Program to Supply Boston Addicts with Antidote Proposed

Battling to reverse an epidemic of lethal heroin overdoses, Boston health authorities are proposing giving drug users emergency kits of a medication that can revive them even as they spiral toward death.

City paramedics or hospital emergency rooms now administer the drug, called naloxone (widely marketed under the name Narcan) to overdose patients. But in a pilot program modeled after campaigns in New York, Chicago, and Baltimore, the Boston Public Health Commission would give addicts a cache of the medication in advance, which they would keep with them in case they took too much heroin or another opiate.

"The number one hope with this is to save lives," said John Auerbach, executive director of the Public Health Commission. "Our paramedics have said it's a miracle drug. They've seen people who are comatose who are then revived and perfectly fine."

Heroin has emerged in recent years as the drug of choice on Boston's streets and has proved to be a prolific killer. From 1999 to 2003, the latest year for which figures are available, drug-related deaths rose 50 percent, with many of the 144 deaths in 2003 also blamed on heroin. In some cities, heroin causes more deaths than guns and knives combined.

The drug is cheap and plentiful, with a small bag of heroin sold for as little as $4, cheaper than a six-pack of beer.

As deaths have increased and the drug has migrated from city streets to wealthy suburbs, efforts to control heroin and its consequences have escalated: Just this summer, state legislators approved the over-the-counter sale of syringes as a way to reduce the spread of HIV and hepatitis from tainted needles. Governor Mitt Romney vetoed the measure, but lawmakers voted to override his rejection.

Next week, the board that establishes policy for Boston's health agency is expected to approve a trial run of the naloxone program, which would begin in the fall and last at least a year. In the first six months, authorities said, they hope to enroll 100 addicts. The initiative earned the backing of Mayor Thomas M. Menino of Boston, an early champion in the 1990s of programs that allowed users to exchange dirty needles for clean syringes.

Critics of the program in other cities have argued that supplying the medication gives addicts an excuse to continue shooting up.

In Boston, users interested in obtaining the emergency kit would have to undergo extensive training and evaluation. First, they would be encouraged to seek treatment for their habit and told where to go for help.

But if addicts decided they were not prepared to stop, they would be instructed in the use of naloxone. The medication comes in two forms: one that can be injected, another that is given through the nose. The Boston program would use the inhalant.

After the training and a medical evaluation by a doctor, addicts would then be written a prescription for one or two doses. Auerbach estimates that the pilot program would cost about $10,000, which the city would cover.

Addicts would keep naloxone with them, and, if they experienced an overdose, someone else could administer it. The medication is absorbed, so the patient does not have to inhale it.

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