For more than 40 years, there’s been a drug that can stop a heroin overdose in its tracks, if someone gives the drug in time.
And it turns out that the same drug works for patients who overdose on prescription painkillers such as morphine or OxyContin --drugs called opiods because they mimic the action of opium.
Patient advocates say many deaths from accidental overdoses of prescription painkillers or heroin could be averted simply and at little expense if there were wider distribution of a drug the drug called nalaxone, or its better known brand name of Narcan.
They're spreading the message in Florida, given the enormous toll in the state from opiod painkillers such as Oxycontin, morphine, and codeine.
Last month they received support from the Florida Board of Medicine, and now a Republican lawmaker from Sarasota has filed a bill, HB 155, to promote the issue.
Dr. Gary Reisfield, a University of Florida psychiatrist, says that prescription painkillers kill many times more people than heroin, although the street drug is making a comeback. Those who take opiods – whether legal or illegal -- should have naloxone on hand just in case, he says.
Naloxone is an injectable drug that saves lives by reviving overdose victims at home before paramedics arrive. But that’s not happening, Dr. Reisfield says:
“Here in Florida, take-home naloxone is scarcely available," he says. "I believe it is medically appropriate to use it and we can put a big dent in our mortality related to opiods if we make it more readily available. "
Dr. Reisfield took the issue to the Florida Board of Medicine last month at the request of Kelly Corredor. She runs a small advocacy group in Jacksonville, the Skeeterhawk Experiment, that’s committed to reducing the harm from prescription drugs.
“I'm actually a stay-at-home mom of twins," she said. "I used to practice law but I’ve been a mom for the last 3 years. This is a passion of mine, so this is my full-time gig right now.”
Step one, she says, is getting doctors to prescribe naloxone to patients at risk. Step two would allow doctors to prescribe naloxone to someone other than the patient – say, a mother. Or a close friend. That would require legislative action.
Twenty-five states have taken that step, says Daniel Wermeling, a pharmacy professor from University of Kentucky brought in to the Board of Medicine meeting as an expert witness. He says take-home naloxone is following the same path as that of a well-known antidote for severe allergic reactions, the Epi-Pen.
A Florida House member from Sarasota, Rep. Ray Pilon, has introduced a bill that would add Florida to the list of states authorizing take-home naloxone for use by Good Samaritans. But the bill may run into skepticism like that expressed by the chairman of the medical board, Dr. Nabil el-Sanadi.
“The only hesitation I have with allowing you to give prescriptions to lay people to give Narcan to people, that may actually encourage patients to use narcotics because they have the antidote, or their family has the antidote,” el-Sanadi said.
Not so, said Professor Wermeling. For one thing, Naloxone is not addictive, and for another, after it revives overdose victims, they usually throw up.
“With regard to encouraging abuse, that’s actually been proven not to be true," Wermeling said. "I’ll give an analogy for you to make it simple: As garlic is to vampires, naloxone is to addicts. It’s the worst experience you’ll have if you have opiods in your system.”
Several board members supported the idea of take-home naloxone. They heard a report in October about growing numbers of young people overdosing on heroin or pain pills.
“ I would encourage that we as a board get the courage to put this through and make sure that all of our physicians do this," said Dr. Bernardo Fernandez. "Because I remember that presentation very clearly stated for all of us the disaster we’re facing today.”
The vote in support was unanimous. Dr. Reisfield will get his authorization in writing, and patient advocates like Corredor will try to get the word out to the medical community that it’s legal for doctors to prescribe naloxone to patients who might be at risk of overdose. Corredor, who published a four-page background paper on nalaxone, says most doctors don’t know that.
"So it was important to come before the Board of Medicine to get that in writing, to get that reaffirmation in writing, to assure physicians to go ahead and start prescribing this on a take-home basis for patients who may be at risk," she said. "They could be saving lives that right now we are not reaching.”