The Growing Opioid Epidemic
Nearly three and a half years ago, I wrote a personal essay, “One Pill Makes You Smaller: Strong Wills, Women, and Drugs,” about the opioid epidemic and how and why I weaned myself from Vicodin. Exactly one week later, the talented and beloved actor Philip Seymour Hoffman died of an accidental overdose of a mixture of drugs, including heroin, a powerful opioid.
Hoffman was alone when he overdosed, but some people die from overdoses when others are there. Witnesses of overdoses are afraid to call 911 for fear of arrest and prosecution, and they end up watching their friends and loved ones die as a result. It’s important to understand how pervasive and insidious opioids are, how their death toll is rapidly rising—and how new laws in response to this problem are helping people save others’ lives.
Because prescription opioids became more heavily regulated through the Prescription Drug Monitoring Program, they’re harder to get legally and more expensive on the street. Opioid addicts started using heroin instead. Heroin is cheaper, and it’s everywhere.
Now fentanyl, up to 50 times more powerful than heroin and up to 100 times more potent than morphine, has become the new drug of choice, and it’s the most lethal of all opioids. Not all users realize they’re buying pure fentanyl. They think it’s mixed with heroin, thus less powerful; a tragic mistake.
In Montgomery County, Ohio, so many people are dying of overdoses each day that NBC correspondent Jacob Soboroff, in his three-part special report, One Nation Under Drugs, calls it “Ground zero for illicit fentanyl use in the U.S.” In one scene of the televised report, drug agents handling the fentanyl recovered in a drug bust wore medical face masks in addition to medical gloves. Why? Because some fentanyl is so potent that simply having skin contact with it or inhaling it can be fatal.
Fentanyl and other opioids now cause more deaths in the U.S. than murders. Dr. Sanjay Gupta reported that drug overdose is the leading cause of unintentional death for Americans, with someone dying from a drug overdose every 19 minutes—more deaths than are caused by traffic accidents. This year in Montgomery County, Ohio alone, there have been 300 overdose deaths in just five months, and the coroner predicts that the number of overdose deaths in the state of Ohio this year will be 10,000.
The New York Times recently reported that the number of people who died from drug overdoses in the U.S. in 2016 most likely exceeded 59,000.
Recognizing Opioid Overdose
Responding to Opioid Overdose
How to Save a Life
Forty states and the District of Columbia have enacted Good Samaritan laws to help prevent overdose deaths by urging those who witness overdoses to call 911. The laws protect witnesses and victims from being arrested and prosecuted for minor drug and alcohol violations. (The laws are not meant to prevent dealers or those with large quantities of drugs present from being charged.) These laws were enacted because getting immediate medical attention is vital; it can save the life of someone who has overdosed. You can check your state’s laws here. The chart provides full information on the protections each state’s laws provide.
What exactly can be done to save a life? Ironically enough, administering another drug. The drug is called naloxone, commonly known by its brand name, Narcan.
The most common way naloxone is administered is through an auto-injector that functions like an Epi-Pen: The drug is delivered from a spring-loaded auto-injector into the thigh muscle. Opioids relax the respiratory system so much that the person stops breathing, and that’s what kills them. Naloxone works by binding to the opioids and reversing their effect, allowing the victim to breathe again.
Naloxone is what EMTs use to treat overdose victims, and trained medical professionals can administer it through a needle the way they administer other drugs. Naloxone is also available in a powerful nasal atomizer that sprays the drug into the victim’s nasal passage.
In some states, third parties, including families and caretakers of addicts, can obtain naloxone to use if their friend or loved one overdoses. By May 2017, all 50 states and the District of Columbia have passed laws that improve access to naloxone by laypeople—including family and friends of addicts. Check this chart (it starts on page 3) to see your state’s laws. In the last two columns, if “Third Party” and “Standing Order” both say yes, pharmacies in that state are allowed to dispense naloxone over the counter without a prescription to a third party who has not seen a doctor to obtain a prescription.
A standing order requirement means that each pharmacy dispensing naloxone to a third party who doesn’t have a prescription must have a doctor who writes a general prescription for the pharmacy, stating that it’s okay for them to dispense naloxone without a prescription to those who meet the qualifications. It’s up to the pharmacies to determine what their qualifications are. For some, it’s merely counseling the third party on how to administer naloxone and to follow up with a medical professional. (There are also videos online explaining how to administer naloxone.)
As with Epi-Pens, two treatments of naloxone are dispensed together, because one treatment may not be enough in some cases. If you are able to administer naloxone to someone who has overdosed, you MUST still get them IMMEDIATE medical care.
In Florida where I live, and perhaps in other states, even though it’s legal to dispense naloxone without a prescription, pharmacies can refuse to do so on moral grounds. If you’re trying to obtain naloxone and your pharmacist won’t dispense it, try educating the pharmacist by bringing in a recent news story—which, unfortunately, won’t be hard to find—to remind the pharmacist that naloxone can be the difference between life and death. The Network for Public Health Law’s pdf, which I’ve already linked to because it provides detailed information on each state’s laws, contains this statement that would persuade all but the most cold-hearted pharmacist to dispense naloxone if it is legal for them to do so: “Over 150,000 laypeople had received training and naloxone kits as of 2014, and naloxone program participants reported reversing more than 26,000 overdoses.” This statement was written in May 2015.
Though our nation is trying on all fronts, we haven’t been able to slow the opioid epidemic, much less put an end to it. But I’m heartened that naloxone saved 26,000 lives in less than a year and a half at the hands of people who aren’t medical professionals—people like you and me.
If you know an addict and you are able to legally obtain naloxone, I urge you to do so. If you know an addict who has been through rehab and is clean, please get naloxone ASAP.
Addicts who have been sober are at a great risk of overdosing if they slip and use drugs again. When people are using, their bodies build up resistance to the drugs, which is why they use more and more. When they haven’t been using, that resistance breaks down, but they don’t realize it. When they slip, they’re likely to use as much as they could handle before, which they can’t handle now.
I learned this from a friend who’d lost two of his friends to heroin overdoses. It was a conversation we had the day after Philip Seymour Hoffman died. “You gotta watch the people who seem strong,” he said. “You never know.”