Good drugs, for once

Maia Szalavitz,a neuroscience journalist for Time.com and a co-author of Born for Love: Why Empathy Is Essential— And Endangered with Dr. Bruce Perry and the author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, has an opinion column in The New York Times about Naloxone:

Mark Kinzly saved two lives this week. But he wouldn’t have been here to help if a friend hadn’t once done for him what he’s now repeatedly done for others: provide overdose victims with Naloxone, the antidote that revived them.
Overdosed now kills more people in the United States than car accidents, making it the leading cause of injury-related mortality, according to the latest statistics from the Centers for Disease Control and Prevention. The number of deaths— 37,485 in 2009— could be cut dramatically if Naloxone were available over-the-counter and placed in every first aid kit.
Addicts have easier access to unprescribed drugs than they do to the one they may need to survive. But that’s not likely to happen until the Food and Drug Administration takes some action. Naloxone is currently available only by prescription. Although dozens of needle exchange programs, rehab centers, and pain specialists in at least sixteen states distribute it, the prescription requirement severely limits its availability to those organizations that can afford to have doctors on staff.
Naloxone (its brand name is Narcan) and can be administered either nasally or by injection. It can rapidly reverse the potentially deadly effects of opioid drugs, which include heroin and prescription pain relievers like OxyContin and Vicodin. It does not produce a high; quite the opposite, in fact, because it blocks the effects of opioids.
Naloxone is much safer than some drugs currently available without a prescription. Both insulin and acetaminophen can be deadly if misused, but it is impossible to overdose on Naloxone, and it has few side effects
Overdose deaths linked to prescription opioids more than tripled between 1999 and 2006. The majority of fatal overdoses involve either prescription opioids or heroin in combination with alcohol and/or another depressant drug, such as Valium or Xanax. Some cases do occur when pain patients mistakenly take too much or drink alcohol with their medications, however most seem to involve people with histories of addiction who get the drugs from non-medical sources. For example, a study of prescription-drug-related deaths in one heavily affected state found that fewer than half of overdose victims had been prescribed the drug(s) that killed them and that 95 percent showed signs of addiction, such as injecting drugs meant for oral use.
But, while people with addiction seem to have little trouble getting unprescribed opioids, Naloxone is tougher to get because there is no black market for it, and few people even know that they should seek a prescription for it. And many pharmacies do not even carry it, as it is typically only used by ambulance crews and in hospitals.
Kinzly is the director of HIV and Harm Reduction Services at the Comprehensive Community Health Care Center in Roxbury, Massachusetts. A recovering heroin addict, he relapsed in 2004 after eleven years off drugs. That year, he was working on an HIV-related project at Yale University and had accidentally been stuck by an infected needle. Fear and depression hit him hard, even after he took medication to prevent infection. “That made me decide to pick up and start using,” he says. His rationalization was: “I took the heroin to get rid of depression because I knew it would work. I really thought I was going to do one bag and walk away and be okay.” Kinzly was watching a Red Sox victory with a friend when he overdosed. “I'm a Red Sox fan, but that not’s what put me into an OD,” he jokes. He had injected two or three bags of heroin, a dose that he thought he could handle. Dangerously, he had misjudged his tolerance after years without heroin.
As in Kinzly’s case, the highest risk period for overdose in drug users occurs following periods of abstinence, often among people who have just come out of prison or rehab. New users are the other group at greatest risk. Both of these groups are hard to reach through programs like needle exchanges, which originated Naloxone distribution to drug users. That’s why making the drug available over-the-counter and campaigning to include it in first aid kits could make a big difference.
Fortunately, in Kinzly’s case, his friend had Naloxone and knew how to help. “He said that he looked over and noticed I was turning grey and my lips were bluish. I had what he called a death gurgle. He loaded the Narcan into a syringe and injected it into my upper arm.” Kinzly woke up, filled with shame over his relapse when he realized what had happened. Because Naloxone reverses the effects of narcotics, it can cause withdrawal symptoms in addicted people. The symptoms are unpleasant but not dangerous. “I certainly didn’t feel great but I sure was grateful,” he says. “I was very embarrassed, but I was incredibly grateful that I was going to have another opportunity to get clean again and watch my son grow up.”
Before his own overdose, he’d saved four people with Nalaxone and has since saved ten others. Studies and reports from drug users suggest that at least half of opioid overdose victims do not die alone, meaning that having Naloxone on hand could potentially save all of these lives. The first program to distribute Naloxone to drug users was the Chicago Recovery Alliance, which started doing so in 2001 with help from prescribing physicians. Dan Bigg, a co-founder of the alliance, reports that, as of the end of August, his group has educated over 22,000 people about overdose, distributed more than 11,000 Naloxone kits and has received 2,720 reports of successful overdose reversal.
A 2006 study published in the Journal of Addictive Diseases found that heroin overdose deaths dropped twenty percent in Chicago the year the program started and an additional ten percent the second year, following years of increases. While the study could not prove that the program caused the decline, it didn’t find any harm associated with Naloxone distribution, nor have other studies.
According to the Harm Reduction Coalition, by 2010, 50,000 Naloxone kits had been distributed nationwide by city, state, and private organizations in at least sixteen states, with ten thousand reported overdose reversals. But undocumented overdose reversals have probably occurred because there is no reporting requirement, and agencies doing overdose prevention don’t always collect this data.
Naloxone is highly effective because it displaces opioids from the receptors in the brain that depress breathing. Slowed and eventually stopped respiration is what causes opioid overdose death, because this happens over the course of an hour or more, there is often time to intervene. Unfortunately, many family members and friends of drug users are unaware of the signs of overdose and believe that, as with drunkenness, the best thing to do is let the person “sleep it off”.  Such ignorance can be fatal.
“We constantly hear stories of a parent going to bed who heard her daughter snoring strangely,” says Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, “It was late at night; they didn’t realize what was going on or thought they were sleeping something off. In the morning, the child is dead. That’s the kind of thing we hear about prescription opioid deaths.”
So what can people do if they suddenly discover that a friend or family member they didn’t even suspect of drug use has turned blue, is snoring in an unusual way or seems to be slowly stopping breathing? That’s when having Naloxone in a first aid kit matters. Calling 911 immediately and performing rescue breathing (not just chest compressions; opioid overdose requires old-fashioned mouth-to-mouth because of its effects on the brain) are critical steps to take.
When someone has overdosed and stopped breathing, however, time is brain. The sooner Naloxone is administered, the better. Amazingly, in most cases, the person wakes up grumpy, but not cognitively impaired or otherwise worse for the wear. The rare cases that have been reported where Naloxone didn’t help have overwhelmingly been either overdoses of other drugs, like cocaine, or situations where the person was dead before the Naloxone was administered.
As with needle exchange, opposition to Naloxone distribution has mainly come from those who fear that reducing drug-related harm will lead to increased drug use. Fortunately, also similarly to the data on needle exchange, the research doesn’t find this occurring.
Kinzly’s experience was typical: unpleasant and not one he wanted to repeat. Nor, apparently, did the woman he saved at a shooting gallery located near his workplace. In her 40s with a nearly twenty-year history of addiction, she’s now in rehab. Kinzly is also back in recovery. “This is a medicine that is benign,” he says, “People caught in the grips of addiction can have something that can potentially save their lives until they hear the message of hope. The more accessible it is, the better off folks are. Dead people don’t have the opportunity to become productive members of society.” Nor can they save other lives.

Rico says the old "ah, they're druggies, let 'em die" response is fine, until it's someone you know... (Fortunately, Rico doesn't know any, so he won't be seeking it out.)