As the year winds to a close, the media is spitting out "Best of 2014" lists on fashion and political blunders as fast as people can think of them. Forgive me for adding to the fray, but 2014 has been a remarkable year for overdose prevention too, and I think we deserve our own list of defining moments in 2014. The countdown starts now.
#5. Death of Actor Philip Seymour Hoffman
On Feb. 2, 2014 the world mourned the passing of legendary actor Philip Seymour Hoffman, dead of an apparent heroin overdose. His death sparked a national conversation on addiction, opioids, the deplorable state of drug treatment access, and naloxone, which has translated into some remarkable gains in drug overdose prevention. 2014 has been the best year so far for new laws that save lives from drug overdose. Seven states (PA, LA, MN, GA, WI, IN, and UT) passed 911 Good Samaritan laws that make it easier to call 911 to report an overdose and two states (AK and MD) amended their existing laws. Nine states (OH, WI, GA, ME, MN, UT, TN, DE, and PA) passed laws that expand access to the opioid reversal drug, naloxone, and four (CA, NY, VT, and CT) passed amendments to further make available this life-saving drug.
Thanks to the passage of new laws and the tireless work of overdose prevention advocates, the country has seen a remarkable expansion in the number of government, nonprofit and community programs that distribute naloxone and provide training to people at risk for opioid overdose and their loved ones. How much of this remarkable progress is thanks to the awareness raised by Seymour's death and how much is the natural outcome of a decades-long push by harm reductionists for overdose prevention tools, we may never know. But his death was a sorely needed wake-up call that drug overdose can take even the best of us.
#4. The Federal Government Is Finally Noticing Harm Reduction
Whether or not you were happy to see Acting Director of the Office of National Drug Control Policy Michael Botticelli give the opening speech at the 10th National Conference for the Harm Reduction Coalition in Baltimore, that speech marked a watershed moment for the movement. After years of slamming doors in harm reduction's face, the federal government is finally realizing that our nation has a public health emergency on its hands and that no one is more qualified to address the opioid drug overdose crisis than the group that has been going it alone for the past two decades. It will take federal resources and funding to expand overdose prevention efforts to where they need to be to reverse the trend in deaths. Botticelli's presence at the conference may be the launch pad that harm reductionists need to reach the next level in saving lives.
Another notable public endorsement for naloxone came from former Attorney General Eric Holder. On Jan. 29, 2014 and several times thereafter, Holder testified on Capital Hill urging first responders to carry naloxone.
In the wake of Holder's comments, many departments have equipped first responders with naloxone, including New York, which rolled out a statewide program this year. Unfortunately, the increase in naloxone availability has been accompanied by a marked increase in price. Coinciding with the expansion of naloxone to more first responders, the price of intranasal naloxone more than doubled.
#3. Red States Are Making a Name in Overdose Prevention
For too long overdose prevention victories have been the primary conquest of northern states. Not any more. In 2014 North Carolina and Georgia launched the first law enforcement naloxone programs in the South. Georgia also followed North Carolina to become the second state with a Republican-dominated legislature to pass 911 Good Samaritan and naloxone access laws. Other traditionally red states, such as Kentucky, Florida, Oklahoma, Tennessee, and Utah have also recently passed overdose prevention laws.
#2. Naloxone in Emergency Rooms
In October the American College of Emergency Physicians adopted the following resolutions at their 2014 conference:
¡Resolution 39: Naloxone Prescriptions by Emergency Physicians
÷A clinical policy on the clinical conditions for which it is appropriate for emergency physicians to prescribe naloxone.
¡Resolution 42: Reverse and Overdose, Save a Life
÷ Advocates support training and equipping first responder, including police, fire and EMS personnel to use injectable and nasal spray naloxone and be it further resolved that advocate and support the availability of naloxone being dispensed over the counter with overdose education by a pharmacist.
The harm reduction community has been pushing for years for physicians to prescribe and dispense naloxone to patients who come to the emergency room for opioid drug overdose and their families. These resolutions are a major milestone towards encouraging emergency departments around the country to work with their physicians to prescribe naloxone to these high-risk populations.
#1. New Mexico, Washington, New York, Rhode Island, Vermont and California Allow Pharmacists to Dispense Naloxone
Perhaps the most exciting development of 2014 was the passage of new laws allowing pharmacists to dispense naloxone to patients filling opioid prescriptions. New Mexico, Washington, New York, Rhode Island, Massachusetts, Oklahoma, Vermont and California now make naloxone available from pharmacists without a prescription, an encouraging trend with the potential to expand naloxone access exponentially.
While the expansion of naloxone distribution programs across the country has greatly increased naloxone availability in some communities, these programs are often too small, too scarce and too underfunded to meet the real need. If we are serious about getting this drug into the hands of people who can use it to save lives, we need to make it available over-the-counter so that anyone who goes to the pharmacy to fill an opioid prescription may also receive naloxone along with training on how to use it. Only then can we hope to reverse the tide of tragic deaths from drug overdose.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.