The rising number of fatal heroin overdoses can be slowed by expanding use of an anti-overdose medication and engaging doctors more in helping their patients who have become addicted, experts told Madison County leaders Thursday.
Dr. Kelly Gable with the Southern Illinois University Edwardsville School of Pharmacy detailed the ongoing heroin epidemic, and lauded Illinois’ progress in combating overdose mortality as compared to other states, such as Missouri.
Gable spoke as part of the Heroin Task Force, which has been having workshops and seminars for health providers, law enforcement and social service workers to educate them and the public about heroin and its treatment.
Drug overdoses now kill more people in the U.S. than car crashes, Gable said, and the number of women overdosing on opioids has risen 415 percent from 1999 to 2010.
As of this week, Madison County has had 56 fatal overdoses this year, according to County Coroner Steve Nonn. Of those, 43 were caused by heroin.
The danger in an overdose from an opioid such as heroin is respiratory depression — it makes you stop breathing, which is why it is more dangerous to overdose on heroin than a stimulant like cocaine, Gable said.
About 80 percent of heroin addicts start with prescription drugs, Gable said. Major reasons they begin using substances include self-medication, sometimes for pain, sometimes for mental health conditions. Most are legitimate prescriptions, though sometimes they are “shared” for free by family and friends.
People self-medicate because they want to be well. Sometimes this is an easier way to do it, because our health-care system has failed them.
Dr. Kelly Gable, SIUE School of Pharmacy
“People self-medicate because they want to be well,” Gable said. “Sometimes this is an easier way to do it, because our health-care system has failed them.”
For example, Gable said, a 53-year-old man was diagnosed with prostate cancer with bone metastasis. During his chemotherapy treatment, he was prescribed the opioid OxyContin and oxycodone for pain. His wife found him unresponsive on the couch.
“He was getting enough opioid to be fatal,” Gable said.
What could have helped him? Naloxone, also known as Narcan, an anti-overdose medication that Illinois now allows to be used by non-medical personnel, allowing addicts and their families to keep the treatment around in case of an emergency. In some states, including Missouri, these drug can only be administered by a doctor.
Overdoses become more likely when prescription pills and heroin are mixed, when the patient is receiving prescriptions from multiple doctors, has other illnesses such as heart disease, or has recently been incarcerated for drug charges without treatment — they are released with a lower tolerance than they had when they went in, and are more likely to have a fatal overdose.
Naloxone is not a new treatment, Gable said. “It has been in the U.S. since the 1970s. The controversy becomes, how accessible should this drug be to the layperson?” In places where it has become common, she said, overdose deaths dropped as much as 42 percent.
Sean O’Bannon, a graduate pharmacy student at SIUE, said naloxone cannot hurt someone who hasn’t overdosed, but can save the life of someone who has.
He said if an addict does not respond to yelling his name, has blue lips, slow or nonexistent breathing and remains limp, the person should call 911, perform mouth-to-mouth resuscitation if there is no breathing, and administer naloxone through the nose or through injection.
It works within two minutes, Gable said, but it also can cost as much as $600, thus it is not covered by Medicaid in many cases. Insurance will often cover only part of the cost.
Madison County State’s Attorney Tom Gibbons said police officers have sometimes been resistant to carrying the drug, as they are not paramedics and may not be comfortable administering medical treatment. But now the drug is available in a self-injecting device similar to an Epi-Pen used by people with severe allergies, which may alleviate their hesitations, Gibbons said.
The self-injecting device is available in a free trainer to help law enforcement and others comfortable with using it, O’Bannon said.
Naloxone is a medication used to reverse the effects of opioids, especially in an overdose. Naloxone may be combined within the same pill as an opioid, to decrease the risk of misuse. When given intravenously, it works within two minutes and when injected into a muscle it works within five minutes. The effects of naloxone last about half an hour to an hour. Multiple doses may be required as the duration of action of most opioids is greater than that of naloxone.
Another issue faced in treatment: doctors dropping patients as soon as they are determined to have an addiction.
A 34-year-old woman had chronic back pain from a car accident and was prescribed multiple painkillers, including OxyContin. She ended up on heroin, at which point her doctor released her from treatment. Now she is using heroin daily.
“At the time she needed the most help, they dropped her off a cliff,” Gibbons said.
Some in the audience said doctors have fear of losing their license or being sued, and thus disassociate themselves as quickly as possible when a patient becomes addicted to drugs. Gibbons said the last statistics he saw showed that Madison County in particular has a higher rate of narcotic prescriptions than the general public.
Warning signs of prescription drug abuse include frequently running out of or losing medications, prescriptions from multiple doctors or filling them at multiple pharmacies, or claiming to have allergies to all alternatives except the addictive prescription.
The task force has been going for more than a year, but has not issued specific findings. Gibbons said its purpose is to continue education and share information.
“We have all been learning, and the things we’re learning are already translating into action,” Gibbons said. Presentations by task force members to schools, community organizations and juvenile diversion programs have included the information they have learned in task force sessions, he said.