Skip to main content


Interview with Dr. Nabarun Dasgupta, Scientist at Epidemico and the University of North Carolina at Chapel Hill
By Tessie Castillo

If you work on overdose prevention in North Carolina, chances are you’ve heard the name Nabarun Dasgupta. From helping to found one of those most successful overdose prevention programs in the nation to delving into research on black market prices for prescription drugs, Nab has his fingers in all pieces of the pie. But he’s more than just a scientist or epidemiologist. Dasgupta may enjoy combing through matrices of poisoning data, but he also uses his findings to launch programs and interventions so that statistics are not just numbers on a spreadsheet, but life-saving tools to prevent overdose.

TC: Describe your work in overdose prevention in North Carolina over the years.

ND: I was interested in prescription opioids and overdose before I came to North Carolina, but when I got here I felt a personal and professional responsibility to help solve the problem. Being a nerdy epidemiologist, I downloaded the state overdose data, figured out where the hot spots were for overdose deaths and got involved with local folks in those areas to work on the issues.

I helped start Project Lazarus and worked five years pro bono on data analysis, writing grants, presentations and designing interventions with Fred Brason and Kay Sanford. I also served on the Board for the North Carolina Harm Reduction Coalition (NCHRC) and tried to steer them towards work on overdose prevention. When I joined the Board, most of our focus was on HIV and hepatitis. I’m glad to see now that NCHRC has adopted overdose prevention in a strong way and has awesome staff to implement it.

TC: What is your latest research on prescription drugs?

ND: We looked at street prices to see if the unregulated black market for prescription drugs could predict the molecular potency of different types of painkillers. Usually when new drugs are being developed the companies run clinical trials to determine which medicines have higher or lower abuse potential. In the trials the researchers ask participants, usually experienced drug users, how much they would pay for certain drugs and compile the quantitative data to determine abuse potential. For our research, we wanted to see if the price differences between drugs on the black market would mirror the results of clinical trials and if they could predict drug potency.

We collected the price data from StreetRx, part of the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System [Link: radars.org] nationwide collection of prescription data, and found that the unregulated street market predicts molecular potency almost perfectly. In other words, the strongest prescription opioids sell for the highest price on the black market, and the weakest drugs cost the least.

Check out the study: http://www.jmir.org/...

   

TC: How can information on black market prices be used to inform drug policy?

ND: Right now the pharmaceutical industry is developing new formulations of drugs that are difficult to tamper with and crush, so the fundamental question is, are the new tamper-resistant products more or less abusable than the projects already on the market? One way to gage this is by looking at street prices. For example, when the new tamper-resistant OxyContin was created, it sold for less on the street market than the old, crushable formulation, which demonstrates that it has less potential for abuse. Doctors might also use information on street desirability to make decisions about which drugs to prescribe to patients.

TC: Couldn’t the creation of more tamper-resistant drugs merely divert abuse to substitutes?

ND: Absolutely, especially in the context of the widespread availability of heroin and other prescription opioids. No one tamper-resistant product is going to solve the broad societal problems of addiction and opioid abuse. Past experience in the United Kingdom and Australia shows that damage and death can result from the introduction of abuse-resistant formulations if they are not rolled out within the public health and harm reduction model.

TC: So what can be done to ensure that tamper-resistant formulations don’t result in drug diversion and more overdose fatalities?

ND: Access to drug treatment and harm reduction services will ultimately reduce the tremendous toll that these medications take on our society. People have been trying to make less abusive forms of opioids since morphine was first isolated. Heroin was once considered less abusable than morphine; codeine less abusable than heroin; methamphetamine less abusable than amphetamine, etc. We have a history of failure trying to come up with a solution to the drug problem without addressing the social issues that contribute to it.

TC: You recently defended a PhD dissertation at UNC. What was it about and how does it relate to your other work?

ND: Basically I discovered that when it comes to opioids and analgesics, there are some serious flaws in studies that are cited to set clinical guidelines on the maximum limit of how much opioid should be prescribed for pain. The policies don’t take into account the co-prescription of benzodiazepines. The risk of overdose is much higher if opioids are prescribed with benzodiazepines, but conversely, if benzos are not being prescribed, we can treat people with higher doses of opioids, for example for cancer.

TC: What’s in the future for you?

ND: I have a paper coming out on the effectiveness of prescription monitoring programs at preventing overdose deaths funded by the Robert Wood Johnson Foundation. They appear to no be sufficient to stop overdose deaths on their own, in fact overdose deaths actually increase after prescription monitoring programs are implemented. That paper should come out in September. After that, I don’t know. Just preparing to be a Dad!

Discuss

On August 1, 2013, the North Carolina Harm Reduction Coalition’s (NCHRC) Overdose Prevention Project (OPP) began dispensing naloxone in North Carolina as part of community-based overdose prevention training program. This program has been made possible under SB20, otherwise known as the “911 Good Samaritan/Naloxone Access” law. By this law, the NCHRC Medical Director, Dr. Logan Graddy, under a standing order, provides naloxone and supplies to administer the medications for patients or families of patients at high risk for overdose who have completed a NCHRC community-based overdose prevention training program.

Dr. Graddy completed his residency in Psychiatry and a Fellowship in Forensic Psychiatry. He is double-boarded in Psychiatry and Addiction Medicine. He works as a psychiatrist for the North Carolina Physician’s Health Program in Raleigh and also has a private practice in Durham.

Q: How did you become interested in harm reduction?

LG: I’ve had an interest in harm reduction since I first learned about it while in my psychiatry residency at Duke. Public health harm reduction strategies like encouraging people to wear seat belts to reduce fatalities from motor vehicle crashes just made sense to me.

As I have grown as a clinician, I have found that using harm reduction strategies in my practice can really help engage patients with an addiction. If you help people start to think about how to use drugs in a safer manner, you can then use that conversation to pivot and ask whether they have ever thought about stopping using altogether. What are their goals in life? Is what they are doing now consistent with where they want to be?

You can see the light switch come on when they see that you care about them and have their best interest in mind. I’m not saying this is easy-- it’s challenging to meet people where they are. I admit at times I’ve struggled with fully embracing a harm reduction approach because I’ve had trouble accepting some of the choices people are making.

But what I’ve come to realize that I have to accept and honor where people are in order for them to trust me to help motivate and encourage them to change their behaviors. I have had the experience that most people, over time, with support and encouragement, will naturally start working towards a healthier life. Our shared goal becomes more stability for them, more balance, and then, hopefully, I can help them imagine, and then realize a life completely abstinent from addictive substances.

Q: NCHRC has spoken to quite a few medical prescribers about prescribing Naloxone to their patients. Why do you think some prescribers are hesitant?

LG: I think when you ask many prescribers to consider prescribing naloxone to patients at risk for an overdose they have an immediate concern about being sued. One thing I learned before I decided to prescribe naloxone that may reassure others is that no prescriber, ever, has ever been sued for prescribing naloxone for overdose prevention.

I think other prescribers may have a knee jerk negative reaction to the harm reduction aspect of this program. Again, I can understand this because I’ve had my own struggles with harm reduction at times. But I think when you understand the overdose epidemic we have in North Carolina, literally over a thousand people dead from this last year, you realize how important it is for the medical community to respond to this crisis. We all need to do our part. And we know that naloxone distribution programs are an evidence-based harm reduction strategy that is going to save lives in our state.

I believe in our program because we are going above and beyond for our patients to try to save lives. It shows that we care, regardless of whether they have health insurance, their immigration status, even if they are on probation or were just incarcerated. I think this kind of outreach makes it easier for people to seek help further down the road and not throw just their life away with drugs. We should not be writing people off because they are using drugs, or thinking somehow that in order to stop using drugs people need to learn a lesson by almost dying.

I believe that every person’s life is of value and we need to all do what we can to save these lives at risk. These folks are our neighbors, our friends and our families. Substance abuse doesn’t discriminate by class or color.

Q: Besides trying to do your part, what reassures you that you are doing the right thing in prescribing Naloxone by standing order?

LG: Well, first I feel reassured because of the wording of SB20. This law states clearly it provides civil and criminal immunity to a provider prescribing Naloxone in good faith under a standing order to a person at risk of experiencing an opiate-related overdose, their family member, or friend.

I also feel reassured because the North Carolina Medical Board (NCMB) has made several statements of support specifically supporting Naloxone prescription through a program like ours. In March 2013 the NCMB said that they encouraged licensees to cooperate with programs in their efforts to make opioid antagonists available to persons at risk of suffering an opioid overdose. In May 2013 the NCMB specifically supported the use of standing orders by prescribers to provide Naloxone prescriptions.

I think it’s pretty clear that the leaders in our State are encouraging prescribers to participate in these kinds of programs and I applaud them for their foresight and support. As I said earlier, I think we all need to do our part in trying to prevent overdose deaths in North Carolina and I think this is my role to play right now.

Discuss

North Carolina’s recent passage of the 911 Good Samaritan/ Naloxone Access law was a ground-breaking achievement in drug overdose prevention. The law passed through the combined efforts of local nonprofits, lawmakers, public health advocates and community members affected by overdose, and no one person could claim credit for an act which will surely save thousands of lives in North Carolina. But there was one person who has been working behind the scenes in overdose prevention for over 10 years and whose research and advocacy helped lay the ground work for this legislation and future efforts. Though you don’t see her name much in the papers, Kay Sanford, retired State Injury Epidemiologist, is one of the heroes of overdose prevention advocacy in North Carolina.

Q: What got you interested in overdose prevention?
Kay: I first became involved in overdose prevention in 2002 when it was discovered that the death rate of unintentional poisonings between 1990 and 2000 had tripled, while at the same time the mortality rate for almost every other injury in the state had stabilized or decreased. I knew something was terribly wrong, but didn’t know exactly what. I requested and received from the CDC a team of EIS (Epidemic Intelligence Service) investigators to help me review close to 1100 medical examiner reports on all of the NC residents who had died from unintentional poisonings between 1997 and 2001. The findings were staggering.  Almost all of these deaths were due to exposure to medicines. Over 60% of them were narcotics.  It was clear from the review of these charts that while the behavior on the part of many (but not all) of these victims was deliberate, i.e, they were either self-medicating to treat their pain or using the drugs for non-medical reasons.  It was also clear that none of these people had meant to take their own life. These were accidental deaths.  In contrast to my perception that most poisonings were due to little kids crawling under the kitchen sink and drinking Drano, one third of these deaths were due to abuse of cocaine or heroin; one third were due to methadone (primarily prescribed to treat chronic/severe pain and not to treat substance abuse); and the final third of the deaths were from an overdose of manufactured opioids to treat pain and other controlled substances that by definition had the potential to be highly addictive. And most of the NC residents who overdosed had been observed before their deaths by family members or friends who thought that they were just snoring and would sleep ‘it off’. Over 60% of the victims died before any medical intervention arrived. It was clear to me that at least two things had to happen.  People taking and prescribing these often highly effective pain medicines had to be better informed of their inherent danger and the family and friends of people who used opioids had to be trained to recognize and reverse an opioid overdose.

Q: Why is OD prevention so important to North Carolina?
Kay: In the past 5 years (2007-2011), over 5,000 N.C. residents accidentally died from poisoning.  Most of these deaths were from an overdose of a prescribed pain medicine like hydrocodone, methadone, and oxycodone. Almost all of these deaths could have been prevented.  During these same five years, there were over 288,000 visits to N.C. emergency departments to treat substance abuse or an accidental poisoning. Since 2008, 7.7 million prescriptions for an opioid pain reliever have been dispensed each year to North Carolinians.  The media would have us believe that overdoses occur most often to the rich and famous or to street addicts. However, research clearly shows that the misuse and abuse of pain medication and other drugs that leads to addiction and accidental deaths happens to people of all races, at all ages and in all socio-economic levels. Because the average age of death from a drug overdose often occurs in the prime of life, between 35 and 45 years of age, the estimated economic and social costs to our community are potentially greater than those for deaths due to heart disease or stroke.  The situation, however, is not hopeless.  There are many things that our community can do to save lives from prescription drug overdoses and to prevent addiction.  Preventing drug overdoses in the first place by teaching people how to use their pain medication or other opioids safely or implementing other harm reduction strategies, such as laws that encourage calling for medical help when someone overdoses without the fear of arrest or providing family and peers with the tools to reverse an opioid overdose, such as encouraging medical care practitioners to prescribe and disseminate naloxone to reverse potentially life threatening respiratory depression during a serious overdose.

Q: What is your personal experience with overdose?
Kay: Years ago after shoulder surgery I was prescribed two medications to assist in recovery.  The pills were for the morphine and prednisone; both looked the same – two little white tablets, the same size and shape.  The dosing, however, was different for each drug: one tablet of morphine and 8 tablets of prednisone.  On the day in question, I had company for breakfast – my father who had come to ‘take care of me’ and a close friend.  Paying more attention to my guests than the pills, I mixed them up, and took 8 tabs of morphine and only one tablet of prednisone.  Within minutes I felt a wave of heat and light-headedness.  I excused myself from the breakfast table and checked the pill bottles.  Yes, I had indeed mixed them up.  I discretely stepped into another room to call a friend who works as a nurse in the local emergency department.  No, I couldn’t stay home, pretend I hadn’t just done one of the more stupid things in my life and guts it out until my father left in two hours.  So, I returned to the breakfast table, confessed my stupidity, and off we went to the local Emergency Department.  Fortunately the amount of morphine I consumed did not result in respiratory depression.   My fiancé (who was sweet enough to marry me that year) spent the day keeping me awake and I was discharged from the ED as soon as he arrived.  However, it was a clear and compelling lesson -- anyone who uses opioids can accidentally overdose – even those of us who theoretically know better.  Having a friend who knows how to recognize the signs and symptoms of an overdose is invaluable to anyone who is using an opioid.  It wasn’t until we were at the ED that we knew my overdose was not life threatening.

As a consultant for the North Carolina Harm Reduction Coalition, Kay Sanford continues her efforts to educate families on how to recognize the signs and symptoms of a drug overdose, and how to respond. In addition to her legislative advocacy efforts and work as a research consultant, she volunteers her time teaching inmates and senior citizens about how to prevent accidental drug overdose.

Discuss

Joe Donovan knows a thing or two about hard living. A few years ago the Raleigh-based veteran was diagnosed with a rare adrenal disorder, Addison’s Disease, which can cause fainting spells that require an emergency injection. Since his diagnosis in 2004, Donovan has been required to carry emergency medication and a syringe on him at all times, as well as to wear a bracelet explaining the disorder and how to administer the injections.

Not long after his diagnosis and the discovery of a tumor on his pituitary gland, Donovan lost his job. Soon after, with pending surgery and medical bills piling up, he became homeless. Over the next five years he was homeless twice, for as long as two years at a time. Living in homeless shelters with nothing but a backpack and some clothes, Donovan had many things to worry about, but among his concerns were the syringes he kept in his backpack along with the emergency medication. As a veteran, he obtained the syringes from the VA for his disorder and had every right to carry them, but because he was and subject to the same stereotypes about drug use that plague many homeless people, he often worried about run-ins with the police. Would they believe his story that the syringes were for a medical condition?

“Homeless people are more likely to be stopped and asked questions by the police,” explains Donovan. “There are assumptions that any homeless person with a syringe must be an addict. Many officers are educated about syringes for medical reasons other than diabetes, but some law enforcement actions come from closed assumptions about who people are based on outward appearance.”

Donovan understands the stress of carrying syringes, which could lead to misinterpretations about their use during an encounter with some officers. Fortunately, in 2009 he received a housing voucher for homeless veterans and has since been able to rejoin the work force and get back on his feet. He can now be found in a suit and tie walking the halls of the NC General Assembly in his new advocacy position. He is interested in a new piece of legislation, House Bill 850, which pertains to syringe possession.

Under current law, police officers are allowed to arrest a suspect for possession of drug paraphernalia if the officer suspects that a syringe or other object might be used for illicit substances. But if the HB850 passes, a person who gives up syringes and sharp objects prior to search would not be prosecuted for possession of paraphernalia. The bill aims to encourage honesty between a suspect and law enforcement, as well as to reduce the incidence of needle-stick injuries to law enforcement and exposure to blood borne disease, such as HIV and hepatitis C. Currently one in three law enforcement officers will suffer a needle-stick injury at some point during their careers. HB850 could do much to improve the health and safety of law enforcement, as well as provide some relief to people like Donovan who carry syringes for medical reasons or otherwise.

Donovan supports HB850 as a practical bill that benefits both law enforcement and people who carry syringes. “Now that I look like your typical middle class guy again, I don’t expect to attract attention from law enforcement that could lead to questioning,” says Donovan. “But I understand what homeless people and others go through. I’d like to be that guy in the legislature who challenges the stereotype that only drug addicts carry syringes.”

Discuss

By Samantha Korb

For sex workers, condom usage is extremely important to protect themselves against HIV and STIs, but in reality, this doesn’t always happen. A customer might pay much more for sex without a condom then sex with a condom, and depending on the day a sex worker has, the decision to not wear a condom may be one of necessity, then one of safety. Wearing a condom might be more risky in the short term if a sex worker is threatened with violence, or a sex worker has had something to drink.  Based on these barriers, for sex workers to exclusively use the male condom during sexual contact might be unrealistic, unsafe, and a question of survival.

This is why the reality condom (or known as the female condom at first) is essential to safer sex work. The reality condom first came on the market in 1993, and was an alternative to the ‘male condom’ in many ways. First, the reality condom’s biggest difference is its internal usage. The reality condom can be used internally in the vagina or in the anus up to 8 hours before vaginal or anal sex. The reality condom is also polyurethane, so for those with latex allergies, it’s also a healthy and safe alternative to use during sex.   The reality condom is also pre-lubricated and loose-fitting, and whether a sex worker is engaging in vaginal or anal sex, it can be inserted 8 hours prior to sexual intercourse. This is important because sex work and drug use might coincide for some engaging in sex work.

It’s advisable not to drink or use drugs during sex work, but it’s also unrealistic to understand that it’s never going to happen. For a sex worker, using the reality condom literally might save their life. If a sex worker isn’t completely sober, having the reality condom inserted in their vagina or anus lessens the chance of HIV and STIs during sexual encounters, but it also leaves still leaves the sex worker with the agency to make decisions and puts the sex worker in charge. In situations where a customer or john prefers sex without a condom, having the reality condom inserted in your vagina or anus already doesn’t complicate the situation, and often times sex without a male condom will result in increased revenue for the sex worker.

There are also a whole host of other advantages to using the reality condom during sex work. As stated before, if you or your john has a latex allergy, then the reality condom provides a safe alternative to using the male condom. The reality condom is also less susceptible to tears, providing added safety during sexual contact. The reality condom also tends to cover more area than the male condom (which only covers the penis), so you are more protected against STIs like herpes and genital warts which can be transmitted through skin to skin to contact. One of the biggest advantages to the reality condom besides its safety protections for sex workers is that it can be provide stimulation for the sex worker as well, particularly when it comes to clitoral stimulation, and the reality condom preserves heat well, so sensation for both partners is preserved during sexual contact.

Access to reality condoms isn’t as pervasive as male condom, but if you are engaging in sex work, reality condoms can be a safe and healthy alternative to relying on the male condom. The reality condom provides sex workers the agency to make safer sex decision and helps sex workers put their safety first in all situations. For more information about the reality condom,  the North Carolina Harm Reduction Coalition provides safer sex tips, including how to use the reality condom vaginally and anally and helps sex workers gain access to the reality condom.

Discuss

Written by: India Johnson

The idea of using condoms is not as popular as it should be in today’s society. There are lots of people advocating for condom use, yet STD rates are steadily rising. One population in particular is at higher risk for contracting STDs the most; sex workers. When most people think of sex workers, they may think of a prostitute or someone who works on the street. While that description is sometimes true, the title “sex worker” is an overall name that sums up all activities in which a person provides sexual or sexual related services in exchange for money, drugs, housing or other favors. Sex workers can range from street workers, to strippers, all the way to high paid escorts. No matter what the title is the use of condoms are equally important.
It has been proven that condoms are 99.9% affective in protecting any person from contracting STDs or HIV if they are used properly. Some sex workers do not have access to condoms and some do, but others are afraid of carrying them due to possible harassment by law enforcement. Depending on the area, police officers use possession of condoms as evidence of prostitution, not understanding that this is how they protect themselves and other community members who interact with them. Other sex workers, who do not use condoms, use unsafe and risky methods that they believe will reduce their chances of becoming infected such as “pulling out”.  Due to lack of knowledge about this topic, sex workers are unaware that “pulling out” can still result in contracting the HIV infection or other STDs. This, in turn, could potentially transfer to the client and create a domino affect to other community members, therefore, raising the rates of STDs once again.

It is imperative that sex workers use condoms each and every time they engage in sexual behavior. Wearing condoms could actually reduce the STD rates within their population and clients that they interact with, which could potentially lower STD rates overall.

Discuss

Denise Cullen has lived through one of the worst tragedies a mother can experience – losing a child. But if there is anything worse than losing a child, it is losing a child to a drug overdose, because grief is accompanied by stigma and blame.

Denise lost her only son, Jeff, when he was 27 years old to a fatal combination of morphine and Xanax. She remembers him as “warm, open, loving, bright and stubborn. He had a huge laugh and a fabulous smile,” she says. He was also impulsive and suffered from ADD.

“We were very, very close,” Denise recalls. “Even during those horrible years [of drug use], he and I never became distant from each other.  It was torturous at times but the one thing that was always, always apparent was that he loved his family and his family loved him.  No matter what.”

Jeff began using drugs in the 9th grade, possibly to self-medicate his ADD. Over the next 12 years he experimented with a variety of drugs, including his final drug of choice, opiates. During those years, “Jeff tried so, so hard to stop,” says Denise. “He felt ‘broken’ and guilty for the hurt he inflicted on his parents. He once wrote about his ‘fairytale life’ that he had screwed up so badly, and his self-esteem was gone toward the end. But he always took total responsibility for what he did.”

For Denise, the pressure and fear of watching her only child battle addiction was “like a roller coaster with good periods and crashes.  You learn to be hyper-vigilant, living always with fear.  You have hope as well – as long as they are alive you have hope, but the sound of the phone ringing at night, or not hearing from them in a normal way is very difficult. It’s always in the back of your mind that your child could die in some way as a result of their addiction. You may think you can imagine it, that you are in a way prepared…but you are not.”

The fateful day arrived on August 5, 2008. Jeff was at the beach with a friend waiting for a bed to open up in a long-term rehab facility. Denise remembers that he was happy and hopeful about the treatment center.

“I called him in the afternoon to ask when he would be home,” says Denise. “He said he’d call, but hadn’t done so by 6:30 or 8:30pm. Finally at 10pm I called and left a very angry message. I was upset that he was acting like ‘the old days’ and making [his parents] worry. He never got those last messages. He was lying on the grass in a nice neighborhood…dying.”

According to eyewitnesses – and shockingly, there were many – Jeff was lying on the grass starting around 4:30pm. He lay very near a curb where cars parked on an active street, yet no one stopped to ask what a clean, good-looking kid was doing motionless on the grass. At 11pm a woman finally called police, saying that Jeff hadn’t moved an inch in two hours.  The time of death was around 10pm.  He could have been saved.

“At around 3:00am a very kind man, a Sheriff from the Orange County Coroner’s Office, rang our doorbell,” says Denise. “He had Jeff’s wallet, keys, phone, and beach gear…I am not a dramatic person but I fell to the floor and screamed until I couldn’t scream anymore and simply made sounds like a wounded animal.”

Losing her only son was the worst kind of pain Denise could imagine, and she began visiting grief groups for parents. To her shock and chagrin, parents whose children had died of non drug-related means were judgmental about Jeff’s overdose. “I could actually feel people move their chairs away from me [when they heard Jeff had died of an overdose],” says Denise. “They had an attitude like ‘your child chose what killed him. Mine didn’t.”

But judgment and accusation didn’t stop Denise. She left the traditional grief groups to found her own chapter of GRASP (Grief Recovery After a Substance Passing), for parents who also bear the unique stigma attached to drug overdose. GRASP was originally founded by Pat and Russ Wittberger of San Diego, but after they stepped down, Denise and her husband volunteered to take over. Today GRASP has 43 chapters in 24 states and offers healing and advice to parents in mourning.

“My advice to parents is to learn as much as they possibly can about  addictive illness and drug use from responsible sources early on,” says Denise. “Talk honestly about the risk factors of becoming addicted by ‘experimenting,’ talk about family history of alcohol or substance abuse.”

Denise and her husband Gary also foundedBroken No More, a nonprofit that works to change how substance abuse is viewed by the public and to fight failed drug policies. Run by people dealing with substance abuse issues in their families, the organization advocates for sterile syringe availability, 911 Good Samaritan laws that encourage witnesses to an overdose to call for help, and greater access to naloxone, an antidote to opiate overdose. Most importantly, Denise believes that to resolve the overdose crisis, people whose lives have been touched by this issue need to speak up.

    “We must get loud about overdose,” she says. “During the AIDS crisis, nothing was done until the gay community spoke up, then help came by the bucketfuls. Now, not only has the disease become more manageable, but the stigma has been reduced as well. With overdose, we must address both these elements. We must research addiction and find better treatments and a cure. It can be done. We just have to care enough to do it.”

Death is not a time for blame. It is a time for reflection. And then, it is a time to speak.

Discuss

Liz Perkins was thrilled when her first child was a boy. She named him John, after his father and grandfather, and throughout his childhood years he was an adorable, active baby who climbed out of his crib early and got into everything.

John did well in school and was always the life of every party. But in college, a series of stressful events lead him to experiment with drugs, particularly opiate pain relievers like Percocet and Oxycontin.

Liz was shocked when she realized her little boy was addicted to drugs. “I spent every waking minute getting him help,” she says. “He and I had a close relationship. He was smart and had his whole life ahead of him and I couldn’t believe this was happening to us. I felt scared and alone.”

She started reading up on addiction, searching for ways to help John and make sense of what was happening. “I read a book called Beautiful Boy by David Scheff and I realized that this road was much harder for John than it was for us. My understanding opened up. I also realized that we had family members who were addicted to opiates as well.”
The road for Liz and John was difficult. John would seek treatment, be sober for a while, and then relapse. It was a devastating cycle that took a strong emotional and physical toll on the family. But the worst was yet to come.

“[After a period of sobriety] John came home one night visibly upset because someone had hit his car in the parking lot,” recalls Liz. “I tried to calm him, but he went to bed. A few minutes later, I heard his car leave and had a bad feeling…the next morning he told me, ‘Mom, I fucked up again.’ I wanted to kill him, but I hugged him instead, told him how much I loved him, and said he would have to fight [addiction] the rest of his life.”

A few days later Liz received a hysterical call from John’s girlfriend saying she had returned home from work and found him unconscious on the bathroom floor. She called 911 and an ambulance took him to the local hospital. Liz and her husband rushed to the ER to see their son, but it was too late. He was on life support for 36 hours, then pronounced dead. It was May 5, 2011. He was 30 years old.

“When I lost John my life lost all of its meaning,” says Liz. “If I didn’t have another child and a husband I wouldn’t bother [living].”

Losing a child by any means is horrific, but losing a child to drugs comes with a unique stigma. The sympathy that most parents get after such a loss often isn’t there, replaced instead with fingers of blame and accusations of deservedness.

But Liz is strong, and instead of giving up, she channeled her grief into helping other parents who are also grappling with a child’s addiction or death.  “After my loss of John, I realized that I could not sit back and be quiet about this [overdose] epidemic,” says Liz. “I founded the only GRASP [Grief Recovery After a Substance Passing] chapter in Delaware.  I want to help parents who come after me. I am also involved in getting our state to institute a Good Samaritan 911 law [to encourage witnesses to an overdose to call 911] and over the counter access to Narcan [an opiate overdose antidote].  If we can save just one kid then it is all worth it.”

As the overdose epidemic continues to grow, more and more mothers experience the unimaginable suffering that Liz and others are going through. But if enough people speak up about overdose and turn grief into action, we might turn the tide of this silent killer.

“If John was alive today, I know he would be very proud of me for not putting my sad head in the sand, but trying to save others,” says Liz. “I miss him every day.”

If you are a parent who has lost a child, visit your local GRASP group (http://grasphelp.org) . To learn more about overdose, 911 Good Samaritan laws and access to Narcan, visit NC Harm Reduction (www.nchrc.org).

Discuss

The Battle for Syringe Exchange in Texas – Interview with State Senator Deuell (R)

It’s normally Democratic candidates who support public health programs like syringe exchange, but Texas, as usual, likes to shake things up. In the Lone Star State, the champion for syringe exchange is none other than state Senator Bob Deuell, an avowed Republican.

Senator Deuell, a medical doctor by profession, was initially against the idea of syringe exchange, which allows drug users and diabetics to exchange used needles for clean ones in order to reduce the transmission of blood-borne disease. Like many people, he worried that these programs would encourage drug use.

“After reading medical reports and studies on [syringe exchange], Senator Deuell decided that it made sense from a medical perspective,” explains Scott Kirby, legislative director for Senator Deuell. “He realized that syringe exchange does not increase drug use, as he’d previously thought, and it actually lowers HIV, which is a problem in Texas. He even told Republicans that they should take opposition to syringe exchange out of their party platform because it saves lives and doesn’t do any damage.”

The bill, SB 308 Relating to Disease Control Programs, was introduced in the Texas legislature in 2003 and 2005, but stifled by partisanship. All the Democrats were for the bill, all Republicans against.

In 2007, Senator Deuell agreed to sponsor the bill. He was able to convince half the Republicans in the House that syringe exchange was a life saving program that lowered disease without raising drug use. He pointed out that syringe exchange is supported by the American Medical Association, the Pediatric Society, numerous law enforcement officers, religious leaders, pharmacists and drug counselors. That year the bill passed easily in the House, but got stuck in committees and was unable to move forward.

In 2009 Senator Deuell and supporters rallied again to pass SB 308 in a revised form. The new bill bracketed syringe exchange programs to only major cities and left the decision up to counties whether they wanted to implement the programs.

“It helps to bracket the programs just to big cities to give cover to people in rural, more conservative areas, because they know their support for the bill could end up in a 30 second ad on TV about encouraging drug use,” explains Scott Kirby.

The new bill passed the Senate easily and had the votes to pass the House as well, but it ran out of time. Then in the 2010 elections, a surge in Tea Party candidates shook up the legislature and rendered SB 308 very difficult to pass. Senator Deuell however, is not giving up.

“Senator Deuell is very passionate about this issue,” explains Scott Kirby. “It’s a long term project and he will keep at it. Syringe exchange is a hard thing because if someone will debate you, you can win, but no one debates this because facts are not on their side. We have to deal with politics and that makes it difficult.”

Senator Deuell serves as a model of brave leadership and common sense over political partisanship. We hope that his example will inspire others to put people before party and to pass much-needed legislation on syringe exchange. The fight isn’t over yet.

Thanks to Scott Kirby, Legislative Director for Senator Deuell for this interview.

Discuss

Saving Lives with Simple Solutions
by Allison Glasser

Seven years ago, Durham resident Chad Sanders lost his sister, Shelly, to drug overdose. Shelly had been using drugs with a friend in her dorm room when she became unresponsive. Her friend, recently released from jail on parole, did not call 911 for fear that he could be arrested for drug possession. Shelly didn’t make it through the night. Unfortunately, Shelly’s story is far too common. Drug overdose deaths have surpassed automobile deaths as the leading cause of accidental death in the United States. In North Carolina, antiquated laws and practices lead to over 1000 preventable overdose deaths each year. It’s time we do something about it.

A person who is experiencing a drug overdose has 1-3 hours before the overdose proves fatal. An adequate amount of time exists for friends or family to call 911 to get this person help. Additionally, administering naloxone, a non-abusable medicine used to reverse overdose, is safe and effective even when administered by people without medical training.

Current North Carolina laws do not support these life-saving practices. Overdose bystanders who call 911 can be arrested for suspicion of drug possession or other drug-related crimes. Not surprisingly, fear of the police is the number one reason cited for failing to call 911 during an overdose.

No one should be arrested for attempting to save a friend’s life.

Distribution of naloxone is legal in North Carolina with a prescription. However, physicians co-prescribing the antidote with opioid pain relievers to patients may be wary of doing so for fear that it will be used on someone other than the person they have examined, violating a state law that prohibits “third-party prescriptions”.

Drug users should be able to be prescribed naloxone to protect themselves and their loved ones.

So, what can we do? We can advocate for enacting 911 Good Samaritan laws that not only protect the individual calling 911 from criminal liability, but also the person experiencing the overdose. The focus in the case of an overdose should not be to punish people, but to keep them safe and bring them back to health. We can also push for a law that will allow medical professionals to prescribe naloxone to any person, making it available to all who are at high risk for overdose. Lastly, we need to endorse a law that provides immunity to individuals who possess, distribute, or administer naloxone.

Other states have enacted such laws over the past two years, most recently Florida, where strong bipartisan support was expressed. Washington was one of the first states to enact a 911 Good Samaritan law in 2010. One year later, 88% of opiate users in the state reported they would be more likely to call 911 during future overdoses as a result of awareness of the new legislation. Several states have amended their laws to educate physicians and lay people on the use of naloxone and to protect physicians who prescribe the drug, so that it does not expose physicians to a greater risk of medical liability. Shelly’s brother Chad supports expanding access to naloxone, relating it to a similar, but over-the-counter drug: “If someone is allergic to bee stings, they have easy access to an EpiPen, but if people overdose, the medicine is not [readily] available…because of stigma…that’s not a good excuse.”

Passing a 911 Good Samaritan law and increasing access to naloxone are not only effective, they require no additional funding. Detective Gary Martin from the Palm Beach County Sheriff’s Office in Florida, a supporter of these laws, reported that they “…don’t cost anything. They may even save money because they mean incarcerating fewer people. Every life saved is one less autopsy, one less law enforcement investigation that the state has to pay for.”

Most members in the community have moved past the “war on drugs” mentality of the 1980’s that engendered stigma and judgment to more of a public health perspective. Yet policies remain in place that do not work and continue to harm people. As Chad can attest, anyone’s life can be affected by drug use: “it is likely that someone in your family or at least someone you know is struggling with the disease of addiction.” It is therefore up to all of us to advocate for better policies that will keep people alive to get help.

Call your legislators today to express your concern about the high rate of overdose deaths in North Carolina. Let them know how important it is for them to support 911 Good Samaritan and naloxone access legislation in the 2013 legislative session.
.

Discuss

Interview with Anne Lamberti, Clinical Addiction Specialist

Add one more voice to the clamor for 911 Good Samaritan laws in North Carolina: substance abuse counselors. 911 Good Samaritan laws, which would allow witnesses to a drug overdose to call for help by removing criminal liability for drug possession for the victim and the caller, are gaining traction among the addictions treatment community. And who better to comment on drug policy than the professionals who face a parade of broken lives every day?

Anne Lamberti is a licensed clinical addiction specialist at Southlight Judicial Services in Wake County, North Carolina. She sees firsthand the devastation that drug addiction can cause. But she sees something else equally disturbing – people being arrested after calling 911 to save someone’s life.

“I had a young client who was cited by police for seeking help for a friend,” says Lamberti. “He was at a suburban party where kids were taking fistfuls of pills and one of his friends had an adverse reaction. My client wanted to call for help, but the other kids didn’t want police involvement because they were afraid of their parents finding out. My client did the right thing and drove his friend to the hospital, but in the car on the way, she started to assault him. The police pulled him over and cited him on drug charges.”

Unfortunately, the case above isn’t Lamberti’s only client who has been cited after placing a 911 call. “The way I see it,” she says, “young kids get into a lot of foolish stuff. If someone has the good judgment to call for help, they should not be arrested.”

In the absence of 911 Good Samaritan laws in North Carolina, it is not uncommon for someone who calls 911 to save the life of a friend to be arrested on drug possession charges. In fact, studies show that fear of law enforcement deters more than half of witnesses from calling for help, leading to preventable death from overdose.

“We shouldn’t allow [these arrests] just to prove a point about illicit drug use,” says Lamberti. “With the increase in opiate pill use, overdose is increasing and people are dying…the current law is actually contributing to death due to overdose. It doesn’t make sense to put a barrier between people helping each other, whatever the circumstances.”

Arresting someone who calls 911 not only affects the person charged, but also decreases the likelihood that others will call for help in the future. “If one person gets a drug charge for saving someone’s life, that person will tell all their friends and then nobody will call 911,” explains Lamberti.

Lamberti dismisses critics’ argument that 911 Good Samaritan laws would encourage drug use or give users a “free pass.”

The 911 Good Samaritan law is about saving lives. Discouraging people from calling 911 doesn’t prevent people from using [drugs], it doesn’t reduce drug use and it increases deaths due to overdose. If there is any way to make an impact on users at the scene of an overdose perhaps the police could give out information on treatment options instead of citations.

“There is a problem with using drugs and there is a problem with people dying of overdose. If we are going to address the drug problem, we need to address the dying too.”

For more information on how to get involved with 911 Good Samaritan laws and overdose prevention in North Carolina, visit www.nchrc.org.

Discuss

Legal Barriers to Overdose Prevention – Interview with Corey Davis, J.D., M.S.P.H. at Network for Public Health Law

Drug overdose from prescription painkillers is a serious epidemic, both in North Carolina and across the nation. In North Carolina alone, overdose death has approximately tripled in the last decade, up to 1000 deaths annually.

Many factors may contribute to the growing number of opiate-related deaths, including increased prescription of painkillers, an aging population, substitution away from illegal drugs, poor pain management, and lack of education and awareness of the signs and risks of overdose. But many legal barriers also stand in the way of effective overdose prevention. Corey Davis, an attorney with the Network for Public Health Law, has been studying these legal barriers and how a slight change to the law can translate into saving lives in NC.

For example, he explains, there is a drug available, naloxone, or Narcan, which blocks the effects of opiates in the brain and reverses an overdose within seconds. Narcan is not a controlled substance, cannot be abused, and has been safely utilized for decades by medical emergency personnel. Studies have shown Narcan to be effective at reversing an overdose even when administered by a layperson, such as a family member or friend of someone experiencing an overdose. However, Narcan can be difficult to access.

“It’s difficult to get naloxone because it is available by prescription only,” explains Atty Davis. “It can be expensive to see a doctor and most doctors don’t routinely prescribe it when they prescribe a strong opioid. Some physicians may be worried that if something should happen, they could be civilly or criminally liable. Although there is no evidence that the [risk] of liability is real, it does seem to be a concern for physicians.”

Some states have amended their laws to protect medical practitioners from liability should they prescribe Narcan and laypeople who administer the drug.

“Eight states so far have explicitly changed their laws to encourage people to use naloxone in an overdose situation without fear of legal repercussions,” says Atty Davis. “[The laws] vary a little bit between states, but in general they remove the possibility of civil liability for prescribers acting in good faith and for bystanders who act in good faith [to save a life].”

Not only is fear of liability a barrier to overdose prevention, but fear of law enforcement prevents more than half of witnesses to an overdose from calling for help, and leads to countless preventable deaths. To address this problem, many states have passed 911 Good Samaritan laws granting limited immunity to overdose witnesses who call 911 to save a life. Under these laws, witnesses may not be prosecuted for possession of small amounts of drugs or paraphernalia. Studies have shown that 911 Good Samaritan laws do increase the likelihood that witnesses will call for help in the event of an overdose.

Additional benefits of 911 Good Samaritan laws and legislation to increase access to Narcan are that they can be achieved at little to no additional cost to taxpayers. As Atty Davis explains, states even save money by reducing costs to both the medical system and the penal system. Fewer people dying and fewer people in jail for minor charges means less spending and greater fiscal flexibility. And of course, the greatest advantage to the laws is the prevention of needless deaths.

“Naloxone access laws and 911 Good Samaritan laws are really just two sides of the same coin,” says Atty Davis. “A model bill in North Carolina would increase access to naloxone by permitting physicians to prescribe it without fear of civil or criminal liability. It would also permit them to dispense naloxone to friends and family of someone at risk for an overdose… [Additionally, a model bill] would encourage people to call for help by removing the possibility that they would face criminal sanction for calling 911 in good faith to save someone's life.”

These simple pieces of legislation make legal sense. They make fiscal sense. They make sense for the people of North Carolina who will lose a loved one to drug overdose and for the one thousand souls who will die too soon this year. As Atty Davis explains, “Nobody should be afraid or punished for trying to save a life.”

Discuss
You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.

RSS

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site