ADDICTS TREAT OTHERS' OVERDOSES

SAN FRANCISCO -- In the newest twist in harm reduction among users of
dangerous drugs, a controversial study conducted here suggests that heroin
addicts can be trained to treat fellow junkies against potentially fatal
overdoses.

The project, co-funded by the San Francisco Department of Public Health,
turned 24 longtime heroin users into enterprising street doctors, organizers
say.

Supplied with syringes containing the anti-overdose drug naloxone and
trained in cardio-pulmonary resuscitation, the users were able to take
timely lifesaving measures with a drug now available only to physicians and
paramedics. The moment a companion had an overdose reaction, the trained
addict injected the drug into the victim's leg or shoulder.

Researchers from the Urban Health Study will release their naloxone study
results Monday at the National Harm Reduction Conference in Seattle. The
group is composed of health-care experts who specialize in such efforts as
needle exchange programs for drug users.

They also want San Francisco officials to consider becoming the first major
city in the West to distribute naloxone. The drug is available to addicts in
New Mexico and Chicago, and Baltimore officials plan to start dispensing
naloxone next year.

Proponents say naloxone is a legal, nonaddictive drug that does not produce
a high or sense of euphoria. When injected into a major muscle, naloxone,
commonly known by its brand name Narcan, sends overdose victims into an
instant acute withdrawal.

The drug works by binding to the brain receptors that normally attract
opiates such as heroin, morphine or methadone. Without naloxone, heroin
overdose victims often die from respiratory failure.

"This drug has been shown to save lives," said Karen Seal, a physician and
lead author of the 2001 study.

But critics say dispensing naloxone to addicts as a harm reduction technique
is really harm promotion. "You're putting a very serious medication into the
hands of untrained people," said Eric Voth, an addiction medication
specialist and chairman of the nonprofit Institute on Global Drug Policy.

"The answer to heroin addiction is aggressive outreach, not an end-around
against modern medicine. City officials should beware of the serious
liability issues if someone dies after being administered this drug by
another addict."

Seal, an assistant professor of family and community medicine at UC San
Francisco, said a citywide dissemination of naloxone would improve the lives
of an intravenous drug population estimated to be as large as 14,000 to
17,000.

Each year, San Francisco hospitals see more than 100 heroin overdose deaths,
many of which Seal believes could have been prevented. Doing her time in the
emergency room, she saw the culture of heroin while responding to as many as
half a dozen overdose victims a day.

She knows the futile result of street techniques used by junkies to stop a
heroin overdose: everything from injecting victims with salt water or milk
to immersing them in an ice bath.

A bigger problem is that many addicts, when witnessing an overdose, are
reluctant to call 911 or summon help, for fear of arrest.

Two years ago, Seal set out to discover "why people could stand by a heroin
overdose victim and not intervene."

For six months, her study employed 12 teams of heroin addicts -- users so
dependent that they no longer take the drug to get high, but rather to avoid
the agony of withdrawal. After eight hours of training, participants were
given kits containing vials of naloxone, latex gloves and alcohol wipes.

Half were homeless. Their median age was 40 and one-third were women. The
goal was for each team member to look out for the other and be on hand with
naloxone if one of them overdosed.

In all, the participants witnessed about 20 overdoses and used naloxone in
14 cases, resorting to CPR in the others. One participant died after
injecting heroin while alone.

Seal said researchers initially feared that they could harm addicts by
giving them naloxone. "We didn't know whether they'd become vigilantes and
use more heroin because they felt they had this magic anti-overdose
antidote," she said.

But researchers found that whereas in the six months before the study the
group reported 68 overdoses, in the six months after the study only five
occurred, although naloxone was no longer available.

Seal said their participation led many study subjects to seek referrals to
methadone clinics, although there is no evidence that the drug itself does
anything to discourage heroin use.

One participant was William Bowden. The 51-year-old Philadelphia native and
longtime junkie said carrying naloxone gave him a new take on San
Francisco's back-alley heroin scene.

"When you're a junkie, nobody cares about you; you don't even care about
yourself," he said. "But this study made me look at things differently. By
being concerned about others, I became more concerned about myself."

Seal said addicts showed researchers even more enterprise: In more than half
of the 14 cases in which naloxone was used, it was administered not to the
participant's addict partner but to strangers they encountered on the
street.

Many offered mouth-to-mouth emergency treatment to strangers who were
violently ill. "They took a risk of being arrested to save somebody else,"
Seal said.

San Francisco officials aren't exactly lining up behind a naloxone program
for addicts.

Joshua Bamberger, medical director of the housing and urban health section
of the city's Department of Public Health, said other outreach efforts
helped drive the city's heroin overdose deaths to a 10-year low of 101 in
2001.

"It's undoubtedly worth exploring," he said of the naloxone plan. "But I
don't know the political lay of the land."

Critics remain disturbed by the image of addicts cast as lifesavers. They
might mistake alcohol or cocaine overdoses and inject naloxone, delaying
proper medical help.

"To receive naloxone is a hellish experience," said Voth of the Institute on
Global Drug Policy. "People go into instant withdrawal and often suffer
vomiting, diarrhea and extreme agitation. I don't think other addicts could
ever be trained to manage such an ordeal."

Seal said study participants were trained for just such a result. "People
who've been given naloxone wake up angry, and we told our participants the
victim might look at them like 'Hey, you just ruined my high,' " she said.

"People don't understand that they've basically died and have just been
saved."

Despite such drawbacks, public distribution of naloxone has worked in New
Mexico, where a state law passed in 2001 legally protects people who inject
an overdose victim with naloxone. San Francisco researchers say they would
push for a similar liability law.

Chicago also has seen dramatic effects since the drug began being dispensed
through private clinics. "Not long ago, 466 people died in Cook County alone
from heroin overdose in a single year," said Dan Bigg, executive director of
the Chicago Recovery Alliance. "The people bitten by the snake of heroin
addiction couldn't cope."

Last year, the county saw a 20% drop in heroin-related deaths, its first.
Bigg attributed that to getting naloxone onto the streets. "It works," he
said.

In contrast, Portland, Maine, has backed away from a plan to give naloxone
to heroin users. "We got flak from law enforcement and the community --
letters and e-mails," said Gerald Cayer, the city's director of Health and
Human Services.

But drug policy experts say naloxone's time may have come.

Ricky Bluthenthal, a social scientist in the health program and drug policy
research center at the Rand Corp. in Santa Monica, said the federal
government should encourage study of naloxone use among heroin addicts.

"If you give drug users the tools that lead them to be healthy, they'll use
them as intended," he said.