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Monday, February 17, 2014

States Expand Use Of Heroin Overdose ‘Antidote Drug’

A tube of Naloxone Hydrochloride, also known as Narcan, is shown for scale next to a lipstick container. (Charles Krupa/AP)

A tube of Naloxone Hydrochloride, also known as Narcan, is shown for scale next to a lipstick container. (Charles Krupa/AP)

It’s only February, but the state of Rhode Island has already lost 38 people to heroin overdoses — 27 in January alone. That’s more than double the number in the previous two Januaries. Of course, Rhode Island’s crisis is part of a larger national heroin overdose emergency. More people now die of heroin overdoses (about 30,000 last year) than they do in car accidents.

Prevention is the ultimate goal, but states are taking other steps to save lives. One of those is the use of a drug called naloxone, or Narcan. It’s known as the “antidote” drug — a shot or nasal spray that can reverse the effects of a heroin overdose. But it must be administered immediately.

Fifteen states and Washington, D.C. now have some type of Narcan distribution program, including some where family and friends of addicts receive kits in case of emergency. Rhode Island is one state trying to expand its use of Narcan, as state officials shift their perspective on heroin from an issue of criminal justice to an issue of public health.

Here & Now’s Robin Young checks in with Dr. Michael Fine, director of the Rhode Island Department of Health about the measures his state is taking.

Interview Highlights: Dr. Michael Fine

On how the Narcan pharmacy program works

“We have a way for people who know someone who’s addicted or is addicted themselves, to pick up Narcan at Walgreens pharmacy. One of our physicians has entered into an agreement with our board of pharmacy that allows them to purchase Narcan at the pharmacy — in any Walgreens in Rhode Island. And they have it at home in case they need it… You don’t actually need a prescription. We’ve used the prescribing authority of one prescriber and we’re actually looking at extending that to all pharmacies in Rhode Island… It’s actually been used by first responders and EMS something like 170 times so far this year.”

On concerns about giving Narcan to law enforcement

“I think people are concerned about training. We’ve had great support from state police who have already decided to do this, and that’s a great thing, I don’t think we’re going to have lots of problems from local police. We’re just working with them to try to get them there.”

On why R.I. is treating heroin addiction like an illness, instead of a crime

“Because it saves lives. And for most people, addiction is an illness. It’s an illness that’s way out of their control. You know, something like 10 percent of the population is susceptible to addiction; 3 or 4 percent is probably addicted at any one moment. There are a lot of lives at stake here. This is the single largest contributor of years of potential life lost to young people in Rhode Island and in the United States. You know, think of the energy we put into stopping motor vehicle accidents. We ought to put at least that energy, if not way more, into stopping this epidemic.”

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Guest

  • Michael Fine, physician and director of the Rhode Island Department of Health. He tweets @m1fine.

Transcript

ROBIN YOUNG, HOST:

Well, there was shocking news from Rhode Island this weekend, the state reporting 38 heroin overdose deaths already this year, 27 in January alone, more than double the amount in either of the two previous Januarys. Of course this is part of the national heroin emergency, more people dying of heroin overdoses - about 30,000 last year - than car accidents, very public deaths like Philip Seymour Hoffman's underscoring that.

But this past Friday, Rhode Island health officials signed a letter asking the state's association of police chiefs to give officers Narcan and Naloxone, known as the antidote drug, a shot or nasal spray that can reverse the effects of a heroin overdose if administered immediately.

Dr. Michael Fine is director of the Department of Health in Rhode Island and joins us from Providence. And Dr. Fine, 38 fatal overdoses this year, a small state. That seems incredible.

MICHAEL FINE: Way too many.

YOUNG: Yeah. Well, as to Narcan, 15 states, Washington, D.C., now have some kind of distribution program. How does it work?

FINE: Well, we have a way for people who know someone who's addicted or is addicted themselves to pick up Narcan at Walgreen's pharmacy. We've - one of our physicians has entered into an agreement with our Board of Pharmacy that allows them to purchase Narcan at the pharmacy, in any Walgreen's in Rhode Island. And they have it at home in case they need it.

YOUNG: So anyone can do that?

FINE: Anyone can do that.

YOUNG: And do you need a prescription, or...

FINE: You don't actually need a prescription. There's a - we've used the prescribing authority of one prescriber, and we're actually looking at extending that to all pharmacies in Rhode Island.

YOUNG: Well, and one of the reasons is this is so lifesaving. New York has introduced a bill that would prescribe Narcan to family members, even friends or addicts. And Massachusetts, it's distributed through support groups. And we spoke to a mother in May who found her son unresponsive and saved his life with her dose of Narcan that she'd been given through such a support group. Here she is talking about the moments after he was saved.

UNIDENTIFIED WOMAN: Of course afterwards when the doctors told us that the Narcan halted the process of his brain shutting down, I felt it was very empowering to bring him back to life and give him another chance. He seems to be very happy right now.

YOUNG: So there's a mother who was able to save her son. Stay for a second with what you're doing in Rhode Island. You already have distributed Narcan to first responders, EMTs, ER workers, people in the emergency room.

FINE: Yeah, it's actually been used by first responders and EMS something like 170 times so far this year.

YOUNG: So when we look at the 38 deaths, there were 170-some that could have been deaths. And now you're looking to expand to the police. It would seem as if this would be a slam dunk. I mean, what might be the questions around that?

FINE: Well, I think people are concerned about training. We've had great support from the state police, who have already decided to do this, and that's a great thing. I don't think we're going to have lots of problems from local police. We're just working with them to try to get them there.

YOUNG: OK, so it seems as if that might be next. And you mentioned that people can go into Walgreen's and purchase this. But we've also read that Walgreen's is willing to donate Narcan to the police department. This is something like $16 a dose. That seems like quite something.

FINE: I think it is a great thing. I don't have much detail about that myself, but it is a great thing for some - for a pharmacy chain to step forward in that way, if that's what they're doing.

YOUNG: But, and Dr. Fine, address the people who might be listening to this and thinking well, wait a minute, you know, people waltzing into Walgreen's and purchasing Narcan, which means they either are using heroin, which is illegal, or know someone who is. You know, there are people who might be thinking this is a crime. Why are you treating this like an illness?

FINE: Because it saves lives, and for most people addiction is an illness. It's an illness that's way out of their control. You know, something like 10 percent of the population is susceptible to addiction. Three or 4 percent is probably addicted at any one moment. There are a lot of lives at stake here. This is the single largest contributor of years of potential life lost to young people in Rhode Island and in the United States.

You know, think of the energy we've put into stopping motor vehicle accidents. We ought to put at least that energy, if not way more, into stopping this epidemic.

YOUNG: Well, and to that end you've introduced a Good Samaritan law. What is that and how does it work?

FINE: Well, it's a law that was passed in 2012, and it protects anyone who calls the police or uses Narcan and calls the police to talk about an overdose from criminal prosecution.

YOUNG: Well, and to be clear, because we've said a lot here, and I know there are ears perking up, we said New York just introduced a bill that would prescribe Narcan to family members. But did I hear you say that in Rhode Island, anyone can go in without a prescription and purchase Narcan?

FINE: That's correct.

YOUNG: Yeah. Well, in just the few seconds that we have, why would this be even more important now? We have this huge crisis because of tainted heroin.

FINE: Well, I mean, the existence of these drugs on the street, anything we can do to prevent these folks from dying is what we ought to be doing.

YOUNG: Well, and as I said, this is particularly toxic heroin at this point, which is why states like yours are seeing the spikes - unbelievable - 38 deaths so far this year, which is a very young year.

FINE: Yeah, we're seeing it in association with a drug called Fentanyl, and that just makes it all worse.

That's laced in the heroin. Dr. Michael Fine, director of Rhode Island's Health Department, trying to get Narcan into the hands of police officers. Dr. Fine, thank you.

Thank you.

YOUNG: You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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