Joy Jacobson, a freelance writer and the former managing editor of AJN, wrote “Heroin: Life, Death, and Politics” for the May issue of the journal. She is a senior fellow at the Center for Health, Media, and Policy at Hunter College in New York City, where she teaches writing to nurses and nursing students.
In just a seven-hour period on Tuesday of this week, the ED at Fletcher Allen Health Care in Burlington, Vermont, treated eight patients for heroin overdose—a number the hospital might ordinarily see in a couple of months, the chief medical officer told the Burlington Free Press. All patients received naloxone (Narcan), an opioid antagonist that counters the effects of an overdose, and all survived.
Several of the overdose victims made it to the ED only because they’d already been given a dose of naloxone in the community. A 2013 Vermont law made the antidote and training in its use available to police officers and other first responders, as well as to friends and family members of a heroin or prescription-opioid user. The state also has a “Good Samaritan” law, which exempts from civil or criminal prosecution any clinician involved in prescribing, administering, or distributing naloxone, as well as any witness who’s reporting an overdose.
Vermont is one of fewer than 20 states with some form of Good Samaritan law or a naloxone-distribution law (click the links for maps). In the May issue of AJN, I write about Vermont’s impressive commitment to addressing the heroin epidemic plaguing the state, and about Maine governor Paul LePage’s veto of a bill that would have expanded naloxone distribution statewide.
But this week, LePage relented. A new law went into effect in Maine on Tuesday, without the governor’s signature.
Nurses around the country are grappling with this epidemic of heroin overdoses and deaths. In my report, I write about the work of Donna Beers, the president of the Massachusetts chapter of the International Nurses Society on Addictions. Beers acknowledges that not all nurses understand or are supportive of naloxone distribution. But she has also been heartened by an unprecedented collaboration among disparate groups:
This is a public health crisis in Massachusetts, and we’re all trying to partner together to keep people alive. Nurses, police officers, emergency medical services, people in the using community, doctors, parents—people are really banded together in ways I don’t know they’ve been banded together before. Young kids are dying from overdose. Children are dying, and that’s getting people motivated.
New programs and devices are being announced continually. In Rhode Island, where there were 38 overdose deaths in the first six weeks of this year, a new law allows anyone asking for it to get naloxone from any of the 26 Walgreens pharmacies in the state (with insurance covering the $25 to $45 cost). The pharmacy also provides training in how to use the antidote, including the need to dial 911 before administering it, according to the Providence Journal.
And the Food and Drug Administration has just approved a new naloxone autoinjector, called Evzio, but the manufacturer hasn’t yet announced a price. Some have speculated that it may well be as high as $500. That raises big questions about the long-term funding of naloxone programs.
And while naloxone undeniably saves lives, its use does require training. As Patricia Carroll, an RN, wrote in a letter to the Hartford Courant last week, “People can suddenly wake up, be disoriented, and be overwhelmed with excruciating pain. As a result, they can lash out and reflexively fight with people beside them.”
But they’re alive.
Nurse Chad Sanders, who lost his sister Shelly almost eight years ago to a heroin overdose, shared his family’s story with me for AJN Reports. Watch this video for a moving account, in which Chad says that he believes a Good Samaritan law “could have saved Shelly’s life.”