by automobile accidents and guns.  Expanding access to naloxone will allow this medication to reach its full public health potential and will be an important part of New Jersey's comprehensive efforts to address drug abuse."

Patty DiRenzo of Blackwood lost her son, Salvatore, to an overdose when he was 26 years old.

"Sal was a beautiful soul who unfortunately struggled with addiction. If the people he was using with on the night he died had access to naloxone, he might still be alive today. Instead, my son was left alone to die. It's extremely important to have policies like this one in place, so that other families are spared the grief that mine has endured."

Eight states and the District of Columbia have already passed legislation easing access to Naloxone in a bid to reduce drug overdose deaths.

Trenton, NJ
United States

Naloxone Cheap Way to Prevent Drug OD Deaths, Study Finds

Drug overdose deaths are now the leading cause of accidental death in the US, surpassing automobile accidents, but a new study suggests that distributing naloxone to opioid drug users could reduce the death toll in a cost-effective manner. The study was published this week in the Annals of Internal Medicine.

Naloxone package (wikimedia.org)
Opioids, including not just illicit heroin but also widely used prescription pain pills, are responsible for about 80% of drug overdose deaths. Naloxone, an opioid antagonist, works by blocking opioid receptors in the brain, making it possible to reverse the effects of overdoses.

At least 183 public health programs around the country have trained some 53,000 people in how to use naloxone. These programs had documented more than 10,000 cases of successful overdose reversals.

In the study published in the Annals, researchers developed a mathematical model to estimate the impact of more broadly distributing naloxone among opioid drug users and their acquaintances. Led by Dr. Phillip Coffin, director of Substance Use Research at the San Francisco Department of Public Health, and Dr. Sean Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, the researchers found that if naloxone were available to 20% of a million heroin users, some 9,000 overdose deaths would be prevented over the users' lifetimes.

In the basic research model, one life would be saved for every 164 naloxone kits handed out. But using more optimistic assumptions, naloxone could prevent as many as 43,000 overdose deaths, saving one life for every 36 kits distributed.

Providing widespread naloxone distribution would cost about $400 for every year of life saved, a figure significantly below the customary $50,000 cut-off for medical interventions. That's also cheaper than most accepted prevention programs in medicine, such as checking blood pressure or smoking cessation.

"Naloxone is a highly cost-effective way to prevent overdose deaths," said Dr. Coffin. "And, as a researcher at the Department of Public Health, my priority is maximizing our resources to help improve the health of the community."

Naloxone has proven very effective in San Francisco, with heroin overdose deaths declining from 155 in 1995 to 10 in 2010. The opioid antagonist has been distributed there since the mid-1990s, and with the support of the public health department since 2004. But overdose deaths for opioid pain medications (oxycodone, hydrocone, methadone) remain high, with 121 reported in the city in 2010. Efforts are underway in the city to expand access to naloxone for patients receiving prescription opioids as well. This study is the latest to suggest that doing so will save lives, and do so cost-effectively.

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