THE SHOT THAT SAVES

IN the last few weeks, at least six people have died of apparent overdoses
of heroin in Lower Manhattan.

The news seems shocking, but in fact, it's not. According to the most
recent analysis based on data collected from the city's medical examiner,
accidental drug overdoses kill more people in New York than homicide or
suicide, about 900 a year.

In the case of two 18-year-old college students, Maria Pesantez and Mellie
Nicole Carballo, the deaths are blamed on overdoses of heroin that was
either ' 'too pure" or was cut with poison and was taken with alcohol and
cocaine.

No matter what the cause, the sad thing about these deaths is that they
were preventable with a simple injection. Heroin is an opioid, just like
methadone, OxyContin and Vicodin, to name a few. Because overdosing kills
by slowly stopping a person's breathing, there is a short time in which a
person can be injected with an antidote called naloxone, quickly reversing
an opioid overdose.

If given early enough, naloxone can prevent damage to the brain caused by
lack of oxygen and leave the victim unharmed. According to research by Dr.
Sandro Galea of the Center for Urban Epidemiological Studies at the New
York Academy of Medicine, at least 75 percent of overdose deaths involve
multiple drugs, usually mixtures of heroin and other depressants like
alcohol. Removing the opioid from the mix with naloxone is often enough to
revive victims.

Naloxone itself is virtually harmless. Its most common side effects are
withdrawal symptoms like nausea, shakiness and agitation in those who are
physically dependent on opioids. While uncomfortable, these symptoms are
not dangerous. Rarely, seizures can occur, but this risk is far lower than
the risk to those who are not treated. The drug has no effect on those who
haven't taken opioids.

Pilot programs in Chicago, Baltimore and London that have trained
needle-exchange users how to administer naloxone are already credited with
saving dozens of lives. In New York, naloxone has been distributed to 300
syringe-exchange participants.

In a study conducted by Dr. Galea and his colleagues, 22 New Yorkers were
provided with naloxone and trained in its use for first aid. Of the 22
participants, half witnessed an overdose in the three months that they were
followed. Naloxone was administered 10 times, and all of those given the
drug lived.

According to a study published in the journal Drug and Alcohol Dependence,
57 percent of 1,184 hard drug users interviewed had witnessed at least one
overdose. Medical help was sought in only two-thirds of the instances, and
this was usually only after efforts to revive the victim by hitting him or
rubbing him with ice had failed. In the college students' case, their
companions tried putting one of the women in a tub of cold water before
dialing 911. But every second is precious when the oxygen supply to the
brain is interrupted.

More than half of the drug users in the study cited fear of arrest as the
main reason for delaying or failing to seek help. That was almost certainly
the case in the deaths of Ms. Pesantez and Ms. Carballo, because at least
one of their companions had a long history of arrests and convictions for
carrying and selling drugs. Without witnesses having to debate whether to
call 911 and potentially face arrest or discovery, almost all overdose
victims could be saved.

So why not make this antidote available not just at needle exchanges, but
also in every first aid kit, with every prescription for painkillers like
OxyContin and at every methadone clinic? Recently, Gov. George E. Pataki
signed a law allowing doctors to prescribe naloxone on request, but for
maximum effectiveness, the drug should be available over the counter and
provided free when doctors prescribe opioids. That way, it would be on hand
if a child gets into his mother's methadone, or a teenager gets into his
grandmother's OxyContin, or an addict overdoses at a shooting gallery. What
mother wouldn't be grateful to have it in her first-aid kit when she finds
an unconscious child -- even if she'd never had any suspicion of drug use,
as was the case in the deaths of Ms. Pesantez and Ms. Carballo? And a
pre-loaded syringe, like the Epi-Pen used to treat people having allergic
reactions to things like bee stings, would make it easy to administer.

Some will argue that reducing overdose deaths will encourage drug use. But
Dr. Galea says there's no evidence to support this position in the naloxone
studies. The same argument was used against needle exchanges, but research
never found support for it. And I'd imagine that no matter what their other
feelings about drug policy are, the families and friends of all six
overdose victims wish naloxone had been on hand in time to save their loved
ones.