How to Stop Heroin Deaths

By ROBERT S. HOFFMAN

PHILIP SEYMOUR HOFFMAN, who died of an apparent heroin overdose on Sunday, was just one of hundreds of New Yorkers who fall victim to this drug each year. Heroin-related deaths increased 84 percent from 2010 to 2012 in New York City and occur at a higher rate — 52 percent — than overdose deaths involving any other substance.

I am an emergency physician at NYU Langone Medical Center and Bellevue Hospital, but I rarely see victims die of heroin overdose because most fatalities occur before patients get to the hospital. Overdoses often take place over one to three hours. People just slowly stop breathing; often they are assumed to be sleeping deeply, or they are alone.

The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.

An analysis in the Annals of Internal Medicine last year suggested that up to 85 percent of users overdose in the presence of others. This provides an opportunity for friends, family and other non-health care providers to intervene. In New York State, it has been legal to distribute naloxone to ordinary citizens since 2006. But the distribution has to be done with medical supervision. Naloxone is purchased by the city and state health departments, which then distribute the antidote through hospitals, harm-reduction programs and other outlets at no cost to patients.

Some New York City hospitals are now distributing kits containing naloxone to users and their friends and families. For the past three years, the New York City Department of Homeless Services has administered naloxone in shelters. And a new pilot program on Staten Island — which has the highest rate of heroin overdose deaths in New York City — is supplying the antidote through the Police Department’s 120th Precinct there.

The city’s health department is conducting a large study following people who get naloxone to assess how frequently the antidote is used to reverse overdose. In 2012, the health department filed a public letter to the Food and Drug Administration recommending that the F.D.A. approve naloxone for over-the-counter use. The letter stated that more than 20,000 kits had been distributed in New York City. It also noted that more than 500 overdose reversals had been reported by civilians who had administered the antidote.

Some people might argue that the widespread distribution of a safe, effective and inexpensive antidote might actually encourage drug use. But that’s like suggesting that air bags and seatbelts encourage unsafe driving. Naloxone is a public-health method of intervening when a life is in the balance. Its distribution is endorsed by the American Medical Association.

A new bill that would make it easier for users to obtain naloxone was introduced in the New York State Legislature just last week, and on Tuesday it passed the State Senate Health Committee. It would increase access to the antidote by allowing doctors and nurses to write standing orders — prescriptions that can be used for anyone — and issue them to community-based drug treatment programs. The programs would then train people on the signs of overdose and provide them with the naloxone kits. This means that the programs would not have to have a doctor present to distribute the antidote, overcoming one major hurdle that impedes widespread distribution.

This bill empowers a community to protect itself and others. If the bill becomes law, it would be one step closer to making naloxone available over the counter — as it already is in Italy.

According to the Centers for Disease Control and Prevention, drug overdose is now the leading cause of injury-related fatalities in the United States, ahead of motor-vehicle collisions and firearms accidents. We make cars safer by having speed limits, seatbelts, crumple zones and D.W.I. laws. We make it harder to buy a firearm with background checks and waiting periods, and we teach gun safety and sometimes mandate trigger locks. We can make heroin safer, too, by supplying methadone or buprenorphine as medications to treat physical dependence, providing clean needles to help prevent the spread of hepatitis and H.I.V., and facilitating the wide availability of naloxone to counteract overdoses.

While Mr. Hoffman’s death was without a doubt a tragedy, it is also emblematic of a societal need to take action to prevent the hundreds of deaths that otherwise go largely unnoticed. We can’t control heroin — that’s the job of law enforcement — but we can make it safer.

Robert S. Hoffman is an emergency physician at NYU Langone Medical Center and Bellevue Hospital and the director of the Division of Medical Toxicology at the New York University School of Medicine.

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