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Mom's last resort: Opiate antidote saves addicts' lives

Michele McDonald / for msnbc.com

Linda and John Wohlen of Massachusetts have struggled with their son Steven's opiate addiction. Linda Wohlen used naloxone, an opiate antidote, to revive Steven from a heroin overdose.

A powerful antidote that can reverse the potentially deadly effects of opiate drug overdoses -- including those from prescription painkillers -- has saved more than 10,000 lives in 15 years, but it’s still little-known and too hard to get, a new report shows.

Naloxone, a drug sold as Narcan, is so effective that it can revive virtually all victims of the ODs within minutes using a simple shot or, more easily, a nasal spray. It was first distributed through needle exchange programs in the mid-1990s to prevent deaths of injection heroin users.

Increasingly, though, naloxone is showing up in the medicine cabinets, kitchen cupboards and even the handbags of middle-class moms as some mainstream families find themselves grappling with escalating opiate addiction in their teens and young adults.

“I kept it right on the counter by the microwave,” said Linda Wohlen, a 65-year-old school secretary who lives near Brockton, Mass. She used a naloxone kit to revive her son Steven, now 28, from a heroin overdose nearly two years ago.

“I have it in my bedroom and I always have one in my pocketbook. It’s a terrible position for a parent to be in, but you are expecting them to use,” she said.

Wohlen and her husband, John, obtained the naloxone through Learn to Cope, a Massachusetts-based group for parents of teens and young adults addicted to opiates.

It’s one of 188 local sites run by 48 programs in 15 states and the District of Columbia. Since 1996, they’ve trained more than 53,000 people to save an addict’s life, said Eliza Wheeler, author of a report published last month by the Centers for Disease Control and Prevention.

“We don’t believe that death should be a consequence of using drugs. Death doesn’t teach a lesson,” said Wheeler, manager of an overdose prevention project for the Harm Reduction Coalition in Oakland, Calif.

Having naloxone on hand can be an act of last resort, a final safety net for parents who've tried everything from threats and demands to jail and drug treatment, only to have their addicted children overdose.

“To me, it’s about parents wanting their children to survive,” Wheeler added.

About one in five U.S. high school students has misused prescription drugs, including painkillers, a 2009 government health study found, and some states, like Missouri, are reporting a renewed rise in heroin deaths among young people.  

But most parents -- like most people -- have never heard of naloxone and have no idea where or how to get it, experts say.

“The light goes off when you’re talking to the parent of a kid who’s dealing with opiate addiction,” said Mark Kinzly, a trainer with the New York-based Harm Reduction Coalition and a former addict. “When they hear that there’s something out there that they could have access to, they’re all for it. It’s just like the parent of a child who’s allergic to bee stings.”

Unlike an EpiPen for allergies, however, naloxone suffers from both the stigma of its association with illicit drug use and from the lack of sustained funding for outreach to drug users, experts said.

“There’s an intangible truth that people care less about drug-addicted folks than other folks,” said Maya Doe-Simkins, a Chicago public health consultant and researcher who has focused on naloxone.

Michele McDonald / for msnbc.com

Naloxone, an opiate antidote, comes in injection and nasal forms.

Slowly, though, distribution of naloxone is growing, along with the nation’s prescription painkiller epidemic, which has seen overdose deaths triple since 1990, according to the CDC. The number of programs distributing naloxone has climbed steadily from about 15 nationwide in 2005 to 48 in 2010, Wheeler’s data showed.

Overall, some 37,004 people died after drug overdoses in 2009, the most recent year for which figures are available, according to the CDC. About three-quarters of the deaths were attributed to prescription painkillers.

Although there are no firm figures, those drugs are starting to show up along with injection heroin in reported naloxone rescues in the San Francisco area, Wheeler said.

“Since around 2010, we have seen an increase in people reporting to us that they’ve used their naloxone to revive people who had taken opioid pills, either in combination with other drugs or alone,” said Wheeler, noting that the pills have included fentanyl, morphine and hydromorphone, among other opiates.

'It all begins with the pills.'
Whether the overdose is caused by pills or heroin hardly matters to Wheeler -- or to the many parents who say their kids may have started out using one kind of opiate but quickly escalated to another.

“It all begins with the pills,” said Joanne Peterson of Randolph, Mass., who founded Learn to Cope in 2004, after her then-teenage son started using prescription drugs, then heroin.

“I never, ever would have imagined my son doing heroin, ever. We lived in a nice neighborhood, we have a nice home, we water ski, we camp. We are not what anyone would picture,” Peterson added. Now 28, her son is in long-term recovery, is married and has kids of his own.

Courtesy Linda Wohlen

Linda and John Wohlen and their son Steven, now 28.

In Linda Wohlen’s case, her son Steven started using prescription pills at about age 19, when he still was a “wonderful kid with a heart of gold” who liked to crack jokes and ride bikes on the half-pipe in his family’s backyard, she said.

By 26, he’d become a heroin addict whose mother watched him walk out the front door one day, and, minutes later, found him blue and unresponsive on the front lawn.

“I knew right away what it was,” said Wohlen, who quickly rushed out with her naloxone kit. “It just takes seconds, half up one nostril, half up the other.”

The kit, which sells for about $10, contained a vial of naloxone nasal spray and an adapter that allows it to be easily administered. Other kits contain injectable versions approved by the Food and Drug Administration that require more skill to deliver.

Naloxone blocks the brain receptors that respond to opiates, instantly reversing the high and sending the addict into an abrupt and often painful withdrawal. It has no effect on intoxication from alcohol or other drugs.

Naloxone typically is available only through drug programs that offer training as well as distribution. Such programs are limited and they're almost non-existent in some states with high rates of opiate overdoses. The South Boston Hope & Recovery Coalition has a national search site that can locate programs in specific ZIP codes. To search, click here.

Prescribing laws are complicated and vary from state to state, said Scott Burris, a law professor at Temple University and director of the Center for Health Law, Policy and Practice.

“If you go to a pediatrician, the doc could prescribe the drug for the child and the parents could pick it up and have it on hand,” he said. “The place where it’s difficult is: You go to the adult doctor and say ‘My kid is using.’”

Some states, such as Washington, have passed so-called “Good Samaritan” laws that absolve users of naloxone from legal penalties that might arise from employing the drug to save someone’s life.

Activists like Doe-Simkins would like to see wider availability of naloxone through doctors’ offices, jails, drug treatment and detox programs, as well as through more parent outreach programs.

“Those models are the next wave,” she said.

But not everyone agrees that take-home naloxone is a good idea.

Critics long have argued that the availability of the drug gives addicts an excuse to use because they don’t have to fear an overdose death. Some charge that parents who keep naloxone on hand are enabling their children’s addiction.

Bertha K. Madras, a former official with the White House Office of National Drug Control Policy, has supported naloxone use by trained health professionals, but has expressed concerns about use by addicts and their families or friends, if naloxone rescue is not supervised by health care workers. 

A professor at Harvard Medical School, Madras cites studies that have shaped her worries that rescued addicts might not be appropriately monitored for medical complications, and that there won't be enough emphasis on getting addicts into treatment. The lives of naloxone-rescued people remain in danger of future overdoses and possibly death, she said.
 
"My foremost principle is to save lives," she wrote in an email to msnbc.com. "My secondary principle is to save more than a life during a crisis, but to prevent a recurrence, or save a person from a lifetime of addiction and its adverse outcomes, from depression, or from noncompliance with pain medications."

But Wheeler said such critics may be confusing rescue with recovery. “Naloxone is not drug treatment,” she said. “It’s an immediately life-saving act.”

The worst conversations, she said, are those with the parents of addicts who died without the antidote, a reality Linda Wohlen can imagine all too well.

Steven is in prison now, serving time for drug-fueled theft. But at least he’s clean, sober -- and alive, she said.

“If people think it’s enabling, too bad, they haven’t walked a mile in my shoes,” Wohlen said. “I was only focused on saving my son. I can’t help him kick this problem if he’s dead.” 

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