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Naloxone, drug that combats heroin overdoses, unavailable to most N.H. emergency responders

More lives could be saved in New Hampshire if a drug that combats heroin overdoses was as widely available here as it is in other New England states.

Naloxone – commonly known by its brand name, Narcan – can stop the breathing failure that causes death in overdoses of heroin and other opioids, including prescription painkillers such as OxyContin. Naloxone can be administered by nasal spray or injection.

“It really is quite a miracle drug,” said Sue Prentiss, the coordinator of emergency medical services at Concord Hospital. “Many times you have someone in complete respiratory arrest and they are up and talking to you in seconds.”

In New Hampshire, only those emergency workers with advanced training can administer naloxone in crisis situations, said Prentiss, the former director of the New Hampshire Bureau of Emergency Medical Services, which sets the rules for pre-hospital emergency medical care throughout the state. The majority of the state’s 3,000 emergency medical technicians are at the basic level and are not allowed to deliver naloxone.

Prentiss said she could see all EMTs being allowed to do so. But Massachusetts and Vermont already go further, allowing family members, police officers and other drug users to administer naloxone.

In 2010, the city of Quincy, Mass., near Boston, became one of the first in the country to allow the police to administer naloxone. In the first year, the number of deaths from heroin overdose was cut in half.

“We have reversed 223 overdoses,” said Quincy Lt. Detective Patrick Glynn. “These numbers represent a family member, son, daughter, husband or wife.”

Quincy officers carry two vials of the drug in their cruisers, Glynn said, and the training involved in learning to administer it was minimal. The cost is $20 per dose.

“We know we are not going to arrest our way out of this epidemic,” he said. “It’s a disease that must be treated.”

N.H. stricter than neighbors

Families and friends of addicts can get prescriptions for naloxone in Massachusetts and Vermont through their doctors, public health centers or hospitals. In New Hampshire, doctors can prescribe naloxone as well, but only to the person who will use it.

New Hampshire law doesn’t specifically permit police officers, public health workers or trained bystanders to administer the drug, said Scott Burris, a Temple University law professor who headed a 2007 federal study of naloxone laws in the United States. But, he said, a “Good Samaritan” law already on the books means there would be minimal legal risk if they did so.

Fourteen states have adopted laws that allow a person to obtain a prescription for naloxone to be used on someone other than themselves, Burris said. Massachusetts and Vermont are two of those states.

Burris said lives would be saved if New Hampshire took the same path.

“Our research shows that laypeople can safely and effectively administer naloxone,” Burris said. The people overdosing “definitely wake up in withdrawal, which does not look pretty or make for good manners, but we’ve now had tens of thousands of reversals in lay programs.”

Political focus

The challenge of heroin – and how best to combat it – is emerging as a focus of political debate. In January, Vermont Gov. Peter Shumlin devoted his State of the State message to what he said was “a full-blown heroin crisis.” In Maine, the legislature is debating whether to provide naloxone to laypersons – an idea Maine Gov. Paul LePage opposes, saying the state shouldn’t encourage addiction. He prefers spending more on law enforcement.

New Hampshire Gov. Maggie Hassan touched on heroin in her State of the State address this month, too.

“New Hampshire has among the highest rates in the country of drug and alcohol abuse and dependence, but ranks at the bottom in accessing treatment,” she said. “Heroin use is on the rise statewide, as the leading cause of drug overdose deaths in 2012, and prescription drug abuse remains high.”

Asked last week about naloxone, Hassan spokesman Marc Goldberg said the governor wants to improve access to treatment alternatives for substance abusers through federal aid.

“Narcan is an important tool in the fight to save individuals from becoming victims of substance abuse, and the governor would support its appropriate use by more local first responders if they are trained effectively and if they are comfortable that they can administer Narcan safely,” Goldberg said.

Concord’s acting police chief, Bradley Osgood, said he’s confident his officers could learn to administer naloxone by nasal spray if they were asked to do so. Initially officers may be hesitant to take on work done by EMTs, he said, such as when the department first considered providing officers with automatic defibrillators, used to save heart attack victims.

“Our police officers are not EMTs by and large, but they learned how to use AEDs and they actually carry them in their cruisers now,” Osgood said. “I don’t see this as being remarkably different.”

However, Osgood said he would have to learn more about the training and costs involved.

“Do I see it coming to Concord anytime soon? The answer is no,” Osgood said.

Osgood also said he doesn’t see equipping Concord officers with the drug as a necessity.

“I can’t think of any incidents where our officers were waiting on (an ambulance) to arrive,” Osgood said. “Concord fire’s response times are quick. I haven’t seen a case yet where we were saying, ‘Geez, I wish we would have had (naloxone).’ ”

The Concord Fire Department has paramedics, the most advanced EMTs, on each of its three ambulances at all hours, every day of the week, Chief Dan Andrus said.

In 2012, the fire department used naloxone on 40 patients, he said. In 2013, the number was 59.

“That’s a 47 percent increase,” Andrus said.

So far this year, the department has used naloxone on 11 patients.

“Of those 11, five occurred within the first 15 days of January, so we were literally getting one overdose about every three days, which is pretty extraordinary for us,” Andrus said.

An ‘evolution’

Prentiss, the emergency services coordinator at Concord Hospital, compared broadening the use of naloxone nasal spray to basic emergency medical responders to EpiPens – auto-injectors used to save people with life-threatening allergic reactions. At first, only paramedics could use EpiPens. Now basic-level responders can, too.

“There used to be very distinct lines, but those lines have changed,” Prentiss said. “There’s been this evolution.”

That evolution has not come quickly enough for the worried parents and friends of drug users, said Donna M., the mother of a recovering heroin user who asked that her last name not be used to protect her son’s anonymity. She founded a support group called Families Sharing Without Shame, which meets Thursday nights at Concord Hospital.

This past Thursday’s discussion was about naloxone, she said, because families in New Hampshire want access to a drug that could save their loved ones’ lives. She said she is working on a bill to put before the Legislature that would allow laypeople to administer the drug.

But she already has naloxone in her home. She said she got it in Rhode Island at a recovery-from-addiction rally.

“They had a booth,” she said. “Instructors taught anyone who wanted to learn how to administer it, and then once you completed the instructional part and passed a test, they gave you a prescription. I was surprised when they gave me a prescription.”

Even though it is not legal to do so here, she said she would not hesitate to use her vial of nasal spray on an overdose victim.

“Not if it meant saving someone’s life,” she said.

(Daira Cline can be reached at 369-3306 or dcline@cmonitor.com)

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