Narcan is saving thousands of NJ lives — and that’s bad news
You probably think you already know about Narcan.
Also known as Naloxone, it's a drug that’s used to reverse an opiate overdose. Administered as a nasal mist, Narcan blocks the receptors in the brain that respond to opiates like heroin or Oxycontin. It shuts them right down. In doing so, Narcan brings someone back from the brink of death.
It’s a lifesaver many times over and an indispensable tool in our arsenal to combat the heroin crisis in this state.
Recently Gov. Chris Christie signed legislation making Narcan available without a prescription. Just a few months before, he touted New Jersey's effort to train every first-responder with the antidote. He reminded us that in 2015, opiate overdoses killed four times as many people as murders in New Jersey — and three times as many people as automobile accidents.
He'd recently spoken to clients of Newark's Integrity House program, "and every one of them around the table had been saved by Narcan at least once — and a number of them had been saved by Narcan multiple times."
Narcan has been deployed more than 18,000 times to reverse an opiate-induced overdose here in New Jersey, according to New Jersey Department of Law and Public Safety data compiled by NJ Advance Media.
Why Narcan saving lives is bad news
Here's my take: Narcan is hardly a sign that society is actually making headway on this issue. Rather, Naran is a benchmark of just how far into this abyss we’ve already fallen.
Because here’s another inconvenient truth bomb: By the time Narcan enters the picture, it’s already much too late, as noted by Brian Everett, an author and academic who focuses on drug policy.
From my recent conversation with him:
"So we shouldn't be here. We should not be celebrating the fact that we have systematically let an addiction get so out of hand that we now require emergency responders and teachers to be equipped with an emergency overdose antidote. ... Narcan addresses a symptom of the problem and that symptom is when addicts overdose. The overall problem is addiction. So what are we doing to address the underlying cause of opioid or heroin addiction."
So how did we get here? What was the impetus that let us to this moment?
"So one of the reasons why the hospitals are trigger-happy on prescriptions is because of the way that they are evaluated based on patient satisfaction. ... What needs to happen as federal and state lawmakers need to push further and make sure that hospitals no longer are so dependent on patient satisfaction for federal and state funding."
The fact that federal funds are tied to patient satisfaction based on their pain seems like we're almost setting up themselves for Narcan down the road. It's almost like that explains how we got here in the first place.
Everett is right. That’s backed up by an actual physician who’s administered Narcan for many decades, long before it was common like today.
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Our physician wished to remain anonymous, so we’ll call him Dr. Doe.
"I can remember being a resident in surgery, the patients would complain of pain after surgery, and we would give them a dose or a couple of doses, and that's after a major operation. But things changed with the release of long-acting narcotics (in the 1980s).
"And there was literature that the companies brought out saying that the people in nursing homes were suffering from terrible pain. And pediatric care was under-medicated as were the post-op surgical patients so I actually felt guilty. I think a lot of doctors (did).
"And we started using the long-acting narcotics and we were told that ... (they) had a slow onset and the patients would not become addicted, that there wouldn't be withdrawal and things like that.
"It really wasn't true."
Nobody wants someone who is in severe pain to suffer. I think everyone could agree on that. But to play on those sensibilities and those sympathies while their marketing something? That's led us down the road to a culture of addiction — one where we've institutionalized Narcan.
What it's like to be revived with Narcan
We connected with Anthony, from Bethlehem, Pennsylvania. He’s a friend of a friend and like me, a former IV drug user.
He’s actually been revived with Narcan. We asked him about that fateful moment and how that scene played out:
"I was overdosed on heroin, obviously, and I was rescued by some good people in an ambulance. ...
"(It's) actually a very strange story. ... But I really thought that I was at a party and I was sitting on a couch, and there were like party sounds around me, and there was a sense of comfort. And then I started to feel like air blowing on my face, which was the mask, the oxygen mask.
"And I tried to sit up, and I couldn’t see. My eyes were open but I couldn’t see anything. And the paramedics were pushing me back down to lay back down. And I mean, that’s when I realized that I definitely was not at a party sitting on a couch."
I wondered if Anthony had been grateful in that moment. Or maybe bad — that they'd taken away his buzz.
"No, absolutely not was I mad. I was definitely not mad. I was far from angry. I was in shock. ...
"And it was just one bag, and I was using many more than one before, so you know, I didn’t think anything of it.
Anthony had been a heroin user for a while. He went to jail, you detoxed, and then when he got out did his first bag — which alone was enough for him to overdose.
"I was in a friend’s car and she called the police. Well, she called 911. And thank God. I mean, the police chief that lives in my town ... was actually the guy who rescued me that day ...
"And I mean, I was scared. There was shock because I had no idea that I had – you know, like 'Oh my God, I almost died.' You know? Because I’ll tell you right now, every heroin addict thinks they’re not the one that’s gonna overdose.
"Never thought I would. 'It’s not gonna be me.' And when it actually happened and I was being rescued, that was an unbelievable shock, a fear. 'Oh my God. Am I gonna get in trouble because I just was in trouble before?'"
But the police chief — a detective at the time of the incident — deserves nothing but respect, Anthony said. He came to see Anthony in his hospital room.
"He was so kind, and he said, 'You’re in no shape to go down to the police station. We’ll send you something in the mail, and I hope you’re all right.'"
He could have taken Anthony to jail. But instead, he showed compassion.
Narcan in action
Above — Kelly Mae Hemphill is dramatically revived with Narcan in Paulsboro in 2016. Her mother later told New Jersey 101.5 she sought treatment after initially lashing out at people who expressed concern for her children online. “People really do care I’m alive,” the mother, Kelly Hemphill, said her daughter told her in the weeks after.
Changes in New Jersey
That more holistic, less punitive approach was also recently adopted in Ocean County, the epicenter of NJ’s Heroin crisis. An acknowledgement that Narcan is only the beginning. We reached out to Ocean County’s top cop, Prosecutor Joe Coronato.
He told us there are several programs that are making a difference. For instance, the county's started presenting overdose victims with recovery coaches after they're revived with Narcan.
Kicking heroin is hard. Having someone at your side obviously makes it a little easier. Recovery coaching offers those with addiction the support they need to navigate recovery —social services, 12-step meetings, sorting out medical issues. Family stuff. It’s all about laying a solid foundation from the get-go.
And that initiative has spread to other counties.
"It's my belief that program needs to evolve but it's a great program and it's made a difference in many, many people’s lives," Coronato said.
Ocean County's also taken on the Blue Hart program, letting addicts walk into police stations, turn in their drugs and get help — without fear of charges.
Coronato said they'll be met by clinicians who'll help them get into detox facilities and treatment.
That’s what happened with Anthony, who in 2001 was shown grace by a thoughtful cop who knows we can’t arrest our way out of this crisis.
Guess what? Anthony’s still heroin-free 16 years later, and a lot of that has to do with that happened after the Narcan.
"And we want to follow it through onto sober living and we're going to continue to track you because we're interested and outcomes" Coronato said.
It's about a continuum of care, he said. It's about making sure that after detox a person moves on to sober living, or a halfway house, or somewhere else support is available.
And those addicts need live human beings they can reach when things get rough.
"That's why I've ordered the police ... to be taken to the emergency room," Coronato said. "So that we can watch them ... to get them all the teardrops or warm.
Just using Narcan alone?
"I would consider that to be a lost opportunity."
What we have to accomplish
And isn’t that usually the goal at the end of the day — to make a difference in some addict’s life? If it’s a cop, a police chief or a county prosecutor, it means knowing when to send them to the ER instead of jail. If it’s a physician or a pharmacist dispensing opiates, that might mean giving your patients one or two pills instead of, you know, 40.
If you’re a voter, it surely means demanding more of your politicians. Everyone in Trenton is up for re-election this year. Every single one of them. Remind them of our shameful body count. It’s OK to demand more from now until Election Day on Nov. 8.
Media has a role to play, too. Sad, dramatic stories with numbing statistics aren’t good enough. Including more input from drug users (and especially from former drug users) is a good start.
And finally, if you’re a politician who wants to make a difference in some addict’s life, then for God's sake, you've got to do more than just Narcan. When it comes to heroin, an ounce of prevention is worth many tons of cure. So how about avoiding the Narcan emergency altogether by setting our sights more squarely on prevention?
Keep up with Heroin Uncut: Thanks for coming on board. Don’t forget to check out our webpage at HeroinUncut.com. Most importantly, subscribe to the Heroin Uncut podcast on iTunes, Google Play or the New Jersey 101.5 app.
Heroin Uncut is sponsored by Carrier Clinic, providing behavioral healthcare services in New Jersey since 1910.
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