Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=186855
Story Retrieval Date: 6/19/2013 11:59:12 AM CST
The large silver and red van is parked every Saturday on West 68th Street, just west of Halsted, next to a pair of well-kept lawns and a row of non-descript houses.
It’s hard to get around inside the van because it’s crowded with materials distributed on a daily basis: condoms, cookers, water, saline, ascorbic acid, filters, cotton balls, and syringes. The volunteers can barely move from one side to the other without bumping into something.
The van is easy to find because that’s what it’s there for: When people are in need, they go to a Chicago Recovery Alliance location.
“I need alcohol pads,” a customer requests from the door of the van. When CRA employees hand her a box, she smiles and says, “These CRA folks, they do their job well.”
But CRA distributes more than safe sex products and cotton balls. They distribute something they believe has saved more than 1,500 lives in the past seven years: a drug called Naloxone.
Known more commonly as Narcan, Naloxone is a drug that, once injected into the body, blocks the opiate receptors in the brain. In short, it reverses the effects of an opiate-related, or heroin, overdose.
Cliff Sanchez, CRA outreach specialist, said he’s seen the drug perform miracles.
“We’ve had people in here, blue lips, eyes rolling back in their heads, and once we administer the Narcan, it brings people back,” he said.
An injection of 1cc of Naloxone, once administered intramuscularly to a person who has overdosed on heroin, will attach itself to any opiates in the brain and essentially erase them. CRA has been distributing the drug for more than five years.
Sanchez, who also works at the Loyola Medical Center, said Naloxone takes between 90 and 120 seconds to work, lasts 30 to 40 minutes, and can be injected as many times as needed. If a heroin user’s overdose comes back, Naloxone can be taken again and again until it is gone.
“The beautiful thing about this is that this stuff is safer than water,” Sanchez said.
A Doctor’s Supervision:
Before Naloxone can be distributed by the CRA, a doctor has to sign off on it. Enter Dr. Sarz Maxwell, CRA medical director and private physician in Chicago. Most of her work is focused on the distribution of Naloxone to help addicted drug users.
“This work is so cool,” Maxwell said of her efforts with CRA.
Normally, Maxwell said, programs like the CRA are focused on harm reduction and needle distribution programs, but don’t have a physician involved.
“But having a physician in a program like this has its benefits,” she said.
With a physician, clients can get inoculated for hepatitis A and B.
“Hepatitis C is a terrible problem,” Maxwell said. “And by inoculating people against A and B, we can better protect them from that disease.”
Maxwell got started with Naloxone distribution at the CRA when Dan Bigg, CRA’s executive director, told her about needle drug recovery programs overseas that were distributing the drug. Maxwell immediately thought it was a great idea.
“We really take it for granted when it’s used by EMTs and in the emergency room,” she said. “It hadn’t occurred to us that you need to get it out to the people who need it most.”
Maxwell said she hasn’t seen any reports of people feeling ill or experiencing problems after taking Naloxone. The only side effect is that occasionally heroin users are disgruntled that their high is gone after being injected with Naloxone. She said this is why it is so important to have others around, to prevent the person from getting high again.
But Maxwell thinks Naloxone distribution is better than the alternative.
“It’s a miracle that we are able to prescribe addicts Naloxone instead of sending them to methadone clinics,” Maxwell said.
Methadone clinics are non-medical facilities, so there is not a physician or doctor on staff at all times, Maxwell said. In fact, Maxwell said a doctor assigned to a methadone clinic only comes to the clinic between four and six hours a month.
“I’ve worked at methadone clinics, and doctor-patient interaction is not a priority,” she said.
Most clinics use a 12-step program similar to Alcoholics Anonymous, Maxwell said. But the problem with this kind of treatment center is that even if a client is not cured by the end of the program, he or she is kicked out anyway.
“People end up being discharged from the clinic, even if they’re still hooked on drugs,” she said.
The point of Naloxone, she said, is not to cure people, but to help them.
And heroin addicts often help each other, too.
“What people don’t realize is that heroin addicts are heroic once they decide to get better,” she said. “They know they are sick; they want to help each other.”
Maxwell said 80 percent of overdoses are witnessed, and heroin users typically witness four overdoses in their lives, one of those four being fatal.
“The people who should be equipped with Naloxone are these people,” she said. “They are ones who can save a life.”
Maxwell calls Naloxone a no-lose drug.
“You can pump a whole bottle of it into a newborn baby and they wouldn’t be hurt.” She said. “In fact, sometimes if a baby is having trouble breathing, that’s just what they’ll do.”
Maxwell said that people who are against the use of Naloxone are opposed to it because they don’t think that heroin addicts who overdose should be revived.
But Maxwell argues that heroin addicts who overdose are more likely to seek better health approaches, especially after being brought back by Naloxone. Often they seek out hepatitis vaccination, get an STD test and search for drug recovery clinics, she said.
“When someone is addicted to heroin, they might not know if they’re still going to be alive next week,” Maxwell said. “When they have Naloxone on hand, they have some assurance that they can survive. And that motivates them to get help.”
CRA funding and legal issues:
Only since 2010 has it been legal for CRA to receive federal funding.
“There were never any legal barriers to doing Naloxone distribution,” Maxwell said. “However, in anything to do with injecting drug users, people in administrative positions tend to erect barriers based on imaginary fears.”
CRA also receives money from private funders like the Ryan White Treatment Fund, a federally funded program for people living with HIV and AIDs. The North American Syringe Exchange Network has also donated money for CRA’s needle distribution.
Maxwell said CRA is an organization that is not burdened by a lot of administration, so setting up a Naloxone distribution did not meet too many legal obstacles.
The passage of the Drug Overdose Prevention Act, passed in 2010, removed a potential barrier to Naloxone distribution. The act protects doctors who prescribe Naloxone in emergency situations from liability.
Most of the barriers to the distribution of Naloxone have been from administrative bodies such as hospital lawyers who say there could be a potential liability, Maxwell said.
“These problems have been overcome in many states by government health agencies taking responsibility for the Naloxone distribution programs themselves,” Maxwell said.
But some are still concerned:
CRA used to require that clients trade in the same amount of syringes they were receiving, but that was eliminated six years ago.
“A syringe exchange became a syringe distribution,” Sanchez said.
Their philosophy was that it was better to have more syringes out there than not. The more people who can have access the needles, the better, Sanchez said.
“All of the people take the needles where there are a lot of people shooting up at once,” he said. “They can bring clean needles for safe injecting to a whole group of people instead of just one or two.”
But some are concerned that the distribution of both needles and Naloxone only facilitates drug use and encourages overdosing.
Daniel LeCour, North Lawndale resident and community activist, said he is concerned about the disposal of the needles, the encouragement of administering of the drug by unsafe persons and the general knowledge base of the drug in general.
“Often in the willingness to obtain the desired highs, heroin users will inject more and more, creating a dangerous circumstance once the Naloxone has worn off,” he said.
LeCour said instead of giving drug users more materials with which to continue their drug habits, we should be teaching them how to step away from the drug entirely. On a recent post on EveryBlock, a community information exchange site, LeCour raised concerns about the disposal of the syringes distributed by CRA and the general education of the community on Naloxone.
“It would be helpful if we started finding creative ways of educating these people on their influences on a community and took progressive steps to help them make better choices instead of facilitating their lifestyles,” he said.
But Maxwell said that when needle sharing is readily available, rates of viral transmission fall dramatically.
“And when injection drug users have a safe place to dispose of used syringes,” she said, “the problem of syringe litter in public places is greatly decreased.”
But is the distribution of Naloxone really preventing overdose deaths? According to data from the Drug Abuse Warning Network, a drug-related national public health surveillance system, opiate-related deaths in the Chicago and surrounding area have been on a steady increase from 2003 to 2008, the most recent year for which data is available.
In 2008, the network said, 634 opiate-related deaths were reported, up from 509 in 2007. The majority of these deaths are reported as a result of multiple drug use.
A source from Rush University Medical Center in Chicago said hospital employees sometimes encounter patients who have adverse reactions to Narcan use, such as agitation, hypertension, vomiting, diarrhea, abdominal cramps and seizures. Often these patients have pre-existing medical issues.
A global outreach:
Chicago Recovery Alliance rotates two vans among 21 locations 7 days a week in the Chicago and surrounding area.
Maxwell recently spent time in Wales, where she spoke at a conference about Naloxone distribution, and began work helping the Welsh government set up a national naloxone distribution program.
“All you need is one doctor with balls,” she said. “The initiative is not insurmountable.”
In some countries, Maxwell said health ministers are making Naloxone distribution a top priority for the World Health Department. She said programs have already been started in Scotland, Thailand, some countries in the Middle East, Germany and Italy. Recommendations to start a program have also been started in other countries, including Australia.
Maxwell is eager to get things going.
“It’s pretty damn exciting,” she said.