Thursday, December 11, 2014

How Texas police can better prevent overdose deaths

Yahoo! News reported (Dec. 3) that, "The rate of deaths involving prescription painkillers like Oxycontin and Vicodin more than tripled between 1999 and 2012, according to a new CDC report. The heroin-related death rate is also on the rise, increasing nearly threefold in the same time period."

Which raises the question: Can law enforcement do more to reduce drug overdoses than just make arrests?

In timely coincidence, out last month from the Bureau of Justice Statistics: A "Law Enforcement Naloxone Toolkit" titled "Engaging law enforcement in opioid overdose response: Frequently asked questions." The introduction to the document reads:
Claiming nearly 120 American lives daily, drug overdose is a true national crisis. The main driver of this epidemic is opioid overdose (OOD), which cuts across class, race, and demographic characteristics. Certain groups, including veterans, residents of rural and tribal areas, recently-released inmates, and people completing drug treatment/detox programs are at an especially high risk of OOD.

The vast majority of OODs are accidental and result from taking inappropriate doses of opioids or mixing opioid drugs with other substances. These drug poisonings typically take 45-90 minutes to turn fatal, creating a critical window of opportunity for lifesaving intervention. Appropriate assistance, including administration of the antidote naloxone, can quickly and effectively reverse the OOD.

Reducing the time between the onset of OOD symptoms and effective intervention is a matter of life and death. Tragically, many victims do not receive timely medical attention. In many cases, witnesses delay calling for help because they do not recognize OOD symptoms or are concerned about getting in trouble with the law. In other cases, emergency medical response may take too long to arrive or the victim may not be discovered until it is too late.

Law enforcement officers (LEOs) have always been on the front lines of the battle against drug-related harm in our communities. The current OOD crisis is no different. Across the US, law enforcement agencies are increasingly initiating programs to stem the tide of overdose fatalities. This document provides an overview of the frequently asked questions (FAQs) that may arise in agencies that are considering or initiating such efforts.
A couple of Texas legislators (Eric Johnson, Ryan Guillen) have already filed bills to create a defense when drug users call 911 to report an overdose. But equally important is having patrol officers carry Naloxone, an opioid antagonist which "has no potential for abuse," according to the FAQ. It is a "very safe medication with the potential side effect of a theoretical risk of allergy that has never been documented." It can administered nasally or be injected - a company that makes a naloxone auto-injector makes the product available at a discount for law enforcement.

Texas has never passed statutes about the drug one way or another, according to a website that tracks state laws related to naloxone, but I've never heard of a Texas police agency using it."Almost half the states in the United States have passed naloxone access laws that shield 'any person' from civil and criminal liability if they administer naloxone."

The FAQ recommends police agencies partner with local health agencies to procure naloxone and train officers in its use. "In most cases, a protocol called a 'standing order' can be issued for the entire department by any provider holding a license to write prescriptions. Larger departments may have a medical director or other licensed prescribers already on staff, the FAQ noted. In New Jersey and New York, their Boards of Pharmacy "have streamlined the process by which law enforcement agencies can order the medication, allowing these agencies to purchase naloxone directly from a wholesaler instead of receiving it from a retail pharmacy via a prescription from a health care provider." (NYPD equipped nearly 20,000 officers with naloxone.) And North Carolina authorized "agreements between law enforcement overdose response programs and EMS agencies to handle purchasing and training."

Grits would like to see Greg Abbott's Criminal Justice Division look into the possibility of grants to Texas police departments interested in these sorts of overdose prevention programs. There seems to be little downside that I can see and also a real opportunity to save lives.


Anonymous said...

I think it is a very important for officers to be able to save a life, give them the tools to do it plain and simple

Marc said...


I must disagree - this is 1) not a overdose prevention program, and 2) ignores the issues involved in misdiagnosing an opioid overdose. A much better option - call EMS to deal with potential opioid overdoses.

First, a response to overdoses is not a prevention program. Prevention would include education programs, needle exchange programs, many of which are unlikely in the current political environment. The current prescription tracking program DPS runs is also a preventative response.

Second, my 21 years of experience as a paramedic indicates there are downsides to the use of naloxone, including incorrect diagnosis of opioid OD's and the reaction of the patient to naloxone (vomiting, potentially aggressive or violent behavior) with the potential for negative interactions with the police.

EMS is trained to deal with these issues already. Rather than spending money to equip 20,000 NYPD officers with naloxone (which has a shelf life and the vast majority would be unused , likely > 19,900 naloxone kits), why not spend it to improve emergency response from EMS with FDNY? The same would be true in any large city.

There may be some places where this is reasonable - rural areas with long EMS response times, for example. But in most places, I'm of the opinion this would be a misuse and waste of grant money that could be used in a more effective way.

Sandy Olson said...

I appreciate the concerns noted by Marc, and these would need to be resolved to satisfaction of parties involved.

I also appreciate the other public health measures you mentioned. The climate may not be ripe for those prevention measures at this time. I don't know. But I do know that overdose response is in fact a prevention measure. Preventing death in finality is prevention. All of these measures are preventative. Prevention is a continuum, in my opinion. I am sure others might disagree.

Saving one life is a big dang deal. If one person gets into recovery and returns to a productive contributing life in the community, this can be a priceless benefit. And, since no one of us can predict a person's future trajectory (I have been wrong many times, in trying to do just that), we can't pick and choose who to save in this world.

I appreciate the article and comments very much, and am glad there is healthy educated discussion around the topic.