22 May Community Naloxone Distribution Programs Gain a Foothold
Naloxone is a pure opioid antagonist that can be used to reverse the effects of an opioid drug overdose. Most developed countries require medical facilities to have naloxone nearby whenever they administer intravenous opioids, and it is on the List of Essential Medicines compiled by the World Health Organization (WHO).
This drug is known to save lives, but it is not always available during the window in which someone who has overdosed from opioids can benefit from it. For many years after it was first put into production in the 1960s, naloxone was carried only by paramedics or administered in hospitals. Too frequently, emergency services would arrive too late to reverse the overdose and too late to save the life of the person who overdosed.
However, the mid 1990s saw the rise of community-based overdose prevention programs, which provide a variety of services for drug users and the family and friends of drug users. Since 1996, one of the key services that these programs have provided is the distribution of naloxone. Naloxone is now available in many places to outreach workers, family members of drug users and drug users themselves.
Legality and Practicality of Naloxone Distribution
Naloxone has typically been available through a direct prescription from a physician. However, a number of states have adopted standing order laws, which are laws that allow individuals or organizations to distribute a medication without a direct prescription. Like pharmacies that give flu shots, these individuals or organizations act under a general directive from a prescribing physician without the physician needing to be present. Many states have also enacted limited liability or Good Samaritan laws to protect laypersons from liability if something goes wrong while administering naloxone.
Taking advantage of these laws, community distribution programs around the country have been training individuals—many of them current opioid users—to administer naloxone in the event of an overdose. The drug can be administered by spraying it into the nose or injecting it into the muscle.
Some people had concerns about making naloxone widely and readily available, and, surprisingly, many of those with concerns were addicts. Many drug users with experience receiving naloxone following an overdose had unpleasant memories of the drug, and were wary of users administering it to each other without medical “first responders” present.
The primary side effect of administering naloxone to an opioid user who has overdosed is sudden withdrawal. Naloxone neutralizes any opioids in the system, so the user goes from a very high volume of opioids to very little in around five minutes. The withdrawal symptoms that quickly appear as a result of this can be severe and extremely painful.
Some community distribution programs, such as the Chicago Recovery Alliance, have reassured drug users that the quantity of naloxone administered by paramedics is often particularly high, but that smaller doses can be effective while lessening the severity of withdrawal symptoms. Early in April 2014, the Food and Drug Administration approved an auto-injectable form of naloxone, which should make it even easier for laypersons to quickly deliver standardized doses of the drug.
Some Worry That Naloxone Could Increase Drug Use
Other critics of increasing access to naloxone have said that the medication could encourage active drug users to avoid treatment and continue using because there is less risk of dying of an overdose. They also question whether active drug users would actually be able to take effective action should a fellow user require treatment.
Advocates have countered these fears, citing research that shows active drug users are performing successful overdose treatment with naloxone around the country. They also point out that drug users are much more likely to take drugs in the company of other drug users, rather than in the presence of family, law enforcement or other “responsible” individuals who may also have access to naloxone.
More research is needed to determine whether increased access to naloxone might encourage some users to continue their habits. A 2003 study out of San Francisco found that a majority of the active heroin users who participated in a survey did not believe that naloxone would encourage them to continue using or increase the amount of heroin they use. However, 35 percent did say they might feel more comfortable taking larger doses of heroin if they knew naloxone was available.
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