Overdose rate inspires antidote distribution

Local hospitals fight rising overdose fatalities, supply outgoing patients with drug Naloxone

Senior Staff Writer
Wednesday, September 24, 2014

Rhode Island, Miriam and Newport Hospitals have begun to distribute naloxone — an opioid-overdose antidote — in kits provided to discharged patients admitted for overdoses, according to a Sept. 12 Rhode Island Hospital press release. This move comes as part of the larger initiative to increase the availability of naloxone statewide in the face of an epidemic of overdoses on the class of drugs, which includes heroin, oxycontin, fentanyl and other prescription painkillers.

The drug Naloxone — also known by its brand name Narcan — is not new, but Rhode Island’s opioid addiction problem is. Drug overdose is now the most common cause of accidental death in the state, The Herald previously reported. Over 140 people in the state died during the first six months of 2014 from an accidental overdose.

Rhode Island has “a really huge prescription drug and heroin addiction problem,” said Kristin Gourlay, a health care reporter for Rhode Island Public Radio. “It’s bad here.”

Josiah Rich, professor of medicine and epidemiology  and attending physcian at Miriam Hospital, cited the role of the pharmaceutical industry in increasing the amount of prescription drugs on the market and the prescribing practices of doctors as two factors contributing to the wider availability of opioids. Both of these could also contribute to the spike in the number overdoses, he said.

Heroin generally costs less than prescription drugs, so people addicted to opioids turn to it as an alternative for financial reasons, Rich said.

The spike in overdoses has spurred a range of responses, which include the greater distribution of naloxone and development of the state’s Prescription Drug Monitoring Program.

Naloxone restores consciousness and normal breathing in an individual experiencing an overdose. The drug ­­— which can be administered intravenously, intranasally, or via injection ­— has no negative side effects and will have no effect on a patient who has not overdosed. With distributions by hospital personnel, pharmacists, volunteers at state prison programs and law enforcement officials, it has become more widely available to at-risk populations.Walgreens and CVS Pharmacy do not require a prescription to buy naloxone.

Since the drug is not covered by all health insurance policies, providing naloxone in hospitals can be challenging financially, Gourlay said.

“It is a cost, but they’re willing to absorb it with the hope that they’ll be able to save a life,” said James McDonald, chief administrative officer of the Rhode Island Board of Medical Licensure and Discipline, referring to the hospitals’ decision to distribute naloxone.

The highest costs associated with overdoses are from hospitalizations and time spent in the intensive care unit, said Traci Green, assistant professor of emergency medicine and epidemiology.

The Care New England health system was the first in the state to begin administering naloxone through various programs at Kent Hospital and Butler Hospital — in Warwick and Providence, respectively — in August, according to a Care New England press release.

Prison programs across the state, such as the Preventing Overdose and Naloxone Intervention Program, have begun distributing naloxone upon release to help prevent relapse among formerly incarcerated individuals with a history of prescription drug addiction. Parolees who were regularly using opioids before incarceration have a decreased tolerance for the drugs since they stop using in prison. But this decreased tolerance heightens the risk of overdosing if parolees resume their former levels of use, Rich said.

State police have been encouraged to carry the drug with them while on duty, and more officers are being trained to administer the antidote, the Providence Journal reported.

The Good Samaritan Law, passed in June 2012, provides immunity to individuals present at the scene of an overdose when police arrive in order to incentivize people to call emergency medical responders.“The trouble is, it’s not being applied uniformly,” Gourlay said. “It’s going to take some change in the culture.”

Distributing naloxone becomes “a bridge to treatment,” Green said. Even though not all patients will enter a treatment program after receiving naloxone, it might be an incentive for them to consider getting help for their addiction, she said.

Both U.S. Sen. Jack Reed, D-R.I., and U.S. Sen. Sheldon Whitehouse, D-R.I., have sponsored bills to increase resources for addiction programs. Reed’s bill focuses on increasing nationwide availability of naloxone, whereas Whitehouse’s bill attempts to address broader issues of addiction by increasing funding for programs, RIPR reported.

Though federal funding for programs to increase the availability of naloxone and counteract the addiction epidemic is “wonderful and necessary,” Green said, “we risk being cut out at some point … at the whim of politicians.”

One aspect of Whitehouse’s bill provides funding for states to improve their prescription drug monitoring programs and databases. Rhode Island’s database, which is managed by the Department of Health, is two years old but has not been as widely used as the department would like, McDonald said.

Only 39 percent of clinicians who can prescribe a controlled substance in Rhode Island are registered to use the database, McDonald said. Clinicians are now required to register for the database when they renew their licenses to prescribe opioids and other drugs in its class. But this does not ensure that providers will check the database before prescribing, McDonald added.

The Department of Health estimates that clinicians look at the database less than 10 percent of the time when writing a prescription, McDonald said. “It’s been two years of asking nicely, and there might come a point where we need to require it,” she said.

The database does not have a steady source of funding from the state, Gourlay said, adding that more money would enable the Department of Health to make it more user-friendly and attractive to doctors.

Information about the black market or the use of illegal drugs, such as heroin, is not captured in the database, Gourlay said, adding that the database is “not a silver bullet.”

Decreasing the stigma associated with addiction and finding new ways to treat pain will be critical parts of turning the tide on the overdose epidemic, McDonald said.

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  1. Are the overdoses suicide attempts ?

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