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Michael Jackson and the Overdose Crisis in America

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As the world continues to mourn the death of Michael Jackson and the details of his final hours emerge, it appears that it may be another in a long line of celebrity drug overdoses. Jackson is reported to have taken a number of painkillers known as opioids on a regular if not daily basis.

Michael Jackson inhabited his own rarefied world, and we are used to hearing about drug overdoses in the context of fast-lane inhabiting music and film stars, like Heath Ledger who died of an opioid overdose last year. But even among average Americans, deaths from drug overdoses have been rising and have reached crisis levels in our country. A recently-released report by the Drug Policy Alliance documents the extent of the problem: drug overdose is now the second-leading cause of accidental death in America, surpassing firearms-related deaths. Many of those affected are young people. Among teenagers there has been a steep rise in misuse of prescription drugs. A December 2008 survey of high school seniors reported that more than 15 percent of high school seniors reported using prescription drugs for non-medical reasons. But it's not just young people who are dying of overdoses: overdose is the number one injury-related killer among adults in Michael Jackson's age group: 35-54.

This spike in overdose deaths is almost entirely attributable to increasing numbers of people overdosing on legal, prescription drugs; overdose deaths from heroin and other illegal drugs have leveled off in many places as a result of harm reduction efforts. Most of these drugs are opioids, which can include both opium-derived drugs like morphine and codeine, and synthetics like Oxycontin and Vicodin, both of which were allegedly used by Michael Jackson, and Demerol, with which he reportedly was injected just before he died. Other commonly prescribed opioids include Percodan and Percocet. Some of the drugs involved in overdoses have been diverted to the black market and sold illegally, while others are obtained through legal prescriptions. Pain patients can misunderstand their doctors' instructions and accidentally exceed their prescribed doses of painkillers.

But in Michael Jackson's case, if it was caused by an opioid overdose, his death might have been averted had people close to him had access to a simple and reliable antidote: naloxone, otherwise known as Narcan.

Naloxone, if administered to someone who has stopped breathing as a result of an opioid overdose, can reverse the effects of the overdose and restore normal breathing in two to three minutes. Naloxone has been used effectively in emergency rooms to reverse overdoses for over 30 years. Tens of thousands of lives could be saved if naloxone were more widely available and more people (including doctors, pharmacists and other health care professionals, as well as law enforcement professionals, many of whom are currently unfamiliar with naloxone), were trained in its use.

Cities with programs that increase the availability of naloxone, among them Chicago, Baltimore and San Francisco, have seen their overdose rates decline dramatically. New Mexico, which for years had a high number of deaths from drug overdoses, saw a 20 percent decline in such deaths after the state's Department of Health began a naloxone distribution program in 2001. Naloxone itself has no abuse potential, making it a good candidate for over-the-counter availability. If people who are prescribed an opioid were also be given a prescription for naloxone, with instructions for them and their caregivers on how to administer it, this spike in overdose deaths could be reversed.

But our country's drug war mentality prevents this safe and effective remedy from being made more widely available. Fear that doing so will encourage drug use causes the government to restrict naloxone's availability. This "abstinence only" mindset is the same one that for years has prevented the federal government from funding syringe exchange programs -- proven to reduce the spread of HIV, hepatitis C and other blood-borne diseases -- for injection drug users. Just as the "abstinence only" model has proven a failure at preventing unwanted pregnancy and sexually transmitted diseases, it has been a failure at reducing drug use or the harms associated with drug use. Rather than continuing these failed policies, we need evidence-based solutions to the problems of drug misuse and drug overdose.

Fortunately some attention is now being paid to the overdose crisis. A bill known as the Drug Overdose Reduction Act was recently introduced in Congress by Rep Donna F. Edwards (D-MD). The bill would create a federal grant program to provide cities, states, tribal governments and community-based groups with funding to prevent and reduce overdose deaths; task the Centers for Disease Control and Prevention with responsibility for reducing overdose deaths; commission studies on the efficacy of various strategies to reduce overdose deaths; and create a nationwide surveillance system for monitoring overdose trends. A Facebook group called Purple Ribbons for Overdose Prevention now has nearly six thousand members across the country and is growing daily.

Another part of the solution to the overdose crisis are "Good Samaritan/911" laws, which provide immunity from arrest and prosecution for drug use or possession to anyone who calls 911 to report an overdose. Many lives could be saved if friends of overdose victims weren't afraid of being prosecuted if the police are called to the scene. New Mexico last year became the first state to pass such a law, and similar legislation is now pending in several states.

We need to accept the reality that people will always use drugs, whether legal or illegal, prescribed or sold on the street, mood or performance enhancers, pain killers or stress reducers or sleep-enablers. We are a nation of drug users. We must learn how to reduce the harms associated with our drug use, including reducing the unconscionable and unnecessary number of deaths from overdose.

Jill Harris is the Managing Director for Public Policy at the Drug Policy Alliance.

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