ANTI-OVERDOSE DRUG GIVEN TO S.F. ADDICTS

For the first time in the state, a public agency is
providing naloxone. Critics say treatment programs
are a better approach.

Marking a first for a public agency in California, the San Francisco
health department began dispensing a controversial anti-overdose
medication to heroin addicts Saturday at a city-sponsored needle
exchange program.

Despite criticism that it could encourage further addiction, San
Francisco health officials say their plan to distribute the
prescription medicine, known as naloxone, will save lives and possibly
give addicts a chance to eventually go clean.

A mix of health department staff and volunteers trained 11 drug users
in a Tenderloin-area clinic. Officials hope to expand that number
substantially over the next few weeks.

"We know this saves lives and has almost no side effects. It's a
miracle drug," said Dr. Josh Bamberger, who oversees the new program
at the city Department of Public Health.

A few other public agencies around the country have taken similar
steps. In California, a private, nonprofit health group in Mendocino
County two months ago began offering naloxone to a small group of clients.

But officials say San Francisco is the first public agency in the
state to distribute the medicine.

The step is part of a 3-year-old initiative that seeks to reduce the
harmful effects of drug use in San Francisco rather than solely trying
to keep addicts from taking drugs. Other efforts include methadone
treatments, needle-exchange programs to reduce the transmission of
diseases and medical attention for complications from addiction, such
as skin infections.

The naloxone program requires people who receive the drug to be
trained in how to administer it and how to perform other rescue
techniques to assist overdose victims. The medicine is injected into
an arm or leg and doctors say victims can recover in a matter of
minutes. It is mainly used with heroin overdoses but is also effective
with other opiates such as morphine and Oxycontin. Each addict in the
training program this weekend received two syringes pre-filled with
naloxone.

Officials describe naloxone as a nonaddictive, non-mood-altering drug
that doctors and paramedics have used to treat victims of opiate
overdose for decades. The medication has no street value and the
common generic version costs as little as a dollar a dose.

The drug works by blocking opioid receptor sites in the
brain.

Critics, including some physicians, worry that dispensing naloxone to
addicts may cause more harm than good. Some fear addicts may not call
paramedics after they revive a friend, while others are concerned that
public funding of such a program endorses addiction.

"This is a huge mistake," says Dr. Eric Voth, a Kansas addiction
specialist and spokesman for Drug Free America, a national group that
targets drug abuse. "It just isn't safe to remove this from a medical
setting and put it in the hands of addicts who are notoriously
unreliable," he says.

Voth adds he would rather see the money spent on treatment programs so
addicts could get off the drugs.

Health officials in Portland, Maine, scrapped plans to distribute
overdose medication to heroin users last year after intense public
pressure.

Doctors say there is a possibility, although rare, that someone
recovering from an overdose after being treated with naloxone may
experience a dangerous seizure.

And for those addicted to opiates, naloxone immediately pushes them
into an agonizing withdrawal that often produces nausea, tremors and
extreme sweats. Because of the discomfort, some addicts may want to
shoot up again quickly, possibly setting themselves up for another
overdose, critics say.

Peter Warren, a spokesman for the California Medical Assn., says the
organization agrees with efforts to reduce the harmful effects of
addiction but is wary of any initiative that doesn't include efforts
to get addicts into treatment and counseling.

Many naloxone programs encourage users to enter such programs but
don't require it.

Last year, a six-month study by researchers at UC San Francisco,
partially funded by the city Department of Public Health, tracked 24
addicts who were given naloxone, along with eight hours of training,
latex gloves and alcohol swabs. In all, participants reported
witnessing 20 overdoses and successfully used the medication on 14
occasions.

For various reasons, the other six overdose victims were not given
naloxone but survived.

Alex Kral, director of Urban Health Studies at UC San Francisco and an
author of the study, says that a large publicly funded naloxone
program in San Francisco is needed and viable. He points out that
groups in San Francisco have been providing naloxone underground for
several years.

"I think the medical establishment is slowly coming around to this and
seeing it as a solution to a needless problem," he says.

New Mexico currently is dispensing the drug in several locations
throughout the state and both Baltimore and New York City are planning
to start similar programs in the next few months. Some private doctors
and community-based organizations have also recently started providing
the medication. (Los Angeles health officials say they have no plans
to distribute naloxone.)

New Mexico and Connecticut have passed laws limiting liability for
nonmedical people who administer naloxone, including law enforcement
officers or friends who are trying to save an addict. In San
Francisco, doctors say they don't need a liability law because they
are prescribing a legal medication and are covered by patient-client
relationship.

But a friend who administers the drug to an addict could be held
liable for any ill effects.

Nationally, heroin use is climbing dramatically, aided by a plunge in
the drug's price.

The number of new heroin users during the last decade grew by more
than 100,000 per year -- a pace not seen since the early 1970s. It's
estimated that 2% of all heroin addicts die each year.

Although overdose deaths in San Francisco have eased in recent years,
the city averages more than 120 annually. That often surpasses the
city's homicide numbers.

Health officials say that people who have gone through drug treatment
and fall back into their old habits are at particularly high risk of
overdose. They often don't decrease the amount of drug they use to
match their newer, lower tolerance to the drug. That's why some
programs around the country are dispensing the anti-overdose
medication to addicts leaving jail after short terms.

Contrary to popular belief, many addicts who overdose on opiates
survive for up to an hour. That leaves a large window of time to treat
an overdose victim, including the use of naloxone, doctors say.

Research shows that most people overdose near someone else and that up
to three quarters of all addicts don't call paramedics if a friend is
overdosing.

Dr. Karl Sporer, an emergency physician at San Francisco General
Hospital, says many addicts instead rely on a slew of popular street
remedies that are believed to revive overdose victims, like filling
their pants with ice or injecting them with milk.

Because the idea of dispensing naloxone to addicts is relatively new,
there is little research proving the programs reduce mortality rates.
Anecdotally, officials in New Mexico and Chicago say they've seen up
to a 20% drop in overdose cases since they've started distributing
naloxone.

Bamberger, the San Francisco health official, expects that his
department will train up to 600 users over the next year. Addicts
interested in receiving naloxone must first go through an hourlong
training on how to administer the drug as well as how to provide
rescue breathing and other life-saving techniques.