By Ellen Weber, Andrea Gielen and G. Caleb Alexander
3:49 PM EST, February 25, 2013
With epidemic rates of prescription opioid and heroin deaths in Maryland, families are demanding easier access to the antidote that could save the lives of their loved ones. Naloxone is used safely to reverse the effects of heroin and prescription opioid medications. Emergency medical technicians administer naloxone when they respond to an overdose emergency.
All too often, however, these emergency responders do not arrive in time. State law bars family members and friends who may be in the best position to save the life of a person experiencing an overdose from obtaining a prescription for naloxone in their own name and administering this medication in an emergency. The Maryland General Assembly should follow the lead of eight other states and enact legislation introduced by Baltimore County legislators that would allow for easier access to this life-saving and safe medication.
Recent data on overdose deaths from the Maryland Department of Health and Mental Hygiene reveals sobering information about the relationship between prescription drug misuse and heroin use. As Maryland has focused on reducing the supply of diverted pharmaceuticals, some individuals who have developed an addiction to prescription opioids have turned to heroin as an accessible and potent alternative drug.
While overdose rates attributed to prescription opioids have fallen across Maryland, there has been an increase in fatal heroin overdoses, with young people tragically experiencing the brunt of this epidemic. Overall, drug-overdose deaths increased by 6 percent from 2011 to 2012, and heroin-related deaths of persons ages 15 to 24 years old increased by 53 percent.
Maryland's health officials have wisely adopted a public health response to this problem. They have promoted outreach to health care providers to help identify and respond to opioid misuse, the development of a Prescription Drug Monitoring Program, and support for innovative local efforts. These efforts should stir frank discussions with physicians about the misuse of and dependence on opioids, and earlier intervention and referrals for treatment.
A naloxone access program is an indispensable piece of this public health response. It would increase the survival chances of all persons suffering from opioid overdose — whether from prescription drugs or heroin — and limit the serious and costly medical consequences of delayed intervention.
A bill to create a program to make naloxone more readily available to persons trained to identify overdose symptoms and administer the medication, SB 610/HB 890, has been introduced in the General Assembly by Sen. Katherine Klausmeier and Del. Eric Bromwell. It deserves the support of the medical, public health, insurance, pharmacy and law enforcement communities. A similar life-saving program for the prescription and dispensation of epinephrine to aid individuals at risk of anaphylactic shock has existed in Maryland since 1995. Naloxone is as safe as epinephrine, and its availability does not promote unsafe drug use. Its singular purpose is to restore a person's breathing, which returns the person to consciousness.
The proposed Overdose Response Program would build on the success of the Baltimore City Health Department's Staying Alive Drug Overdose and Prevention Response Program. This program has trained more than 3,000 individuals on how to identify and respond to overdose, including the administration of naloxone. The program has documented more than 220 overdose reversals since its inception in 2004.
While the Staying Alive program should be replicated across the state, its reach would still be restricted by legal barriers on prescribing and dispensing naloxone to family members and friends who can immediately administer the medication prior to calling 911.
Other states have documented that naloxone access programs save lives. In 2010, the Centers for Disease Control and Prevention reported on a Harm Reduction Coalition study of 48 naloxone distribution programs in 15 states and the District of Columbia. The programs had documented 10,171 opioid overdose reversals over a 14-year span, with a distribution of naloxone to an estimated 53,000 individuals. The American Medical Association adopted a policy in 2012 to further implement community-based programs that offer naloxone; the Office of National Drug Control Policy supports expansion of naloxone distribution by medical professionals and first responders; and the National Association of Drug Diversion Investigators has declared its support for police officers carrying intranasal naloxone — a method of administration Staying Alive is currently piloting.
The fact is that opioid overdose is a significant public health issue in Maryland that requires a long-term, comprehensive prevention and treatment response. It is also a life-threatening emergency that affects individuals, families and communities every day. Expanded access to naloxone would be another step in the right direction and could make the difference between life and death for our citizens.
Ellen Weber is a professor of law and director of the Drug Policy and Public Health Strategies Clinic at the University of Maryland Carey School of Law. Andrea Gielen is a professor and director of the Johns Hopkins Center for Injury Research and Policy. Dr. G. Caleb Alexander is an associate professor and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. Also contributing to this article were Ameet Sarpatwari and Viola Woolums, student-attorneys at the Carey School of Law, and Shannon Frattaroli, an associate professor at Hopkins' Center for Injury Research and Policy.
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