CONFUSION ABOUT HEROIN COST CITY LIVES

Life-Saving Medicine

The city officials in charge of paramedic services need to reevaluate
whether they are doing all they can to respond to a crisis in heroin overdoses.

Heroin tainted with the powerful painkiller fentanyl has killed more
than 500 people nationwide, including about 150 in Philadelphia. As
an article in Sunday's Inquirer detailed, officials in the city's
emergency medical services and Fire Department have reacted slowly
and disjointedly to this development.

City paramedics still aren't authorized to administer the stronger
dose of an antidote called Narcan that is needed to counteract the
heroin/fentanyl mix.

There is no dispute that Narcan saves lives. The drug blocks the
effects of opioids such as heroin on the brain. Paramedics tell
stories of injecting Narcan into overdose victims who had stopped
breathing, only to see them revive and try to walk away minutes later.

But the heroin laced with fentanyl is much more powerful.

In Philadelphia, however, paramedics have encountered bureaucratic
roadblocks in getting permission to administer more than the standard
dosages of Narcan. Proponents of the city's needle-exchange program
say dozens of overdose victims have died needlessly.

Interviews with various city officials showed their confusion. The
chief of the fire paramedics at first said he didn't think Narcan had
any effect against the fentanyl-laced heroin. Then he changed his
mind, and said the dosages of Narcan would be increased. That was
news to C. Crawford Mechem, medical director of EMS, who called city
guidelines "perfectly adequate."

Worse than this lack of communication, a personnel shortage has
caused the city to reassign paramedics - the only ones besides
emergency-room workers certified to administer the drug - away from
neighborhoods where the overdoses are occurring. City officials in
charge of emergency services need to review their policies and
coordinate better.

It's not known how many overdose fatalities might have been prevented
by proper use of Narcan. The fentanyl-tainted heroin is so lethal
that victims often die by the time a companion thinks to dial 9-1-1.
In Baltimore, Philadelphia and other cities, health officials and
needle-exchange advocates are training heroin users how to administer
Narcan supplied to them to save fellow addicts.

Law-enforcement authorities now believe they may have broken up the
supply chain of this extra-deadly brand of heroin. However long this
added danger persists, Philadelphia officials should do more to make
sure their response is as coordinated and effective as possible.