CITY PROGRAM TO LET ADDICTS GIVE OVERDOSE MEDICATION

Heroin Users To Inject Opiate-Blocking Drug

Pressed by a staggering number of fatal heroin overdoses, Baltimore health
officials will launch a program this spring that will allow addicts to
administer Narcan, a drug that can revive a person near death from a heroin
overdose.

The plan calls for distribution of vials of Narcan - used by paramedics and
hospital personnel to treat opium-based narcotics overdoses - to begin May 1
after a training period for a group of 50 addicts.

Last week, training started for emergency services and health officials who
will, in turn, fan out across Baltimore and teach addict-rescuers basic
medical protocol with the drug, syringes, resuscitation techniques and other
lifesaving methods.

"There is a chronic problem here," said Dr. Peter L. Beilenson, Baltimore
health commissioner. "A significant number of people are dying each year
from heroin overdoses - in one year, more than the homicide rate - and while
this may be viewed as enabling, this is a worthwhile attempt to keep people
alive."

In the past four years, more than 1,000 people have died from heroin
overdoses in Baltimore, officials said.

Baltimore County's top health officer, Dr. Michelle A. Leverett, said she
will be keeping a close watch on the city's Narcan program. "I will be very
interested to see what happens in the city. ... Heroin overdose deaths are
also going up in the county."

Last year, 109 people died from heroin overdoses in Baltimore County. Other
metropolitan counties have problems with heroin use, but none comes close to
Baltimore's or Baltimore County's heroin morbidity rates.

Mixed Message

While supporters of the Narcan program said lives have been saved in other
heroin trouble spots in the nation and world, critics contend the city's
plan sends a mixed message to Baltimore's estimated 60,000 addicts: Use as
much heroin as desired, anytime, anywhere.

Critics also wonder whether addict-rescuers can retain the necessary
information about varying doses of Narcan needed for different overdose
scenarios, all involving life-and-death decisions. There are also questions
of whether a heroin user, high on the narcotic, can efficiently administer
Narcan to a dying member of their shooting party.

Under the program, addict-rescuers will be given vials of Narcan and
syringes. After recognizing an unconscious user experiencing difficulty
breathing, the addict-rescuer will be expected to fill a syringe with a
specific dose of Narcan and properly administer it.

The city started a needle exchange program eight years ago in which nearly
3.8 million syringes have been exchanged in an effort to staunch the spread
of HIV and other diseases among addicts sharing needles.

Baltimore Mayor Martin O'Malley declined to comment on the Narcan program.

Tony Tommasello, director of the Office of Substance Abuse at the University
of Maryland's School of Pharmacy, said that while caution should be
exercised in implementing the Narcan program in Baltimore, the situation
requires innovative steps to reduce the high number of heroin deaths.

Tommasello notes a time when families stocked up on syrup of ipecac in their
households for poison emergencies. "That saved a lot of lives and prevented
emergency room visits," he said.

"Admittedly, we are not dealing with the same mindset here because lots of
things could go wrong with naloxone [the generic name of Narcan] in the
hands of heroin addicts," he said. "But naloxone is a terrific drug and it
has saved countless lives, and while there are lots of questions, the only
way to answer them is test it."

Dr. Robert K. Brooner, professor of psychiatry and director of addiction
treatment services at the Johns Hopkins medical institutions, said he is "a
bit conservative" on the Narcan program. "But we are in a culture that is
reluctant to apply the death penalty to serial killers ... and the sins of a
drug abuser should certainly not mean a death sentence.

"While there are a number of unanswered 'ifs' about such a program, Narcan
should limit the number of people who die from heroin overdoses, and I don't
think anyone would really argue with that."

Still, the Narcan program concerns others familiar with treatment and the
subterranean world of heroin addiction.

The Narcan program "takes the most serious deterrent away from someone
considering a life of addiction - that shooting heroin is dangerous and can
kill you," said Michael W. Gimbel, former director of Baltimore County's
bureau of substance abuse and a former heroin addict.

"The Narcan program sanctions heroin addiction," said Gimbel. "It's like the
city has given up."

But city officials say the body count from overdoses is staggering. They
contend that the innovative program will save lives and drastically cut the
1,800 emergency calls the Fire Department receives annually to revive
overdosed addicts.

'Serious Heroin Abuse'

The National Drug Intelligence Center of the U.S. Department of Justice said
in an August report that Baltimore "has one of the most serious heroin abuse
problems in the nation."

Beilenson said the Narcan project will be accompanied by thousands of
educational brochures, some of which have been distributed to addicts,
detailing lifesaving steps such as CPR and how to inject Narcan into a
muscle, and instructing them to summon paramedics.

In Maryland in 2001, 516 people died from heroin overdoses.

The use of Narcan on heroin overdose patients by paramedics throughout
Maryland also provides an indication of heroin's spread. Last year, more
than 2,000 Narcan revivals were recorded by the Maryland Institute for
Emergency Medical Services Systems.

Baltimore isn't alone in reaching for new solutions. Officials in Chicago,
New Jersey and New Mexico have initiated Narcan street programs and claim
impressive declines in their heroin mortality numbers, 17 percent to 20
percent in some cases.

During the past several years, Baltimore has seen a steady influx of potent
heroin from Colombia, federal officials said. Addicts unaccustomed to such
high-grade heroin inject the drug intravenously, fall into respiratory
arrest and often die.

Some paramedics and emergency room personnel said that while Narcan can keep
down heroin mortality rates, rarely do addicts revived with the drug seek
treatment and work to end their addiction. Instead, they usually return to
the drug dealer who sold them the high-quality heroin that nearly led to
their deaths.

Opiate Blocker

Narcan, approved by the U.S. Food and Drug Administration in 1971, is
generally a benign drug that is also used to revive hospital patients who
experience respiratory problems after receiving too much of an opiate pain
reliever such as morphine, fentanyl or Dilaudid.

Narcan works by blocking opiates from brain receptors. It does not work with
drugs such as cocaine or barbiturates.

Usually, Narcan is administered in varying doses intravenously or into
muscles. It can also be given in a nasal spray.

Doctors and paramedics point to another problem with having nonmedical
personnel administer Narcan - some cases call for a small dose while other
overdose victims require a larger amount of the drug to restore breathing.

Also, other opiates such as methadone and Oxycontin have a longer half-life
in the body. If someone overdoses on those drugs and receives an injection
of Narcan in time, he will be revived. But because of the chemical
composition of the two narcotics, the overdosed user could, within 20
minutes, relapse into unconsciousness and die.

Beilenson said the Maryland attorney general's office is "ironing out the
legal kinks" of the program, namely distributing vials of Narcan under his
prescribing authority as a physician.

The program is funded for two years by a $300,000 grant, Beilenson said.
Most of the money comes from the Open Society Institute, a private
foundation started by financier George Soros. The institute is based in New
York and operates in 30 other countries.