Naloxone is a prescription drug that can reverse the effects of a heroin overdose in users in a matter of minutes. If administered in time, naloxone can even save a patient’s life. The news of naloxone’s approval and effectiveness came at a crucial time for New Jersey. In July 2015, NJ.com wrote that the death rate from the opioid epidemic in New Jersey was more than three times the national rate. In some parts of the state, the rate is more than seven times the average.
If all the heroin users in New Jersey lived in the same place, the area would account for the fourth largest city in the Garden State. That is the scope of the opioid epidemic in the most densely populated state in the country, and one that has galvanized local and state officials to think of new and innovative ways to fight back. Public and private services have taken to offering naloxone to help combat the spate of heroin overdoses in the state. How New Jersey responds to the largest public health crisis in America might indicate how the rest of the country would fare.
The Naloxone Miracle
The Centers for Disease Control explains that naloxone is a prescription drug that can reverse the effects of a heroin overdose in users in a matter of minutes. If administered in time, naloxone can even save a patient’s life.1 As an opioid antagonist, naloxone blocks the overdose effects of opioids on the central nervous system and the respiratory system, whether those opioids are illegal narcotics like heroin or prescription drugs like oxycodone and buprenorphine.2,3
The CDC strongly advocated that caregivers and emergency response teams, especially those operating in rural areas, use naloxone when treating patients undergoing opioid overdose. Researchers claim that the drug is one of the most cost-effective forms of acute medical treatment that can be found, and it is virtually risk-free for the patient, the first responder, or caregiver, or even for some who accidentally receives an unnecessary dose (naloxone will have no effect on someone not under the influence of opioids).
North Jersey News writes of a study of a state-supported naloxone pilot distribution program in Quincy, Massachusetts, that found the drug was 98 percent effective when used to revive a person who had overdosed on heroin. Quincy police officers have been carrying naloxone in a nasal spray form since 2010. In July 2013, they reported having used it 179 times, successfully reversing 170 overdoses (and saving the lives of the people who were at death’s door) – a success rate of 95 percent.4
A doctor and former paramedic tells NJ.com that the use of naloxone is “truly a no brainer,” saying that depriving police and emergency medical personnel of it will lead to patients dying.5
The drug was 98 percent effective
Treating the Epidemic
In November 2015, the Food and Drug Administration moved to approve Narcan, a naloxone nasal spray solution, as a method of naloxone administration (in addition to previously approved injectable forms of the drug). With Narcan, a single shot is sprayed into each nasal cavity.6 The first responders and primary caregivers who had been using naloxone in syringes made the case that the nasal spray form was easier to deliver and cut down on the risk of using syringes. This led to many unapproved naloxone kits being used, which prompted the FDA to step in and approve a product that they found met their standards.7
The news of naloxone’s approval and effectiveness came at a crucial time for New Jersey. In July 2015, NJ.com wrote that the death rate from the opioid epidemic in New Jersey was more than three times the national rate. In some parts of the state, the rate is more than seven times the average. “A heroin epidemic is plaguing New Jersey,” says Vice News; heroin is the “deadly secret” of New Jersey’s suburbs, says North Jersey News.8,9
The New Jersey Department of Health reported that more people have succumbed to heroin overdoses than have died as a result of:
- Car accidents
The first responders and primary caregivers who had been using naloxone in syringes made the case that the nasal spray form was easier to deliver and cut down on the risk of using syringes.
Reversing what would otherwise have been 200 fatal overdoses
But naloxone (and Narcan) offer the best weapon against the crisis, to the point where another NJ.com article says that the drug is working “brilliantly,” reversing what would otherwise have been 200 fatal overdoses in Monmouth and Ocean Counties over a period of seven months.
However, such is the depth of New Jersey’s heroin problem that even those 200 success stories were considered a failure for their inability to make a significant impact on the larger picture.
One way the state of New Jersey has tried to get more people trusting the police officers who respond to a 911 call about a heroin overdose in progress is to offer immunity from arrest to the people making the call, even if they are found with heroin in their possession. The “Good Samaritan Emergency Response Act” signaled a reversal of position by Governor Chris Christie, who had initially vetoed a similar bill because it did little to offer any kind of deterrent to the larger issue of substance abuse. But hundreds of grieving parents of teenagers and young adults who overdosed on heroin pressed Christie to change his mind.
The result is statewide legislation that protects people calling 911 from being arrested or prosecuted for having and using drugs, which proponents say will encourage more people to go to the authorities for help and not risk an overdose for fear that calling 911 will lead to criminal penalties.11
…more than 40 such cases were successfully treated
Christie called the expansion of the Narcan program the best step forward in what has otherwise been an “abject failure” in the decades-long War on Drugs. In March 2014, 28,000 emergency medical technicians and police officers were approved to carry and use Narcan when responding to calls related to heroin overdoses. Between April and June 2014, said Christie, more than 40 such cases were successfully treated.
Addressing concerns that while Narcan saves lives, it only makes a dent in the bigger opioid epidemic, the governor’s task force on heroin abuse also introduced a number of reforms that target the factors that give rise to the illicit opioid market in New Jersey. Changes include reforming the state’s prescription pill monitoring system, where people who cannot afford to take more of the prescription medications, to which they’ve become addicted, resort to using heroin to achieve the same effects (at a much greater cost).12
CVS and Walgreens
Private organizations have also joined the fight. As of May 2016, two major pharmaceutical chains in New Jersey have announced that their branches will not require a prescription for a client to purchase naloxone. In pointing out that over 44,000 people die from drug overdoses every year in the United States – and how most of those deaths are the result of opioid overdoses – the vice president of pharmacy professional practices at CVS said that the role in saving lives is what prompted the CVS brand to provide prescription-free access to naloxone as a “safe and effective antidote.”13
The New Jersey state director of the Drug Policy Alliance applauded CVS’s decision to eliminate the “barrier” of a prescription to getting a medication that can bring an overdosing patient back from the brink of death in literally minutes.
Similarly, in May 2016, Walgreens announced in a press release that their 190+ locations in New Jersey will now make naloxone “more accessible and easier to obtain,” because families and caregivers would no longer need a prescription to have the medication on hand.14
Want Heroin Treatment in New Jersey? Get Arrested.’
While a lot of good work has been done in bringing the opioid crisis to the forefront of conversation in New Jersey, and while Narcan saves lives and expanded drug court programs give people second chances, advocates wonder about why people have to wait for months to get into public drug treatment programs, and why the efforts to raise Medicaid rates have been delayed.
“Want Heroin Treatment in N.J? Get Arrested.”
The New Jersey director for Drug Policy Alliance argues that even as drug courts have broadened their scopes, a person still needs to be charged with a crime in order to reap their benefits. “You shouldn’t have to be arrested to get treatment,” she says, pointing out that if people received counseling services before drug courts were needed, then they wouldn’t need to be in the criminal justice system at all.
In the words of a headline from NJ.com, “Want Heroin Treatment in N.J? Get Arrested.”15
Likewise, the president of the New Jersey Association of Mental Health and Addiction Agencies praised what Christie has done for shining more light on the treatment of drug addiction as an issue of public health and offering chances for nonviolent offenders to rehabilitate themselves. But she notes that caregivers and healthcare professionals who are tasked with helping low-income and uninsured people in New Jersey have been waiting for years for the state to raise Medicaid reimbursement costs, notwithstanding Christie embracing the Medicaid expansions covered by the Affordable Care Act.16
Big Problems for a Small State
New Jersey’s government estimates that approximately 40 percent of the 79,000 who needed substance abuse treatment in 2014 did not receive any. The situation has led some observers in New Jersey to express that the praise Chris Christie has received for his efforts is “misplaced.”17
The point is echoed by State Senator Joe Vitale, who the Washington Postcalls “one of the New Jersey legislature’s most persistent treatment advocates.” Vitale says that notwithstanding Christie’s efforts to increase the scope of treatment in New Jersey, treatment centers do not have the funding they need to increase the number of beds they can offer. Other people in New Jersey complain that their insurance does not give them access to substance abuse treatment, which the Affordable Care Act was expected to fix with its implementation of the Mental Health Parity Act (that mandated that insurers had to treat addiction-related claims as they would any other medical condition).18
40% of the 79,000 that needed substance abuse treatment in 2014 did not receive any
Herointown, New Jersey
At the center of the celebration of Narcan expansion, and the debate about funding treatment programs, is the people whose heroin and opioid admissions account for 49 percent of all the substance abuse treatments in New Jersey – the population NJ.com says would make up the hypothetical city of “Herointown,” and would constitute the fourth largest city in the state.19 The figure of opioid users making up 49 percent of all drug addiction treatment admissions is the highest in at least a decade, NJ.com found, also pointing out that private insurance was able to cover only 10 percent of those admissions in 2014. Despite the demand for heroin treatment “soaring” in New Jersey, healthcare professionals have said that most people do not have the means or the insurance to pay for treatment.20
One resident of Herointown tells NJ.com that after serving 30 years for armed robbery which he committed to keep his heroin habit going, he was “struck by the ubiquity” of the drug upon his release. Heroin destroys not only lives, he says, but entire communities.
In Herointown, prescription pills are legally prescribed and easily obtained. That, says the Monmouth County Prosecutor, is the root of the opioid crisis that has swept over towns, cities, and counties across the United States. People take the medication for legitimate reasons and get hooked, sometimes upping their doses because they assume that there’s no risk involved in taking more of what their doctor told them to take. Doctors write out hundreds of prescriptions, perhaps because they have a massive list of patients they need to get through, perhaps because they think that most problems can be solved by a dose of OxyContin, perhaps because they receive huge bonuses from the pharmaceutical companies that manufacture and distribute the drugs. Other people get the drugs from friends and family as a substitute for heroin, and then find themselves pulled deeper and deeper into the addiction spiral.
When the prescription drugs run out (because doctors stop prescribing them, or they become too expensive), the desperation sets in – the desperation to feel the euphoric bliss of a hit at any cost, no matter how much it costs. Herointown’s residents cut deals with street dealers, they sell their cars, they gamble, they drop out of school, they don’t go into work anymore; they watch their whole lives fall to pieces, and they dive deeper into the heroin to make the pain go away.
Heroin costs $5 a bag, less than an order at McDonald’s; or, as NJ.com puts it, an “economically sound alternative” for someone hooked on the opioid rush who can’t afford their OxyContin or hydrocodone anymore.
Is Naloxone ‘A Way Out’?
Naloxone might be what cures Herointown of its plague, but notwithstanding its effectiveness and high-level support, there is still some uncertainty about how it can fight back against the opioid nightmare. In reporting that CVS pharmacies are offering naloxone without a prescription, a local news agency in Wayne, New Jersey, found some people weren’t too sure about it. They were concerned that having naloxone so easy to purchase might encourage a heroin user to maintain their addiction “because now they have a way out.”21
That was the reasoning behind Paul LePage, the Governor of Maine, vetoing a bill that would have approved first responders and relatives of addicts to use Narcan in the event of an opioid overdose. LePage argued that authorizing widespread distribution of naloxone would give drug users a false sense of security, even as NPR reports that for “several years,” the number of drug overdose deaths in Maine have come close to, or even exceeded, the number of fatal traffic incidents.22
But in May 2016, lawmakers in Maine overrode LePage’s veto, listening to the opinion of treatment experts who rejected fears that naloxone would be used as an enabling drug.
The number of drug overdose deaths in Maine was on par with that of fatal traffic incidents
The vice president of addiction treatment at a mental health and substance abuse treatment organization in Massachusetts touted Narcan as something that opioid users need to live long enough to get into recovery. Curbing access to naloxone could be the difference between bringing someone back from the brink of death and chalking up another statistic in the opioid epidemic.23
“Death,” says the vice president,” is not an appropriate consequence for having a disease.”
Rethinking Addiction and How to Treat It
The point was echoed by Brenda Wilson, a pharmacist speaking at a substance abuse forum in Kentucky, where over 1,000 people overdosed on opioids in 2014.24 In praising naloxone for being a “safe and effective antidote” that can have a “substantial impact” on saving people from dying as a result of overdosing on opioids, Wilson pointed out that advocating for wider availability of naloxone is not enabling heroin addicts; overdoses can happen to anyone who is taking a form of opioid, whether that opioid comes in a bag sold on a street corner or a bottle at a pharmacy, legally purchased with a doctor’s prescription.25
One reason behind Governor Paul LePage’s opposition to naloxone, and the similar sentiments expressed by the people outside the CVS pharmacy in Wayne, New Jersey, might be a fundamental and long-dispelled misunderstanding about the nature of drug addiction. For more than a generation, it was believed that substance abuse was the result of a moral failing, a weakness of willpower and character. Modern understandings of psychology and science have changed that paradigm, to the point of realizing that addiction is similar to any number of other chronic diseases that also have behavioral components; in the same way that a diabetic who has to give up sugar will always face the temptation to indulge again, so too will a person looking to live a sober life after a heroin (or any other drug) problem.
Naloxone and the Bigger Picture of Addiction Treatment
Neither politicians nor the general public would withhold treatment options for a diabetic person who was struggling to maintain a healthier diet; comparably, holding back naloxone for fear that it enables an addict does not appreciate the psychological damage done by the opioid abuse. Wilson, the pharmacist, stressed that while the initial decision to consume the drug may be voluntary (albeit compelled by various factors), the crux of the addiction is that the person has “limited ability to exert self-control” because of what the drug does to the areas of the brain that control judgment, decision-making, learning, and behavior.
the effects of the drug last for about 30-90 minutes
To the point of naloxone merely treating the symptom but not the disease, Wilson clarified that the effects of the drug last for about 30-90 minutes, so the user will not merely walk away from the experience. Upon naloxone-induced revival, urgent medical and mental health treatment has to be made part of the process, so that the overall intervention goes far beyond the initial lifeline of 30-90-minutes.
Drug abuse is a complicated and nuanced issue, especially when legitimate substances like prescription opioids can open the door to a world of misery, pain, and death. As heroin seeps into the suburbs and neighborhoods of New Jersey, a medication like naloxone can provide one of the best counters yet against the epidemic of people letting their lives slip away from them.
- How the DHS of NJ Addresses Addiction
- Syringe Access Programs
- Why Some Drugs Are Legal & Others Are Not
- Marijuana Legalization in New Jersey
- The National Fight against Opiate Addiction
- Drug Trafficking in the Northeast
- NJ’s Substance Abuse & Mental Health Treatment Industry
- Analyzing the Liquor Laws in the Garden State
- Public Perception on Substance Abuse Treatment
- Exorbitant Prescription Drugs Pricing
- Rates of Drug Use: Urban, Suburban, & Rural
- Curbing Online Sales of Synthetic & Herbal Drugs
- Prescription Painkillers: The New Gateway Drug
- Naloxone Offered in New Jersey
- The History of the Mafia’s in Atlantic City
- The Emergence of Drug Courts
- PTSD Caused by a Natural Disaster
- Evolution of Mental Health Treatment
- Exposing Pseudoscience in the Industry
- “Expanding Naloxone Use Could Reduce Drug Overdose Deaths and Save Lives.” (April 2014). Centers for Disease Control and Prevention. Accessed May 9, 2016.
- “Treating a Drug Overdose With Naloxone.” (n.d.) WebMD. Accessed May 9, 2016.
- “Naloxone Hydrochloride.” (n.d.) Drugs.com. Accessed May 9, 2016.
- “Heroin Overdose Antidote: Who in New Jersey Gets to Carry It?” (April 2014). North Jersey News. Accessed May 10, 2016.
- “Narcan Saving Hundreds Of Heroin Overdose Victims In N.J., But Leaves Addiction Untreated.” (November 2014). NJ.com. Accessed May 9, 2016.
- “What is Naloxone?” (April 2016). CNN. Accessed May 10, 2016.
- “FDA Moves Quickly To Approve Easy-To-Use Nasal Spray To Treat Opioid Overdose.” (November 2015). Food and Drug Administration. Accessed May 9, 2016.
- “A Heroin Epidemic is Plaguing New Jersey.” (April 2014). Vice News. Accessed May 10, 2016.
- “Heroin: Suburbia’s Deadly Secret.” (April 2015). North Jersey News. Accessed May 10, 2016.
- “N.J. Heroin-Related Death Rate Among Worst In The Country | Your Questions Answered.” (July 2015). NJ.com. Accessed May 9, 2016.
- “Christie, Inspired By Victims’ Parents And Bon Jovi, Signs ‘Good Samaritan’ Drug Overdose Bill.” (May 2013). NJ.com. Accessed May 10, 2016.
- “Christie Announces Expansion Of Program To Fight Heroin Addiction.” (June 2014). NJ.com. Accessed May 10, 2016.
- “CVS To Offer Anti-Overdose Drug Without Prescription At N.J. Locations.” (October 2015). NJ.com. Accessed May 10, 2016.
- “Walgreens Makes Life Saving Naloxone Available Without Prescription in New Jersey Pharmacies.” (May 2016). Walgreens. Accessed May 10, 2016.
- “Want Heroin Treatment in N.J? Get Arrested.” (January 2015). NJ.com. Accessed May 10, 2016.
- “Why Did Chris Christie Embrace Obamacare’s Expansion of Medicaid?” (December 2015). Forbes. Accessed May 10, 2016.
- “Praise for Chris Christie’s Approach on Drugs Misplaced, Some Say.” (December 2015). Huffington Post. Accessed May 10, 2016.
- “Chris Christie Continues To Talk About Drug Addiction on the Campaign Trail.” (November 2015). Washington Post. Accessed May 10, 2016.
- “Welcome to Herointown, New Jersey’s 4th Largest City.” (n.d.). NJ.com. Accessed May 10, 2016.
- “Heroin Treatment Demand Soaring in N.J, New Data Shows.” (May 2015). NJ.com. Accessed May 10, 2016.
- “How CVS Pharmacies Are Trying To Stop Fatal Heroin Overdoses With An Over-The-Counter Remedy.” (October 2015). PIX11. Accessed May 10, 2016.
- “It’s Proven to Save Lives, So Why Is Maine Opposed to Narcan?” (February 2014). NPR. Accessed May 10, 2016.
- “Maine Widens Access to Overdose Reversal Drug Naloxone.” (May 2016). FOX News. Accessed May 10, 2016.
- “Disparate States, a Common Horror.” (August 2015). Boston Globe. Accessed May 11, 2016.
- “Pharmacist Debunks Belief That Naloxone Enables Addicts.” (May 2016). Central Kentucky News. Accessed May 11, 2016.