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December 28, 2015
Naloxone saving lives but not solving opioid addiction epidemic
By Jon Kelvey
WESTMINSTER, Md. — It wasn't an uncommon call that Westminster Volunteer Fire Company paramedic Kim Royer responded to around the beginning of December, so the exact date eludes her memory, but she does remember this: A male subject, unconscious, lay on the asphalt of a parking lot along Md. 97 in Westminster, barely breathing. His friends stood over him, next to their car and shouting, "Narcan, Narcan, Narcan," the name brand for naloxone — an antidote for poisonous doses of opioid drugs and for heroin.
"I said, 'What happened? What did he take?' and of course the people that were with him said, 'Oh, he didn't do anything,' " Royer said. "Of course he didn't. His pupils are pinpoints, he's barely breathing, but he didn't do anything."
The unconscious subject had been driving down the road, his friends explained, when he complained that he didn't feel good. They just managed to pull the car over when he passed out.
"I said, 'He was driving?' and they said, 'Yes, he was driving,' " Royer said. "That's scary. That's going to hurt innocent people."
It happens all the time, and it has been getting worse, according to Royer, who has been with the fire company for 10 years. Emergency responders find people unconscious in their cars, in the bathrooms of restaurants, in alleys or along the street.
In 2015, opioid overdoses have continued rising in Maryland: There were 648 heroin and opioid drug-related deaths in the first half of 2015, according to the most recent Department of Health and Mental Hygiene statistics available, compared with the 579 deaths by June 30, 2014, an increase of 69 deaths. Compared with the 204 additional overdose deaths in the first half of 2014 from the first six months of 2013, however, this seems to indicate that even as more people are dying, the rate at which people are dying might be slowing.
That could be a result of the naloxone overdose prevention program, according to Van Mitchell, secretary of the Maryland Department of Health and Mental Hygiene, or DHMH. While Naloxone had long been used by emergency medical personnel, it wasn't until the prevention program launched in March 2014, under the Martin O'Malley administration, that civilians — including users — could receive training and begin carrying naloxone.
An additional legal change allowed law enforcement officers to begin carrying the drug antidote as well.
"I certainly think the training and availability of naloxone, with over 6,000 people trained in the state, has and will make a tremendous difference," Mitchell said. "The laws had to be changed for that to happen, and getting the supply, all of that stuff took a year, a year and a half to get in place."
Between July 2014 and June of this year, DHMH reported 131 administrations of naloxone, according to the program website. Between July 1, 2015, and Dec. 18, there have been 130 reported administrations. Those numbers do not include administrations by medical personnel, and reflect only those known uses of naloxone by law enforcement and civilians trained in its use, whose number has reached more than 13,000, according to Dec. 18 statistics from DHMH.
The ranks of users, friends, family members and others carrying the opioid antidote might soon swell even further after the Dec. 14 order from DHMH that will allow pharmacies to dispense naloxone to anyone who has completed a training class in its administration, without the need for a doctor's prescription.
"The way the training was working before in some counties was, you got trained and then you could go to your primary care doctor and they would write a [prescription for naloxone]," said Sue Doyle, of the Carroll County Health Department. "That wasn't really working very well."
While people with Medicare or Medicaid had their naloxone covered, Doyle said, many private insurers refused to cover the medication, and for many users, requiring a visit to the doctor was an additional step too far that reduced the likelihood that they would actually obtain the naloxone and use it to save a life. Under the new standing order, people will leave their training with a naloxone kit in their possession.
"They still need the certificate that they were trained in order to have it dispensed," Doyle said. "The important part of all this is not just that we get it out there, but that the people that have it in their possession know how to use it."
It remains to be seen how much this shift toward greater public access to naloxone will change what paramedics and firefighters experience in the field.
Naloxone administrations by Westminster fire company personnel have steadily increased over the past three years. In 2013, the fire company administered the drug 127 times for opioid or heroin overdoses, according to fire company Lieutenant Brett Pearce. In 2014, that number rose to 171, and in 2015, as of Dec. 21, the number of administrations stood at 189.
"I suspect that we will be in the 230 to 235 range once the end of the year arrives," Pearce said. "That is a staggering number with our population, and it does not even include the reported numbers from the other fire departments countywide."
Not all of the fire companies in Carroll were able to provide statistics on their administration of naloxone in time for this story, but from what numbers are available it is clear that the vast majority of overdoses occur in Westminster. The Mount Airy fire company reported using naloxone 11 times in 2015, as of Dec. 24, whereas the Gamber fire company had used the antidote six times.
Not all naloxone administrations are successful, Pearce said, and for numerous reasons. There might not be enough naloxone to counteract the amount of opioid drug in a person's system. It also wears off over time, such that a person could be revived and then overdose again due to the amount of opioid in their system. Sometimes people die before the antidote can be administered. As of Nov. 30, 11 people had died in Carroll County from an opioid drug or heroin overdose, according to Carroll County Sheriff's Office statistics.
"I think that Narcan is a good thing, it's a good thing that we have it. I think it's has helped save a lot of people," said Royer, the Westminster paramedic and firefighter. "But I also think it's not a fix; it's a Band-Aid to the problem that is going on."
Westminster fire company Lt. Brett Pearce also believes naloxone has been helpful, but he said he doesn't see it as a complete solution to what he believes is a multilayered problem that will require a multifaceted approach.
"[Naloxone] does make a difference; if it saves one life, it's worth it," he said. "It doesn't address the root of the problem, their tendencies and everything else, why they are doing it … it needs to be treated across the board."
©2015 the Carroll County Times (Westminster, Md.)