Naloxone helps cut deaths as heroin use rises in Rose City

by: PHOTO COURTESY: MAAYAN SIMCKS - Multnomah County heroin overdose deaths have dropped as distribution of naloxone has begun with addicts who can administer the medication to each other. A single dose costs about $30.New York City police officers last week were given the go ahead to start carrying kits of a medication — naloxone — that has proven to save the lives of addicts who overdose on heroin or prescription painkillers.

Police in Portland aren’t close to being similarly outfitted. But the latest data from nonprofit social service agency Outside In shows that naloxone is getting used here, and very effectively.

Naloxone can be delivered either through an injection or nasal spray. It can stop an overdose almost immediately, quickly restoring breathing. It has no apparent harmful effects, even in cases where it is given mistakenly to someone who is not overdosing.

Last June, the Oregon Legislature passed a bill allowing organizations to train individuals to use the medication.

Almost immediately Outside In took the lead. The downtown nonprofit was a natural choice. Heroin users often inject in groups. If one heroin user overdoses, others often are present. Outside In runs a downtown needle exchange for drug addicts. So over the course of the last year, Outside In has trained 747 clients who came in for needles (along with 67 of its own staff) to administer naloxone and provided naloxone kits to take with them.

The results are startling. Heroin use continues to climb in Portland. Outside In knows this because demand for needle exchanges has increased. Yet in the last six months of 2013, which is when Outside In began distributing naloxone to addicts, there were 29 heroin overdose deaths in Multnomah County. For the same period in 2012, before the naloxone program was begun, there were 52 heroin overdose deaths.

In the past year, 312 times an opiate user in Portland appeared to be overdosing, was treated with naloxone and survived. Kathy Oliver, Outside In’s executive director, says staff have told her stories about reaching underneath locked bathroom stalls and shooting naloxone into the legs of addicts who have passed out, and boyfriends saving girlfriends who suspected they eventually would need the help.

Oliver says it is impossible to know how many of those 312 cases would have ended in an overdose death had naloxone not been present, but certainly that would have been the case for many of them. New York has recognized that often police officers are the first on the scene when addicts overdose, so it is supplying naloxone to its street officers and hoping to save even more lives.

Portland police spokesman Sgt. Pete Simpson says that the bureau has not been approached yet about getting officers equipped with naloxone. He notes that Portland firefighters already carry the medication, but that issues such as training and liability would have to be addressed before police officers would do the same.

The training part wouldn’t be much trouble. Teaching addicts to use the medication takes about 20 minutes, says Outside In’s Oliver. That could be done in a classroom setting for a large number of officers, she adds.

Expense would not be a major obstacle either. A dose of naloxone sells for about $30. Most kits have two, sometimes necessary in cases where an extreme amount of opiates have been taken.

Providing the medication first to addicts made sense, says Kim Toevs, a manager in Multnomah County’s health department.

“The primary priority is getting naloxone into the hands of heroin users who are currently injecting drugs,” Toevs says. “They don’t have a hesitation about handling a syringe because they do that anyway.”

Also, Toevs says, many heroin users are afraid to call 911 for an overdose because they don’t want involvement with police. Toevs says she hopes that during the next few years police and others will become naloxone carriers. Methadone clinics could hand out the medication to their clients, some of whom still use heroin and are around heroin addicts. Detox centers could distribute it as well.

“It would be great to get it into people’s hands when they leave Corrections,” Toevs says.

A significant number of people released from jail or prison overdose because they haven’t had access to illegal drugs for awhile. “They don’t realize how much their tolerance has gone down,” Toevs says.

She says more attention needs to be given to people addicted to prescription painkillers, which, like heroin, are opiates. Those addicts don’t use needle exchanges, so there is no obvious way to connect them with naloxone.

The next step, according to Toevs, is to get all the area needle exchange sites following Outside In’s example of providing the classes and medication. The county runs three needle exchange programs on the east side of Portland, and social service providers in Washington and Clackamas counties that work with addicts can be identified as additional providers of naloxone.

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