Recently rapper Lil' Wayne was discharged after a six day hospital admission in Los Angeles, where he was reportedly recovering from an overdose of sizzurp -- a cocktail of prescription cough syrup, soda, and flavored candy. The Young Money star is the latest in a string of high-profile overdoses involving prescription drugs. But while tragic, celebrity overdose might help raise awareness about the dangers of prescription misuse and ignite the push for drug policy reform.
Case in point, last November Jon Bon Jovi's daughter, Stephanie Bongiovi, overdosed on heroin in her college dorm room in upstate New York. When a friend called 911 to summon an ambulance, police arrived and arrested Stephanie and the caller. Both were charged with criminal possession of a controlled substance and other drug crimes. The story made national news, but so did the fact that under New York law, neither of them should have been charged.
A year prior, New York had passed a 911 Good Samaritan law, which prohibits law enforcement from charging or prosecuting an overdose victim or a witness who calls 911 to save the person's life. New York Assembly Member Richard Gottfried (D), who sponsored the bill with Senator John DeFransisco (R), explains, "Most accidental overdose deaths are preventable if emergency services are contacted immediately, yet the number one reason people don't call for help in the event of an overdose is fear of getting arrested. Good Samaritan laws encourage people to take life-saving action without fear of prosecution."
Stephanie Bongiovi was released and the charges were dropped, but not before the story had gone viral, prompting a scramble in New York police departments to educate officers about the law. In the Bon Jovi case, a high-profile arrest led to greater knowledge and awareness about overdose laws, but not all experts agree that celebrity misfortune can spur positive change.
"High profile overdoses represent both an opportunity and a threat to advancing policy and public health strategies to reduce overdose fatalities," says Maya Doe-Simkins, a public health researcher and Chicago-based overdose prevention advocate. "While they can be a vehicle to raise awareness about overdose prevalence and new legislative protections (like NY's Good Sam), there is also the risk of reinforcing the public perception that drug use and overdose are the domain of rich spoiled people, pop star hooligans, hopeless drug addicts and other groups that 'normal' people do not identify with."
Attorney Corey Davis, Board President of the North Carolina Harm Reduction Coalition, a nonprofit that advocates for overdose reform in southern states, also questions the effectiveness of celebrity overdose as an educational tool. "The average overdose victim isn't a celebrity," says Atty. Davis. "He's a completely average, middle-aged working man -- your co-worker, your father, the guy from your kid's soccer team. But I think people are starting to understand that, and that's helping to push calls for reform."
As drug overdose continues to trump auto fatalities as the leading cause of accidental death in the United States, calls for reform are echoing across the nation with or without high-profile tragedies to fuel them. Dr. Sharon Stancliff, Medical Director of the national Harm Reduction Coalition, works with diverse coalitions to implement overdose prevention strategies. Here is what she says about what works and how states and communities can reduce drug overdose:
1) 911 Good Samaritan Laws -- While these laws are relatively new and have yet to be evaluated at length, a Washington study reported that 88 percent of drug users surveyed said they would be more likely to call 911 as a result of Good Samaritan laws. Ten states have 911 Good Samaritan laws on the books and over a dozen more have introduced them this year.
2) Naloxone Distribution Programs -- Fifteen states have one or more community programs that train people at risk for opioid overdose and their loved ones on how to respond to an emergency, including how to safely administer the opioid antagonist, naloxone, to reverse an overdose. Since 1996, these programs have distributed over 53,000 naloxone kits and report over 10,000 overdose reversals. A 2013 study on the effectiveness of naloxone distribution programs in Massachusetts reported a 27-46 percent reduction in overdose rates in towns where a program was implemented, even when adjusting for other factors.
3) Law Enforcement Naloxone Programs -- In parts of New Mexico, Massachusetts and New York, police officers can administer naloxone if they arrive at the scene of an overdose before paramedics. In a pilot program in Quincy, Massachusetts, the overdose death rate plummeted by over 60 percent in 18 months.
What Needs More Evaluation:
1) Prescription Monitoring Programs (PMPs) -- PMPs are statewide databases that track when and where people obtain prescriptions. In many states, doctors and pharmacists are encouraged (or required) to check the database before dispensing new medication in order to restrict drug access to people seeking prescriptions from multiple providers. Although PMPs might help reduce "doctor shopping," a 2013 study published in the Public Library of Science concluded that supply-based interventions such as PMPs might simply divert prescription opiate users to heroin. Other concerns are patient privacy issues and fear that the system might wrongly flag people with chronic pain.
2) Prescription Drug Take-Back Days -- Some communities have implemented take-back days when community members can turn in unused prescriptions for proper disposal. While promising and popular, these strategies have not yet demonstrated a reduction in overdose rates in clinical trials or controlled studies.
While many strategies for reducing overdose deaths exist in addition to those mentioned above, nationally, drug overdose continues to rise at alarming rates for the 11th straight year. The majority of overdose prevention programs and laws are in their infancy, and awareness of the prescription drug problem is only beginning to enter the national consciousness. Perhaps celebrity overdose can help remind us that not even the rich and powerful can escape addiction or death. But perhaps increasing awareness of the tragedies in our own communities is enough to push us towards reform and effective overdose prevention. Either way, it is high time to address the crisis of prescription deaths.
For information on the closest overdose prevention program, visit the Overdose Prevention Alliance. If you are a health care provider interested in prescribing naloxone rescue kits, check out Prescribe To Prevent.