Narcan access saving lives — Stronger drugs call for strong weapon
Photo by Matthew T Rader on Unsplash
BY JAIMIE JULIA WINTERS
If the overdose reversal drug Naloxone had been available in 2012, Donna Andelora’s son may be alive today. On Dec. 21, 2012, after a year of sobriety following years of battling a heroin addiction, Joey Andelora overdosed in the family’s home bathroom in Wayne. He died two days later.
What started out experimenting with OxyContin from his friend’s medicine cabinet while in high school turned into an everyday battle with addiction from that day on, Donna Andelora said.
“First it was the pills. Then when he couldn’t raid people’s medicine cabinets and the pills on the street were too expensive, he started with heroin,” she said.
In and out of rehab centers, one in Florida finally made an impact and Joey had just marked a year of sobriety when he flew back before Christmas in 2012 to see his ailing grandmother.
Donna Andelora overheard her son and daughter talking, when her daughter suggested taking it one day at a time. Joey responded, “It’s one [expletive] minute at a time for me,’” she said.
Donna contends that if she had Narcan, an “opioid antagonist” used by police, EMS and now the public at large, to counter the effects of opioid overdose, she could have saved his life that day.
“It wasn’t available back then,” she said.
Soon after Joey’s death, Donna Andelora formed Lost Angels based in Passaic and Essex counties for parents and families who have lost a child specifically to addiction after finding that other grief groups didn’t give her the comfort she sought. She also speaks to parents and at schools — her first piece of advice is urging parents to get opioids out of the medicine cabinet and into the trash.
THE GOOD, THE BAD
While opioid prescription dispensing is way down in Essex County, from 304,498 dispensations in 2018 to just 46,486 as of July this year according to the NJ Department of Health, the number of Naloxone deployments used by police and EMS to reverse an overdose is on the rise.
In Montclair, the number of overdoses responded to by police and EMS rose by 3 percent last year, while the number of Naloxone administrations almost tripled, according to numbers provided by the attorney generals’ office.
Heroin and prescription opioids like Oxycontin, fentanyl, morphine, Vicodin and Percocet affect the body’s central nervous system, which slows breathing, blood pressure and heart rate, and in turn reduces body temperature and can lead to death. Naloxone reverses the overdose effects in people who have been prescribed opioid pain medication and in people who use heroin and morphine, and can be administered by anyone as a nose spray.
The drug has been used to treat opiate overdoses since 1971, when it was approved by the U.S. Food and Drug Administration. But it wasn’t until 2014 that police and EMT responders began carrying it and administering when responding to drug overdoses.
In Montclair, the number of Narcan deployments by police and EMS personnel dropped from 22 in 2017 to 11 last year.
However, during the first seven months of 2019, police and EMS personnel have already administered it 30 times, according to numbers supplied by the attorney general’s office.
But those numbers could be deceiving, says Sgt. Charles Cunningham, who heads the Montclair Police Department’s Narcotics Division, and could represent stronger drugs that require multiple deployments to bring an overdose patient back.
According to Naloxone Deployment Reports supplied to Montclair Local, patients are now regularly requiring more than one dosage — in one case as high as seven, with most at two dosages this year. In 2017, most patients only required one deployment of Narcan to reverse the effects of opioids. In 2018, most patients began requiring two doses.
In addition, patients are also taking more time to overcome the overdose once Narcan is administered — in 2017 it averaged one to three minutes, it now takes three to five minutes or more, according to the reports.
STRONGER STREET DRUGS
Stats from the federal Centers for Disease Control show that Montclair has seen an 8.5 percent increase in overdoses over a five-year period, and a 3 percent increase from 2017 to 2018 alone. Of those overdoses, 13 to 25 percent of the patients took synthetic opioids or fentanyl. Fentanyl, an opioid prescribed only for those in the last stages of chronic illnesses due to its high rate of addictiveness, is now being cut into heroin and killing people at an alarming rate in New Jersey, said Cunningham.
It’s cheap and gives a higher high, a win-win in the drug world, said Cunningham.
“Cutting Fentanyl into the drug increases the dealer’s profit and gets the user higher who is ‘chasing the dragon,' chasing that next level of high,” said Cunningham.
Mixed with heroin and then injected or snorted by addicts hoping to reach a new high, fentanyl is linked to 44 percent of overdose deaths nationwide.
Changes in state law in 2017 allowed any state-licensed pharmacist in good standing to apply for a standing order from the Department of Health to dispense Naloxone without a prescription.
“Standing orders allow pharmacists to dispense naloxone to individuals at risk of an overdose or to an individual who wants to administer it to a loved one or someone in an emergency,” said Judith Persichilli, acting commissioner at the state Department of Health.
Roughly 450 pharmacies, including those at ShopRite, Wegmans, Costco, CVS and Rite Aid, can dispense the anecdote without a prescription. The seven Harm Reduction Centers located throughout the state — the closest being the North Jersey Community Research Initiative in Newark — also dispense naloxone without a prescription.
Narcan deployments by family members are saving lives. Five incidents have been recorded in Montclair in 2019 in which naloxone had already been administered by a loved one prior to police coming on the scene. In 2018, there was only one incident of personal use of naloxone.
Whether the availability of naloxone and an easy access to a drug overdose reversal is increasing users’ decision to take more drugs is up in the air.
“That would be an unfortunate byproduct of its availability if that was the case,” said Cunningham.
Although many insurance plans and Medicaid and Medicare now cover brands like Narcan, the cost can be prohibitive — $130 to $140 for a kit that includes one to two doses. And if the number of deployments per patient increases, it can become costly for municipalities as well.
On June 18, in the largest single-day public distribution of free naloxone in the country, the New Jersey Department of Human Services distributed more than 32,000 free doses to 16,000 residents statewide to help them be prepared to respond to an overdose.
“Parents, friends, and neighbors from across the state came out on our Free Naloxone Day to be part of the solution and are now better prepared to stop overdoses and save lives,” said Carole Johnson, commissioner of the state DHS.
While most overdose patients now live whether it’s through a loved one administering the Naloxone, or police and EMS now having it on hand, reports stated that a 53-year-old Montclair woman did die in November 2018.
On June 24, the health commissioner issued a directive to authorize paramedics to carry buprenorphine, an oral medication used to mitigate what can be severe symptoms of opioid withdrawal after a Naloxone reversal. EMS can — but are not required to — stock the medication.
And the decreasing number of opioids being prescribed is creating fewer drug addicts, said Cunningham.
The patient who visits his doctor for a football injury or back pain and gets an opioid prescription can easily become an addict. When the doctor stops prescribing, some resort to buying the pills on the street. Street value for pills are can go as high as $60 for an OxyContin pill, while a dose of heroin is much cheaper at most $20 a hit, but gives the same effect. Addiction is a disease of the brain and the disease can take over anyone’s life, he said.
Cunningham’s team of three narcotic detectives follow up with every overdose victim, and investigate every death by overdose. Help is offered through resource groups such as the Essex County Opioid Task Force and the Essex Health and Wellness Recovery Center who try to place the patient in an addiction facility. An attempt is also made to get information on how the drug — usually heroin — was obtained.
“A detective is always assigned to the case. Help is always offered but they don’t always take it,” said Cunningham.
Joey would have been 29 this year. “He fought his battle bravely with everything he had and always with a smile,” said Donna Andelora.
While Lost Angels started out with a few parents in 2013, the group now has about 60 members.
“Addiction doesn’t discriminate,” Cunningham said.