Naloxone opioid antidote no cure in heroin epidemic, by Katharine Seelye, NewYorkTimes, Jul 27, 2016
...Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being revived with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life. As a virulent opioid epidemic continues to ravage the country, with 78 people in the United States dying of overdoses every day, naloxone's use has increasingly moved out of medical settings, where it has been available since the 1970s, and into the homes and hands of the general public.

But naloxone, also known by the brand name Narcan, has also had unintended consequences. Critics say that it gives drug users a safety net, allowing them to take more risks as they seek higher highs. Indeed, many users overdose more than once, some multiple times, and each time, naloxone brings them back. Advocates argue that the drug gives people a chance to get into treatment and turn their lives around and that there is no evidence naloxone increases the use of opiates. And, they say, few addicts knowingly risk needing to be revived, since naloxone ruins their high and can make them violently ill.

With drug overdoses now killing more people than car crashes in most states, lawmakers in all but three -- Kansas, Montana and Wyoming -- have passed laws making naloxone easier to obtain. Its near-universal availability reflects the relatively humane response to the opioid epidemic, which is based largely in the nation's white, middle-class suburbs and rural areas -- a markedly different response from that of previous, urban-based drug epidemics, which prompted a "war on drugs" that led to mass incarceration...

Nonprofit organizations began distributing naloxone to drug users in the mid-1990s, but most of the state laws making it more accessible have been enacted only in the last few years. Between this and so-called good Samaritan laws that provide immunity to people who call 911 to report an overdose, the chances are much greater now that someone who overdoses will be saved and given medical attention instead of left for dead or sent to jail.... But in Maine this spring, Gov Paul LePage...questioned the effectiveness of naloxone and vetoed legislation that would have increased access to it.

"Naloxone does not truly save lives; it merely extends them until the next overdose", Mr LePage wrote in his veto message in April. "Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction".

Yet most users loathe naloxone's effects. By blocking opiate receptors, it plunges them into withdrawal and makes them "dope sick", craving more heroin or pills. "I hate it", said Melissa Tucci, 44, a heroin user here who has been revived seven times. "When I start withdrawing, I vomit, you get diarrhea, you sweat profusely, your nose will run, you sneeze and have runny eyes, and you ache so bad you can't even walk". She said she has overdosed so often not because she relied on naloxone to save her, but rather because she underestimated how potent the heroin was. And she said she keeps using heroin to avoid the agony of withdrawal....

Dr Mark Publicker, an addiction medicine specialist in Portland, said that repeated overdoses were often the result of increasingly potent heroin, especially when combined with drugs like fentanyl and sedatives, producing a lethal cocktail. "While your psychological tolerance becomes greater, your cardio-respiratory tolerance doesn't", he said. "You keep pushing the limit because your reward threshold has become impossibly high". Naloxone can start to wear off 20 to 30 minutes after it is administered and dissipate entirely after 90 minutes. The withdrawal from the opiate can be so brutal that it often drives people to use heroin again right away....

ORWELLIAN WAR BY DRUGS & IN AFGHAN FIELDS

BC music fest crowdfunds for drug-checking machine amid fentanyl crisis, by Tamsyn Burgmann, CanadianPress, Aug 1, 2016
VANCOUVER -- For the past 14 years, organizers of a giant electronic music festival on a British Columbia mountain ranch have quietly helped participants test their recreational drugs to find out what substances are inside. Shambhala organizers will also hand out 4,000 pamphlets warning about the deadly drug fentanyl to those attending the festival that starts Wednesday. But what they really want to increase safety is a miniature mobile mass spectrometer. Unable to secure government funding for the sophisticated drug-testing machine, which could cost up to $250,000 or more, organizers have launched an online crowd-funding campaign hoping to make the purchase by next year. The machine can detect many ingredients in one substance.

The campaign comes amid the declaration of a public health emergency over a surge of opioid overdose deaths in the province, many of them related to fentanyl. Premier Christy Clark announced last week that a task force had been created to scale up the response. One of its stated goals is to improve street drug checking. But Shambhala organizers say they can't wait. "We have to move very quickly if we're going to stop any more deaths from happening," said Chloe Sage, who has run the harm-reduction operation at the festival for the past six years. The tent provides recreational users chemical agents that change colours when tested so they can personally check their drugs, but they don't work for fentanyl. Sage said the creation of the provincial task force is movement in the right direction, and has only recently become possible as public opinion shifts. B.C.'s Ministry of Health funded Sage and a colleague to write a 60-page "how-to guide" for drug checking at music festivals this spring. "The conversation has only become a national conversation in the last year," she said.

Participants at music festivals aren't typically opioid users, Sage said, but the tainting of many street drugs with fentanyl means it could show up. The drug, which is up to 100 times more powerful than morphine, was linked to hundreds of overdose deaths in B.C in the first six months of this year. Sage would ideally like the government to acquire several mobile mass spectrometers that could be rolled out to large events across the province. They could be made accessible to the public in high-risk communities or at supervised injection sites during the rest of the year, she said. Experts and health policy makers in the province say a harm-reduction plan that facilitates drug checking has merit, but aren't convinced that buying expensive machines is the answer. Provincial health officer Dr. Perry Kendall, who is one of two leaders on the new task force, said the mass spectrometers must have a broad enough detection spectrum to be worth investment of tens of thousands of dollars. "If you have the capacity to do that, that would certainly add an extra level of check," he said. "It would certainly improve the safety of a safe-consumption site." But Kendall said many machines only test for some varieties of fentanyl, and noted some other killer drugs, such as the synthetic chemical W-18, are not even detectable by most hospital equipment yet.

Organizers of the Pemberton Music Festival, north of Whistler, said they prepared last month for potential fentanyl overdoses by stocking naloxone, a life-saving reversal agent. Among 650 people who were treated by medics for various ailments, only one person needed the antidote.... Mark Tyndall, executive medical director at the B.C. Centre for Disease Control, also urged the new task force to prioritize an examination of harm-reduction measures including drug checking. He too advised implementing a low-tech solution that could be rolled out much more quickly. One option involves distributing "dip sticks" that detect some types of fentanyl, which he believes could make a "significant impact." Tyndall is hopeful the crisis will prompt more cost-effective solutions to emerge. "With all the attention on opioids and drug overdoses, a lot of companies are revving this up. So I'm optimistic that the technology will rapidly improve."

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