Thursday, December 04, 2014

Police, Lege can do more to prevent overdose deaths

I wonder how many Texas police departments have patrol officers carry naloxone to save lives after drug overdoses? The New York Times coverage this week prominently re-raised the issue and US Attorney General Eric Holder this summer said it was a good idea (possibly the kiss of death in these parts). But Grits hasn't heard the question confronted for years here in Texas, so I'm guessing not many. Increasingly naloxone is used to respond to overdoses from prescription opioids as well as illicit ones, which along with its high rate of effectiveness and general overall safety may explain growing public support. "That naloxone has rapidly gained acceptance, expanding from needle-exchange programs to police precinct station houses, underscores how widespread the twin scourges of heroin use and painkiller abuse have become in recent years," the Times reported.

Here in Texas, Rep. Ryan Guillen has filed "Good Samaritan" legislation creating a defense from prosecution for people who call 911 when a drug user overdoses. Rep. Eric Johnson filed similar legislation two years ago and may still do so again. But that's just one component of overdose prevention. Equipping and training first responders with naloxone would help a lot, too, especially in departments facing a serious heroin problem. (States with legal needle exchanges may train addicts to use naloxone and send them home with a dose in case of emergency, but obviously Texas is several steps away from that.)

According to the CDC, "In 2012, there were 41,502 deaths due to drug poisoning (often referred to as drug-overdose deaths) in the United States, of which 16,007 involved opioid analgesics and 5,925 involved heroin."  Texas' death rate from overdoses is slightly lower than the national average, at 9.8 deaths per 100,000 people, while nationally. the death rate from drug poisoning is around 13.1 per 100,000, up from 6.1 in 1999, says CDC.

Though lower than the national average, the number of overdose deaths grew in Texas by 150 percent from 1999 to 2007, according to the most recent available analysis from the Drug Policy Alliance, which added that, "Legal prescription opioid drugs such as oxycodone and hydrocodone were identified in 50% of all accidental overdose deaths between 2005 and 2009 in Houston, claiming more lives than all illegal drugs combined." Indeed, "in 2007 more people died from accidental overdose in Houston than from car crashes." Further, "Statewide, accidental poisoning (most commonly due to drug overdose) is the third-leading cause of injury-related death in Texas, behind car crashes and suicide."

For more on the scope of this problem, check out this tidbit promoted in October by Mother Frances hospital in Tyler titled, "Prescription painkillers fueling overdoses in ERs, study finds." The press release concluded:
Study author Michael Yokell, medical student at Stanford University School of Medicine, and his colleagues reached their conclusion by analyzing tens of thousands of reports of narcotic overdoses from a sample of nationwide emergency room visits from 2010.

Almost 68 percent of the overdoses involved prescription drugs. That number may be higher since the drugs were unspecified in 13 percent of cases, and multiple narcotics were involved in 3 percent of cases in the study. Heroin alone was responsible for 16 percent of the overdoses.

Narcotic overdoses were most likely to happen in urban areas (84 percent) and the South (40 percent of the total). Most were in women; 1.4 percent of the total patients in the study died.

"Opioid [narcotic] overdose exacts a significant financial and health care utilization burden on the U.S. health care system. Most patients in our sample overdosed on prescription opioids, suggesting that further efforts to stem the prescription opioid overdose epidemic are urgently needed," the researchers wrote.

The study is published online Oct. 27 in the journal JAMA Internal Medicine.
Training first responders to use naloxone and allowing cities and counties to sanction legal needle exchanges both make good public policy sense for the same reason drug and veterans courts work: At root, addicts must not just abstain from drugs but change their lifestyle in order to avoid recidivism and possibly death. Put an overdose treatment in someone's hand and perhaps its mere presence reminds of the dangers and serves as a deterrent. Similarly, the interaction with needle exchange workers that puts the naloxone in an addict's hands represents an opportunity to provide education, shepherd them toward treatment and medical assistance, and in more ways than one potentially save their lives.

It's hard to stop people's bad choices and they can't change unless they want to. But there are ways at the margins to keep overdoses from turning tragic, saving the addict's life until they can turn it around: Where they don't already, patrol officers and EMTs should keep naloxone in their vehicles and be trained how to use it. And the Legislature could authorize local needle exchange pilots in cities that want them and allow them to distribute naloxone to heroin addicts along with needles, kit cleaning equipment, medical and treatment referrals, etc.. Nobody wants addicts to use drugs, but the public has an equal or greater interest in drug users not spreading Hep C, HIV (which the taxpayers will likely pay for through either Medicaid or the prison system), or overdosing with no insurance and being taken to the local ER.

Though it's treated as a crime, and regrettably the only treatment options available for many people are through the courts, at root substance abuse is more of a health (or perhaps mental-health) issue than a traditional crime with victims, etc.. When confronted with an overdosed addict, whether the cause is heroin or Oxy, the sensible approach is to save their life first and worry about punishment, treatment, or whatever one thinks is the right legal comeuppance later.


Anonymous said...

I'd like to point out an unintended consequence of these restrictions put on hydrocodone in the last couple years. Lost access to life altering drugs for those who truly need them.

Those of us who have used hydrocodone for years for chronic and severe pain are essentially out in the cold now. If you have no health insurance, as I do not because I earn too much, but not enough to afford it, I am forced out of having access to the medicine I took safely for 12 years. I suffered hip damage in an auto accident in 2001 and have a very kind primary care doctor who gave me what I needed. She knew I was not an abuser. I took it when needed, and didn't when not.

However, as of last October, I am squeezed out. She now refuses to prescribe hydrocodone to me. She is happy to provide a referral to a pain management practice. Who has $600 per appointment, per month for that without insurance? I do not. I barely managed to scrape together $150 (reduced for cash pmt) 2x a year to get a renewal.

In the end, I lose work due to pain. I lose quality time with my spouse, and quality time with my grandchild due to pain. I guess I should be grateful that the nanny state everyone loves to hate is protecting me from myself, huh?

Anonymous said...

"Prescription painkillers fueling overdoses in ERs, study finds."

We can't say "Prescription painkiller use fueling overdoses in ERs." The word use points to people's behavior and, of course, we know that people are never responsible for their own behavior.

R Johnson said...

Lives can certainly be saved by training and equipping all emergency workers in the use of naloxone and by making it available to them. Fortunately, strides are being made in that direction.