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Heroin Overdose Antidote Becoming More Widely Available, Including Behind Bars

by Joe Watson

Just months after New York's prison system launched a heroin overdose prevention program by training prisoners to administer naloxone – an opioid overdose antidote also known as Narcan – Maryland made it easier to obtain the medication without a prescription.

According to the Baltimore Sun, the state of Maryland adopted recommendations made by its Heroin and Opioid Emergency Task Force last year and invested $150,000 annually to distribute naloxone. Governor Larry Hogan, a Republican, also signed an expansion of the state’s Good Samaritan law that exempts from liability paramedics, firefighters, first responders and other trained individuals who administer the antidote, which reverses the effects of an opioid overdose by helping the victim breathe on his or her own again. The expansion of the law was a response to a dramatic rise in heroin and opioid-induced deaths across the country.

The wider availability of naloxone has coincided with the implementation of overdose prevention programs in prisons and jails in New York, California and Rhode Island, among other jurisdictions.

The New York State Department of Corrections and Community Supervision (DOCCS) began a pilot program in February 2015 at the medium-security Queensboro Correctional Facility. [See: PLN, June 2016, p.22]. While prisoners were not given their own supply of naloxone while incarcerated, they received training on how to administer the drug, which can be injected or sprayed nasally. They were also educated about the dangers of opiate use and about New York’s Good Samaritan law, which prohibits the state from prosecuting someone seeking help for an overdose victim.

Research presented by the Albion Finch Medical Centre in 2016 found that the “rate of death from overdose is more than 50 times higher in the two weeks following [a prisoner’s] release from custody.” This is partly due to the decrease in prisoners’ tolerance to drugs while they are incarcerated. But when they are released and suddenly exposed to the vast availability of drugs, they become more susceptible to experiencing an overdose. Additionally, they might be more anxious and “triggered to use, and they may not have support systems to help them” soon after release, said Dr. Ingrid Binswanger at the Institute for Health Research.

Another contributing factor is the increased use of fentanyl – an extremely strong narcotic – to cut heroin, sometimes without the user’s knowledge. The recent increase in overdose deaths nationwide has coincided with the increased availability of fentanyl.

For those reasons, prisoners who complete overdose prevention training programs while incarcerated are offered naloxone kits upon their release from some correctional facilities. Others receive instructions on how to handle an overdose or where to obtain the kits in the community.

“Arming those leaving our correctional facilities with the knowledge and training they need to deal with a potential opioid overdose situation is a valuable tool for this vulnerable, at-risk population,” said DOCCS Acting Commissioner Anthony Annucci when the naloxone pilot program was launched. “I am pleased DOCCS will offer such an exceptional program that can help save lives in the community.”

Maryland’s enactment of naloxone-related legislation, meanwhile, coincided with an announcement by CVS in September 2015 that its pharmacies will offer naloxone without a prescription in 14 states: Arkansas, California, Minnesota, Mississippi, Montana, Massachusetts, Rhode Island, New Jersey, North Dakota, Pennsylvania, South Carolina, Tennessee, Utah and Wisconsin. The pharmacy chain added four more states to that list in March 2017, including Arizona, Georgia, Iowa and South Carolina.

“Over 44,000 people die from accidental drug overdoses every year in the United States, and most of those deaths are from opioids, including controlled substance pain medication and illegal drugs such as heroin,” said Tom Davis, CVS’s vice president of pharmacy professional practices. “Naloxone is a safe and effective antidote to opioid overdoses, and by providing access to this medication in our pharmacies without a prescription in most states, we can help save lives.”

Naloxone is not available over-the-counter everywhere because critics in many states believe its availability promotes the use of heroin and other opiates. But Dr. Joshua Blum, at the Denver Health Medical Center, argued that while naloxone is not a cure for substance abuse addiction, “overdose reversals can offer a chance to seek more comprehensive treatment.” In states such as Massachusetts and Rhode Island, where naloxone was already widely available, the National Institutes of Health (NIH) reported there has actually been a reduction in self-reported drug abuse.

“It is unethical,” the NIH said in a statement, “to allow a narrow focus on the harms of drug use to overshadow an opportunity to save human lives.”

And those lives need to be saved within prisons and jails, too, not just on the outside. There have been increasing reports of opioid overdoses among prisoners as fentanyl-laced heroin has found its way behind bars. In February 2017, for example, four prisoners at the Pickaway Correctional Institution in Ohio overdosed in a two-day period; they recovered after receiving naloxone.