Dead Addicts Don’t Get Better

More than 350 Long Islanders lost their lives to accidental overdose last year – about one per day. Nationwide, someone dies of an overdose every 19 minutes and countless others survive, but suffer irreversible brain damage.

Last Friday was International Overdose Prevention Day, but if today is like every other day in recent memory, at least one Long Island family will begin making funeral plans for a loved one whose untreated addiction to prescription painkillers, heroin, methadone, cocaine, Xanax or some combination of drugs and alcohol claimed their life. More than 350 Long Islanders lost their lives to accidental overdose last year – about one per day. Nationwide, someone dies of an overdose every 19 minutes and countless others survive, but suffer irreversible brain damage.

Overdose fatalities involving prescription painkillers like OxyContin, Vicodin, Percocet and Fentanyl are three times what they were a decade ago. The misuse of these and a few other medications were responsible for 15,000 US deaths in 2008 and 475,000 emergency department visits in 2009. A whopping 12 million Americans reported using prescription painkillers non-medically in 2010 and an estimated two million more people will join their ranks in 2012.

The National Health Center for Health Statistics recently found that drug overdose has edged out car crashes to become the leading cause of accidental death in the US. If only there were something like say, seatbelts, or airbags or anti-lock brakes that could save someone who is careening through the pitch black tunnel of an overdose death. There is.

It’s a drug called called Naloxone, which is distributed under the brand name “Narcan.” Developed in the late 1960’s, Narcan immediately reverses opiate overdoses by blocking key brain receptors and counteracting life-threatening central nervous system and respiratory depression. The generic drug, which can be administered via a nasal spray or injection is not prone to abuse because it doesn’t get you high (in fact, it does just the opposite) and has no major side effects if administered in error. Addicts in the throes of overdose who get the drug will likely suffer significant withdrawal symptoms and they’re frequently pissed rather than thankful, but they’ll live to see another day.

Emergency departments and emergency medical technicians (EMTs) have dispensed Narcan for decades, but too many folks are dying waiting for an ambulance to arrive and in many cases, the 911 call happens long after the person has expired. Few non-medical people know about Narcan and it’s only available via prescription, though the federal Food and Drug Administration (FDA) held a hearing earlier this year to explore over-the-counter availability.  It costs less than $20 per dose.

Community access to Narcan happens now through a limited number of overdose prevention programs that train drug users and their families to recognize the signs of overdose, underscore the importance of immediately calling for medical help and equip them with life-saving Narcan kits. In February, the federal Centers for Disease Control and Prevention (CDC) released results from a survey of 48 such programs nationwide that detailed 10,000 overdose revivals since 1996. The New York State Department of Health has approved about 75 Opioid Overdose Prevention Programs to date, including one run by the Long Island Council on Alcoholism and Drug Dependence (LICADD), which so far has trained in excess of 300 community members, including two dozen residents of the Shinnecock Indian Reservation.

Those efforts got a boost in recent weeks as the Suffolk County Police Department kicked off a pilot program that put Narcan nasal sprays in the hands of 300 cops in the 4th, 6th and 7th Precincts. Sector cars often arrive on the scene well before ambulances and during a medical emergency, every second counts. The early results are mind-blowing: cops have revived three people in as many weeks. Those three people likely got the wake-up call of their lives and their families can arrange drug treatment, rather than a funeral.

Suffolk lawmakers led by Kara Hahn (D-Setauket), who voted unanimously to create the pilot program, should immediately expand it to include every sector car in the county. Nassau should do the same. School nurses across Long Island – particularly those working in high schools where prescription drug abuse is rampant – should be trained and given Narcan kits. Parents of addicted kids need access more than anyone else and drug users should be trained and equipped to help their friends.

Seventy percent of people who abuse prescription painkillers say they get them from family, friends or straight out of the medicine cabinet. Shouldn’t an overdose antidote like Narcan, which is safe, cheap and proven to save lives, be as easy to obtain? Why isn’t Narcan included in every first aid kit distributed across America?

New York has been pretty progressive on this issue. State lawmakers approved a bill in 2006 that allows non-medical folks to administer Narcan and extends good samaritan protections to those who use the drug in good faith. The Legislature also approved a measure last year that provides for limited immunity from prosecution for certain drug offenses when someone calls for help during an overdose.

We’re also beginning see an awakening at a national level. Even Obama’s drug czar, Gil Kerlikowske, who as a former police chief is a law-and-order kind of guy, recently spoke out in favor of increased access to Narcan. “The Administration supports the use of naloxone by public health and law enforcement professionals because we have seen how effective the drug can be,” he told a group in North Carolina last week.

So, with questions about potential liability, safety and costs handily addressed, what’s the hold-up? It’s apathy more than opposition, though a few naysayers have suggested that educating drug users about overdose and giving them Narcan will leave them a false sense of security and encourage them to use more drugs. That’s the same mindset that allowed HIV/AIDS to kill hundreds of thousands of Americans as we bickered about whether a piece of latex would encourage people to become promiscuous. Think about it. We don’t all drive faster because our cars are equipped with airbags, nor do we eat more Ring Dings because there’s an automated external defibrillator (AED) bolted to the wall in our corporate cafeteria.

Potentially avoiding death doesn’t encourage drug use any more than the fear of death stops it.  Addiction is an inherently irrational brain disease, but it’s also treatable and needn’t prove fatal. Too many families are losing the race against time as they beg, plead, and try to cajole their loved one into treatment for a disease whose calling card is massive denial. Too many young people never make it through the doors of a treatment center, never come face-to-face with a counselor and never get a shot at experiencing the miracle of recovery.

Given the enormity of the opiate crisis and recent advances in substance abuse prevention and addiction treatment, it’s easy to wonder whether getting an addict breathing again is the best we can do. Nope, but it’s certainly the least we can do.

Our Addicted Island Hits Rock Bottom

The seeds of addiction have been sewn into the Long Island community and its roots have firmly taken hold. At a time when Long Island as a whole could use an intervention, funding for critical programs is being cut. LICADD Director Jeffrey Reynolds examines needed policy changes to put our Island on the road to recovery.

If four people being shot dead in a pharmacy isn’t hitting rock bottom, I don’t know what is. As the victims – Jaime Taccetta, Raymond Ferguson, Jennifer Mejia, and Bryon Sheffield – are laid to rest, they join Courtney Sipes and Rebecca Twain Wright and countless others who are also victims of Long Island’s drug crisis.

Sipes was run down on Main Street in Smithtown in November, 2009 by a driver allegedly high on heroin. Wright was gardening in her Hempstead front lawn when she was mowed down by Kayla Gerdes who was allegedly high on Xanax. Factor in all the others who each year, are killed by drunk or high drivers, in workplace accidents, assaults and other incidents and the collateral damage associated with unfettered and untreated addiction becomes absolutely stunning.

Indeed, addiction has always torn apart families, disrupted workplaces, ruined lives and given its progressive nature, often proves fatal to the one with the disease. But now it seems that the wreckage can’t be contained behind closed doors where families quietly and privately suffer the consequences – and is spilling out into the public domain, sweeping unsuspecting folks into its path.

How bad has Long Island’s addiction gotten when you can’t even pick up a prescription, cross a street or walk out your front door without being in danger? Or better yet, how bad does it need to get before we do something?

Pretty bad, it seems. After all, we’ve been talking about Long Island’s heroin crisis for years and the connection to prescription meds has been clear from day one. Addicts make the move to heroin from more expensive prescription meds once they figure out that 80mg of OxyContin costs $40-$50 on the street, while heroin runs just $10 per bag. Despite the media attention, school-sponsored parent workshops, legislative forums, educational campaigns and ambitious policy recommendations from blue ribbon panels like the Suffolk County Heroin and Opiate Task Force, not much has changed.

Arrests and overdoses continue to climb and the pain in our community is palpable, ironically due in large part to the misuse and diversion of prescription meds. That’s not to say that we should restrict access to medications that give chronic pain sufferers some relief and increased quality of life. As our population ages, we needn’t go back to dark ages, but we do need to get serious about a drug crisis that is claiming far too many lives. Here’s how:

  • Opiates are controlled substances. Control them. Prosecute the bad doctors that sell prescriptions and run pill mills. Convict them, take their licenses and sentence them like street drug dealers.
  • Educate, train and support the other 99.9% of doctors and physician assistants who try to do the right thing, but are often fooled by addicts who are charming, demanding and laser-focused on getting their fix.
  • Limit doctor shopping and pharmacy hopping by strengthening the prescription drug monitoring database to include real-time updates and give access to pharmacists. This database already exists, but is updated just monthly and only physicians – with limited time on their hands – have access to the information.
  • It’s time to reign-in the burgeoning pain management industry. The good guys will tell you that they can spot drug-seeking behavior a mile away, are willing to turn patients away, even if police intervention is required and they perform routine drug testing of patients. If you’ve been given a thirty-day supply of Vicodin and a quick urine test reveals that you’ve got none in your system or other drugs are present, then it’s time for a conversation.
  • National surveys suggest that 77% of those under the age of 25 get their first taste of prescription painkillers from their parents’ medicine cabinet, a friend or relative. How about we enforce state law requiring pharmacists to counsel patients picking-up prescriptions about the proper use and storage of medications? As consumers, we waive counseling when we sign that log at the pharmacy desk. A simple question from a pharmacist or pharmacy tech about whether there are teenagers in the home, along with a sentence or two about the addictive properties of opiate painkillers could go a long way.
  • OxyContin, Vicodin and other opioids are used to treat pain and are quickly replacing alcohol and marijuana as the drug of choice among adolescents. Being a teen has never been easy and kids have always done unsafe, unhealthy things, but we need to figure out why adolescence has become so damn difficult that our young people are turning to the strongest painkillers known to man to relieve the suffering. And by the way, how about we stop allowing pharmaceutical companies to promote expensive pills as a solution for everything from impotence to anxiety to difficulty urinating? 
  • Just as substance abuse is 100% preventable, addiction is treatable. Despite all the attention to heroin, drug treatment slots have not grown in recent years. In fact, they’re shrinking thanks to state budget cuts and an unprecedented demand for assistance. The Baldwin Council Against Drug Abuse, for example, is in the process of shutting down and two other drug treatment providers in Nassau will likely suffer the same fate before Summer’s end. Surviving agencies report long waiting lists and an unprecedented demand for help. We need to make treatment on demand a reality.

Without intervention and treatment, addiction is a progressive disease that often proves fatal. It gets worse as time goes on. It deepens and becomes more intractable. The risks to health, safety and well-being multiply and the consequences worsen. That’s where we are here on Long Island right now.

While accused Medford gunman David Laffer and his wife Melinda Brady have denied that they’re addicts, the storyline sounds far-fetched and may change at trial. Struggling with dependency, though, doesn’t earn them a free pass and if convicted they should be punished accordingly. The Medford murders do, however, remind us that our continued denial and collective failure to adequately address what has become Long Island’s top public health problem places each and every one of us at risk.