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Heroin Addiction and Narcan
'It doesn't happen all at once, ....... You become. It takes a long time. That's why it doesn't happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don't matter at all, because once you are Real you can't be ugly, except to people who don't understand.” –Margery Williams, The Velveteen Rabbit
The Mother of the boy who died from a Heroin overdose sent this to me. A quote from The Velveteen Rabbit. She, who had faced the despair, and heart wrenching pain of losing her son. Her Sun. She held tightly onto the child’s story about love and understanding. Something every person who loves an addict wants others to have for their loved ones.
It is a wild cry that softens with the passage of time, only to those who have never experienced the loss of a loved one to overdose. For others, our ears stop hearing, and we move on, we live our addiction free lives until another story pops up on our feed, or another friend from school dies.
Man Overdoses on Heroin on Bus, Is Revived By Narcan
“Man causes wreck on highway after overdosing on Heroin while driving”. We’ve all seen our social media Newsfeeds filled with the same headline. Man, woman, with children, without, overdosing on heroin killing themselves, their children or others.
In turn, you’ve likely read the angry comments filling the stories, or the passionate pleas for understanding addiction. It’s a hot topic- because if it’s not affecting you or your loved ones personally, it is threatening to affect you and your family simply by driving in your car.
Now the issue has been revived again: by Narcan.
Narcan Now Available Without a Prescription
Kroger’s announced it is planning on selling Narcan without a prescription in Ohio and Kentucky, but they are not the first to offer it. CVS has been selling Narcan in 14 states without a prescription for more than a year, and announced this month it would make Narcan available without a prescription at all of its pharmacies in Ohio beginning next month.
But Walgreens pharmacies in Cincinnati have been carrying the overdose antidote since May 2015.
Jeff Talbot, vice president of merchandising for Kroger, said. “We want families dealing with addiction to know that they can count on having this drug available in the event that they need it. (Cincinnati.com, 2016)
Since the most recent announcement by Kroger’s, social media has gone wild, and everyone weighing in on how the problem should be approached, but it goes a little deeper than just throwing a comment on a news topic. We need to understand more.
Why Is This Such a Hot Topic in Ohio?
"Unfortunately, Ohio and Kentucky rank in the top five when it comes to the highest overdose death rate according to the Centers for Disease Control. Kroger wants to help reverse this horrible statistic,” Top Five…let that sink in. Ohio and Kentucky are in the top 5 overdose death rates by state. The top 10%. We live in a state of death.
More Americans now die from drug overdoses than from car crashes. Opioid overdose deaths are rising sharply, reaching 28,648 in the U.S. in 2014, according to the Centers for Disease Control and Prevention (CDC) . As the death toll rises, something must change. So what is it? Users just stop? Users get treatment? Users get revived? How do we tackle the issue?
Is it a choice or a disease?
Choice or Disease?
The opinions are loud and passionate:
- Many feel Heroin users don’t deserve a second chance. It’s a choice, not a disease. “No one forces them to stick a needle in their arm”.
- Others feel it is a Band-Aid for addiction. Where is the cure/treatment? Narcan Enables.
- Many have lost loved ones or witnessed them struggle and Narcan OTC gives them the hope that their loved one will live, and change. It’s a disease, not a choice.
So we see the emotional investment, but is this helping or hurting addicts? What other options are being considered? And of course, WHO is paying for this?
The State's View
Ohio Attorney General Mike DeWine said Kroger's move to provide Narcan will save lives. "It is so very, very important that people have this available," he said (Cincinnati.com, 2016)
Before we find out if Mike Dewine is right, let’s get some background on opiate addiction, abuse, and Narcan.
Why Do People Abuse Opiates?
When opiates are used by someone not experiencing pain, it induces euphoria by affecting areas of the brain that control pleasure. The intense rush is brief and is followed by hours of feeling relaxed and content. Users enjoy this feeling so much they become addicted, seeking the euphoric high of happiness, regardless of the resulting pain it causes their loved ones (Jems, 2008). Welcome to the world of addiction.
How Does an Overdose of Opiates Occur?
Overdosing on heroin or other opiates (morphine, oxycodone, methadone, hydrocodone, codeine, and other prescription pain medications) causes one to stop breathing. Per the US Library of National Medicine “ Overdose occurs when the opiate binds to the μ2 receptors in the brain stem, desensitizing it to the carbon dioxide levels in the blood so that breathing mechanisms are not triggered, leading to respiratory failure" (2009).
So CPR will not revive a person, unless you can continue to give oxygen until, and if, the person’s breathing mechanisms are restored after the opiate wears off. Enter: Narcan.
What is Narcan?
It is a prescription medicine that reverses an opioid overdose. It cannot be used to get high and is not addictive.
Narcan is an overdose antidote, and works by reversing the effects of the opiates. In order for Narcan to work, it has to get to the receptor sites along the spinal cord and in the brain to block the effects of the opiates. Once it arrives at the receptor sites it acts as a blocker of opiate binding to the receptors (Jem, 2008). This allows the opiates to wear off more quickly and breathing mechanisms to restore.
How Do You Give Narcan?
Stopoverdose.org reports “Bystanders can safely and legally spray Narcan into the nose or inject it into a muscle.
How long does Narcan take to work?
Narcan acts in 2-5 minutes. If the person doesn’t wake up in 5 minutes, bystanders should give a second dose. (Rescue breathing should be done while you wait for the Narcan to take effect to that the person gets oxygen to their brain.)
Can Narcan wear off before the drugs that cause the overdose do?
Yes. Narcan typically wears off in 30-90 minutes and the person can stop breathing again unless more Narcan is available. For this reason, it is safest to call 911 and have the person taken for medical care.” (2016)
An important point to include from the above statement is that one injection may not stop the overdose. One user reported needing seven injections to be revived.
So what has motivated the FDA to approve this drug for over the counter purchase, especially when no data has proven that it has reduced the number of overdose deaths?
From 1996 through June 2014 laypersons reported using Narcan in 26,463 overdose reversals, according to a June report from the CDCP.
In 2013 alone, nearly 40,000 laypersons with 93 organizations reported 8,032 overdose reversals (Huffington Post, 2015)
In 2015, Ohio Department of Public Safety records show that Narcan was administered nearly 13,000 times around the state last year. Whoa-That number is nearly half the total administrations from 1996 through 2014, and nearly twice that of 2013’s reported numbers. That’s a big increase!
Is there a connection with use Narcan and the increased overdose reversal? In other words, is Narcan’s availability actually causing people to use more, and care less? Is it just extending their demise? Is death a better deterrent?
The Walking Dead
Drug overdose was the leading cause of injury death in 2013. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.
There were 43,982 drug overdose deaths in the United States in 2013. Of these, 22,767 (51.8%) were related to prescription drugs.
Of the 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines.
Heroin use more than doubled among young adults ages 18–25 in the past decade.
45% of people who used heroin were also addicted to prescription opioid painkillers (CDC, 2015).
More persons died from drug overdoses in the United States in 2014 than during any previous year on record. From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes . Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000 (CDC, 2015).
Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled. When Narcan has become more available, how are more people overdosing?
It could be that pain killer prescriptions quadrupled between 2000 and 2010. Why does that matter? Because as data showed many heroin users started off on prescription pain pills. According to American Society of Addiction Medicine, “94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were ‘far more expensive and harder to obtain’.” (2015). Common sense says there is a definite correlation between increase in pain prescriptions and overdose deaths. So we treat it with another drug made by the same people making the pain pills? Yes, it may postpone a death, but is it really saving lives?
Little data is available regarding the lasting efficacy of Narcan in saving lives or deterring repeat overdoses. Where are the numbers regarding those revived with Narcan and their success in treatment and rehab? What data is being collected on Narcan buyers and recipients to track success and use? Without meaningful tracking, are these addicts really alive, or are they becoming one of the Walking Dead?
These are all unanswered questions that fuel the debate of Narcan and Heroin users. The voice here is what is being done to ensure they are helped, and not just revived?
Narcan Has Not Reduced the Number of Overdose Deaths
So, it saves lives, but do those lives last? Narcan has been used for decades, and has been increasingly available across the US. But if it is a life-saver, why are the death tolls rising?
USA Today reports “Drug overdose death rates have increased in 26 states and Washington, D.C., and overdoses continue to outpace car crashes as the leading cause of injury-related deaths, according to a new report. Nearly 44,000 people die from drug overdoses each year….” (2015).
Nearly half a million Americans died from drug overdoses from 2000 through 2014 (CDC).
Additionally, very little research is available on Narcan’s effectiveness in not only saving, but preserving an addict’s life. Some reports show Narcan has not reduced the number of overdose deaths but rather the overdose rate has either remained steady or even increased-right alongside the increased use of Narcan. So is Narcan just prolonging the inevitable? If so, what does this say about our approach? If Narcan isn’t truly saving lives, whom, or what, is benefiting from it?
A buyer shared his experience regarding the purchase, delivery method, and cost of the drug.
He stated “I asked the pharmacist for Evzio. It’s a newish option, an injectable form of Narcan, kind of like an EpiPen….Evzio total cost, $570; Narcan spray: total cost, $20” (commonhealth, 2015).
But that was before the hike in cost.
The price in Maryland was reported at $40, jumping from $20 prior to its OTC availability (Huffington Post, 2015).
Georgia reported the same doubling in price (Aljazeera America, 2015.
Massachusetts reported seven years ago, it paid $22 per Narcan kit. Today, that kit costs $42.
Wisconsin reported the cost of the drug has gone from $7 per bottle in 2014 to $98 per bottle in 2015. ).
Ohio saw an increase of 55 percent in just three weeks, from about $27 a dose to $42 a dose.
Other police and fire departments reported the same increases doubling if not more, the price of Narcan. Isn’t it convenient its increase came around the same time as the OTC availability?
Additionally, the CDC reported that more than 53% of organizations offering Narcan reported inadequate resources to sustain or expand their organization's efforts to disseminate naloxone kits (CDC, 2015). So if in 2013 they couldn’t afford to offer it, how is raising prices helping?
And remember, as reported before, one injection may not be enough. With averages of doubling prices or more…is it a surprise that Amphastar a maker of Narcan reported a 70% increase in profit during this time more states were offering it over the counter? Would you be surprised this maker of Narcan also makes the very opiates that many users claim contributed to their addiction? Me thinks not. So who is benefiting here?
Do you think an addict is going to drop his $40 on a kit prior to overdosing? No. So who is buying it? You guessed it, the loved ones of the addicts. So again, who is paying and who is profiting, I mean, (air quotes) benefiting from the OTC status?
But does any of this really matter? The cost, Big Pharm getting fatter, if you have a loved one addicted? This may be an answer to their prayers. One more day with their son. One more day with their daughter….Think about it. If someone asked you if you would pay $40 to save your loved one, what would you say? Of course you’d say yes. And that’s exactly what Narcan manufacturers are counting on. Your yes.
In researching this story, I learned a little about the addiction backroad, a bit about Heroin use, overdose, and Narcan’s Makers’ growing pockets. But what I didn’t have insight on is what it’s like to be a Heroin addict, or a loved one of an addict. So I went looking for someone who does.
She was the Mother of the Velveteen Rabbit. The little boy she loved until he was too broken to live anymore. He died after overdosing on Heroin.
“I am only doing it with strength from God and (my son). I promised I would help others . I really want to curl up in a ball. I adored (my son) he was my world. We were so much alike….dear God help me”
The Little Rabbit’s Mother is determined to make her voice heard and to make changes. When I spoke with her, she clearly had done as much, if not more, research than I had on Heroin treatment.
Insurance Obstacles and Access
The Velveteen Rabbit’s Mother sent a lengthy email, it was as if her mind opened up and dumped all of her thoughts at once onto the blank digital canvas. She had relived his and the potential prevention every day since he died.
“So many things need to be changed between the insurance and rehab facility rules. Inpatient maximum at 28 days is not enough. (And) I would love to know why there has to be 30 day wait between leaving a facility and reentry when relapse occurs. The insurance claims it's the rehabs rules not the insurance.
The insurance companies need to step up and stop making it so difficult for people to get treatment. Hearing comments like the degree of their addiction, or what they are addicted to, does not warrant inpatient. …That's like saying "I'm sorry, you only have skin cancer... We need to wait until it metastasizes before we can treat you"
Health Insurance Plans make it impossible. One addict’s mother reports her son has a health plan through his job with a $3,000 deductible and 20% copay for treatment while paying $375 per month for suboxone. He cannot afford it. And how could he afford to take off work and get treatment to keep his insurance and keep income flowing? Enter: Parents.
“Parents are going bankrupt trying to save their kids.” She says.
If He Were Your Child
“I would like for people to know that I wouldn't put their kid in jail because they have cancer and an addict shouldn't be jailed because of his disease. It's a proven disease and we need to bring back the humanity to the way we deal with this. Jail doesn't help, treatment and education is what they need. It costs society a lot more money to turn our backs on the disease of addiction and put them in jail, where drugs are still rampant. Our country has more prisoners than any in the world for our size with a large amount of addicts. The war on drugs has failed. Let's change the perception and face the facts that these are people who need our help, not punishment.”
Stop the Stigma
“I wish people would accept this is a disease. Second I wish people would stop the stigma. The reality is that the back alley, poor homeless person who grew up on skid row is NOT who our addicts are. Many if not most of them grew up in loving homes, are educated and were the last people you would imagine would become Addicts”
We Need a CURE
WE NEED FUNDING! Come on people, this is an epidemic! Our children are dying day after day after day. I see the broken hearts of mothers …. Insurance companies need to make it easier for addicts to get the help they need at the treatment facility that is right for them, not the insurance companies. Additionally, addicts are being charged ridiculous amounts of money for drug testing when on probation. How is that helping by making their already unmanageable lives even more unmanageable. I revert to my initial statement. I wouldn't put your kid in jail for cancer, diabetes, or whatever their disease is - stop putting our loved ones in jail and turning a blind eye to what the real problem is and its remedy.”
The Mother participates in a group called Mothers of Addicts Shout Their Stories . It is a place where knowledge, experiences, healing and resources are discussed. Barbara Theodosiou, a member, also began The Addict’s Mother which started with 40 members and has grown to more than 50,000. The Mothers’ endeavors are simple: share, heal, educate, treat, and cure.
“When enough people say, ‘I’m an addict’s mom,’ it becomes normal. You’re looked at as courageous for coming out,” she says. “So we’ve changed what it looks like to be an addict’s mom. We’ve changed the whole picture for our society, and we’ve stopped being scared.” –Barbara Theodosiou.
In reviewing the difficulties in getting into treatment, staying in treatment, paying for treatment, and then recovering-truly recovering in life, it seems impossible. And how else would we know without this insight, from the inside, from the families of addicts?
We hear you, Moms, we hear you. On the horizon is a bill pending called the Comprehensive Addiction Recovery Act (CARA).
The CARA ACT
Cincinnati.com reported “Ohio AG Mike Dewine touted a Comprehensive Addiction Recovery Act (CARA) that on Thursday passed the U.S. Senate Judiciary Committee. The bill…is designed to encourage states and local communities to pursue a full array of proven strategies to combat addiction.” (2016)
“Recently, Congress effectively lifted a destructive, longstanding ban that prevented state and local governments from using federal money on needle exchange programs. A similar shift in attitude is reflected in bills like the Comprehensive Addiction and Recovery Act, which is pending in both houses of Congress. Its purpose is to expand and improve drug treatment services nationwide” (New York Times, 2016).
Ok, so it sounds like someone has been reviewing what could be more successful, but let’s simplify CARA. What is it, and what changes does it make to our current process to make it more effective at helping addicts recover?
- Provide up to $80 million in funding for prevention, treatment, and recovery
- Launch an evidence-based opioid and heroin treatment and interventions program.
- Strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services
- Expand prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations—to prevent the abuse of opioids and heroin and to promote treatment and recovery
- Expand recovery support for students in high school or enrolled in institutions of higher learning
- Expand and develop community-based recovery services in communities across the country
- Expand the availability of Narcan to law enforcement agencies and other first responders to help in the reversal of overdoses to save lives
- Expand resources to identify and treat incarcerated individuals suffering from addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment
For more information watch the CARA Act webinar review here (Faces and Voices of Addiction, 2016)
After reviewing NAADAC’s site, the summary of CARA states it expands Narcan availability, is aimed at assisting school aged kids and women in recovery, and requests the removal of drug convictions from disqualifying convicted drug offenders from receiving federal aid for school. What about men-why are provisions aimed at women and children? Where are the funds coming from? What is the process for qualifying for assistance under CARA? The Bill references offenders, so will CARA be available for those who were not ‘caught’ but need help? And what about relapsers? According to the National Institute on Drug Abuse, drug addicts who have entered into rehabilitation have a 40 to 60 percent relapse rate. (App.com, 2016).
How will CARA change that?
These were questions that were not answered during my research, so I reached out to NAADAC, the Association for Addiction Professionals, which represents the professional interests of more than 85,000 addiction counselors, educators and other addiction-focused health care professionals requesting additional details regarding funding, focus, and objectives of CARA, but have not yet heard back. With an early opinion, I like the direction this is going-we definitely need a wing to wing approach to cure addiction, not just save someone from overdosing. But we need more information. If we can answer these questions, maybe, just maybe, the lives Narcan stalls from death will be at a time when we are prepared to offer actual treatment to an addict. I am reaching out to the sponsors to obtain more information. In the meantime, I've passed along the information to the Mothers of Addicts team.
In Summary (and Honesty)
When I first began this article, it was my endeavor to discover Narcan’s effectiveness, or lack thereof, in treating Heroin addiction and preventing inevitable death.
My initial reaction to the announcement by Kroger’s was that Narcan OTC enables users and that they need to get real treatment, not Band-Aids. And I still believe that, but I have a softer view on an addict's struggles to recover after what I've found.
Like most people who don't have an addiction, my view is that I don’t stick a needle in my arm, so why did you? Obviously that was their choice. It was a choice to stick the needle in their arm. Now, once the addiction is created in the brain, is it still a choice? I need more information to form an educated opinion. But one thing I cannot deny is the glaring evidence that shows once someone is addicted, it’s easier to shoot up than get help and recover. And maybe that’s the separation we need. Stop arguing whether it’s a disease or choice, it's a problem. How do we solve it?
Honestly, it is difficult for me to feel sorry for the addict-because I cannot relate to why why why with all the information out there, they would take that chance. And because they are hurting many more people than just themselves. They put more lives at risk than just their own. Including yours, mine, and our families'. I'm not ok with that.
However; I sympathize deeply with the families of the addicts. They have no control over their emotional investment and love for their children, brothers, sisters, mothers, and fathers who are addicted. They can only watch in horror as their loved ones slowly slip away, into someone else, something else, and finally, slip away forever.
These loved ones are true victims of addiction. I cannot imagine what it would be like to watch my son waste away, and then tell me “Mom, I want help but I cannot get it”. It would kill me before it killed him. And for that, I support your endeavors, loved ones of addicts, to save your children from themselves, and to keep the ones you lost, real.
If you would like to follow the progress of the Cara Act you can do so here.
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