Editor's note: This is the first in a two-part series on naloxone, an anti-overdose serum, and how the difference in access from state to state has affected users. The second installment can be found here.
ATLANTA — Kareem’s most recent Lazarus moment came in March, while getting high at home with a friend before his graveyard shift at the meat cutting plant. A tall, bony African-American man, he has used heroin four or five times a day for most of his 58 years. It usually puts him in just the right mood to play chess or shoot pool, but this time, he said, “I noticed the drug had overpowered me.” When he awoke to his friend’s terrified face, he knew he had overdosed.
Twice before in his long affair with heroin, Kareem, who did not provide his last name for legal reasons, had OD’d and been saved by paramedics using naloxone (brand name: Narcan), which immediately induces withdrawal from opiates. In March, though, it was his friend getting high alongside him who acted as a first responder. “He noticed I became non-responsive; I stopped breathing. He got the Narcan and the syringe and put in the prescribed dose. It didn’t work, so after five minutes, he put it in again.”
Kareem would have died without naloxone, but his supply, like the heroin, was contraband. Last year, health workers slipped him a zip-up kit containing a vial of the serum, a syringe, a nasal adapter and instructions, and he told his family and friends where to find it, just in case.
Emergency rooms and paramedics have stocked naloxone for years, but until recently, state pharmaceutical regulations kept it otherwise out of reach. On April 24, however, Georgia Governor Nathan Deal signed the 9-1-1 Medical Amnesty bill, relaxing restrictions on the drug and granting immunity to users who call for emergency medical help. Within a year, the bill went from draft to statute in this conservative, Republican-led state, and similar bills have moved just as quickly in North Carolina, Kentucky, Ohio, Vermont, Virginia and New York.
Since the mid-1990s, when San Francisco, Chicago and Massachusetts began to pass local and statewide legislation expanding access to naloxone, an estimated 10,000 people have been revived — most by fellow drug users. Nearly 20 states now permit lay people and first responders to carry naloxone, either by individual prescription or through a “standing order” deputizing syringe-exchange clinics and other health organizations to hand out easy-to-use kits. Many states have also passed companion “medical-amnesty” bills that assure drug users who call for help that they will not be charged with possessing drugs or drug paraphernalia.
Unintentional drug overdose is now the leading cause of accidental death in the country, far outpacing motor-vehicle fatalities. Between 2000 and 2010, the number of people who died from overdoses doubled, to more than 38,000 per year, causing public health experts to declare an “opiate epidemic.” But some believe that in addition to spiraling rates of addiction, the race and class of overdose victims have hastened the enactment of these life-saving policies. According to Dan Bigg of the Chicago Recovery Alliance, a pioneering harm-reduction group, “There’s a perception that the younger, whiter, suburban face has been part of the changing landscape and has brought more people to pay attention to this issue.”
Overdose prevention has become a major health concern. Naloxone is all over the national news and endorsed by such high-profile officials as Attorney General Eric Holder. Prior to 2012, however, only a handful of cities and states had passed laws broadening access to naloxone or granting medical amnesty to 911 callers, and strategies outside the drug-treatment paradigm were harshly stigmatized, too fringe and controversial to inform public policy.
“It was thought that this harm-reduction thing is radical,” said Eliza Wheeler, of the San Francisco-based Harm Reduction Coalition. “The real shift in the mainstreaming of this has happened since prescription-drug use has fueled a rise in heroin use throughout the country, in communities that maybe weren’t as affected in the past.”
“Before, you had to go to a dark, scary place to get these drugs. Now you just go to your school bathroom,” said Robin Elliott, a real-estate agent in suburban Atlanta whose son Zack, a promising student-athlete, died of a heroin overdose in 2011. “You used to think of [heroin users] as being outsiders, not in the mainstream group. Not the beautiful, blonde, high-achieving daughter that goes to the University of Georgia.”
As the epidemic spread, young people like Zack were OD'ing and succumbing to respiratory failure, collapsing and turning blue. Co-users and other witnesses were failing to call for help, fearing arrest and imprisonment. In Georgia, Elliott and a band of grieving mothers and fathers lobbied for the naloxone bill like it was their second job. Justin Leef, Zack’s best friend, was instrumental in drafting it.