HEALTH CARE/Joan Retsinas

The Opioid Challenge

Kudos to the 24 states that took the opioid challenge (NY, IL, WA, CA, RI, CT, MA, NC, OR, CO, VA, KY, MD, VT, NJ, OK, UT, TN, ME, GA, WI, MN, OH and the District of Columbia)! Let’s hope that more states follow. (https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf)

The opioid challenge asks state bureaucracies, those traditionally cumbersome bodies that move at glacial speed, to substitute common sense for ideology. And to do this quickly, without years of studies.

The problem, public health-wise, is the mounting death toll from overdoses of opioids. Opioids include illegal drugs, like heroin and cocaine, and legal ones, like Percocet, Oxycontin, morphine and methadone. One estimate is that 15,000 people die each year from an opioid overdose. Connecticut estimates that 1 resident dies each day from an overdose. Crucially, deaths from overdoses have tripled since 1990. (http://www.cdc.gov/homeandrecreationalsafety/rxbrief/)

The traditional definition of the problem, fueled by ideology, has been the drugs themselves. Public health departments have mounted “just say no” campaigns against the illegal pharmacological goodies, and warned about the legal ones. States, furthermore, have regulated people licensed to prescribe them. Opioids are not easy or cheap to buy.

But realistically a lot of Americans do buy them, legally and illegally. Some reach for the drugs because of physical pain, others because of psychological pain. There is no one common profile of the user: some live in homeless shelters; some in McMansions. The common denominator: they take opioids.

And some people will inadvertently take too much.

So savvy public health departments have shifted their focus, from trying to stop users from abusing, to tamping down the number of deaths.

Technology – in the shape of another drug – provides a deus ex machina from this unremitting tragedy. Naloxone, taken through the nose or by injection, can stop a fatal reaction. Typically, the abuser will become sleepy, will have trouble breathing; a dose of naloxone can revive him, giving the person who administers the naloxone time to call 911, time to get the person to a hospital. Naloxone has no known serious side effects; a person will not overdose on it. Simply, it stops the fatal reaction to the opioid. It will not address the person’s “problem” with drugs, but it will keep the person alive. (Naloxone will not help the person overdosing on non-opioids, like alcohol.)

The challenge has been to get naloxone in time to the person who needs it.

Traditionally, states have allowed physicians to prescribe drugs like naloxone (even though it is not a controlled substance); and physicians have been allowed to prescribe only for the patient him/herself. Physicians have not been allowed to prescribe for a relative or friend standing in place of the patient. Furthermore, states have restricted the ability of third-parties to administer drugs: the friend who gives naloxone to a person overdosing may justifiably worry about liability. (Common sense kicks in here: a person who has overdosed cannot administer the dose to him/herself. Somebody else must administer the syringe or the nasal spray.)

So states have been expanding prescription privileges to include nurses, podiatrists, physician assistants, dentists. States have been allowing family and friends to fill the prescriptions. (Naloxone has no street value.) Finally, states have been enacting “good Samaritan” laws to protect the person who administers the drug – thereby encouraging family and friends to act forcefully when they see somebody slipping into what may be a fatal reaction. Some states have discussed making naloxone available over-the-counter, so that a person who takes opioids might carry the antidote, much as a person allergic to bees or peanuts carries an epinephrine pen.

People will still be taking opioids; people will still be abusing them, overdosing on them. But some states have helped more of these people survive.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, October 15, 2014