Moving America Forward

A Push to Make the Life-Saving Antidote to Overdose Available to All

March 4, 2014
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A Push to Make the Life-Saving Antidote to Overdose Available to All
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Overdose kills more Americans each year than car crashes or homicide. That's why Dan Bigg wants to get the antidote, naloxone, into every first-aid kit in the country.

Through the work of his nonprofit organization, the Chicago Recovery Alliance, Dan Bigg has helped save thousands of lives from drug overdose. Bigg, personally, has saved at least six. One night a few years ago, for example, Bigg was doing outreach work with a group of intravenous drug users in their apartment in Chicago when he noticed that a striking young woman in her 30s had become ashen. Her breathing had slowed dangerously. Her friends said that she had taken heroin. Brushing aside their objections that he would tear her designer clothes — the woman “looked like a fashion model,” according to Bigg — or bring her down too hard from her high, he injected her with an overdose antidote called naloxone and instantly restored her breathing to normal.

A few weeks later, she called him to say thank you: If you hadn’t been there, she told him, my friends might not have realized I was so close to death.

It is a scenario that has grown increasingly common in the United States: accidental overdose from opioids like heroin and, more commonly, prescription painkillers including oxycodone and Vicodin. There are now more deaths from drug overdose — roughly 100 Americans every day, according to the Centers for Disease Control and Prevention (CDC) — than from car crashes or homicides. And in at least half of the overdose cases, people die in the presence of friends or bystanders who could have done something to save them.

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Dan-BiggDan Bigg

Without Bigg, that number would be much, much higher. Since the mid-1990s, the 55-year-old co-founder of the Chicago Recovery Alliance (CRA) has been handing out naloxone, the antidote, to drug users and to their loved ones, who would be in a position to help them in case of an overdose. The life-saving drug, which goes by the brand name Narcan, was previously used only in hospitals and emergency departments (today, many first responders like emergency medical technicians and some police officers and firefighters also have it at the ready) — and it worked well in these settings, except for the fact that many witnesses to overdose don’t call for help or get victims to the hospital in time.

So Bigg pioneered the strategy to get naloxone into more hands. You don’t have to be a health-care worker to use it safely. Naloxone is nontoxic and non-addictive, and it can quickly — typically within seconds, or sometimes minutes — reverse the potentially deadly effects of opioids. It can be injected or delivered through the nose, though so far, only the injectible formulation has been approved by the Food and Drug Administration (FDA). Naloxone also reverses overdose from combinations of drugs — generally, opioid overdoses involve other depressant substances like alcohol or Valium — as long as one of the drugs is an opioid. It’s safe to use because you can’t get high on it; it works by blocking the effect of opioids on the brain, so it produces the opposite of a high: withdrawal.

There has been an upswell of interest in naloxone since the actor Philip Seymour Hoffman was found dead of an overdose on Feb. 2, reportedly with a needle still in his arm and in possession of dozens of bags of heroin. Many in the media have called for making naloxone more widely available, not only for medical workers and first responders, but also for addicted people and their families. It’s an idea that has been around a long time — no one can remember who first came up with it as a way to save overdose victims — but Bigg is credited with being the first to take action on it.

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The second son of a surgeon and a nurse, Bigg started his own public health work as an undergraduate at Claremont McKenna College in California and then at Indiana University. Aiming for a doctorate in psychology, he worked at Chicago’s Lakeshore Hospital in the mid-1980s in one of the first programs in the country to address the connection between injection drug use and the risk of HIV. “I remember reading about what was then called GRID,” says Bigg, referring to the acronym for “gay-related immune deficiency,” which was what health officials called AIDS before the human immunodeficiency virus was discovered and its transmission understood. Soon thereafter, researchers realized that what they thought was a gay disease spread particularly fast among at-risk groups like injection drug users.

Bigg himself isn’t gay and has never suffered from addiction, but many of his close friends did and they were affected by AIDS. So his main goal was to break the connection between addiction and AIDS, and he did it in an unconventional way. Rather than pushing drug users to achieve abstinence, he wanted to try to simply reduce the harms associated with their habit — the risk of HIV being the worst of them at the time. In the early ’90s, Bigg co-founded CRA and began distributing clean needles and information on safer injection practices. And while most other anti-addiction groups were defining recovery as total abstinence, Bigg’s organization described it as “any positive change” that led to better health. By using a more inclusive, less severe approach, Bigg explains, CRA was better able to reach and protect the people at highest risk for AIDS. Soon, his group would become one of the country’s best known “harm reduction” programs.

But in 1996, John Szyler, a recovering heroin addict and co-founder of CRA, relapsed. He overdosed and died shortly thereafter. “We asked, ‘What positive change can we make in John’s memory?’” says Bigg. The idea that had the most resonance was to distribute naloxone and promote its use to others.

It was a choice that prompted a lot less blowback than CRA’s other harm-reduction strategies, such as needle exchange. In recent years, Congress has seesawed on allowing federal dollars to be spent on needle-exchange programs (since 2011, federal funding has been banned), despite decades of evidence showing that they’re safe and effective. Though every public health agency that has examined the data on needle exchange, from the World Health Organization to the CDC, has come down in favor of them, conservative critics of the programs continue to suggest that they enable drug use. Naloxone distribution has been viewed somewhat more positively, however, perhaps because it has the overwhelming public support of so many grieving parents whose children might have been saved by the harmless medication.

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Since CRA started distributing the drug and training people to use it, more than 32,000 people in Chicago alone have participated in his program, with 5,000 successful overdose reversals reported. At least 180 other organizations around the U.S. are now following CRA’s lead, including some state and city health departments. New York State, for example, which has the world’s largest population of injection drug users, now provides naloxone to people leaving drug treatment and to those using needle-exchange programs. Nationwide, to date, 10,000 successful overdose reversals have been reported.

Massachusetts also has a naloxone distribution program, the effectiveness of which researchers studied and reported in January 2013 in the medical journal BMJ. The results? Overdose death rates in localities with the highest access to the drug and the largest number of people trained to use it fell to nearly 50 percent lower than those in regions with limited or no naloxone availability or response training.

Even the federal government has climbed aboard the naloxone bandwagon. In 2012, the Obama administration called for making the antidote more widely available. And last month, shortly after Hoffman’s death, the hardline Office of National Drug Control Policy, the drug czar’s office, which has traditionally viewed addiction as a law-enforcement issue, acknowledged that it is actually a public-health problem — a “disease that can be prevented, treated and from which one can recover.”

“We cannot arrest our way out of the drug problem,” R. Gil Kerlikowske, the current drug czar, told reporters, noting that strategies like wider distribution of naloxone, along with prescription-pill take-back programs and better treatment of addiction, are needed.

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There are still holdouts: Maine’s Republican governor, Paul LePage, the only known remaining anti-naloxone activist, recently rejected laws expanding access to naloxone because he believes it will make drug users feel invincible and, therefore, more likely to take more drugs. But there’s no evidence to support his view. More commonly, a brush with death leads drug users to seek recovery, not to continue their addiction.

Mark Kinzly is a recovering addict and a harm reduction advocate in Massachusetts. Between 1993 and 2004, the 11 years he was drug-free, he saved four people with naloxone. In 2004, he relapsed and had to be revived with the drug himself. “I didn’t feel great, but I sure was grateful,” he said in an interview in The New York Times in 2011. He went back into recovery and then proceeded to revive at least 10 other overdose victims — some of whom, like him, sought help for their drug problems upon their revival.

Of course Bigg supports current efforts to expand naloxone access, but he thinks they aren’t enough. Among the nearly 40,000 people a year who die by overdose, some of those who are at highest risk of death are new drug users, like teenagers who get pills from their parents’ medicine cabinet and whose family members have no idea they are taking drugs. They won’t be saved by making naloxone available only to drug addicts and their families. We would have to put naloxone in almost every home — for example, as part of every first-aid kit.

“I don’t think we will have successfully dealt with this until naloxone is available over the counter at an affordable price,” says Bigg. It’s possible that could happen, if the FDA approves the version of the drug that’s delivered nasally; the National Institute on Drug Abuse is testing it now. But it probably won’t happen quickly without public pressure of the type exerted by AIDS activists in the ’80s and ’90s to push the agency.

Until then, if you want to have naloxone on hand, visit this website to find a local distribution group. And then call the FDA and urge them to make the drug available over the counter. It could save the life of an infant who gets into his older sister’s dental codeine, or a grandfather who takes too much of his prescribed OxyContin, or a teenager who does something stupid with heroin. It could save your life as well.

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