OVERDOSE REMEDY

New city program aims at reducing heroin deaths by prescribing preventive drug

The city has quietly begun funding a cutting-edge program aimed at
reducing heroin overdose deaths by distributing an antidote drug to
users at needle exchanges.

Experts say naloxone, known by its trade name, Narcan, may have
already saved dozens of lives in the city since the Harm Reduction
Coalition, an advocacy group that seeks to reduce the harms of drug
use, began prescribing it about seven months ago.

Under the program, users are prescribed syringes of Narcan, which can
be injected into a muscle of a person who is overdosing. Doctors say
the drug's only effect is to reverse heroin and other opiate
overdoses. It is not dangerous, they say, and can't be misused.

"It's sort of a revolutionary idea, in a way, to put a medicine in
the hands of anybody," said Dr. Sharon Stancliff, the program's
medical director. "Overdose is really preventable in many, many cases."

Narcan is one of the city's latest efforts to combat heroin, which
experts believe causes more deaths in New York than homicides. The
high-profile deaths this summer of two college students who overdosed
on a mixture of heroin and cocaine cast a spotlight on the rate of
drug fatalities. According to city Department of Health statistics,
drugs kill about 900 people each year - nearly 700 of them from
opiates, which include heroin and other drugs like oxycontin.

Doctors believe Narcan is used to prevent approximately one death for
every 10 prescriptions written, Stancliff said. It works by blocking
opioid receptors in the brain, reversing heroin's effects.

The city's Department of Health has given the Harm Reduction
Coalition about $200,000 to distribute Narcan. That funding, approved
by the City Council in June, puts New York ahead of all but a handful
of U.S. cities, and even state law. Until April, the fact that
non-professionals are administering a prescription medication could
potentially be legally "sticky," Stancliff said.

"So I'm a little outside the lines now but I don't think it's a big
deal, everyone knows I'm doing it," she said.

Come April, the city - which is monitoring Stancliff's success
closely - hopes to expand the program.

"One area that we're looking into would be seeing if EMTs might have
the ability to use naloxone," said Dr. Andrew Kolodny, medical
director of the health department's mental hygiene division. "We've
begun a very preliminary conversation with the Fire Department."

In addition to supplying users with the antidote drug, Stancliff and
outreach workers train them how to spot the signs of an overdose and
what to do - call 911, do mouth to mouth, and, if necessary, inject
them with Narcan. A pamphlet given to users warns them that someone
may be having an overdose if he or she is unconscious, breathing very
slowly and not responding.

"We know about 80 percent of the time people shoot up with a peer.
It's like drinking, people don't do it alone," Kolodny said.
"Historically, heroin users do all the wrong things when they witness
an overdose - there are reports about injecting people with milk,
putting ice on people. They are scared to call 911."

Stancliff, who left a post at the state Department of Health to run
this program, said she has prescribed Narcan to about 700 heroin
users, many of them in the South Bronx, since last spring. About 100
other prescriptions were distributed in a smaller program before
that, she said.

So far, 51 people have reported using Narcan to reverse overdoses.
Not all of those people would have died without Narcan, Stancliff
said, but some of them would have. Outreach workers believe there may
have been even more "saves" that users, perhaps out of fear,
neglected to report.

"I ask people when I train them to please let me know if they used
it, if the person lived," said Yolanda Birthwright, an intern at the
Lower East Side Harm Reduction Center, one of the needle exchange
programs that Stancliff works with, who trains about half a dozen
users a week. "It's beautiful. I feel like I'm making a difference, I
really do."