A Small Step

Wider access to lifesaving overdose drug

Paul Ravella (l) and Kent Livingston (Photo by Jana Birchum)

On Sept. 1, a new law went into effect that makes it possible for anyone in Texas to get a prescription for Naloxone, a medication used to stop the effects of an overdose from opioids – whether the drugs in question are prescription painkillers or heroin. Naloxone has no other effects: If you take it when you're not overdosing, it will not impact your day. But anybody in overdose will be sent into withdrawal within two minutes of ingestion.

Naloxone, which is typically found in the form of nasal spray or as an injector like an EpiPen, works by blocking the opioid receptors – the same receptors that remind your body to keep breathing – enough to stall their reactions to the drug, thus reversing the effects of what's been injected. It's nonaddictive and has circulated throughout the user community for decades, both passed peer-to-peer and given out by public safety services. (Austin-Travis County medics have carried the antidote for decades. APD reports it's currently "looking into the issue" of having its officers carry it and has started a conversation with the Austin-Travis County Medical Director's office. Austin's Harm Reduction Coalition has distributed it under the table since last May.) Nationally, 41 states and the District of Columbia have laws in place that consider the application of Naloxone, with 12 states offering it over the counter.

These types of laws first started popping up in 2001, when New Mexico legislators voted to excuse anybody administering any opioid antagonists to overdosing individuals from any type of civil liability (commonly referred to as the "Good Samaritan" law). In retrospect, the wash of new legislation can be seen as reaction to the widespread effect of OxyContin.

In 1996, Connecticut pharmaceutical company Purdue Pharma began marketing OxyContin as a low-addictive drug to doctors the company identified as prescribing the most painkillers to their patients. Reports note that Purdue Pharma produced $45 million in sales in OxyContin's first year on the market. By 2000, that number had increased to $1.1 billion, then to $3.1 billion by 2010. (In 2007, the company pleaded guilty in a Virginia federal court to making misleading claims about the addiction potential of OxyContin, and is currently fighting a similar lawsuit in Kentucky.)

No surprise, then, that the number of prescription drug-related deaths also rose during that time. In fact, according to the National Institute on Drug Abuse, the number of deaths from prescription drugs has more than doubled since the turn of the century, going from roughly 10,000 in 2001 to more than 22,000 in 2013. In April, a joint study by the Houston Chronicle and Austin American-Statesman said the Texas Depart­ment of State Health Services chalked up 622 deaths to opiate overdose in 2013, with 17 coming from Travis County. Those active in the community will quickly tell you, however, that those numbers are woefully underreported. Indeed, that same joint study reported medical examiners from just 17 of the state's 254 counties counting more than 798 deaths in that year. The Travis County Medical Examiner's Office in particular counted more than 114.

Activists, users, and physicians who spoke with the Chronicle agreed that the newfound ability to get a prescription for Naloxone is a net positive, but stressed that it's only one small part of the changes necessary to make opioid addiction less deadly. Naloxone is effective, but only if another person is there and aware of the overdose to administer the antidote. Moreover, they must find a way to pay for it. One area Walgreens listed a single 2-millimeter dose of Naloxone at $51 without insurance, with the largest available supply, a 21-millimeter vial, running $510. (A free millimeter when you buy bulk, apparently.) People wishing to obtain Naloxone must first get a prescription from a doctor, which, for an opiate user, as opposed to concerned and informed friends and family members, may be intimidating, since it means telling a doctor about their own addiction.

The stigma surrounding addiction is likely what held Gov. Greg Abbott and Lt. Gov. Dan Patrick from helping the state of Texas make more progress. Both played a significant hand in killing bills – House Bill 65, a bill that would have allowed for users to exchange used needles for fresh ones, and HB 225, Texas' iteration of the Good Samaritan bill, which would have granted immunity from prosecution or arrest to any user who called 911 on an overdosed acquaintance. (HB 225 passed through both the House and Senate. Abbott vetoed it because he considered the language to be too lenient on repeat users.) Advocates for drug reform believe that both bills would have helped to further bring users out of hiding, and keep them safe while they're battling addiction, but that those within the Capitol chose to nix both in order to keep their hard line on drug abuse.

"You have lawmakers and policymakers within state institutions who were reluctant ... to be seen as being soft on drugs," said Kerby Stewart, clinical director at MAP Health Management. "It borders on the bizarre; the idea that if someone overdoses and you provide them with the remedy to save their lives, that you're encouraging them to go on and risk overdosing again."

Paul Ravella, a 19-year-old Austinite now sober for one year after two and a half spent abusing painkillers, crack cocaine, and heroin, believes changing the way we talk about and acknowledge the presence of drug addiction will have more of an impact than any specific antidote. He points to sober homes, and the fact that they aren't allowed to carry Naloxone, despite being places where addicts often go – and sometimes relapse. "Managers aren't trained in CPR," he says. "They don't have any medical knowledge. They're total laymen. I have a lot of friends who manage sober houses, and I have a lot of Naloxone. I want to give it to them. But if I do and they administer it without the protection of the law, they could be liable if someone died.

"It's a dangerous drug, and it's not that difficult to overdose. Too often, people are driving up to the hospital, pushing their friend onto a curb, and speeding off. Or dumping you behind a gas station, calling the cops, and bouncing. Or they're just dead and left somewhere. That happens all the time."

He advocates today for users to be more upfront about their use. On May 18, he lost a childhood friend – Quentin Livingston – to an overdose that Ravella says could have been prevented. Livingston, 19, had been shooting up for less than a month, and had kept the news from his roommates. He overdosed in his bedroom, where nobody knew to check on him. "Maybe if the people in his house had known that he was doing smack, they could have gotten some free [Naloxone] from Harm Reduction and it could have been prevented," he said. "'Hey, I'm going to start messing around with this drug. Maybe I should have Naloxone, and tell my roommates that I'm getting high."'

That's a sentiment echoed by Quentin's father, Kent, who since his son's passing has befriended Ravella and a few of Quentin's other acquaintances. "It's a huge subject, but one of the things is, did he know how dangerous it was to be doing it alone?" he questioned when we met in early October. "Which ties into the shame factor, the stigma. You'd think a 19-year-old wouldn't care [about shame], but to me it's this ball of wax, whether it's a low-income kid or a no-income kid or a high-income kid who's dealing with some pain or anguish and doesn't know how to cope with it. That gets things started. Then some of the shame kicks in and they're doing it behind closed doors," where nobody can help.

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drug addiction, Naloxone

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