Reefer Madness: Opiate Overdoses on the Rise

There is little doubt that dying of an opiate overdose is excruciating: The drug – found in heroin or any number of prescription drugs, including OxyContin and Vicodin – attaches to receptors in the brain that regulate breathing, blocking their ability to tell the body to inhale and exhale. "It's a slow process where the body completely loses its ability to tell itself to breathe," says Meghan Ralston, harm-reduction coordinator for the Drug Policy Alliance. "It's slow, it's agonizing, and it's ghastly."

It's also largely preventable. Nonetheless, in Texas, opiate-related overdose deaths have increased 150% between 1999 and 2007 according to a recent report from the DPA. That's part of a national trend: In 2005, the second leading cause of death in the U.S. – behind motor vehicle accidents – was accidental overdose, which claimed 22,448 lives. The increase in deaths, around the country and in Texas, is driven primarily by prescription medicine overdoses. The number of cocaine and heroin deaths isn't increasing at anywhere near the same pace, says Grant Smith, DPA's federal policy coordinator.

In Travis County, deaths due to overdose have also increased, from 60 in 2005 to 100 in 2009, according to records from the Travis County Medical Examiner's Office. (There were 61 in the first nine months of this year, according to ME records.) In 2005, heroin and prescription drugs accounted for 12 of those overdose deaths, while in 2009, they accounted for 48.

"There are several things that are happening that are contributing to this," says Smith, and they could all be fixed easily with a change in focus: Drug use should be handled primarily as an issue of public health, not law enforcement. Advocates say the tools to reverse the trend are relatively simple to implement, if there's a will to do so.

Part of the problem – and key to reversing it – is a lack of government-led harm-reduction education. The public – including teens and young adults, who have been provided little information about drugs beyond "just say no" – needs to learn how to spot the signs of overdose and how to help. And advocates say many more deaths could be prevented by more widespread use of the so-called "overdose drug," commonly known by the name naloxone. It's been in use for 40 years – primarily in emergency rooms and by paramedics – and can reverse an overdose within 90 seconds by blocking opiates from attaching to brain receptors. (Austin paramedics regularly use nalo­xone, says EMS spokesman Warren Hassinger; however, Hassinger had not yet responded to a request for information about how frequently the drug is used.)

Harm-reduction groups began using the drug in earnest in the Nineties, mostly in large East Coast cities, in response to an uptick in heroin deaths; they saw great success, says Smith. But to date, the drug has not caught on as a regularly prescribed medication for individuals who use opiates for pain and are at higher risk for overdose. In part, doctors have been hesitant to prescribe a drug for a patient when a person other than the patient is likely to have to administer it, says Ralston. Advo­cates and researchers have been pushing for the federal Food and Drug Administration to take steps to make the drug available over-the-counter, but to date those efforts "have largely been unsuccessful," he says. "But there's a great deal of potential" for the drug to reduce preventable deaths, he says.

Also key to the problem – and to fixing it – is the lack of so-called "Good Samaritan laws," which protect individuals from facing jail or prison time for simple drug possession or intoxication. As it stands, family members or friends – who often may be using drugs with the individual who is overdosing – face criminal charges if they take the chance and call 911 for help with an overdose. That's exactly what happened to 29-year-old Kristin Metz, who was handed 10 years in prison for the death of her friend Stevie May, whom Metz injected with heroin at May's request. May overdosed and died in Metz's McKinney apartment; when the police arrived, they arrested her. Meanwhile, the dealer who sold them the drug received only minimal jail time followed by probation. Stories like Metz's are not uncommon and have a negative effect on reducing overdose deaths, says Ralston. "It's just really chilling that this kind of thing is happening," she says.

Two states, New Mexico and Washington, have passed Good Samaritan laws, and dozens of colleges and universities have also adopted such policies, including the University of Texas. Universities "have been on the vanguard of this issue for years and years," she says, which makes "perfect sense, if from nothing else than a liability standpoint."

Still, there's been some opposition – typically from law enforcement and lawmakers responding to old drug-war thinking that such measures are soft on drugs. Texas lawmakers have put forth this argument year after year in opposition to legalizing needle exchange, another cost-effective way to reduce drug-related harm to public health. The attitude of law enforcement, Ralston says, is simple: "What do you mean we can't arrest a person for simple drug possession?"

Of course, the point is not to let bad guys go free but to save lives. Furthermore, unlike educational programming and naloxone use (and research), the passage of a Good Samaritan law costs nothing – and, in fact, could save money through the reduced need for incarceration and associated criminal justice costs. It is exactly the kind of policy that Texas lawmakers, staring down a giant budget deficit, could justify as a way to reduce the state's skyrocketing overdose-related deaths. Regardless of that logic, it seems unlikely that when state lawmakers convene in 2011 they will see fit to take up such a measure. As far as Ralston is concerned, that would be a shame: "It is a small but so important policy," she says. "It doesn't effect anybody except those who are in imminent danger of dying. It is a commonsense, no-cost policy that will never affect the majority of people – but, boy, if it were your kid at a party and something went wrong, you would certainly want someone to not be scared and to call 911."