I WANT A NEW DRUG

If only John Travolta had known. Instead of piercing Uma Thurman's chest
with a needle and stabbing her in the heart with an adrenaline shot in
"Pulp Fiction," Travolta's Vincent Vega could have saved her from a heroin
overdose by simply filling the syringe with naloxone and sticking it in her
backside. Of course, such a move would have robbed the 1994 film of one of
its most talked-about scenes. But even with far less edge-of-your-seat
suspense, it would have accomplished the same thing: The life of Thurman's
character, Mia Wallace, would have been saved.

Compared to Vincent Vega's option, the choice of naloxone seems like a
simple solution to a growing problem - make it available to heroin users
and more deadly overdoses would be avoided. But resuscitating an overdose
victim is hardly a casual affair, and the use of naloxone by laypeople is
still very much open for debate.

In fact, in Massachusetts and in all but one of the other 49 states, it is
illegal to possess naloxone without a prescription. Naloxone, an
anti-overdose drug also known by the brand name Narcan, reverses the
effects of opiates such as heroin and OxyContin. The drug restores an
overdose victim to full consciousness within minutes, as Essex County
Sheriff Frank Cousins Jr. can attest.

A few years ago in his hometown of Newburyport, he watched as a paramedic
used naloxone to save the life of a person overdosed on heroin. Without it,
he says, there's no question that person would have died. But that doesn't
mean the veteran law-enforcement official and Springfield College graduate
wants to see the drug passed out on every street corner on the North Shore.
Cousins, like many in his field, believes the idea of providing naloxone to
the injection-drug-using community as a cure for overdoses would be
misleading and ill conceived.

But they all agree it works, in the right hands. They even admit that
without this fairly new drug the number of overdose deaths in this country
would be much higher.

"It's a miracle drug in the hands of trained professionals," says Essex
County District Attorney Jonathan Blodgett. "People who were blue lining
are jumping off the table."

To keep more heroin and opiate abusers from not being so lucky, however,
drug counselors and others in the health-care field believe naloxone should
be in the hands of those who need it most, or at least in the hands of
their family members and friends.

"I have no problems with Narcan being made more available," says Dr.
Michael Levy, director of clinical treatment services at CAB Health and
Recovery in Peabody. "These people are using needles anyway ... they're
shooting heroin." But don't expect Bay State lawmakers to approve the
public distribution of naloxone anytime soon, especially since
Massachusetts is one of only four states - the others being California,
Delaware and New Jersey - that doesn't allow the purchase of hypodermic
needles without a prescription. There haven't even been any concrete talks
about Narcan on Beacon Hill, and here on the North Shore, both Blodgett and
Cousins, at least, are against such a distribution program. Word on the
street Naloxone has no street value, but law-enforcement officials fear its
availability would remove some of the deterrent from injecting heroin. They
believe it is a dangerous mistake to offer access to this drug as an
alternative to professional emergency care. They say drug users armed with
naloxone may be less likely to call 911 in case of an emergency - a
particular concern to officials who question the ability of someone high on
heroin to identify an overdose and give required emergency care.

"It's a good option for medical people," says Cousins of Narcan, which
first got FDA approval in the early 1970s. "It can save a life. It's
another tool first-responders and paramedics can use in our fight against
heroin. But nobody wants to see non-medical personnel administering
Narcan." Well, not exactly. Since the drug has proven so effective, some
communities outside Massachusetts have made naloxone available to outreach
workers and drug users.

In 2001, New Mexico became the first, and is still the only, state to
legalize the distribution of Narcan to addicts and their relatives. The law
was adopted in an attempt to lower the state's overdose death rate, which
is among the highest in the country. The program has curbed the number of
fatal overdoses slightly.

Chicago, San Francisco and Baltimore all have sanctioned similar programs
to distribute the antidote. Australia also allows the distribution of
Narcan to the public.

Revere resident Gary Langis is working to do the same here. He is drafting
a proposal he hopes will one day make it legal for needle exchanges to
distribute naloxone in Massachusetts.

In the meantime, the board president of the New England Prevention Alliance
will continue to help heroin, OxyContin and other opiate users gain access
to naloxone in Boston's north suburbs.

"Narcan can't be abused. It can't get you high," says Langis, noting there
are underground programs in Massachusetts that dispense Narcan and train
people how to use it. "Where's the danger? It's a harmless drug that
reverses the effect of an overdose ... By the time an EMT gets there, it's
often too late." Langis says he does not know how many referrals he has
made for heroin users seeking access to naloxone. But he notes that he is
aware of at least 200 reported cases in Cambridge in which laypeople have
reversed overdoses using naloxone, since underground programs began making
referrals there in 2001. The drug is easy for a layperson to administer,
because it can be injected into muscle, rather than into veins or under the
skin. Naloxone also gives users who are unwilling to call 911 or afraid to
bring a drugged-up friend to the hospital an alternative that could save
lives, Langis says.

However, critics argue that users suffering from a heroin overdose
immediately become unable to help themselves. Unlike diabetics, who make
insulin injections part of their daily routine, or people with bee-sting
allergies, who remain conscious after they are stung and identify the
problem themselves, Narcan needs to be administered by another person. This
fact creates another layer of questions and concerns, according to
opponents of Narcan distribution. Narcan, they say, does not cure heroin
overdoses. The true cure - oxygen, breathing support and airway control -
gets lost in any naloxone discussion, they say. "I don't like the idea of
Narcan being in the hands of people who are not medical professionals,"
says Cousins.

Opponents of the drug's widespread availability also note that opiate
addicts can become combative after receiving Narcan, because it kills their
high. Dr. Levy, for one, doesn't see that as a roadblock to making Narcan
more available. "Opiate withdrawal is not a life-threatening illness," he
says. "It's a much better option than dying."

Unwanted smack down Ever since a 2003 federal report claimed heroin-related
deaths in Massachusetts had risen 76 percent since the start of the 21st
century, Bay State lawmakers and law-enforcement officials have been
calling for more state and federal resources to win the war against drugs.

That White House Office of National Drug Control Policy survey found that
Massachusetts had one of the highest rates of illegal drug use in the
country, with heroin use reaching epidemic rates.

The same year that report came out, the Essex County Drug Task Force made
300 heroin-related busts, and seized more than 21,000 single-dose bags of
heroin and 2,172 grams of pure heroin, enough for more than 65,000
additional single-dose bags.

Massachusetts law-enforcement officials say the street price of heroin has
dropped to an average of about $4 per bag, down from about $40 per bag in
the 1990s. The drug also is becoming more popular among affluent people and
those who live in the suburbs, according to Blodgett and others. "There's a
stigma that only junkies, thieves and the homeless are using these drugs,"
says Langis. "But our sons and daughters are using. Kids that should be
hanging out at the Gap."

The aforementioned facts and figures have Langis believing naloxone use
will become more prevalent.

Just last September, in a Melrose elementary school parking lot, police
found a sandwich bag containing a syringe and a bottle of naloxone. The bag
also included detailed instructions showing a layperson how to respond to a
heroin or OxyContin overdose using naloxone.

Police believe the kit belonged to a drug user. Langis is hardly surprised.
"We can't arrest this problem away," says Langis, whose organization
teaches users to call 911 first and not to just "dump" those suffering from
an overdose at the hospital and then take off. "Narcan alone isn't the
solution either, but it would bridge the gap and it would give us another
tool for engaging these people. They do want to change their lives. Nobody
wants to be strung out on heroin."