TEACHING DRUG OVERDOSE SURVIVAL

Program Goal: Limit Addicts' Overdose Risk

To a group of Allegheny County Jail inmates, Alice Bell gave a
detailed presentation aimed at keeping them and others from dying
from a drug overdose.

Overdoses kill more people locally than traffic accidents or
homicides, Bell said before outlining ways to prevent an overdose or
to intervene if one occurs.

Bell and other staff members and volunteers for Prevention Point
Pittsburgh, a local nonprofit, have presented the hour-long training
to 3,000 people, 2,000 of them county jail inmates, since 2003.

"We hope the 3,000 people we've talked to about this, and the people
they've talked to, may have contributed to saving some people's
lives," Bell told her audience, noting that drug overdose deaths in
Allegheny County declined last year for the first time since 1999.

Though other communities have overdose prevention initiatives, the
Pittsburgh program is unusual because it targets jail inmates, said
Robert Heimer, associate professor of epidemiology and public health
at the Yale University School of Medicine.

But reaching inmates is important, he said, because they are at high
risk for overdosing once they are released.

Even a few days in jail can cause inmates to lose some tolerance for
the drugs they typically use. Returning to the same level of drug use
after their release can be deadly.

Many inmates have drug problems, and many overdose soon after leaving
jail, Heimer said.

In 2002, 68 percent of the nation's jail inmates reported symptoms in
the months prior to their incarceration that indicated substance
abuse or dependence, according to the Bureau of Justice Statistics.

While eliminating drug use is the best way to prevent overdose, "the
reality is a lot of people continue to use drugs," Bell told about 75
inmates gathered in a maximum security area for her presentation
earlier this month. "There are way too many people dying, and that
doesn't need to be happening. So that's why we're here today."

Unlike overdose prevention programs in some other cities, Prevention
Point does not distribute naloxone to drug users and others who
complete overdose prevention training. The nonaddicting drug, whose
trade name is Narcan, can quickly reverse the effects of an opiate overdose.

But Prevention Point is working to begin a program to distribute
naloxone to drug users in conjunction with its syringe exchange
program, which provides clean injection equipment, medical testing
and information to prevent the spread of HIV and hepatitis C.

Marc Cherna, director of the county Department of Human Services,
expressed strong support for those programs, saying they help reduce
overdoses, disease and health care costs.

Dr. Ronald Roth, medical director for Pittsburgh EMS, said
distributing naloxone to drug users "certainly has the potential to
save lives."

While paramedics often administer naloxone in overdose cases, drug
users may not call 911 for help.

"If you're doing something illegal, you may be reluctant to call," Roth said.

Syringe exchange and overdose prevention are known as "harm
reduction" programs, which assist drug users in making choices to
reduce drug-related harm. Those choices could include drug treatment,
abstinence, or other strategies for people unable to stop using drugs.

The Surgeon General and many experts have concluded that syringe
exchange programs reduce the spread of disease and do not encourage drug use.

Whether overdose prevention programs reduce deaths is unclear. The
programs are relatively new and have not been rigorously evaluated,
though proponents believe they are effective.

In Chicago, deaths from opiate overdoses have decreased since the
Chicago Recovery Alliance began an overdose education and naloxone
distribution program in 2001, said Dan Bigg, the group's director.

In New Mexico, which began similar programs the same year, no trend
toward fewer deaths has emerged, "but we believe we're having an
impact," said Phillip Fiuty, the state health department's harm
reduction coordinator. Without those initiatives, even more deaths
may have occurred, he said.

Both the Chicago and New Mexico programs report many anecdotal
accounts of people who have been revived by receiving naloxone or
through other interventions.

Prevention Point has had similar reports of people helped by the
overdose prevention training.

One former inmate told Bell that guidance from the training helped
him save his girlfriend's life.

Another man told her that if he had received the training a year
earlier, his daughter might be alive. She had overdosed and he
"didn't know what to do," Bell said.

In Allegheny County, 205 accidental overdose deaths occurred last
year, down from 228 in 2003, according to the Allegheny County
coroner's office.

Despite the decrease, police and health professionals say local drug
activity remains significant.

"Heroin's still a major issue," said Stephanie Murtaugh, director of
prevention and intervention services for Mercy Behavioral Health.

Heimer said the rise in overdose deaths in some communities has been
linked, in part, to the greater number of people who began using
drugs in the 1960s and '70s. Local experts ascribe some of the
increase to purer, more addictive heroin and the greater availability
of prescription drugs.

Responding to the rising number of deaths, Prevention Point helped to
organize an overdose prevention task force in early 2003 that
includes police and representatives from the jail, emergency medical
services and other human service agencies.

That effort led to the overdose prevention effort in the jail, Bell
said, noting that Calvin Lightfoot, the former jail warden, was
especially supportive. Prevention Point also has presented the
trainings, which are funded by grants, at local detox and methadone
treatment programs, drop-in centers for homeless people, and other settings.

Groups of jail inmates are trained three times a month. Jack Pischke,
the jail's inmate program administrator, said he tries to select
units where inmates are more likely to be released.

"Not using drugs at all is the surest way to prevent an overdose,"
Bell told inmates during the training earlier this month. "But if you
are using, not mixing drugs together goes a long way toward
preventing an overdose."

Many local overdose deaths, she noted, have been linked to use of
more than one drug.

She also recommended awareness of factors that could affect drug
tolerance, such as illness and periods of drug treatment or
incarceration, and suggested that her listeners not be alone when
they use drugs. If an overdose occurs, another person present could
intervene or summon help.

Bell also addressed the common misconception that victims of opiate
overdose should be packed in ice, noting that doing so could make the
problem worse. "It lowers their body temperature, and their systems
are already depressed."

If overdose victims are conscious and breathing, walking them around
might help, she said.

If they're unconscious, she recommended calling 911 and starting
rescue breathing, demonstrating the technique with an assistant, Alex Bennett.

"The cure for a heroin or other opiate overdose is oxygen," she said.
"If you can keep someone breathing, you can keep them alive."

Narcan, if available, can be a big help, she said.

"It's a pretty miraculous drug. People can be blue and not breathing,
then they get an injection of Narcan and they come back."

Bell stressed the importance of calling 911, but conceded her
listeners may not want to stay until paramedics, and possibly the
police, arrive.

"Stay as long as you can," she said.

Inmates applauded when she finished. One of them, Frederick Tillman,
47, of the Hill District, said he was in jail for a probation
violation, had used heroin or other drugs off and on for years and
had witnessed two overdoses, one of them resulting in death.

"I think everybody needs this training who is in active addiction or
knows someone who is," said Tillman, who hoped to get into a drug
treatment program.

"I learned some things today that may help save a life -- maybe my
own life, though my goal is to go out of here and stay clean."