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Matters of Substance

Underdosing naloxone

Globally, an estimated 69,000 people die each year from opioid overdose. The drug naloxone can quickly block opioid receptors in the brain and is used in some cases to bring people back from the brink of overdose death. Amberleigh Jack looks at why naloxone is not being used more widely.

Mark Kinzly almost died from opioid overdose. Twice. He survived thanks to a life-saving drug known as naloxone. Others he knew weren’t so lucky. “I’ve watched my community die,” he tells me. “The community is dying – either from AIDs or drug overdose – and the community has been dying for decades.”

These days, he’s off the drugs, lives in Texas and is an overdose prevention advocate. Unsurprisingly, he thinks the medication that saved his life should be an over-the-counter drug.

Naloxone works by instantly blocking opioids from receptors in the body, stopping them having any effect. It works in minutes and has the ability to bring people back from the brink of death. Its availability is a major part of overdose prevention programmes, particularly in the US.

The recent attempts by government to prevent overdoses is a good start, according to Kinzly, but there’s still much more than can be done. And largely, it comes down to that vital drug.

“I have a 16-year-old son,” he tells me, referring back to his own near-fatal experiences.

“I bet if you talked to him he’d be pretty happy that naloxone was available.”

But for too many others, the potential lifesaver has not been at hand. Now, overdose prevention advocates, often with the backing of government officials around the world, are increasing efforts to actively prevent overdoses and make naloxone more readily available, saying hundreds of lives are being unnecessarily lost. As yet, nothing is happening in New Zealand, and perhaps it’s time to ask why.

In the US in October 2014, the Office of National Drug Control Policy’s Acting Director Michael Botticelli (otherwise known as the White House Drug Czar – the first person to hold the title who is in recovery himself) told the Harm Reduction Conference in Baltimore a disturbing fact. In 2010, there were 38,000 overdose deaths in the US – a figure that superseded the road toll deaths in the same year (35,000). The number of road deaths has been steadily declining for the past two decades, while the drug overdose death rate has more than tripled.

In 2012, 41,502 drug overdose deaths were recorded in the US – almost 80 percent of which were accidental, and almost 7 percent were of unknown intent. And the drugs? More than half were pharmaceuticals, and more than 70 percent of these were opioid analgesics. The non-pharmaceutical deaths? Heroin, mostly, either on its own or combined with alcohol, pharmaceuticals or cocaine. Looking further into the stats makes for some depressing reading. In 2011, there were about 2.5 million visits to US emergency departments due to drug misuse and abuse. Around 71,000 of those were by people under 18 years of age.

And it’s not just the US. Globally, an estimated 69,000 people die each year from opioid overdose (both pharmaceutical drugs like Oxycontin and morphine as well as illegal drugs like heroin and ‘homebake’ opioids). In the US, it’s hit epidemic status, and the rest of the world is seeing increases, especially as prescription medicine misuse is on the rise. It’s also no longer limited to the streets. With the rise in prescription opioids, middle-aged women are one of the rising demographics for overdose rates.

And the world is starting to take notice as it struggles to get the rates under control. While the ultimate goal is to reduce use and abuse, as Allan Clear of the Drug Harm Coalition in New York says, “You can only help people get off drugs if they’re alive.”

Enter naloxone. It’s a major component of overdose prevention programmes and methods. A lifesaving drug that, if injected quickly enough, reverses opioid overdose and does so safely. It’s been around for decades, yet in a number of states, it’s been difficult to obtain until recently. It was in 2001 that the Chicago Recovery Alliance first established a US programme to allow injectible naloxone to be prescribed. By 2010, this decision had resulted in more than 15,000 naloxone prescriptions being filled to potential overdose witnesses, with more than 1,500 reported overdose reversals. In 2011, 15 states had introduced more than 180 programmes that had doctors available to prescribe naloxone. By this time, more than 10,000 overdoses had been recorded and more than 53,000 people trained in naloxone administration.