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Anti-Overdose Drug Given to S.F. Addicts

For the first time in the state, a public agency is providing naloxone. Critics say treatment programs are a better approach.

November 17, 2003|Daniel Costello | Special to The Times

Marking a first for a public agency in California, the San Francisco health department began dispensing a controversial anti-overdose medication to heroin addicts Saturday at a city-sponsored needle exchange program.

Despite criticism that it could encourage further addiction, San Francisco health officials say their plan to distribute the prescription medicine, known as naloxone, will save lives and possibly give addicts a chance to eventually go clean.

A mix of health department staff and volunteers trained 11 drug users in a Tenderloin-area clinic. Officials hope to expand that number substantially over the next few weeks.

"We know this saves lives and has almost no side effects. It's a miracle drug," said Dr. Josh Bamberger, who oversees the new program at the city Department of Public Health.

A few other public agencies around the country have taken similar steps. In California, a private, nonprofit health group in Mendocino County two months ago began offering naloxone to a small group of clients.

But officials say San Francisco is the first public agency in the state to distribute the medicine.

The step is part of a 3-year-old initiative that seeks to reduce the harmful effects of drug use in San Francisco rather than solely trying to keep addicts from taking drugs. Other efforts include methadone treatments, needle-exchange programs to reduce the transmission of diseases and medical attention for complications from addiction, such as skin infections.

The naloxone program requires people who receive the drug to be trained in how to administer it and how to perform other rescue techniques to assist overdose victims. The medicine is injected into an arm or leg and doctors say victims can recover in a matter of minutes. It is mainly used with heroin overdoses but is also effective with other opiates such as morphine and Oxycontin. Each addict in the training program this weekend received two syringes pre-filled with naloxone.

Officials describe naloxone as a nonaddictive, non-mood-altering drug that doctors and paramedics have used to treat victims of opiate overdose for decades. The medication has no street value and the common generic version costs as little as a dollar a dose.

The drug works by blocking opioid receptor sites in the brain.

Critics, including some physicians, worry that dispensing naloxone to addicts may cause more harm than good. Some fear addicts may not call paramedics after they revive a friend, while others are concerned that public funding of such a program endorses addiction.

"This is a huge mistake," says Dr. Eric Voth, a Kansas addiction specialist and spokesman for Drug Free America, a national group that targets drug abuse. "It just isn't safe to remove this from a medical setting and put it in the hands of addicts who are notoriously unreliable," he says.

Voth adds he would rather see the money spent on treatment programs so addicts could get off the drugs.

Health officials in Portland, Maine, scrapped plans to distribute overdose medication to heroin users last year after intense public pressure.

Doctors say there is a possibility, although rare, that someone recovering from an overdose after being treated with naloxone may experience a dangerous seizure.

And for those addicted to opiates, naloxone immediately pushes them into an agonizing withdrawal that often produces nausea, tremors and extreme sweats. Because of the discomfort, some addicts may want to shoot up again quickly, possibly setting themselves up for another overdose, critics say.

Peter Warren, a spokesman for the California Medical Assn., says the organization agrees with efforts to reduce the harmful effects of addiction but is wary of any initiative that doesn't include efforts to get addicts into treatment and counseling.

Many naloxone programs encourage users to enter such programs but don't require it.

Last year, a six-month study by researchers at UC San Francisco, partially funded by the city Department of Public Health, tracked 24 addicts who were given naloxone, along with eight hours of training, latex gloves and alcohol swabs. In all, participants reported witnessing 20 overdoses and successfully used the medication on 14 occasions.

For various reasons, the other six overdose victims were not given naloxone but survived.

Alex Kral, director of Urban Health Studies at UC San Francisco and an author of the study, says that a large publicly funded naloxone program in San Francisco is needed and viable. He points out that groups in San Francisco have been providing naloxone underground for several years.

"I think the medical establishment is slowly coming around to this and seeing it as a solution to a needless problem," he says.

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