An Effective Strategy Against Accidental Deaths: Why Isn’t it Being Widely Implemented?
On Friday, October 19th, the New York Times reported that Westminster Choir College student, Justin Warfield, died of a drug overdose. Earlier that day, he and a classmate, Kieran Hunt, drove to a school parking lot, “where, according to the Mercer County prosecutor’s office, Mr. Hunt injected Mr. Warfield and then himself.” So not only has there been an accidental death due to overdose, but Mr. Hunt is facing criminal charges in connection with Mr. Warfield’s death.
Overdose is one of the leading causes of accidental death in several cities across the country, including San Francisco, New York, and Portland, Oregon. The most recent data, from 2002, showed a total of 5,528 deaths from prescription opioids and 1,937 deaths from heroin, an increase of 91% and 12% respectively from 1999. In response to this public health crisis, several jurisdictions in the United States have developed overdose prevention programs that include education, instruction in mouth-to-mouth resuscitation and the provision of Naloxone, an opiate antagonist that temporarily reverses an opioid overdose, for use by lay persons. These programs are associated with significant decreases in overdose deaths.
People typically think of opiate overdose as affecting mainly heroin addicts, but there is an emerging trend of abuse (misuse) of prescription opioid painkillers in many parts of the US. The problem of preventing deaths from opioid overdose is more pervasive across class and geography and demands a nationally coordinated policy.
Recently, in California, Senate Bill (SB) 767, the Overdose Treatment Liability Act, was signed by Governor Schwarzenegger. Senator Ridley Thomas' bill was cosponsored by the Harm Reduction Coalition (HRC), the County of Los Angeles, and the Los Angeles Overdose Taskforce. SB 767 creates a 3 year pilot project in seven counties in California which authorizes overdose prevention programs and protects providers who prescribe take-home Naloxone, a medication used to reverse overdoses, to people who use opiates such as heroin and methadone. This bill has eliminated a barrier for clinicians who were concerned about civil or criminal liability if a patient uses his or her Naloxone on someone else. Similar efforts in New York City, Albuquerque, Maryland and Chicago have already been in place.
There is a need to widely diffuse opioid overdose prevention as a public health intervention. The Harm Reduction Coalition has outlined five-point strategy:
1. The Centers for Disease Control (CDC) create surveillance systems that will yield a more accurate picture of opioid overdoses and are capable of early detection of emerging trends and threats.
2. The National Institute of Drug Abuse (NIDA) makes emergency research funds available that can answer urgent questions in order to immediately address the overdose epidemic in the most effective ways.
3. The Substance Abuse and Mental Health Services Administration (SAMHSA) rapidly replicate existing overdose prevention programs, and fully fund them.
4. The Drug Enforcement Administration (DEA) inform the CDC better so as to notify the public of dangerous levels of purity and presence of fentanyl and other hazardous contaminants in local drug supplies.
5. The US Department of Health and Human Services (HHS) prepare an emergency report of the current overdose epidemic for Congress. This report should make emergency recommendations for prevention measures including:
Improving drug user response to overdose including the use of naloxone by users and their loved ones
Improving police and emergency medical services responses to overdoses
Substance abuse treatment availability
Unfortunately, there is not a supportive government policy that currently exists that would provide widespread access to overdose prevention. Perhaps if Mr. Hunt and his classmate had had access to it, it could have resulted in a different outcome for them both.