News

Iowa Official Advocates Naloxone Prescription to Addicts

Lee Hermiston

10/17/2014

Oct. 17--CEDAR RAPIDS -- Heroin overdose deaths in Iowa jumped from five in 2009 to 20 in 2013.

During that same period, deaths from opioid overdoses -- drugs such as oxycodone and hydrocodone -- ranged from lows of 23 deaths in 2010 to highs of 45 in 2011 and 44 last year statewide.

And in July, the Johnson County Department of Public Health reported that a record 10 heroin-related deaths had occurred in that county so far this year, topping the previous high of nine in 2012.

There have been no reported heroin-related deaths in Johnson County since that information was released. County Public Health Director Doug Beardsley said those efforts primarily have focused on education and making people aware of the deadly consequences of heroin and opioid abuse.

However, one county official wants to take lifesaving efforts several steps further. Mike Hensch, administrator of the Johnson County Medical Examiner's Office, is an advocate of providing heroin and opioid addicts with a prescription of naloxone, a opioid antagonist that is highly effective in halting opioid overdoses.

The drug, also known by brand names such as Narcan and Naloxone, is commonly carried by paramedics, emergency medical technicians, firefighters and, in some jurisdictions across the country, law enforcement.

Throughout the country, different states have enacted laws that allow non-medical professionals to administer naloxone to someone suffering from an overdose without facing potential liabilities. Hensch believes Iowa, which still requires the drug be administered my medical professionals, should follow suit.

"I think we should do what other states have done," Hensch said. "(In addition to addiction treatment), they also get an prescription of naloxone."

However, Hensch isn't sure if he'll get much support. One might argue that giving an addict a safety net for drug use amounts to tacitly allowing that abuse to continue.

"If we give them naloxone, we're condoning their addiction," Hesch said, explaining the expected opposition to his proposal. "I don't believe that at all. They need help and they need treatment.

"As in all treatments, sometimes the person has to decide when they're ready ... I'm all about, let's keep people alive and hope we can get them rehabilitated."

Local authorities are split on whether giving naloxone to addicts or their friends, family and relatives would be a good move. While all of them agree naloxone is effective in stopping an opioid overdose, some feel administering that drug still should be in the hands of medical professionals.

"We closely monitor vitals as we do those doses," said Keith Rippy, executive director of Area Ambulance. "We start with the smallest dose possible and go from there and make sure we don't cause more harm ... It's best left to the professionals, at this point."

There's no debate over the effectiveness of naloxone, which works by binding to opiate receptors in the central nervous system. Cedar Rapids Fire Department's Emergency Medical Service Capt. Jason Andrews has seen the drug administered many times.

"It's very, very effective," Andrews said.

Naloxone programs such as the one for which Hensch is advocating are not uncommon. Daniel Raymond, policy director for the New York City-based Harm Reduction Coalition -- an organization that offers training and advocacy for drug abuse related issues -- said there are naloxone programs in approximately 20 states.

And they've been effective. Raymond points to a 2012 report from the Centers for Disease Control and Prevention, which polled naloxone distributions programs and found that, between 1996 and 2010, naloxone had been provided to 53,032 people, which resulted in 10,171 overdose reversals.

"That was a really helpful validation of this strategy," Raymond said of the CDC report. "All of the preliminary data was pointing in the right direction. We were really encouraged by that and saw it as an important strategy."

In areas with naloxone distribution programs, Raymond said distributors have included county health departments, drug treatment programs, syringe exchange programs or even parent support groups. Those states, however, have laws that protect people from any potential liabilities associated with prescribing or administering the drug.

"Currently Iowa is not one of the states that has passed one of those laws yet," Raymond said. "A lot have been passed over the last two years. They typically are not controversial laws ...

"The perception of a liability is more symbolic than a reality. If you save my life by administering naloxone, I'm not going to sue you."

Earlier this year, Iowa State Rep. Ako Abdul-Samad, D-Polk County, introduced a bill that would have, in part, allowed someone acting "in good faith" to obtain, possess and administer naloxone to someone suffering from an opiate-related overdose. That bill did not make it out of the judiciary committee.

However, Becky Swift, data manager for the Iowa Department of Public Health's behavioral health division, said that this month the IDPH and Governor's Office of Drug Control Policy will be reconvening a prescription drug task force.

That meeting could result in a recommendation to expand naloxone access across Iowa, Swift said.

Mike Polich, chief executive officer of the Des Moines-based United Community Services, which includes a medication-assisted treatment center that assists those with opioid addictions, is among those in favor of widening naloxone access for addicts.

"Any time we can save a life, I think it's a good thing," Polich said. "Let's save lives, let's not judge them."

Johnson County Sheriff Lonny Pulkrabek said the most important goal for addicts is to get them into substance abuse treatment, and he's not sure if a naloxone program would achieve that. That said, he said a distribution program might be worth considering.

"My first blush is, if it can save lives, maybe it can make sense,"

Steve Spenler, director of the Johnson County Ambulance Service, said that while naloxone is effective, it also must be carefully administered. He said his staff is trained to administer the drug to improve a patient's respiration but not necessarily to wake them up.

"Then you're faced with an individual who can be combative," Spenler warned. "We don't want to get into that situation. We want to get them where their breathing is better."

Spenler also noted that naloxone has a shorter period of effectiveness than that of most opioids, meaning the naloxone can wear off before the other drug does. As Andrews with the Cedar Rapids Fire Department said, "It's not a magic pill."

"I think there's some potential benefit to (a naloxone program) with the mind-set that it's a stop gap measure," Andrews said. "If a well-researched and well-administered program was in place, sure, there's potential for benefit."

Ultimately, however, Andrews said the goal is to get an overdose patient into long-term, definitive care and work toward ending the addiction.

For Hensch, a naloxone distribution program is just common sense.

"If something is killing people and you can keep them alive, why wouldn't you do it?" he asked. "You can't treat someone's addiction if they are dead."