Pubdate: Sun, 20 Dec 2015
Source: Orange County Register, The (CA)
Copyright: 2015 The Orange County Register
Contact:  http://www.ocregister.com/
Details: http://www.mapinc.org/media/321
Author: Jenna Chandler

OVERDOSE ANTIDOTE MOVES TO MAINSTREAM

Aimee Dunkle believes her 20-year-old son's death - from an overdose 
of heroin - could have been avoided.

Not if he had gone to rehab. The Tesoro High School graduate had been 
several times.

But rather if he or his friends had carried naloxone, the 
fast-acting, easy-to-administer antidote that at about $25 a dose 
snaps back to life someone overdosing on opioids, a class of drugs 
that includes heroin and prescription painkillers.

Naloxone has been around for decades, but despite an explosion of 
opioid abuse in Orange County  1,171 deaths since 2011, according to 
coroner data  officials here have been slow to embrace it. Under 
California law, when Ben Dunkle died in 2012, naloxone was only 
available with a prescription or through community and public health 
distribution programs and there were none in Orange County. Dunkle 
said she didn't even know the antidote existed.

"In a county of 3 million people, this hasn't been handled from a 
public health perspective," she said.

That's starting to change. Some Orange County sheriff's deputies are 
carrying it, and a new state law and local efforts, if successful, 
will make naloxone available in the county in unprecedented numbers. 
Ralphs and CVS have said they will sell the antidote without 
requiring a prescription, and Dunkle is on a mission to distribute it 
to parents of users, as well as to rehab centers and sober living 
homes across the county.

"Our recognition of the issue has taken some time," said UC Irvine 
Health's director of pain services, Dr. Padma Gulur, who researches 
opioid tolerance. "At this point, I don't think there are too many 
objections to it anymore."

Opioids affect the part of the brain that regulates breathing. During 
an overdose, breathing slows, and may stop altogether. Naloxone binds 
to the same receptors as opioids and knocks the opioids off so an 
overdose victim can breathe again.

Doctors say it's not addictive, and it's easy to administer: It can 
be sprayed into the nose or jabbed into arm or leg muscles. It also 
comes as a much more costly auto-injector, a small, prefilled plastic 
cassette that, when opened, plays audio instructions. The 
auto-injector is priced at $885 for a set of two doses at CVS.

Naloxone is mostly safe but can trigger serious side effects such as 
a spike in blood pressure or seizure, and withdrawals, especially for 
people with heart and neurological conditions. That's why some argue 
it's safe only when medical professionals administer it. (When 
nonmedical professionals are given the drug, they're trained how to 
administer it and are advised to dial 911 immediately.)

UC Irvine Health is partnering with public health officials, the Drug 
Enforcement Administration, insurance companies and hospitals to come 
up with new ways to expand access to naloxone, which is also known by 
the brand names Narcan and Evzio, to users and anyone else in Orange 
County. The group met for the first time last month.

Gulur said one goal is for the drug to be given to every patient who 
is prescribed a certain amount of opioids. "For a while now, the 
efforts weren't quite organized enough. Sometimes people try to get a 
doctor to write 100 prescriptions for naloxone. They buy it, then 
distribute it," she said. "That's not systematic enough."

The UC Irvine-led collaborative also will focus on responsible 
prescribing practices and signs of addiction. Giving out more 
naloxone will not end the opioid epidemic. But naloxone can keep 
people alive until they are ready for treatment.

"I'm tired of having people die," said Dr. Randy Holmes, a 
Whittier-based family doctor who specializes in addiction and who is 
chairman of the California Society of Addiction Medicine's public 
policy committee. "Let's give them something that will save their 
lives now, then get them into treatment. I'm a big fan of treatment, 
but this is one more little tool."

Holmes acknowledged that giving naloxone to a patient might seem an 
invitation to use drugs again.

"It's tough to say to a person, 'You're doing the right thing, you're 
not using heroin, but here's naloxone in case you need it,' " he 
said. So the doctor will encourage family members to keep it in the 
house. "I've had a couple like that who we've saved."

In late October, the Orange County Sheriff's Department put naloxone 
in the patrol cars of deputies who serve Stanton, Laguna Niguel and 
Mission Viejo. Derek Bishop is one of two deputies who has used it 
successfully to revive an overdose victim.

"The mom was outside kind of frantic ... the person who had OD'd was 
lying on the floor. ... I looked into the bathroom and saw (heroin) 
paraphernalia," he said. "I was not really nervous at all. If I was 
wrong about his medical issue, then naloxone wouldn't hurt him. If 
anything, I thought it might help the guy, give him a second chance."

Many overdoses involve a mixture of drugs and alcohol. Naloxone works 
only for opioids.

In the past decade, Bishop said, he has responded to a handful of 
overdose calls in which he arrived before EMTs or paramedics. Before 
he carried naloxone, though, the only thing he could do was monitor 
vital signs.

Putting the antidote in the hands of police is helpful, but equipping 
users and their family and friends is critical, advocates say. The 
San Francisco Department of Public Health was the first local public 
health department in the state to fund naloxone distribution in the 
community. Officials say the availability of naloxone has reduced the 
number of overdose deaths from 120 in 2000 to 10 a year in 2010, 2011 and 2012.

In Orange County, 315 people died on average from drug overdoses each 
year from 2010 to 2012.

In the U.S., more people die every year from drug overdoses than 
motor vehicle crashes. More than 80 percent of overdose victims are 
revived by other users, according to a national survey published in 
June of organizations that provide naloxone kits to "laypersons."

Ralphs to carry it

On Tuesday, Ralphs announced it would become the first grocery store 
chain to carry naloxone in its Southern California pharmacies, saying 
it was "empowering pharmacists to put this overdose rescue medicine 
in the hands of those who are in a position to help an opioid overdose victim."

"Access to naloxone can literally be the difference between life and 
death for our sons and daughters," said Denise Cullen, whose son Jeff 
fatally overdosed in 2008, shortly after he was released from Theo 
Lacy Jail for a drunken-driving conviction. "(Ralphs) deserves a lot 
of credit."

CVS Pharmacy has made a similar promise, but naloxone is still not 
stocked in at least some of its Orange County stores.

The changes are possible because of a new California law that, as of 
January 2015, allows pharmacists to dispense naloxone to anyone, 
without a prescription from a doctor.

But before Ralphs and UC Irvine, there were Aimee Dunkle and Margie 
Fleitman, whose son also died of an overdose.

In July, they formed a nonprofit, the Solace Foundation, and began 
handing out naloxone to the homeless, recovery and rehab centers and 
parents they met through grief support groups. In five months, Dunkle 
said, her organization has trained 368 people at more than 35 rehab, 
detox, sober living homes and drug houses and given out nearly 300 
auto-injectors.

Dunkle said her son Ben was with three people the day he died in 
2012. None had naloxone. By the time paramedics arrived, fluid had 
seeped into his lungs. He was in a coma for eight days with a severe 
case of pneumonia before the family decided to take him off life 
support. His younger brother held his hand.

"People think overdoses are painless," she said. "It was eight days of horror."

Dawn Ament, 56, runs a sober living home in Mission Viejo and was 
trained by Dunkle in July. The next month, she used naloxone to save 
a resident's life.

"I had never seen someone come back to life. I didn't know what to 
expect," she said. "It was just like 'Pulp Fiction.' It was like, 
'Gasp, gasp.' "
- ---
MAP posted-by: Jay Bergstrom