The scene of a heroin overdose is familiar to Michelle Hodge, a patrol officer on the Near Westside of Indianapolis: someone lying blue and unconscious on the floor, a very faint heartbeat, long pauses between breaths, and the family in a panic, begging her help. Until last spring, all she could do when she arrived was monitor the pulse and wait for an ambulance to arrive.
Then last April, the officers in Hodge’s district received a supply of naloxone, also referred to by the brand name Narcan, a drug that instantly reverses overdoses. It can be administered as an injection, or a nasal spray, which is what Hodge’s department uses. “It's just amazing that this one medicine, you shoot it up their nostril, and they [can] come back and be conscious, and alert and talking within a minute,” says officer Hodge.
In making it legal for police to administer naloxone, Indiana has joined 27 other states that have passed recent laws widening access to the drug. Many of these were enacted in the last four years in response to the nation’s epidemic of overdose deaths from both prescription drugs and heroin. Now the state is considering a new bill, Senate Bill 406, which would allow third parties—family members and friends of addicts –to get a prescription for the drug, giving them the ability to save a loved one’s life without waiting for emergency response.
Senate Bill 406 passed the state senate unanimously this February, and is headed for the house. State Senator Jim Merritt, the bill’s author, says he believes family access is crucial because so many young people have died before police or EMS arrive at the scene. “When you talk to emergency room doctors not much time goes by between a heroin overdose and [when] they're looking at a kid who’s died,” Merritt says. Twenty-four states permit third-party prescriptions for naloxone.
Tools to fight an evolving epidemic
Prescription drug overdoses have risen to rates declared epidemic by the CDC in 2011. The death rate nearly quadrupled between 2000 and 2001, rising to over 16,900 in 2011. Since then, rates have stayed relatively stagnant, but at the same time, heroin overdose deaths climbed dramatically, from about 3,000 in 2010 to over 8,000 in 2014.
There’s a connection between flattening prescription drug overdoses and the increase in heroin overdoses. In three recent studies of young people who inject heroin, nearly half reported abusing prescription opioids first, and some reported switching to heroin because it’s cheaper and easier to use than prescription drugs.
Two main factors have made it more difficult to abuse prescription opioids in the past three to four years: some pharmaceutical companies are now making pills that cannot be ground up; and many states, including Indiana, instituted prescription monitoring programs to prevent patients from filling multiple prescriptions at the same time. Indiana Attorney General Greg Zoeller predicts the shift to heroin is going to get worse before it gets better.
“We're going to see more people cut off that shouldn’t have as much access [to prescription opioids], but you're going to see rates of heroin use skyrocket,” he says.
Zoeller says naloxone will become increasingly important in saving the lives of the growing number of heroin users, before Indiana can truly “get a handle on the whole problem” of prescription drug and heroin addiction.
A Lifesaver, But Not A Solution
In affluent Hamilton County, just north of Indianapolis, former addicts, parents touched by heroin, and others in the community formed the group “Hope Overcoming Heroin” to raise awareness and combat stigma. They support the passage of Senate Bill 406 to make naloxone available to family members of drug users.
At a meeting in February, organizer Larry Parsley spoke to the group about naloxone. “Tell me there's one soul out here, one soul in this room that doesn't matter,” he entreated the supportive crowd. “You can't. Because we all matter. We need the Narcan to get into the hands not just of the officers and the paramedics, [but] us.”
One of the group's board members, Kevin Moore, is the mother of two daughters in their 20s who both are recovering users. Her elder daughter had an overdose in 2011. Her daughters are now clean, but she still wants to have Narcan on hand. There’s always a chance of relapse, she says, and the consequences can be especially dire for former addicts. “Heroin addicts, if they do relapse, they tend to use [the same dose] they used before, and their body's not ready for it,” Moore says.
At the meeting, the group addressed a concern they’d heard from community members-- that making naloxone more available could enable addicts to continue using and push themselves to the brink of overdose—knowing that the drug is there to save them.
But Moore says addicts’ brains don’t work that way. She says addicts are focused on the high, not the chance of overdose: “The last thing they remember was feeling fantastic, they don't even realize that they're near death. And they wake up and Narcan not only has taken away the great high; they're sick. You go to withdrawal in zero seconds.” she explains.
Nonetheless, naloxone advocates want to see more done to prevent the problem of overdoses, rather than relying on naloxone to rescue users. In Indiana, there are recovery programs available for addicts who can afford to pay out-of-pocket, like Fairbanks on the Northside of Indianapolis. For people who can’t pay, the state doesn’t provide free treatment, says Zoeller, and even if the funding was there, the state doesn’t have enough doctors and facilities to bring about a significant change.
The Attorney General hopes to see Indiana catch up to other states in the coming years. With so much crime linked to drug addiction, Zoeller explains, the costs of naloxone - as well as programs to help addicts recover - are far less than the costs of the epidemic. “It’s a lot cheaper than building another prison,” he says.
Update: Senate Bill 406 was signed into law by Governor Mike Pence on April 17, 2015, and is now in effect.
Andrea Muraskin can be reached at firstname.lastname@example.org or (317) 614-0444. Follow Andrea on twitter: @Andrea_Muraskin.