This Drug Won’t Stop the Heroin Epidemic. But it Can Help.

Should police officers carry Narcan, a heroin antidote, as Eric Holder is calling for?

National Journal
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Brian Resnick
March 10, 2014, 10:55 a.m.

The pa­tient is not re­spond­ing. He is not breath­ing. Pu­pils are tiny. Pulse is weak­en­ing. Skin is grow­ing colder. That deadly blue is set­tling in.  

Heroin has af­fixed it­self to the opi­ate (re­ward) path­ways of his brain, and it’s not let­ting go. Along with the eu­phor­ia this path­way reg­u­lates, it also com­mands a more ba­sic func­tion — con­trolling the steady tides of the breath­ing muscles. Back in the 19th cen­tury, heroin was mar­keted as a cough sup­press­ant. But it’s too good of one. Too high a dose, and your un­con­scious body no longer re­sponds to the bio­lo­gic­al cues that com­mand it to breathe.

Enter Nar­can, (or nalox­one, its gen­er­ic name).

Nar­can is the good twin to heroin’s bad. It’s sim­il­ar chem­ic­al shape al­lows it to push heroin out of the opi­ate re­cept­ors in the brain. But un­like heroin, it does not ac­tiv­ate those same path­ways. It shuts them down. After a para­med­ic sprays it in­to the nose or in­jects it in­to the blood stream, the ef­fect is an im­me­di­ate re­versal of over­dose symp­toms. Of­ten, this oc­curs with start­ling speed. “There’s some­body who’s on the ground, who’s lit­er­ally dead,” a fire of­fi­cial told a Bo­ston NPR af­fil­i­ate, “some­times they’re blue, some­times they’re black. And you ad­min­is­ter this stuff and some­times in a minute or two or three they’re ac­tu­ally up and talk­ing to you.”

That the pa­tients are talk­ing means they are breath­ing. And this is why At­tor­ney Gen­er­al Eric Hold­er is call­ing for more first re­spon­ders to carry the drug — es­pe­cially con­sid­er­ing heroin over­doses have ris­en by 45 per­cent in re­cent years.

“Used in con­cert with ‘Good Samar­it­an’ laws, which grant im­munity from crim­in­al pro­sec­u­tion to those seek­ing med­ic­al help for someone ex­per­i­en­cing an over­dose, nalox­one can save lives,” Hold­er told re­port­ers.

This sug­ges­tion that first re­spon­ders (mean­ing po­lice of­ficers and fire­fight­ers — para­med­ics already have Nar­can in their ar­sen­al) should carry the drug is more con­tro­ver­sial than it sounds. Al­though 17 states have laws that sup­port the use of it, Maine Gov. Paul LePage ve­toed a bill that would do the same last year. LePage thought the drug would give ab­users “a false sense of se­cur­ity.”

While his lo­gic is flawed — akin to the HPV vac­cine mak­ing young girls more promis­cu­ous — the gov­ernor is right in that the drug has some side ef­fects that need to be taken in­to care­ful con­sid­er­a­tion.

Like all drugs, Nar­can has side ef­fects. For one, a dose only lasts for 30 minutes to an hour. If the per­son who over­dosed had enough heroin in her sys­tem, she could slip back in­to res­pir­at­ory ar­rest after the Nar­can wears off. One sur­vey of re­search on the drug sug­ges­ted that the pa­tients need to be ob­served for two hours after tak­ing the an­ti­dote. If Nar­can is sold over the counter, and avail­able in the home, it alone will not pre­vent death.

Ad­di­tion­ally, while the drug will get a per­son breath­ing again, it can in­duce im­me­di­ate opi­ate with­draw­al, which can be vi­ol­ent. “This over­dose re­versal of­ten leads to a com­bat­ive, with­draw­ing pa­tient who does not want to be trans­por­ted, who then po­ten­tially could bring risks to the out-of-hos­pit­al and hos­pit­al staff,” reads a 2003 re­port in the journ­al Aca­dem­ic Emer­gency Medi­cine. However, the study didn’t find any deaths in 998 pa­tients who re­ceived the Nar­can from para­med­ics but then re­fused fur­ther hos­pit­al treat­ment.

Nar­can can cause con­fu­sion, dizzi­ness, vomit­ing, ag­gress­ive­ness, and even seizures. In Hunts­ville, Ala., the loc­al EMS med­ic­al dir­ect­or told re­port­ers that even though he car­ries the drug on am­bu­lances, it isn’t his first op­tion. “In my opin­ion, if I have some­body that is a sus­pec­ted opi­ate over­dose, the thing that’s go­ing to kill them is the res­pir­at­ory de­pres­sion, and it’s easy just to vent­il­ate the pa­tient and let the drug meta­bol­ize,” he said.

But the be­ne­fits of car­ry­ing the drug may out­weigh the risks. And spray­ing a chem­ic­al in­to the nos­trils is a lot easi­er for a lay re­spon­der than main­tain­ing con­stant vent­il­a­tion. With the right train­ing, pro­lif­er­a­tion of Nar­can has proven to save lives. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion stud­ied com­munity Nar­can pro­grams between 2006 and 2010 and found they re­versed 10,000 over­doses in 53,000 cases. An ex­ample of such a pro­gram is found in Bo­ston, which hands out Nar­can, along with train­ing, for free.

In Quincy, Mass., every po­lice of­ficer is re­quired to carry Nar­can. Since 2010, of­ficers have used the drug 179 times, re­viv­ing all but nine people. Sen. Ed­ward Mar­key, D-Mass., has in­tro­duced le­gis­la­tion that would ex­tend Good Samar­it­an pro­tec­tions to those who ad­min­is­ter the drug.

“The Opioid Over­dose Re­duc­tion Act re­moves the fear of leg­al jeop­ardy for fam­ily mem­bers, friends, and oth­er bystand­ers who ad­min­is­ter lifesav­ing drugs like nalox­one,” he said in a state­ment.

Hold­er called heroin over­doses “an ur­gent and grow­ing pub­lic health crisis,” and he’s right. And as the num­ber of heroin over­doses con­tin­ues to rise, any one in­ter­ven­tion will make an even great­er dif­fer­ence.  

(2012 National Survey on Drug Use and Health) 2012 National Survey on Drug Use and Health
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