FREEPORT — Legislation that would expand statewide access to Narcan, a drug that can help reverse heroin overdoses, will go to the House floor in March.
LD 1686, an act to address preventable deaths from drug overdose, would authorize a greater number of individuals to receive, possess and administer the drug. That could include police, firefighters and basic emergency medical technicians, as well as family members and caregivers of opioid users.
The bill also would allow pharmacists to dispense Narcan, whose generic name is naloxone, to users and caregivers who don’t have a relationship with a primary care physician. Every dose would come packaged with detailed instructions.
The drug acts by blocking opiate receptors in the brain, enabling overdose victims to regain control of their central nervous systems and breathe again. Victims typically still require emergency medical care, but naloxone can buy them a few crucial minutes.
At a Feb. 24 work session, the legislature’s Health and Human Services Committee voted along partisan lines, with all eight Democratic members voting ought to pass on the majority report and all five Republican members voting ought to pass on a stripped down minority report.
“Even though the minority ought to pass report doesn’t go as far as I think this legislation ought to go, it still pushes us to a better place than we are right now, and still gets naloxone into the hands of more people who are likely to encounter somebody suffering from an overdose,” said Rep. Sara Gideon, D-Freeport, the bill’s sponsor. “Everyone seems to recognize that we really have a problem with drug overdoses on our hands. I feel like we’re definitely going to end up with some legislation that makes a difference.”
The minority report, which came from a motion by Rep. Deborah Sanderson, R-Chelsea, would not provide access to family and caregivers of users, nor would it allow pharmacists to dispense the drug without a prescription.
“I understand the importance of this drug,” Sanderson said during the work session. “I still have a tremendous level of discomfort with parents, partners and spouses (administering it).”
The legislation comes amid a huge rise in opioid use across the state. The state attorney general’s office announced last month that the number of fatal heroin overdoses quadrupled from 2011 to 2012, from seven to 28. The numbers in 2013 are expected to be even more grim.
A July 2013 report in The New York Times detailed a heroin epidemic across New England and used Portland as its case study.
But LD 1686 is not without its detractors, most notably Gov. Paul LePage, whose office has suggested that increased access to Narcan could empower users to abuse drugs without fear of consequence, Gideon said.
That argument hasn’t rung true with many health-care providers.
“It’s not a euphoric drug,” said Chuck Romanoff, clinical supervisor at Discovery House, a drug treatment center and methadone clinic in South Portland. “It doesn’t encourage people to use drugs. If anything, it discourages it because the experience is devastating. They don’t look forward to going through that again. It’s instantaneous withdrawal, so it doesn’t encourage repetition. It’s a safety drug, a lifesaving medication. It’s like a fire extinguisher.”
In his Feb. 4 State of the State remarks, LePage pointed to law enforcement and prosecution as a way out of the drug problem. That speech drew criticism from national pundits who contrasted LePage’s approach with that of Gov. Peter Shumlin, who one month earlier devoted his entire State of the State address to Vermont’s heroin crisis and the increased need for drug treatment.
“I think there are multiple ways in which we have to attack this problem as a society,” Gideon said. “It does include law enforcement, which is the governor’s primary and exclusive way that he plans on dealing with this problem. I also think treatment is a huge part of it, and unfortunately, during Gov. LePage’s administration, the treatment of people who are addicted to heroin or other opioids, we’ve really seen that on the chopping block.”
Other objections to expanded Narcan access have come on the grounds that it’s dangerous for untrained individuals to administer the drug and that recipients can become aggressive when a dose jars them out of an overdose.
Intranasal delivery of the drug can help to reduce both of those risks, said Jayne Harper, health educator with the MaineGeneral Prevention Center in Augusta. Administering the drug as a kind of nasal spray, as opposed to giving it intravenously or intramuscularly, as paramedics often do, is easier for non-professionals. It also provides a lower dose of the drug and produces fewer side effects, though reports of aggressive behavior from overdose victims who’ve been given the drug are low to begin with, Harper said.
“You would expect a person experiencing symptoms of withdrawal to be uncomfortable,” Harper said. “They could be irritable, restless, agitated. Some folks have reported wanting to re-dose. … But from reports and anecdotes from across the country, people are pretty good about appreciating the fact that somebody brought them back to life.”
Some are simply waiting for more information before passing judgement on the bill.
Freeport Fire Chief Darrel Fournier said Narcan has been used successfully by the town’s paramedics, but he had questions about training, liability and funding with regard to putting it in the hands of every one of his firefighters.
“It’s a wonderful drug,” Fournier said. “It works very well when it’s properly administered. But with the amount of training we already have to give our people, and all the responsibilities they have, I’d need to find out a lot more” about the bill before weighing in on it one way or another.
Regardless of how and whether Narcan access is expanded, and to whom, there’s no question the drug saves lives when it’s available to the right people at the right time.
A 2012 morbidity and mortality report from the Centers for Disease Control and Prevention states that “Providing opioid overdose education and naloxone to persons who use drugs and to persons who might be present at an opioid overdose can help reduce opioid overdose mortality, a rapidly growing public health concern.”
Romanoff, from Discovery House, said, “We’re not talking about lobotomies or shock treatment here. This is something that has a positive effect. It keeps people from going to funerals.”