Medications That Help Prevent Death from Drug Overdoses

What National and Washington State Officials are Saying about Naloxone:

“Naloxone is non-addictive, and expanding training on how to administer the drug can help basic emergency medical service staff reverse an opioid overdose and save more lives.” ~ Dr. Mark Faul, PhD, MA, Senior Health Scientist for the Centers for Disease Control and Prevention “We have a life-saving tool at our disposal to save families from losing loved ones to increasing heroin addiction in our communities.” ~ Washington State Representative Brady Walkinshaw “Washington State should take pride in being an innovator when it comes to responding to the public health crisis of opiate overdoses. In 2010, Washington became only the second state to pass a 911 Good Samaritan law, which provides immunity from criminal drug possession charges to people who seek medical assistance in drug overdose situations.” ~ Mark Cooke, Campaign Policy Director for the American Civil Liberties Union of Washington “If there is any definition of a miracle, this is it. You have people at death’s door and you bring them back to life within a minute.” ~ Yakima Police Captain Jeff Schneider “A person acting in good faith who seeks medical assistance for someone experiencing a drug-related overdose shall not be charged or prosecuted for possession of a controlled substance…” ~ Washington State Law

The Scope of the Opioid Epidemic in Washington State and the Rest of America

According to the Alcohol and Drug Abuse Institute at the University of Washington, opioid use and mortality have increased throughout Washington State, just as it has across the United States. Even a brief review of the latest data highlights the need for timely intervention to prevent the loss of life fatal opioid overdoses: In Washington State, comparing two different time periods, 2002-2004 and 2011-2013:

• Police crime lab testing suggests that opioid use has risen by 85%.
• Opioid-involved deaths increased by 31% statewide
• The greatest increases were seen in Lewis and Mason Counties, +187% and +145%, respectively.
• 2002-2013, there were 6668 opioid deaths in Washington.
• Publicly-funded admissions for opioid treatment increased 197%, representing 38 out of 39 counties.
• In 2013, the average Washington short-term pain patient was given 1.9 opioid prescriptions, with a cumulative 16-day supply.
• The average Washington long-term pain patient was given 14.6 prescriptions, with a cumulative 334-day supply.
• In 2008, there were 512 deaths in Washington State due to prescription narcotics, but by 2014, that number had dropped to 319.
• However, during that same timeframe, heroin deaths in Washington State approximately doubled.
• First-time heroin admissions in Washington State in 2014 were more than triple what they were in 2002.
• 62.5% of King County needle exchange participants under the age of 30 were hooked on prescription opioids before switching to heroin.
• In 2012, approximately 6% of 10th-grade students admitted to using a prescription opioid to get high.
• Of those, roughly 25% reported having tried heroin.

Washington State only seems to be mirroring the opioid problem throughout, according to data released by the American Society of Addiction Medicine. In 2014:

• Approximately 2.5 MILLION Americans had a substance abuse disorder involving prescription opioid painkillers or heroin.
• There were 18,893 prescription opioid-related deaths.
• Another 10,574 deaths were attributable to heroin.
• In 2008, the overdose death rate due to prescription opioids was quadruple the 1999 rate.
• 2013-2014, deaths from non-methadone synthetic opioids rose by 80%, with much of this increase attributable to illegally-made fentanyl.
• Seizures of fentanyl increased 7X 2012-2014.
• In 2012, there were 259 MILLION opioid prescriptions written – enough to give every American adult their own personal bottle of pills.
• 80% of new heroin users started out by abusing prescription painkillers.
• 28,000 adolescents between the ages of 12 and 17 used heroin within the past year – and 16,000 were CURRENT users.
• Up to 25% of heroin users overdose every year.
• As much as 70% of heroin users overdose within their lifetime.

Washington State’s Response to the Opioid Problem – the Good Samaritan Law

In 2010, Washington State passed the “911 Good Samaritan Overdose Law” as a means of addressing the drug overdose problem in the state. This law grants immunity from drug possession charges to both the victim and/or any bystanders who seek help during an overdose. Additionally, overdose witnesses were granted additional protections, to encourage the use of opioid overdose reversal medications. In addition to legal immunity, bystanders now also have medical immunity – they may carry and administer naloxone (brand name Narcan) to people experiencing an opioid overdose. One immediate impact of the passage of this law was the response from opioid users – 88% said that they would now be “more likely” to call 911 during any future overdose events. This law had two major components:

• Physicians may prescribe naloxone to entities such as fire departments, homeless shelters, or police departments.

In a 2015 revision to the law, pharmacists are now able to dispense naloxone without a prescription to people who are in a position to help others experiencing an opioid overdose, as long as the pharmacy has a collaborative agreement with a doctor.

• Allows a standing order, so non-licensed nonmedical personnel can administer naloxone in an emergency situation. This would include:
  • The staff at community-based organizations that serve populations at elevated risk of an opioid overdose.
  • Law enforcement personnel
  • Correctional officers
  • Treatment professionals who provide services to people with substance abuse disorders
  • First responders – paramedics and EMTs
  • Associates of people who use or are prescribed opioids – spouses, significant others, family members, companions, etc.

What Is Naloxone and How Does It Help Opioid Overdoses?

The name “naloxone” is the generic label for brand-name Evzio or Narcan, which comes as a nasal spray or as an injectable. Naloxone is a medication used as an antidote to opioid overdose. It reverses the respiratory depression – the cessation of breathing – caused by opioid drugs. To explain: All opioid drugs slow the user’s breathing, and at high doses can cause breathing to stop completely. Within 2-3 minutes, naloxone binds directly to the brain’s opioid receptors and inhibits the uptake of more opioid molecules for up to 90 minutes. It even dislodges the opioid molecules already bound to the receptors, thus reversing the overdose and allowing respiration to resume naturally.

What Drugs Is Naloxone an Effective Antidote for?

Naloxone works as an antidote for overdoses of all-natural, semi-synthetic, and fully-synthetic opioids, including:

• Natural – opium, morphine, codeine
• Semi-synthetic – Dilaudid (hydromorphone), Vicodin (hydrocodone), OxyContin, Percocet, and Percodan (oxycodone), Buprenorphine, and heroin
• Fully-synthetic – methadone, fentanyl

When Should Naloxone Be Administered?

ANYTIME there is a suspected opioid overdose, naloxone should be administered. Some of the symptoms of an opioid overdose include:

• The victim is unconscious and completely unresponsive to outside stimuli:
  • Shake them
  • Shout their name
  • Try to get a “Pain Response” – Rub your knuckles hard over their sternum or in the area between their upper lip and nose.

• The victim is conscious but unable to communicate.
• The victim may be “dead weight” – completely limp.
• A purple or black hue on the fingernails and/or lips.
• Light-skinned people will have a purplish tinge.
• Dark-skinned people will have a gray or ashen appearance.
• Slow, shallow, erratic, or stopped breathing or pulse.
• There may fluids coming out of the victim’s mouth or nose.
• The victim may have vomited.
• The victim is making odd gurgling or choking sounds – this is referred to as the “death rattle”.

Anytime you notice any of these signs, you must respond right away – call 911 and administer a dose of naloxone. Because naloxone only lasts for 90 minutes, put the person into the “rescue position”, stay with them, and monitor them until emergency help arrives. Sometimes, it may be necessary to administer another dose. The effectiveness of naloxone is completely time-dependent. Death from an opioid overdose typically occurs within 1 to 3 hours. Naloxone is ONLY successful in reversing an overdose if given before overdose symptoms worsen to the point of death. Naloxone is ineffective for overdoses from other non-opioid drugs, such as benzodiazepine times (Valium, Xanax, etc.), methamphetamines, cocaine, or alcohol. However, it’s important to note that naloxone IS effective in multi-drug overdose situations, as long as one of the drugs is an opioid.

What Are the Side Effects of Naloxone?

The first thing to consider is that naloxone is perfectly safe. It was first approved by the FDA in 1971 and has been used safely for over 40 years in emergency rooms and ambulances around the country. It can even be given to children and pregnant women. As naloxone is administered in the absence of an opioid overdose, there will usually be no effect on the person. This is important because, during an emergency overdose situation, it’s not always possible to know what drugs are the cause. When in doubt, naloxone can be safely administered, with no serious adverse effects. The most serious side effect that may sometimes occur after the administration of naloxone is opioid withdrawal because naloxone “ejects” opioids from the brain’s receptors. This is why naloxone cannot be used to get high and why it is not addictive. Symptoms of opioid withdrawal include:

• Irritability
• Muscle aches
• Nausea
• Vomiting
• Diarrhea
• Runny nose
• Sweating
• Headache

How Effective Is Naloxone?

Absolutely. Administered correctly in a timely fashion, naloxone will save lives that may otherwise be lost to a fatal opioid overdose. According to the Centers for Disease Control and Prevention:

• 1996-June 2014, 152,283 naloxone kits were distributed to nonmedical personnel.
• Those kits were responsible for reversing at least 26,463 opioid overdoses.
• Over 81% of those kits were received by laypersons who use drugs.
• Nearly 83% of the reversals were performed by people who use drugs.
• Almost 82% of the reversals involved heroin as the causal drug.

What does this tell us? First, it shows that naloxone works – over 26,000 lives potentially saved. Second, it shows that the message is getting out because the overwhelming majority of those kits were obtained and used by drug users while they were witnessing heroin overdoses.

Does Naloxone Use Promote Continued Drug Use?

Although the fear of overdose is not an effective deterrent for most opioid abusers, studies have found that opioid addicts who have survived an overdose are more likely to seek treatment. 26.2% of drug users seek professional help within 30 days following an overdose.

Where Can I Get Naloxone and How Can I Learn How to Use It?

You can get naloxone at any pharmacy, provided you have a doctor’s prescription. Because of Washington’s Good Samaritan Law, however, more pharmacies are working with local doctors to make naloxone available without a prescription – major chains Walgreens, CVS pharmacy, and Rite-Aid are among the companies participating. Any time naloxone is dispensed, the pharmacist will give instructions as to how it can be used. Since there are different naloxone products, the training is item-specific. All naloxone anti-opioid overdose products are designed so they can be quickly and easily used during an emergency situation, even by someone who may also be drug-or-alcohol impaired. Recently, some community agencies in Washington State have begun periodically dispensing naloxone rescue kits free of charge to those members of the local population who are most at-risk for opioid overdose. In early 2016, the Center for Opioid Safety Education of the University of Washington’s Alcohol and Drug Abuse Institute managed a project where 10 counties in the state dispensed over 2000 injectable doses of naloxone via county health departments. After sitting through a 30-minute training session that covered the Good Samaritan law, how to identify an opioid overdose, when to call 911, how to give emergency aid, and how to properly administer the naloxone medication, attendees were each given two doses – the recommended amount to have on-hand. Such interventions are especially necessary in Washington’s rural areas, where other resources and services may be lacking. Funding for this pilot program comes from the state Division of Behavioral Health and Recovery.

A Quick Recap About Naloxone – the Life-Saving Anti-Opioid Overdose Drug

78 Americans die every day due to fatal opioid overdoses, and any programs or interventions that can reduce that number deserve to be expanded. Since its introduction 55 years ago, naloxone has a proven track record, and both its performance and numerous studies have confirmed:

• Naloxone is effective – thousands of lives have been saved.
• Naloxone is easy to use – after just a few minutes of training, even drug users can learn to respond.
• Naloxone is available – first responders, treatment professionals, treatment professionals, and outreach programs already have naloxone, and it is becoming easier for at-risk individuals and their families to acquire, even without a prescription.

The State of Washington supports continued expansion and has passed laws protecting bystanders who render aid when they witness an overdose. In 2014, then-US Attorney General Eric Holder said – “Addiction to heroin and other opiates – including certain prescription painkillers – is impacting the lives of Americans in every state, in every region, and from every background and walk of life – and all too often, with deadly results. Used in concert with Good Samaritan laws, which grant immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose, naloxone can save lives.” SOURCES: https://adai.uw.edu/pubs/infobriefs/ADAI-IB-2015-01.pdf https://housedemocrats.wa.gov/brady-walkinshaw/final-approval-for-walkinshaw-bill-to-make-emergency-overdose-medication-available-to-all/ https://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf https://www.thenewstribune.com/news/local/article91155037.html https://www.naloxoneinfo.org/sites/default/files/Frequently%20Asked%20Questions-Naloxone_EN.pdf https://www.healthy.ohio.gov/vipp/drug/~/media/11A4765509B74405BF6CE39954AF0AF6.ashx https://www.doh.wa.gov/Newsroom/2015NewsReleases/15188OpioidOverdoseDeathsNewsRelease https://www.emcdda.europa.eu/system/files/publications/932/TDAU14009ENN.web_.pdf https://link.springer.com/article/10.1186/s40621-015-0041-8 https://mynorthwest.com/15056/its-possible-to-stop-a-heroin-overdose-death-with-this-drug/ https://www.drugstorenews.com/article/washington-latest-state-where-cvs-pharmacists-can-dispense-naloxone-without-prescription https://www.businesswire.com/news/home/20160617005117/en/Walgreens-Leads-Fight-Prescription-Drug-Abuse-Washington https://www.spokesman.com/stories/2016/jun/02/naloxone-life-saving-drug-to-reverse-od-to-be-sold/ https://depts.washington.edu/pcapuw/inhouse/FAQs_Naloxone_for_Community_Agencies.pdf https://www.bellinghamherald.com/news/local/article96783272.html https://stopoverdose.org/cose/ https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf