SECOND CHANCE FOR ADDICTS

WITH A SMALL bag of heroin selling for less than a six-pack of beer,
it is no surprise that heroin overdoses have become a major public
health problem in Boston and elsewhere. Between 1999 and 2003, the
latest year for which figures are available, drug-related deaths in
Boston rose 50 percent. Heroin was involved in many of the 144 drug
deaths in 2003. The Boston Public Health Commission is acting
responsibly in trying to reduce this toll by making a key medication
available to addicts for use in emergencies. Mayor Thomas M. Menino
deserves credit for giving the pilot program his support.

The drug is called naloxone, marketed as Narcan. Hospital emergency
rooms and city paramedics administer it, but now Boston is following
New York, Baltimore, and Chicago in distributing it to addicts
themselves. Under the plan, which is expected to get the approval of
the commission's board next week, addicts participating in the city's
needle-exchange program would be invited to enroll in the Narcan
program as well. It would include training in treating overdoses and
a consultation with a physician.

An overdose antidote that can revive patients near death, Narcan is
available both as an injection and as an inhalant. According to John
Auerbach, executive director of the city health commission, Boston
will use the inhalant method. He said addicts will be taught to
insert the pre-packaged dose into the nose of the overdose victim and
squeeze a small ball to spray the medication, which will be absorbed
by nasal membranes even if the victim is not inhaling voluntarily.

Needle exchanges protect addicts against blood-borne diseases such as
HIV-AIDS and hepatitis C by providing them with uncontaminated
syringes. Boston, Cambridge, Provincetown, and Northampton have such programs.

This year, the Legislature legalized over-the-counter sales of
hypodermic needles, overriding Governor Romney's veto.

The public health term for distributing clean needles or Narcan is
harm reduction.

The best choice in dealing with drug abuse is persuading individuals
not to start taking them in the first place. The next best course is
to get addicts into treatment. Needle exchanges and Narcan programs
are third-tier methods: Simply keeping the drug abusers alive for the
day when they can embrace treatment.

Baltimore's "Staying Alive" program of training and equipping addicts
with Narcan is credited, along with an expansion in drug treatment,
with reducing fatal drug overdoses in 2004 to the lowest level in five years.

Auerbach said there is a short window after addicts survive an
overdose when they want to "turn their lives around." But many will
no longer have a life at all unless Narcan is more readily available.