The Way to Curb Overdose Deaths, One Spray at a Time

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Intranasal Naloxone spray, used to reverse the effects of a heroin or prescription painkiller overdose.

Remember that scene in the movie "Pulp Fiction" when the John Travolta character plunges a syringe full of adrenaline into the chest of Uma Thurman, who is overdosing? It turns out a real heroin overdose is easier to reverse — and much safer. 

The drug Naloxone has been available to EMTs for decades. It is injected into the muscle tissue, not the chest. Now it comes in a nasal spray. Police officers in Staten Island began carrying it in September as part of a pilot program and saved one 44-year-old man's life in January.

Deaths from opioids, which include heroin and prescription pain killers like OxyContin and Percocet, increased 84 percent increase from 2010-2012 in New York City, according to the Department of Health and Mental Hygiene. The department calls it an epidemic, responsible for more deaths than car crashes.

Dr. Hillary Kunins, the assistant commissioner for the Bureau of Alcohol and Drug Use Prevention Care & Treatment for the city, said Naloxone is the best shot health officials have at curbing unnecessary deaths.

"It is very safe," she said. "It can be administered without any ill effects over the long term. If a person doesn't have an opioid in their body already it simply won’t affect them."

Physician Michael Duncan is on the front line of overdose prevention in New York City. The 45-year-old physician spent part of a recent morning in the basement of After Hours Project, a community-based harm reduction center in Bushwick, Brooklyn, preparing Naloxene kits that can be given out to people who are likely to witness overdoses. 

Each kits costs $50, and includes a plastic mask for mouth-to-mouth resuscitation, as well as a vial with one dose of Naloxone. Similar kits have been available to lay people since 2006. But to get one into your hands, the law requires a physician, like Duncan, to administer a training session and sign a prescription. A bill churning through Albany now would not require a physician's note. California, Illinois, Kentucky, North Carolina and Vermont have already passed similar legislation.

The bill has not met much opposition in New York, although lawmakers in other states have argued that overdose-prevention drugs will encourage more risk taking. Duncan disagrees.

"Theoretically, it could happen, sure," he said. "But that’s like arguing that if you have a fire extinguisher in your house you’re more likely to burn your house down."

Michael Duncan conducting Naloxone training sessions with the After Hours Project in East New York. (Stephen Nessen/WNYC)

Next, Duncan and two workers from the After Hours Project drove to East New York, also in Brooklyn, and parked their unmarked black van on a commercial street. Across the street was an empty lot. The No. 3 train rumbled overhead.

They offered free $5 MetroCards for HIV screening and overdose-prevention training. It did not take long to get a few participants.

One was Franqui Maria, 48, who lives in the neighborhood. She said she wanted the training because she has a friend who has been using heroin, and she wanted to be ready in case of an overdose. 

She filed into the back of the van. Duncan took out a Naloxone kit. He emphasized the importance off first calling 911 and outlined the Good Samaritan Law, which ensures that no one would be arrested for drug possession if the police are called during an overdose. He then showed her the basics of breathing oxygen into someone's mouth. Finally, he showed her how to administer a dose of Naloxone.

"God forbid I would ever have to use this," Maria said afterwards, shaking her head. "But you never know, better safe than sorry,"

All together the training took about 25 minutes.

The city is conducting a study to see how effective this process is for preventing overdoses. A study out of the University of Washington found one out of every 36 kits that are distributed may be used to save a life.

If the bill in Albany passes, staff members of the After Hours Project could distribute Naloxone themselves, the way they offer clean needles, or condoms. It would put Duncan out of work, but he said he wouldn't mind — he would be able to focus on providing other types of health care.

One of the city's $50 overdose prevention kits, which includes Naloxone and a face mask for mouth-to-mouth resuscitation. (Stephen Nessen/WNYC)