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2/26/2014 How to Stop Heroin Deaths - NYTimes.com http://www.nytimes.com/2014/02/07/opinion/how-to-stop-heroin-deaths.html?ref=contributors 1/6 http://nyti.m s/1nY9VC3 THE OPINION PAGES | OP-ED CONTRIBUTOR H o w to S to p H e r o in D e a th s By ROBERT S. HOFFM AN FEB. 6, 2014 PH ILIP SE YM O U R H O FFM A N , w ho died of an apparent heroin overdose on Sunday, w as just one of hundreds of N ew Yorkers w ho fall victim to this drug each year. H eroin-related deaths increased 84 percent from 2010 to 2012 in N ew York C ity and occur at a higher rate — 52 percent — than overdose deaths involving any other substance. I am an em ergency physician at N YU Langone M edical C enter and B ellevue H ospital, but I rarely see victim s die of heroin overdose because m ost fatalities occur before patients get to the hospital. O verdoses often take place over one to three hours. People just slow ly stop breathing; often they are assum ed to be sleeping deeply, or they are alone. T he m ost frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. N aloxone, an opioid antidote, is a sim ple com pound that has been in clinical use for m ore than 30 years. It can be adm inistered via needle or as a nasal spray, and it w orks by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and norm al breathing. A n analysis in the A nnals of Internal M edicine last year suggested that up to 85 percent of users overdose in the presence of others. T his provides an opportunity for friends, fam ily and other non-health care providers to intervene. In N ew York State, it has been legal to distribute naloxone to ordinary citizens since 2006. B ut the distribution has to be done w ith 2/26/2014 How to Stop Heroin Deaths - NYTimes.com http://www.nytimes.com/2014/02/07/opinion/how-to-stop-heroin-deaths.html?ref=contributors 2/6 m edical supervision. N aloxone is purchased by the city and state health departm ents, w hich then distribute the antidote through hospitals, harm - reduction program s and other outlets at no cost to patients. Som e N ew York C ity hospitals are now distributing kits containing naloxone to users and their friends and fam ilies. For the past three years, the N ew York C ity D epartm ent of H om eless Services has adm inistered naloxone in shelters. A nd a new pilot program on Staten Island — w hich has the highest rate of heroin overdose deaths in N ew York C ity — is supplying the antidote through the Police D epartm ent’s 120th Precinct there.
T he city’s health departm ent is conducting a large study follow ing people w ho get naloxone to assess how frequently the antidote is used to reverse overdose. In 2012, the health departm ent filed a public letter to the Food and D rug A dm inistration recom m ending that the F.D .A . approve naloxone for over-the-counter use. T he letter stated that m ore than 20,000 kits had been distributed in N ew York C ity. It also noted that m ore than 500 overdose reversals had been reported by civilians w ho had adm inistered the antidote. Som e people m ight argue that the w idespread distribution of a safe, effective and inexpensive antidote m ight actually encourage drug use. B ut that’s like suggesting that air bags and seatbelts encourage unsafe driving. N aloxone is a public-health m ethod of intervening w hen a life is in the balance. Its distribution is endorsed by the A m erican M edical A ssociation. A new bill that w ould m ake it easier for users to obtain naloxone w as introduced in the N ew York State Legislature just last w eek, and on T uesday it passed the State Senate H ealth C om m ittee. It w ould increase access to the antidote by allow ing doctors and nurses to w rite standing orders — prescriptions that can be used for anyone — and issue them to com m unity-based drug treatm ent program s. T he program s w ould then train people on the signs of overdose and provide them w ith the naloxone kits. T his m eans that the program s w ould not have to have a doctor present to distribute the antidote, overcom ing one m ajor hurdle that 2/26/2014 How to Stop Heroin Deaths - NYTimes.com http://www.nytimes.com/2014/02/07/opinion/how-to-stop-heroin-deaths.html?ref=contributors 3/6 im pedes w idespread distribution. T his bill em pow ers a com m unity to protect itself and others. If the bill becom es law , it w ould be one step closer to m aking naloxone available over the counter — as it already is in Italy. A ccording to the C enters for D isease C ontrol and Prevention, drug overdose is now the leading cause of injury-related fatalities in the U nited States, ahead of m otor-vehicle collisions and firearm s accidents. W e m ake cars safer by having speed lim its, seatbelts, crum ple zones and D .W .I. law s. W e m ake it harder to buy a firearm w ith background checks and w aiting periods, and w e teach gun safety and som etim es m andate trigger locks. W e can m ake heroin safer, too, by supplying m ethadone or buprenorphine as m edications to treat physical dependence, providing clean needles to help prevent the spread of hepatitis and H .I.V ., and facilitating the w ide availability of naloxone to counteract overdoses. W hile M r. H offm an’s death w as w ithout a doubt a tragedy, it is also em blem atic of a societal need to take action to prevent the hundreds of deaths that otherw ise go largely unnoticed. W e can’t control heroin — that’s the job of law enforcem ent — but w e can m ake it safer. Robert S. Hoffm an is an em ergency physician at NYU Langone M edical Center and Bellevue Hospital and the director of the Division of M edical Toxicology at the New York University School of M edicine. A version of this op-ed appears in print on February 7, 2014, on page A23 of the New York edition with the headline: How to Stop Heroin Deaths. S ite In d e x N ew s W orld U .S. Politics N ew Y ork Business Technology Science H ealth