By Scott Burris
The rising public and legislative awareness of opioid overdose has been a case study in the twists and turns of culture, risk perception and the role of evidence in policy making. An interesting case study, which does not mean I understand what happened or why.
I first got involved in overdose through Dan Abrahamson, the Legal Director at the Drug Policy Alliance. This was back in 1999 or 2000, and a group of drug researchers and drug policy people convened a meeting in Seattle to discuss the chronic, neglected problem of overdose among heroin users. There were a few health people who were highly aware of the human and economic costs, and the scale of the problem. Karl Sporer, a San Francisco ER doc, was one of the few publishing on the problem. One of the interesting ideas discussed at the meeting was distributing naloxone, the standard antidote for opioid overdose, directly to heroin users. New Mexico, which had the nation’s highest OD death rates, was trying it as a way to deal with the great distances that divided rural heroin users from EMS assistance. With Joanna Norland and Brian Edlin, I ended up writing an analysis of the legality of distributing this prescription drug to drug users.
In the next few years, led by people like Dan Bigg of the Chicago Recovery Alliance, needle exchange programs in urban areas began naloxone programs. They were spurred in 2006 when several US cities experienced an epidemic of overdose tied to the adulteration of the heroin supply with a synthetic opioid, fentanyl. By May, 2009, 57 naloxone programs were operating in 17 U.S. states. That year, DPA funded a group of scientists and practitioners to brainstorm on how to increase drug users’ access to this life-saving intervention.
Most of us working on this issue were veterans of the on-going struggle for needle exchange programs, so we had been pleasantly surprised that giving naloxone to drug users seemed to strike a different nerve than giving them syringes. While we had the usual problems of indifference, we did not have anywhere near as talk of enabling illegal drug use. By 2009, however, the rise of opioid overdose among users of prescription opioids was being unmistakeably documented by epidemiologists like CDC’s Leonard Paulozzi (yes, Tea Party, they also serve who sit and count.) The meeting highlighted three strategies: passing state laws to remove any legal doubts about prescribing naloxone for third-party administration by lay bystanders; passing good samaritan immunity legislation to encourage people to call 911; and pushing FDA and related agencies to develop a nasally administered formulation and consider naloxone for an over-the-counter classification.
A blog post is not the place for history, so I will cut to the impetus for today’s post: yesterday, California made its pilot third-party naloxone law permanent. Fourteen states affirmatively authorize this life-saving practice, with most of them passing their laws in the last two years. And they pass with bipartisan support. Apparently, saving lives dramatically by giving drug users naloxone is different than saving lives imperceptibly by giving them needles. Or it could have something to do with the fact that so many OD deaths are among young people, “good kids” and older white males. Blogs are not the place for social history either. I’m just happy to see this attention, rationality and progress. As lawyer Corey Davis explains in this video, expanding naloxone access is a critical opportunity for public health.