ADDICTS TO RECEIVE OVERDOSE ANTIDOTE

Kit And Training For Heroin Users

State health authorities will start supplying addicts next month with
a kit containing two doses of a medication that can reverse a
potentially lethal overdose within minutes, hoping to reverse a tide
of heroin deaths sweeping Massachusetts.

The initiative by the Department of Public Health mirrors a similar
project in Boston, where at least 66 overdoses have been reversed
since the program began a year ago.

State Public Health Commissioner John Auerbach, who introduced the
Narcan program while leading Boston's health agency, said the results
are so impressive that he wants to expand it to four areas of the
state grappling with heroin epidemics. That drug and other opiates
killed 544 people in Massachusetts in 2005, more than double the
number felled by firearms.

"We are aware sadly that despite our efforts, there are people who
will not be ready for treatment, and we want to prevent them from
dying from a fatal overdose before we have an opportunity to convince
them to get into treatment," said Auerbach, stressing that treatment
remains the state's priority.

But some substance abuse specialists criticize the distribution of
Narcan to addicts, arguing that the practice encourages continued use
and delays entry into treatment. Some also question whether it is
wise medically to have one addict squirting Narcan up the nose of
another user who is overdosing.

"You give them the Narcan, where is their motivation to change? The
addict is going to say, 'I just overdosed and I got another lease on
life - great,' " said Michael Gimbel, a recovering heroin addict who
was director of substance abuse in Maryland's Baltimore County for 23
years. "Giving Narcan might give them that false sense that 'I can
live forever,' which is not what we want."

Narcan has been administered for decades in hospital emergency rooms
and by paramedics, but time is crucial: Heroin races to regions of
the brain that control breathing. Too much heroin dangerously slows
breathing, starving the heart of oxygen and causing it to stop
beating. The whole process can take just three to four minutes,
making it essential to have the antidote readily available.

Heroin attaches itself to receptors in the brain, like a key sliding
into a lock. But Narcan wrenches heroin out of brain receptors,
taking the place of the opiate and reversing the devastating
reduction in breathing.

Narcan, known generically as naloxone, was developed as an antidote
for overdoses. It is not habit-forming and causes no long-term side
effects, although the sudden reversal of a heroin high can induce
vomiting, specialists said. A single dose costs about $20.

"It's a remarkably safe drug," said Dr. Peter Moyer, medical director
for Boston's fire, police, and emergency medical services. "I've used
gallons of it in my life to treat patients."

State authorities said they believe that Massachusetts will be just
the third state with a Narcan program. A number of cities including
Chicago, New York, and Baltimore already provide the antidote to drug users.

In Baltimore, nearly 1,600 addicts were trained in using the
medication from April 2004 through the end of 2005, and participants
reported that 194 overdoses were reversed. At the same time,
heroin-related deaths in the city reached their lowest point in six
years, dropping one-third from the peak recorded in 1999.

Heroin has maintained a powerful hold on New England, fueled by high
demand and low prices. At $5 or $6 for a small bag of the drug, it
can be cheaper to get high on heroin than to buy a six-pack of beer.

"It's the perfect storm in all the wrong directions. We talk about
availability, price, and potency of the drug," said Kevin Norton,
president of CAB Health & Recovery Services, which will work with the
state to provide Narcan in cities and towns on the North Shore.

State authorities estimate that their campaign, which is being
treated as a test run, will cost less than $50,000 and enroll 450
users. If successful at saving lives, it may be expanded.

Most of the funds will go to buying the medication, while other costs
will be absorbed by four independent agencies that have partnered
with the state to enroll users in the North Shore, the Connecticut
River Valley, Cape Cod, and Southeastern Massachusetts.

In Boston, 358 users have enrolled in the city's Narcan program since
September 2006. In training sessions, they are first urged to enter
substance-abuse treatment. If they're unwilling, they are then
instructed in how to use a Narcan kit, which includes a syringe
filled with the liquid and a device that turns the medication into a
mist that is inhaled through a cone.

In Boston, an average of 119 people died each year between 1999 and
2004 from drugs or alcohol.

Drug use is rarely a solitary pursuit, so it makes sense to train
addicts in how to give the antidote to their friends, substance-abuse
specialists said.

"It was easy to implement in Boston," said Andy Epstein, who helped
start the program in the city and who will fill a similar role with
the state, as a senior adviser to the public health commissioner.
"The clients were grateful to see that someone was interested in
whether they lived or died. And they were very facile in putting
together the Narcan" kits, she said.

As part of the training, addicts are told to call 911 even if their
friend's overdose is fully reversed, because further medical
attention may be needed. A city report on the first year of the
program found that most of the time, 911 was not called, a finding
that Moyer described as disappointing.

Boston's campaign has drawn internal opposition from paramedics. Matt
Carty, of the Boston Police Patrolmen's Association EMS Division,
said he and some colleagues worry that addicts are not equipped to
deliver medical treatment.

The White House Office of National Drug Control Policy also condemns
the practice of Narcan distribution. A heroin overdose is such a
serious medical event that addicts should be cared for by medical
professionals, not their injecting friends, said Bertha K. Madras,
deputy director for demand reduction in the White House office.

"This is a medical emergency - this is not a friendly, communal
chit-chat situation," said Madras.