This story was originally published on January 5, 2016 and details information about naloxone (sold under the brand name, Narcan), a nasal spray that was used to treat opioid emergencies including overdose. In light of recent news that Demi Lovato was reportedly given naloxone, we're republishing the story below. Currently, naloxone is a prescription drug, but there are access provisions in every state that allow people to obtain naloxone from a pharmacist without an individual prescription, according to the company’s website.
Katie, 25, overdosed the very first time she tried heroin.
She woke up on a July morning in her apartment in Wilmington, NC with a mysterious pain in her chest. She remembered shooting up the night before, after already having taken pills, but the rest was a blur.
Katie had overdosed, her boyfriend explained. A friend called an ambulance. She had been given CPR, which explained the chest pain. And the doctors were able to reverse her overdose using a drug called naloxone. They saved her life.
Two years later, Katie is just over 60 days clean, works as an optometric tech, and keeps naloxone in the glove box of her car. "As much as I wanted to die at some points in my life," she says, "I am so grateful that somebody was there to be able to call to save my life."
Heroin and prescription drug overdoses have skyrocketed in North Carolina in the past decade, as well as in the rest of the country. According to a report released by the CDC in 2015, heroin use surged between 2002 and 2013 in pretty much every demographic. And the rate of heroin use among women has doubled. In 2014 alone, heroin and prescription opioid overdoses killed over 18,000 women in the U.S.
Katie, 25, overdosed the very first time she tried heroin.
In fact, Sylvia Burwell, Secretary of the Department of Health and Human Services, lists naloxone as one major way to curb these rising drug-related death rates (along with reducing opioid painkiller prescriptions and focusing on medication-assisted addiction treatment). “We’ve got to get more people to have access to it,” Burwell says.
Just this past December, NYC became one of a handful of places in the U.S. to make it legal for people to get naloxone at pharmacies (like CVS) over-the-counter — and Ralph’s made it available in their California supermarkets. But it still isn’t in the hands of everyone who needs it.
Naloxone, also known by the brand name Narcan, is quite literally life-saving. Heroin gets you high by binding to opioid receptors in your body. If you have too much, this also causes your breathing to slow down, and eventually cuts off oxygen to the brain. Naloxone, which can be injected or sprayed into your nose, knocks heroin out of those receptors, and prevents them from being activated.
“I could hear things before I could open my eyes,” says Katie, of her second overdose, which took place in September of 2013. After being injected with naloxone, she remembers hearing people say her name, and finally opening her eyes to see an EMS standing over her. “I was almost paralyzed,” she says. “I felt this intense tingling all over my body. When I sat up, it was like things were echoing.”
Then, she got sick. If you’ve overdosed, naloxone begins to work within five minutes and will send you into immediate withdrawal, which often means you’ll vomit. The effects only last for up to 90 minutes, so people who have reversed others' overdoses are advised to stick around with their "patients" (or get them to a hospital) to make sure they don’t slip back into an overdose or choke on their vomit. If you were to take naloxone, for some reason, when you didn’t have any opioid drugs in your system, you wouldn’t feel much of anything. But when you're on heroin, the effects are fast, and usually miserable.
Although the drug is clearly useful — it prevents people from dying — naloxone doesn't solve the underlying problem. “It’s not itself treatment of opiate addiction,” says Joshua D. Lee, MD, who studies addiction at New York University Langone Medical Center. That’s one reason why there are still people out there who don’t see the value of naloxone. Gov. Paul LePage, of Maine, for instance, is notorious for opposing legislation that would let police officers administer the drug. “It’s an escape,” he said of naloxone at a press conference last March. “It’s an excuse to stay addicted.”
“There’s been a fear that if we give people who use drugs wider access to naloxone, they’re just going to use more drugs — that it will be a safety net,” says Roxanne Saucier, a researcher and analyst with the Open Society Foundations, "but there's evidence to show that's not the case."
But even if naloxone doesn’t address the root of addiction, having it available is “like having a lot of defibrillators in the shopping mall,” says Dr. Lee: “It’s a way to prevent heart attacks, but it’s not treatment for heart disease.” The hope is that you’ll save someone’s life in the short-term, and open the door to recovery in the long-term.
When Katie overdosed, she and her boyfriend had just stolen money from a friend to buy heroin. But their heroin had been laced with fentanyl — the same combination some speculated (incorrectly, it turned out) that was involved in the death of Philip Seymour Hoffman — which caused them to overdose. Their lives were saved by another drug user, a short blond guy who happened to be hanging out at their apartment after losing his own. He called 911, but took off as soon as the ambulances arrived — with Katie’s jewelry box.
Despite the jewelry box (which she did eventually get back), Katie was very lucky. People who are present for overdoses don’t always call for help, often because they’re scared of getting in trouble for using illegal drugs. To combat that reticence, many states have enacted Good Samaritan laws, which broadly protect those who are helping others with a medical issue. Now, 20 states and the District of Columbia (including North Carolina) have Good Samaritan laws that specifically protect people who call for help during an overdose from minor drug-related violations (such as possession of drug paraphernalia) or arrest. But these laws don’t protect people from other drug-related violations, including selling drugs.
I don’t think there’s a wrong way to save someone’s life.
And even if someone does call for help, the first responders who show up don’t always have naloxone with them. Which makes it even more crucial that, as of June of this year, third-party prescriptions are legal in 38 states. That means, in those states, a doctor can prescribe the drug to a parent or friend of a drug user that they’d administer it to. And in 28 states, doctors can prescribe “standing orders” for the drug, which allow harm reduction groups to pass out and administer the drug to those who need it, similar to the way flu shots are given out every year in bulk. Through standing orders, Dr. Stancliff says people in the field can be using and training others to use naloxone prescriptions in her name.
Someone who understands how helpful these laws can be firsthand is overdose reversal expert Louise Vincent, MPH, 39. After struggling with drug addiction herself, she became an advocate with tight connections in the harm reduction community. Before the prescription-related laws were passed, Vincent would do anything she could to get it to those who needed it (even though it wasn't exactly legal for her to distribute it) — including giving it to dealers because it would extend their customers’ lives. Currently she works with the North Carolina Harm Reduction Coalition (NCHRC) and is basically a hero. She’s reversed over 100 overdoses (including one caught on camera for Sanjay Gupta’s CNN show) and been involved in countless more reversals, often giving instructions over the phone.
“I don’t think there’s a wrong way to save someone’s life,” she says.
Indeed, Vincent values naloxone not just for its overdose-reversing powers, but because the sense of trust it builds can open the door to recovery. “When you offer [drug users] something like naloxone, it sets the stage and gives you an in,” she says. “This is a group that is not getting service from anyone, and they are not being honest with anyone. So when they are ready to do something different with their life, they do that with us.”
But laws aren’t the only problem these days. “One of the biggest barriers [to expanding access to naloxone] is not legislation,” says Lindsay LaSalle, a staff attorney at the Drug Policy Alliance, “it’s the logistics of paying for naloxone... Funding is in very short supply.” Indeed, it’s been difficult for Dr. Stancliff to expand as much as she would like in her community as the price of naloxone has risen so much in the past decade. Today, a single dose costs about $20. Although that doesn’t sound like much, a decade ago it was just $1.
That cost can vary widely: A single Narcan kit in Massachusetts could cost over $40. And, because naloxone has been around since the '60s, its patent has expired, and it’s available as a generic medication. Companies have begun packaging the drug in new patentable ways, which raises the price even further, Dr. Lee explains. For instance, the Evzio device provides visual and audio instructions to people using it — and can cost up to a whopping $570.
Michelle Mathis, a minister with North Carolina’s Olive Branch Ministries, who practices “faith-based harm reduction,” says that when it’s late in the year, she has to save naloxone kits for only the most at-risk people in her community. She’s been eagerly awaiting January when the next wave of grants will kick in, allowing her organization to pass out the kits more widely.
Demand for kits was especially high in 2015, which resulted in saving just over 1,500 lives in North Carolina as of December. But this is partially a good thing, Mathis says, because people now know to reach out to her to get kits, which are received in bulk through a blanket prescription through the NCHRC. Each one is numbered and logged when given out, to help keep track of where and when the kits are used.
Mathis and her wife Karen hand out kits to the local homeless population, but she doesn’t have a personal connection to addiction. “I’ve never even smoked a joint,” Mathis says. “But I see the need for people to be supportive of those in active addiction... We’re not here to judge. We’re simply here to help them lead healthier lives, make smarter decisions, and help those around them bring them back, should something happen.”
At the same time, there has been some progress. For instance, we’ve made it easier for law enforcement, school nurses, and harm reduction workers to get their hands on naloxone. But advocates point out the one type of person who is missing from the list: drug users. No matter how uncomfortable they may make us, advocates say, drug users should get top priority.
For instance, Morgan Solis, 21, has already experienced seven overdoses. Six of them were reversed by her husband, Michael, nicknamed the “Narcan Superman” for how many lives he’s saved. Although the couple are both still using heroin, Solis has cut back her use, and the two regularly help pass out naloxone kits in their area in Durham, NC.
The one thing I’m clear on is that dead people don’t get better.
Advocates like the Open Society Foundations’ Saucier, Dr. Stancliff, and NCHRC's Vincent have been pushing for even wider, mainstream access to the drug. But the key is not just making it available through these go-to organizations, but also in supermarkets and drug stores, such as the Ralph's and CVS stores already providing it.
“Some people like the idea of police or parents being in the picture because they think there will be some kind of accountability,” says Saucier. “There’s this urge to make people have a consequence for their drug use because they want people to improve, but it’s a little bit wrongheaded.” Instead, she believes users may be more open to the idea of change when their overdoses are reversed by friends or someone they actually know, rather than, say, a cop.
That urge, stemming from a moral opposition to drug use rather than a medical one, causes us to see drug users as “criminals,” as if they are intentionally making evil, unhealthy choices. But Katie insists that’s one of the biggest misconceptions about drug users.“I did a lot of crappy things and hurt a lot of people,” she says, but she was using against her will to avoid withdrawal, rather than because she wanted to get high. “I would cry on the way to the drug dealer’s house,” she says.
All of this comes down to one radical idea — people who use drugs are, fundamentally, people. And they deserve to have their lives saved, too.
“The one thing I’m clear on is that dead people don’t get better,” says Mark Kinzly, 55. After surviving two overdoses, he now works in harm reduction in Austin, TX. “We’re not unproductive members of society,” he says. “We raise children, we have jobs, we go to church — we do all those things. But not when we’re dead.”
Correction: An earlier version of this article incorrectly stated that naloxone is available over-the-counter in New York state. It is only available without an individual prescription in NYC where pharmacies may take advantage of the standing order.