HEROIN ANTIDOTE USE SURGES ALONG WITH OVERDOSES

While Jimi Reinke has trained 109 people to administer an antidote for
heroin overdoses, he never thought he actually would have to do it
himself. The drug users he works with aren't usually high when he sees
them.

But on Oct. 8, Reinke had parked his van in front of Luke House on
Ingersoll Street, where he offers AIDS Resource Center of Wisconsin
services during the free meal program there, when a woman ran up and
said, "You have any Narcan?"

A man down the block had passed out. He was not breathing.

"I was ready to hand it to her and she says, 'I never did it,' and I'm
like, 'Neither have I.'

He grabbed the Narcan and followed her the half block to Williamson
Street, where a group of people were starting to gather around a
25-year-old man who was lying on the sidewalk.

"I got there and he was purple and he was on his side," Reinke said.
"It was scary. The adrenaline takes over."

He injected 1 cubic centimeter of the drug into the man's leg. He
didn't come out of it, so he gave him another. He began coming around.
As Fire Department emergency medical technicians arrived, Reinke got
out of the way and went back to work.

According to Reinke, the man he saved was the 84th heroin overdose
victim in south central Wisconsin treated with an emergency dose of
naloxone -- known on the street by its original brand name Narcan --
that was provided by the AIDS Resource Center in the last two years.
In the two weeks since, he's had reports of two more, bringing the
total to 86.

The agency chose Madison for its pilot program in 2005 and rolled out
a similar program in Milwaukee over the past year. The program is
working so well that the AIDS center hopes to work with law
enforcement to get naloxone in the hands of police officers, often the
first on the scene of medical emergencies. When breathing stops,
seconds count. Irreversible brain damage can occur in only a minute.

The naloxone program is modeled after one launched by the Chicago
Recovery Alliance in 2001, which is credited with saving nearly 500
people from overdoses, reversing an alarming four-fold increase in
heroin deaths between 1996 and 2000, according to an October 2006,
article in the Journal of Addictive Disease.

In Dane County, despite the program, heroin deaths have seen a recent
spike, according to Coroner John Stanley. He said he couldn't
immediately provide exact figures, but the trend has caught the eye of
coroner's and law enforcement officials.

He blamed the increase on a big rise in heroin use. In fact, police
officials last week announced the largest heroin bust in Dane County
history.

And the drug on the street today is of a higher grade.

"People aren't used to it," he said. "They shoot it like they normally
do, and it's fatal."

Not only is the drug more plentiful and powerful, it keeps getting
cheaper.

After heroin fell out of favor among drug users in the 1980s and
1990s, it is now rapidly becoming the addictive drug of choice.

"People are getting hooked on Oxycontin and finding that it's too
expensive to keep purchasing," said Scott Stokes, prevention services
director for the AIDS Resource Center. "And heroin's a cheaper,
similar high."

And for people under 21 looking to get intoxicated, legal means are
often out of reach.

"There are 18-year-olds saying it's easier to get drugs than to get
beer because I don't need an ID," Reinke said.

With so many factors contributing to heroin use, Stanley said demand
for naloxone is increasing. He said the drug is effective and safe,
with no side effects if taken in prescribed doses.

"It's a wonder drug," he said. "There's no question about
that."

How It Works

Unlike stimulants like cocaine and methamphetamine, opiates like
heroin, morphine, Oxycontin and fentanyl do not kill by causing heart
attacks. They simply make you too relaxed to breathe.

Naloxone works by blocking the brain's receptors, in effect stopping
the high.

"If you're not on an opiate it's like injecting water," Reinke said.
"It's not going to alter someone. It's not going to get you high or
make you low. It's not going to change anything about you unless
you're on an opiate, and then its going to block the opiate receptors
and prevent an overdose."

The man Reinke saved two weeks ago, through Reinke, declined an
interview with The Capital Times.

But 36-year-old Paul of Baraboo said he has been on both sides of the
needle. The Capital Times is not disclosing his last name because he
still uses illegal drugs.

He's been brought out of heroin overdoses twice by naloxone, though
the first time was more of a precaution.

But the second time, he's sure he would have died.

He was at West Towne Mall two years ago with his brother when he
collapsed. His brother immediately called 911, and emergency medical
technicians arrived and administered the drug.

"That definitely saved my life," he said.

Reinke, who had been providing Paul with fresh needles for years, told
Paul about the naloxone program a short time later.

"Being a user I just got hold of him to get fresh needles, and he told
me this was coming up and asked me if I would be interested," Paul
said. "I said, "Yes, very much so."'

He, his brother and his brother's girlfriend went through a five-hour
training seminar, and he's carried naloxone with him ever since.

A few months after the seminar his brother overdosed on methadone.
After noticing that he had stopped breathing, Reinke brought him out
of it by injecting him with naloxone.

The incident highlights the importance of one of the primary messages
the AIDS Resource Center and other prevention groups try to impart to
opiate users: Never use drugs alone. By the time an overdose sets in,
a victim will be unable to self-administer naloxone.

And because naloxone last only 45 minutes to an hour -- while heroin
remains in the body for up to eight hours and other opiates for even
longer -- someone has to be around to make sure the overdose doesn't
come back.

Before Reinke told him about the drug, Paul had never even heard of
it. He was among many who were misinformed by popular culture, such as
the graphic overdose revival scene in the movie "Pulp Fiction,"

"As far as I know up until that point they did the adrenaline shot to
the heart, which as far as I know now is a bunch of crap," he said.

Now he keeps naloxone in the same kit that he uses to carry his
drugs.

"If you're going to be in that sort of lifestyle it's very important
to have a backup, because when you're buying street drugs you have no
idea what the purity's going to be," he said. "So from time to time
you're going to get a really, really hot batch and if you're not
prepared for it, there's no real other way to bring somebody out of it
as far as I know."