Monday, April 21, 2014
A hospital group in central Maine is starting the state’s first large-scale program to provide Narcan kits, which can reverse the effects of heroin overdoses, to people who at risk.
The Narcan emergency opiate overdose kit is designed so the drug naloxone can be sprayed into the nose of someone who has overdosed on heroin or another opiate and stopped breathing. The MaineGeneral Health Program is the state's first to provide the kits to people at risk.
Joe Phelan/Kennebec Journal
MaineGeneral Health, which serves the Augusta-Waterville area, is using private and state grants to distribute 500 emergency opiate overdose kits to patients with chronic pain through its Harm Reduction Program.
“This is a rescue remedy,” said Jayne Harper, manager of the program. “There are a lot more folks at risk for opiate overdose than folks might think.”
Overdoses have been on the rise recently in part because some people who got hooked on prescription painkillers have started using heroin, which is cheaper and more accessible. An overdose of an opiate, whether heroin, methadone or oxycodone, slows breathing so much that a person can die or be permanently disabled.
Narcan, also known by its generic name, naloxone, can reverse such effects. A bill being considered by the Legislature would expand access to prescriptions for Narcan beyond patients, to family members and first responders who might be in a position to reverse someone’s overdose.
The Harm Reduction Program also wants to train family members of people at risk to use Narcan kits.
“When someone needs naloxone, they are not able to give it to themselves,” Harper said. “They have stopped breathing. It is important for people to learn how to use a kit in case a loved one needs it. It is similar to an EpiPen for anaphylactic shock.”
At least 17 states already have naloxone programs, according to MaineGeneral Health. Nationally, naloxone programs trained and distributed kits to 53,032 people, who reported a total of 10,171 overdose reversals from 1996 to 2010, the health care group said, citing statistics from the U.S. Centers for Disease Control and Prevention.
Gov. Paul LePage, in his State of the State address Tuesday night, talked about Maine’s drug problem, saying he wants to add resources to prosecute drug crimes, including more officers for the Maine Drug Enforcement Agency, more prosecutors and more judges for drug courts around the state. He did not address drug treatment.
Adrienne Bennett, spokeswoman for LePage, said the administration had not announced a position on MaineGeneral Health’s program but referred to the governor’s position last year, when he vetoed a bill that would have expanded access to Narcan.
In his veto message, LePage said he was concerned that people would be more prone to “push themselves to the edge” if they knew that a life-saving drug was nearby.
Overdose deaths in Maine rose to 163 – almost the same number as traffic fatalities – in 2012, with the number of overdoses from heroin climbing from seven in 2011 to 28 in 2012.
Naloxone “does help stop some of the dying,” Harper said, “but it doesn’t solve the problem with prescription medication, or even heroin, that we have.”
The kits will include two doses of naloxone, a cone-shaped nose adapter, instructions and a refrigerator magnet on which a patient can write the location of the kit, Harper said. Each kit will have a hard-sided case with the prescription label on the outside.
The adapter is placed in the nose of the person who has overdosed. Liquid naloxone is turned into a spray that is quickly absorbed into the body. It’s easier to administer than an injection and doesn’t cause the violent reaction that can come from naloxone injected with a needle, Harper said.
The kits sell for $40 to $50 retail. MaineGeneral Health anticipates providing the kits and training for patients and family members starting in March.
The patients who are eligible to receive the medicine are those most at risk of overdosing from among about 5,000 patients being treated for chronic pain through the hospital group’s psychiatry department.
“Inherent in chronic pain and detox patients is a high risk for overdose, intentionally or unintentionally,” said Dr. Mark Bucksbaum, medical director of rehabilitation services for MaineGeneral Health.
“This is designed to give them a home rescue,” he said. “Because it’s in the house, it can be implemented much, much faster than even an ambulance could get there.”
He said many of the patients have breathing problems and psychiatric conditions that make them more likely to overdose.
“Many patients who are in chronic pain management, if they didn’t have access to chronic pain management services, would be forced into using street medication. The populations are not entirely different,” he said, noting that the kits may end up saving people other than those with the prescriptions.
The program plans to gather data on how the kits are used, Bucksbaum said, to provide information for other health care institutions and for the state to determine whether to expand the program and make kits available through MaineCare, the state’s Medicaid program.
“The cost is negligible compared to even the ambulance ride,” Bucksbaum said. “Not only are we saving lives, we believe we would substantially be saving costs to the system. One case that would have to be hospitalized for an overdose would probably fund our entire pilot program.”
MaineGeneral Health’s Harm Reduction Program recently received $30,000 from the Maine Attorney General’s Office to help fund the Narcan program, along with a $60,000 grant from the Bingham Program and $5,000 from the Stephen and Tabitha King Foundation.
The plan is modeled after a program in North Carolina called Project Lazarus, Harper said.
David Hench can be contacted at 791-6327 or at:firstname.lastname@example.org
click image to enlarge
A tube of Naloxone Hydrochloride, also known as Narcan, is shown for scale next to a lipstick container in Quincy, Mass., home. Narcan is a nasal spray used as an antidote for opiate drug overdoses.
2012 File Photo/The Associated Press
click image to enlarge
Project manager Jayne Harper demonstrates the emergency overdose kit Wednesday in Augusta.
Joe Phelan/Kennebec Journal