Wednesday, November 17, 2010

Solutions for Texas' "Overdose Crisis"

A new briefing paper (pdf) from the Drug Policy Alliance hones in on Texas drug overdoses, pointing out that, "Between 1999 and 2007, overdose deaths increased by more than 250 percent. Statewide, accidental poisoning (most commonly due to drug overdose) is the third-leading cause of injuryrelated death in Texas, behind car crashes and suicide. While a majority of these poisoning victims are middle age adults or older (ages 35-54), almost one-third (31.4%) were either youth or young adults (ages 15-34)."

Most of these, says DPA, are preventable deaths: "over half of all accidental overdose deaths in Houston in the past five years could have been prevented if the overdose reversal medication naloxone, coupled with overdose prevention education, had been available to people at risk of an opiate overdose and their loved ones."

Our current approaches to the problem, however, may be making things worse, says DPA: "Despite the severity of this epidemic, the steps the state has taken to date have been ineffective, and even counterproductive. Texas has largely focused on punitive measures, like prosecuting people who use drugs with someone that later overdoses, such as the case of Kristin Metz, a 29-year-old woman sentenced to 10 years for injecting her best friend with heroin, at the friend’s request."

Among the group's policy recommendations are to expand access to drugs that counter the effects of opiate overdose: "Naloxone, or Narcan, is a life saving tool used to reverse opiate-based drug overdoses. Naloxone has been FDAapproved since 1971, and presents no potential for abuse as it has no pharmacological effect; it also has no effect if it is taken by a person that does not have opiates in their system. It needs to be made more readily available to those who may be in a position to respond to an overdose."

However, suggestions which cost new money, regrettably, will be difficult to pass in the 82nd Texas Legislature because of the massive budget shortfall. But DPA did suggest one excellent idea that would cost no new money and which could immediately start to save lives:
911 Good Samaritan Laws encourage people to call 911 by creating an exemption from arrest, charge or prosecution for possession of small amounts of drugs or alcohol when needing or calling for medical assistance in the event of an overdose. The policy prioritizes saving lives over arrests for minor drug or alcohol law violations. Such laws are essential because overdose fatalities often occur when peers delay or forego calling 911 out of fear of arrest or police involvement, which researchers identify as the most significant barrier to the ideal first response of calling emergency services.

Such legislation does not protect people from arrest for other offenses, such as selling or trafficking drugs. This policy protects only the caller and overdose victim from arrest and prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence.

Texas’ neighbor, New Mexico, became the first state in the nation to adopt a life-saving Good Samaritan law in 2007. Washington passed a Good Samaritan law in 2009 and several other states are considering similar legislation.

In fact, Good Samaritan policies for alcohol and/or other drugs are already saving lives at many of Texas’s major universities, including the University of Texas at Austin, Rice University, Baylor University, Southern Methodist University, and Texas Christian University, as well as nearly one hundred other college campuses nationwide. SMU’s decision to adopt a Good Samaritan policy for alcohol and other drugs was a direct response to the tragic overdose deaths of several students in recent years. According to school officials, the policy appears to be working: students are less reluctant to call for help now that they do not face student conduct sanctions.
This suggestion raises the question: Should the goal of drug policy be to save lives or maximize punishment? Historically, it's been the latter, but to me the approaches suggested by DPA make a lot of sense.

UPDATE: Via Sifting the Haystack, "8th Annual Harm Reduction Conference Comes to Texas Nov. 18-21."


Gritsforbreakfast said...

10:31, what do you think should be done about the issue? Do you agree with DPA's suggestions?

Prison Doc said...

I don't have any objection to the ready availability of naloxone or the Good Samaritan policies, but I doubt that many lives would actually be saved. Most people who are overdosing, accidentally or recreationally, are not having themselves monitored as to their breathing pattern and if they are addressed too late a whole bottle of Narcan isn't going to bring them back.

I agree with 10:31 that by far the biggest problem I see both at jail intake areas AND in the community is the rampant and ever-increasing use, overuse, and abuse of various prescription narcotics and psychoactive meds. These are available like candy not only in Harris County but in almost any county that you scrutinize in Texas and across the whole nation.

And yes, our goal should be to save lives rather than to punish or incarcerate--but there is a helluva lot more to saving lives than treating the overdose. It's all about rehabilitation, redemption, and restoration, and until such time as affordable programs and jobs are available to help the addicts out, the ready availability of naloxone is not going to make one bit of difference in the big picture.

Anonymous said...

Most of these people are too stupid or strung out to care about whether calling 911 will get them in trouble or not.

Anonymous said...

In all honesty, Grits. I don't think the DPA recommendation would have much of an impact one way or the other. In my county, most of the people who've died of drug overdoses have died alone. I may be wrong, but I don't think the people taking these prescription pills are having pill parties with others. In addition, since a lot of these addicts are getting a prescription (albeit fraudulent ones) from a doctor for their pills, they don't think they're violating the law to begin with.

I hope the legislature will increase the oversight of doctors and pharmacies as it relates to these particular drugs. I worry about this though with the budget constraints. A few years back, the Legislature cracked down on the over the counter sales of ephedrine and meth labs in Texas pretty much went away overnight.

As for the addicts, it will have to be some combination of treatment and enforcement just as it is with other drug addicts and alcoholics. But this "cocktail" really is pretty lethal and I don't think most of the public has any appreciation for just how bad the problem really is.

Gritsforbreakfast said...

11:29 writes: "A few years back, the Legislature cracked down on the over the counter sales of ephedrine and meth labs in Texas pretty much went away overnight."

That's true, but almost immediately cheaper, higher quality meth replaced it on the black market from Mexico. That's not really an example of a tactic that reduce availability, and arguably made meth cheaper and more accessible. It did solve the problem of dangerous mom-and-pop type labs in neighborhoods, which is a good thing, but it reduced neither supply nor demand overall.

Anonymous said...

I promise you that in Southeast Texas, the use of meth has declined significantly due to the decline in local meth labs. Perhaps not so much in the more urban areas, but in the suburbs and rural areas we're not seeing nearly as many meth users as we once did. Same thing for crack. But the pill cases have absolutely gone through the roof.

Tracey Hayes said...

The assumption that people who are addicted will not be responsible enough to administer narcan is plain wrong. Regardless, that isn't a justification for failure to make that drug available. In states around the country, overdose prevention does save lives, and I've gotten to know some amazing recovered addicts who are grateful for narcan due to personal experience. It confuses me, why should we continue to keep this substance from being available to save lives? What is the justification for that? Because we're afraid people won't use it enough? really?

The 8th Annual Harm Reduction Conference is in Austin this week, a real treat for those of us with an interest in improving our drug policies

Prison Doc said...

I'm not sure what Tracey is saying. Naloxone (Narcan) is readily available now and is a commonly used resuscitation drug. Anyone who is motivated should be able to obtain a prescription if they have an established doctor-patient relationship. Likewise there is no legal barrier to forming a Harm Reduction Group.

It is indeed naive to feel that addicts not in recovery are disciplined enough to use this medication with the aid of their own social safety net. Such a net probably does not exist for them.

I could be wrong but I don't know of any official barrier to the use of Narcan. Unofficial barriers such as lack of Good Samaritan protections should be addressed.

Anonymous said...

I agree that the average person has no idea what a serious problem these pills are causing and that they are so readily available and dangerous.

We need to stop this TV advertising by drug companies which convinces everyone, especially kids, that the solution to every problem is in a pill.

Doctors need to be educated about addiction and quit thinking their role is to make sure no one ever experiences any pain. Some minor gum surgery and they send me off with a script for a 2 week supply of hydrocodone? I threw the script away and took one Advil and went on about my usual business.

I hear tell they now have mini-rehabs for folks that became "accidentally" addicted - folks who would never buy a bag of heroin off a street corner and perhaps never even drank alcohol, but got hooked after a surgery.

These drugs are powerful, mean and and seductive and most of the medical profession and the public hasn't a clue about it.

Anonymous said...

If they don't dose, they are unlikely to overdose.

Anonymous said...

Wade cites a recent report in the journal PLoS Medicine by two Dartmouth researchers, Steven Woloshin and Lisa Schwartz, called “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick.” These skeptics, Wade writes, “argued that its prevalence had been exaggerated by pharmaceutical companies and uncritical newspaper articles, and that giving people diagnoses and powerful drugs were serious downsides of defining the elusive syndrome too broadly.”

Here is the lead of their report:

Life can be hard. Sometimes you feel sad or distracted or anxious. Or maybe you feel a compelling urge to move your legs. But does that mean you are sick? Does it mean you need medication?

Maybe, maybe not. For some people, symptoms are severe enough to be disabling. But for many others with milder problems, these “symptoms” are just the transient experiences of everyday life. Helping sick people get treatment is a good thing. Convincing healthy people that they are sick is not. Sick people stand to benefit from treatment, but healthy people may only get hurt: they get labeled “sick,” may become anxious about their condition, and, if they are treated, may experience side effects that overwhelm any potential benefit.

Anonymous said...

Great job, as usual, Grits. However, in Travis County about 1/3 of the accidental prescription drug deaths aren't opiates, they are benzos like Valium and Xanax. Naloxone isn't going to touch those.

Because these are not street drugs but prescription drugs, we need to track where the drugs involved in these deaths come from, conduct audits, and if appropriate, criminal and disciplinary proceedings against outliers like docs with numbers of overdose patients, or high volume prescribers. In this way, we can reduce the number of drugs on the street as well as recovering Medicaid dollars.