Kathleen, a mother of four and a recovering heroin addict, would be dead without naloxone.
She had detoxed six months ago, but fell into old habits, got back in touch with old friends and got high at a McDonald’s. Not realizing her tolerance was lower after detox, she overdosed and her friends left her on the bathroom floor.
“The next thing I know I had woken up in an ambulance,” she said. “Paramedics were all around me, and I just remember seeing the lights and thinking ‘Thank God,’ because I knew. I knew what had happened.”
The Virginia woman, who is under treatment for addiction in Arlington at Greenhouse Treatment Center, has been clean for six months — since paramedics saved her by administering naloxone, also known by its brand name, Narcan. The drug, which stops an opiate overdose in seconds, became more readily available in Texas Aug. 1, as the result of a law passed by the state Legislature during its last session.
A standing prescription for the drug now in effect allows those who need naloxone to get it through a pharmacist without seeing a doctor first.
Previously, only first responders and patients prescribed opiates could get naloxone without a prescription.
The increase in accessibility comes as MedStar, the ambulance service used in 15 Tarrant County cities, reported a huge increase in patients receiving the intervention drug: 77 patients received doses in July 2016 compared to 15 in July 2015.
Addiction may start innocently
Kathleen, 46, who asked that her last name not be used, was given naloxone just in time. A customer found her turning blue on the floor of the restaurant bathroom, performed CPR and called 911.
Like many of today’s addicts, Kathleen started out using pills, then went to heroin when she couldn’t get pills anymore.
“It hijacks you. It makes you sick so you have to have it,” she said. “It’s a hopeless prison that you’re in, and an opportunity to be free of that is a miracle.”
The rise in overdoses and the need for Narcan is partly because of prescribing practices, said Matthew MacKrell, a second-year resident in the John Peter Smith Hospital emergency department.
“Quite often people get addicted very innocently,” said Dr. Kristina Domanski, North Texas Poison Center toxicologist. “They’re prescribed a medication for a pain or after a surgery and they become exposed to it that way.”
That’s how Jamie, 33, of Oklahoma and also in treatment in Arlington, was introduced to opiates. She was prescribed pills after an accident.
“My tolerance grew, and grew, and I needed more, and I needed more,” she said. “There’s so many people that happens to, and a lot of them turn to heroin, which I eventually did. It is cheaper.”
While overdoses are on the rise in both legal and illegal users of opiates, illegal users run the risk of not knowing what they are actually getting, making overdose more likely.
Currently there is an influx of illegally manufactured Fentanyl, an opiate painkiller, being sold as heroin, MacKrell said. Fentanyl is much purer and more potent than heroin, causing addicts who take their normal amount of heroin to accidentally overdose, he said.
Since 2000, the national rate of drug overdose deaths has increased 137 percent, including a 200 percent increase in the rate of opioid-involved deaths, according to the Centers for Disease Control and Prevention. Prescription pain relievers and heroin are the main drugs associated with overdose deaths.
The CDC data also backs up MacKrell, stating that illicit Fentanyl may be contributing to the increase in heroin-involved deaths.
In 2014, 61 percent of all drug overdose deaths across the nation involved an opioid.
Texas didn’t have a significant increase in the number of deaths, at 4.3 percent, according to a CDC state-by-state breakdown.
The CDC characterizes the rising trend of opiate-involved overdose deaths as an epidemic.
How naloxone works
During an opioid overdose, breathing slows or stops, said Domanski. The time it takes for an ambulance to arrive can be too long, so the standing order can prevent deaths, she said.
Narcan stops the brain from receiving opiates for 30 to 120 minutes, allowing patients to breathe again and giving them crucial time, said MacKrell.
The standing order doesn’t make Narcan available over-the-counter, said Justin Hudman, public affairs division director for the Texas Pharmacy Association.
A bill passed during the last legislative session allows pharmacists to distribute the drug to someone prescribed opiate pain medication, someone who shows a medical need for potential overdose prevention or a family member, friend or other person in position to help someone at risk of overdose.
“A good way to think about it is it’s going to be much more similar to pseudoephedrine. They’re technically over-the-counter, but they’re behind,” Hudman said.
Pseudoephedrine, the active ingredient in medications such as Sudafed, has been sold from behind the pharmacy counter since 2005, in an effort to combat the manufacture of methamphetamine.
The standing order for Narcan covers current and any future formulations of the drug, Hudson said.
But cost could keep the drug out of the hands of people that need it most, MacKrell said.
The cheapest is an injectable solution, which costs $18 to $39 per vial, he said.
“You’re also talking about someone needing to have some technical skills and knowledge, because they need to be able to utilize a needle and syringe to draw the medication up and administer it appropriately,” he said.
A nasal spray is the mid-priced level, but can cost about $75 per dose, and the auto injector, which injects the liquid without using a syringe, is the most user-friendly, but costs about $2,200 per dose, he said.
“We’ve seen the price of naloxone going up drastically, and that’s a very unfortunate part of this,” Hudman said. While part of that rise is contributed to the rise in demand, he said profits for the drug manufacturers also come into play.
Does Narcan hurt or help?
naloxone has its opponents.
State Sen. Charles Perry, a Republican who represents Lubbock and San Angelo, asked during a committee hearing whether making the drug more readily available would feed into the problem instead of helping solve it. Perry asked if those addicted to opiates would be more inclined to toe the line of overdose if they knew there was a drug at the ready to save them.
Hudman spoke in support of the bill allowing the standing order during the 2015 regular legislative session. He concedes that it can act as a safety net for someone that wants to continue to do drugs, Hudman said, because it gives them an ability to overdose and survive. But he said that isn’t likely because it immediately causes painful withdrawals: diarrhea and vomiting, sweating, goosebumps, discomfort and restlessness.
“It doesn’t cause seizures or some of the other life-threatening effects,” Domanski said. “Withdrawal from opioids is deeply unpleasant, but it’s not usually life-threatening.”
Domanski said it has no effect on someone without opiates in their body and actually takes the high away. One study, she said, proved the drug powerful enough to take away a runner’s high.
For users, the withdrawal discomfort is so unpleasant it’s the main reason people seek opioids again, she said. The need is physical, not psychological.
“But they can’t fix their problem if they die,” Hudman said. “The only certainty is, if they die they aren’t going to improve their lives.”
Dylan Bradley: 817-390-7984, @dbradley1220
Overdose deaths, 2013 to 2014
Here are the latest national figures from the U.S. Centers for Disease Control on opioid overdose deaths:
- Male deaths: up 7.6 percent
- Female deaths: up 4.6 percent
- Non-Hispanic blacks: up 8.2 percent
- Non-Hispanic whites: up 8 percent
- Hispanics: up about 6 percent
States with highest drug-overdose death rates
- West Virginia
- New Mexico
- New Hampshire
States with highest increases in drug-overdose deaths
- North Dakota: 125 percent
- New Hampshire: 73.5 percent
- Maine: 27.3 percent
- New Mexico: 20.8 percent
- Alabama: 19.7 percent
Seeking help with addiction?
Fort Worth Narcotics Anonymous: 817-624-9525