Moving mountains: A rare bright spot in the relentless fight against prescription pill abuse
A life-saving antidote to reverse drug overdoses is finding widespread acceptance amid the prescription pain pill epidemic.
A program launched two years ago to combat the staggering death toll from prescription pain pill abuse in North Carolina aims to put doses of Narcan nasal spray into the hands of drug users and their friends and relatives at no cost.
“Unfortunately giving medicine out free to help prevent overdose deaths is sad but necessary. It is saving lives,” said Dr. Craig Martin, a psychiatrist based in Waynesville who specializes in addiction.
Paving a path for Narcan hasn’t been easy. Advocates had a slew of daunting hurdles to clear, from changing laws and public perception to the sheer logistics of getting the overdose antidote into the hands of drugs users.
But it’s paid off. The N.C. Harm Reduction Coalition, which led charge, has funneled more than 26,000 doses of Narcan to those caught in the clutches of addiction and tracked more than 3,000 cases where they were used to counteract an overdose, usually given to the victim often by someone close to them.
Until recently, however, witnesses to a drug overdose — especially fellow users — were leery of intervening if their friend’s high took a dangerous turn.
“Some people weren’t calling 911 because they were afraid they would get busted and put in jail,” said Martin, the chief medical officer for Smoky Mountain Mental Health, a managed care organization serving a 21-county region.
That changed in 2013 with state passage of the “911 Good Samaritan” bill. It grants immunity to those seeking help in an overdose crisis — meaning that officers will overlook small amounts of drugs and paraphernalia or probation and parole violations of bystanders trying to help. It applied to underage drinkers reporting cases of alcohol poisoning, as well.
It was a huge milestone, Martin said, and a necessary one. Narcan can revive an overdose victim, but it’s only temporary. Victims have to get to a hospital right away, and the new law paved the way for help to be sought without fear of criminal prosecution.
But there was an equally big barrier on another front: the logistics of actually getting Narcan into the public’s hands. You needed a prescription for it, and it was unrealistic to think drug users would walk into a doctor’s office and ask for it.
“It is a courageous step to say ‘I have an addiction, I have a chronic disease called ‘substance abuse disorder,’” Martin said.
And there was also the problem of arming people close to a drug user with Narcan, since they’re most likely to be the one administering it.
“The person who has overdosed may not be aware enough to use it,” Martin said. “Opiates suppress your respiration and you stop breathing.”
Thanks once more to the lobbying wheels of the N.C. Harm Reduction Coalition, a new state law created a “standing order” for Narcan, giving pharmacists permission to dispense the overdose drug under a standing order from the state without a doctor’s script.
Meanwhile, an equally big game changer was in the works in the labs of pharmaceutical companies. Narcan came out in late 2014 with a pre-loaded, single-dose nasal spray version, as opposed to the injection form, making it possible to tuck in purses, pockets and glove boxes.
“We found some people were reluctant to use a needle,” Martin said.
The nut still wasn’t cracked, however. The stigma of walking up to a pharmacy counter and asking for Narcan would hamper its widespread use. It was also costly.
So the N.C. Harm Reduction Coalition set out to build a network of volunteer partners and advocates who would obtain the nasal spray from pharmacies and, in turn, dispense it for free within the community. More than 26,000 doses and counting have been distributed this way.
Advocates have also pushed doctors to prescribe Narcan to patients in conjunction with writing opioid prescriptions as a matter of course.
With the proper channels and systems in place, the biggest remaining challenge is money to keep the doses of Narcan flowing into communities.
To that end, Smoky Mountain Mental Health donated $100,000 to the Harm Reduction Coalition this spring for bulk orders of Narcan nasal spray.
“Heroin and opioid addiction is a very real problem throughout the region,” SMMH CEO Brian Ingraham said. “True solutions will take hard work by many people over many years, and this initiative will both save lives in the here and now and pave the way for future efforts.”
The program isn’t without critics, however. Some view Narcan as a free pass for drug users, aiding and abetting the abuse of prescription pain pills. But in realty, that’s not how the psychology of addiction works, Martin said. Having Narcan in their back pocket has no bearing on whether or how much they use, Martin said.
The Harm Reduction Coalition claims that providing health services to drug users brings them out of the shadows and closer to seeking help for their addiction — a storyline that’s played out among drug users who were saved by Narcan and say it was the wake-up call they needed.
“For the health of a whole population, people will get better if the kits are available,” Martin said.
Martin said society needs every tool it can get its hands on to overcome the prescription pain pill epidemic foisted on impoverished Appalachian communities by predatory pharmaceutical companies.
The most reviled, Oxycontin, was such a close cousin to heroin it earned the nickname “Hillbilly Heroin.” But when Purdue Pharma rolled out their miracle pain pill in 2000, they claimed it had essentially no risk of addiction.
“They progressively marketed Oxycontin as being safe and that people wouldn’t become addicted to it,” Martin said. “Doctors were duped into thinking it was not addictive. It took a while for people to figure it out.”
The maker of Oxycontin has been forced to settle lawsuits with the state of Kentucky as well as the U.S. government for its mischaracterization of the drug’s addictive nature.
Unfortunately, it’s too late for those trapped by its grip.
“You can’t arrest yourself out of this problem,” Martin said. “Addiction is a chronic disease. It starts to change the brain structure.”
Or, visit any Rite Aid or Smart Pharmacy in Franklin.