RELUCTANCE TO CALL 911 BLAMED AS HEROIN OD DEATHS INCREASE

The number of heroin deaths in San Francisco and the United States has
risen at an alarming rate, even though most of the deaths are
preventable, a new study says.

The report published Tuesday in the Annals of Internal Medicine said
that 911 was used as a first response in just 14 percent of heroin
overdose cases nationwide, often resulting in delays of medical
treatment that proved fatal.

The report's author, Karl Sporer, cites fear of the police as the
reason, despite the fact that overdose victims are "almost never"
arrested or prosecuted for their illegal drug use.

"We need to encourage people when there is a problem, call 911," said
Sporer, an attending emergency room physician at San Francisco General
Hospital and an associate clinical professor at UCSF.

Sporer reached his conclusions after studying numerous reports on
heroin use in the United States, including San Francisco. Nationally,
he noted, heroin-related emergency department visits more than doubled
from 33,900 in 1990 to 70,500 in 1996. From 1993 to 1997, heroin
deaths in San Francisco rose from 120 to more than 200.

Although typically only 2 percent of heroin users die of an overdose,
the fatalities usually occurred within one to three hours after taking
heroin.

In many overdose cases, a caretaker delayed calling for medical help
while trying to bring the victim out of trouble, Sporer said. Rescue
attempts, he found, included placing the victims in cold water,
slapping them awake or performing mouth-to-mouth resuscitation.

The quickest and safest remedy, Sporer said, would have been to call
paramedics, who would have treated the patients with a drug called
narcan to restore sensory controls and calm overdose symptoms on the
way to a hospital.

Still, Sporer said, paramedics often aren't called until it is too
late out of fear that the police will intervene.

Sporer's report also called for more widespread availability of
methadone treatment programs for heroin addicts. Typically, he said,
an addict who has been hospitalized goes through a 28-day methadone
treatment program to help calm the heroin cravings, but once released,
many take up the habit again.

But there are a few long-term methadone treatment programs that offer
addicts a more structured regimen, routine drug tests and long-term
therapy. The problem, Sporer said, is that the programs are too few
and too costly because methadone is strictly regulated.

"Very few people do well cold-turkey with heroin," Sporer said. "Is it
such a terrible thing to flood the market with methadone? I don't know."