Prince’s Death Spotlights Overdose Antidote Dilemma

Health officials find people saved by rescue drug often are in need of another rescue soon after

Six days before he died, Prince was treated with a dose of naloxone, also known as Narcan.
Six days before he died, Prince was treated with a dose of naloxone, also known as Narcan. PHOTO: KEVIN MAZUR/WIREIMAGE/GETTY IMAGES
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May 11, 2016 5:30 a.m. ET

Prince’s death last month from a possible opioid overdose highlights the challenge for health officials using the overdose-reversal medication naloxone: getting people saved from overdoses into addiction treatment.

Six days before he died, the 57-year-old musician overdosed on the painkiller Percocet while on a flight, forcing the plane to make an emergency landing in Moline, Ill., a law-enforcement official said. Hospital staff revived him with a dose of naloxone, also known as Narcan.

While the cause of Prince’s death remains unclear as authorities await toxicology results, Prince had what appeared to be prescription painkillers in his possession when he died at his home outside Minneapolis, the law-enforcement official said. Plans to get him help from an addiction specialist came too late.

 

Across the country, public health officials are embracing naloxone as a key life-saving tool in the opioid crisis. Thirty-nine states, including Illinois but not Minnesota, have laws allowing naloxone to be prescribed to third parties such as the friends and family of addicts, according to the Prescription Drug Abuse Policy System, which is funded by the National Institute on Drug Abuse.


One or more doses of naloxone, knock the opioids off brain receptors, generally restoring breathing within minutes to prevent brain damage or save a life. PHOTO: MEL EVANS/ASSOCIATED PRESS

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But despite greater access to the rescue drug, first responders and health officials around the U.S. say they are frustrated that the same people saved from death with naloxone can succumb quickly to yet another, sometimes fatal, overdose.

Following up on overdose rescues is “something that we need to figure out how to do better,” said Sharon Stancliff, medical director at the New York City-based Harm Reduction Coalition, an advocacy group for people and communities affected by drugs. “When people have one overdose, they’re at very high risk of having another one.”
Prescription opioids—like Vicodin, Percocet and OxyContin—affect the brain and the nervous system to relieve pain, typically between four and 12 hours, and can be highly addictive. But taken in excessive amounts, these drugs can suppress a person’s breathing until it eventually stops.

One or more doses of naloxone, by injection or nasal spray, knock the opioids off their receptors in the brain, generally restoring breathing within minutes to prevent brain damage or save a life. Naloxone begins to wear off in about 30 minutes and may be largely gone after 90 minutes.

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But the window of time immediately following revival with naloxone is particularly difficult for opioid addicts. Naloxone can trigger almost immediate, brutal withdrawal symptoms, including sweating and vomiting caused by the body’s craving for opioids.

Some addicts treated with naloxone turn combative, and may even seek opioids again to calm themselves and stave off withdrawal symptoms.

“We don’t have protocols for post-overdose” in emergency departments, said Traci Green, deputy director of the Boston Medical Center Injury Prevention Center. “You come in with a heart attack, and it’s very clear what to do when you discharge.”

Some communities hit hard by the opioid crisis are launching new programs aimed at connecting revived addicts with recovery services as soon as possible after an overdose.

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In Camden County, N.J., officials launched a program this year aimed at redressing two problems: the tendency of rescued addicts to leave the emergency department without a referral to treatment, and the difficulty in finding inpatient facilities quickly for those who do want it.

Under the program, which received $150,000 in funding from the county, users who were revived by naloxone are offered recovery services while still in the hospital.

If they agree, the county will pay for them to receive outpatient treatment—usually involving counseling and either methadone or buprenorphine, drugs used to wean addicts off opioids—until a spot at an inpatient center becomes available.

One success case earlier this year involved a 23-year-old man who was revived on three occasions with naloxone, and after the third time, agreed to seek treatment, said William Lynch, clinical pharmacist at Kennedy University Hospital in Cherry Hill, N.J., one of the participating medical centers. He received outpatient treatment for three weeks until a bed opened up.

“You don’t really know where is rock bottom for everybody,” Mr. Lynch said. “What’s key is that information is offered each and every time.”

Seth DeSantis, a 37-year-old from the Lowell, Mass., area, didn’t want to become another statistic. A doctor prescribed OxyContin to help him treat the pain he suffered after a 2001 motorcycle accident. He eventually began using illicit heroin and got hooked, overdosing four times since early March.

He was saved with naloxone each time, he says. His most recent overdose put him in a coma for several days, said Mr. DeSantis, and prompted his latest recovery effort. “I don’t want to die from this,” he said.

In Massachusetts, bulk purchasing allows cities to buy the rescue drug for $20 a dose, a steep discount from prices that could otherwise reach almost $67 a dose. Drug users, friends and family members in the state can also receive naloxone and training on how to use it.

In Lowell, a riverside city of about 110,000, ambulance company Trinity EMS Inc. reported 91 overdoses in the first quarter in which the person would have died within minutes without naloxone treatment, up 34% from the year-earlier period.

In 2015, Trinity counted 284 overdoses in Lowell where patients could die within minutes without naloxone treatment. Of these, 28 patients were listed twice by the company as being treated for an overdose, and two of them were listed three times. But Trinity doesn’t track if patients have overdosed outside its territory, which includes 13 towns and cities in Massachusetts and New Hampshire.

Lowell has had at least 27 suspected opioid-related deaths so far this year compared with 46 opioid deaths in all of 2015.

The city in February began using data collected through 911 calls to track people rescued with naloxone after they leave the hospital, then urge them into addiction treatment. The police, fire and health departments are all taking part, along with Lowell House Inc., a local treatment center.

“Instead of waiting for them to come to us, we’re going to find them,” Lowell Police Superintendent William Taylor said.

—Pervaiz Shallwani contributed to this article.

http://www.wsj.com/articles/princes-death-spotlights-overdose-antidote-dilemma-1462959001

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