Overdose treatment not be-all, end-all for opioid epidemic, but saving lives in McHenry County, some experts say

CRYSTAL LAKE – Vanessa Lindahl awoke in an ambulance shaking uncontrollably and soaking wet from sweat after receiving a dose of naloxone.

“It felt like my extremities were on fire – like someone was taking a torch to my fingertips and toes,” the 36-year-old Woodstock woman said.

The first time she had a heroin overdose, her neighbor called 911 and she was given the dose from emergency responders.

“I was pissed off that they Narcan’d me because I was so high and enjoying my high, and they took me out of it,” Lindahl said of the first time she was given naloxone – also known by its brand name, Narcan – in October 2015. “Really, that was my mentality at that point. I was so sick.”

After Lindahl was admitted to a hospital, she signed herself out against medical advice and was high again within an hour. In her nine years as a heroin addict, she’s gone to seven treatment centers, detoxed 21 times, was in and out of county jails and overdosed twice. But she said she wouldn’t be in recovery today – or alive – without the doses of naloxone she received.

Naloxone, a drug that can rapidly reverse an opioid overdose, has been called a “miracle antidote” by police.

However, one medical expert is saying it does more harm than good. Other critics have said it gives addicts a false sense of security and encourages risky behavior. The use of naloxone dates back to the 1970s, when it was used in medical settings, but it now is in the hands of the general public. 

Lewis Nelson, professor and chairman of emergency medicine at Rutgers New Jersey Medical School, said naloxone brings on rapid withdrawal, possibly leading to a person taking more drugs. Nelson spoke to reporters during a conference about the opioid epidemic in Chicago.

Naloxone is an antagonist that brings a person out of an overdose, but the heroin remains in his or her system.

People will vomit, aspirate and have profound hypertension, and then they’ll go out and try to overcome their withdrawal, Nelson said. Naloxone wears off in one to two hours. If a user takes more opioids, they will have a double dose in their system, which could lead to another overdose, Nelson said.

“It’s a bit of a crutch,” Nelson said.

Lindahl said people immediately should go to the hospital.

“Not because that’ll stop them from using again, but because they might overdose again,” she said. “Sometimes Narcan can only be temporary, and the drugs might overpower the Narcan.”

Reversals in McHenry County

The McHenry County Substance Abuse Coalition’s police naloxone program had 31 overdose reversals in 2017, said Laura Crain, who works as the coalition’s drug-free program coordinator. One of the reversals was for a woman who was six months into her pregnancy.

There were 62 deaths attributed to opioid overdoses in McHenry County in 2017, which was about 80 percent of all overdose deaths in the county last year. Two deaths still are being investigated as possible overdoses, McHenry County Coroner Anne Majewski said.

Of the opioid overdoses, almost half were caused by heroin, with a third from prescribed opioid medication alone or with other drugs, and a quarter from fentanyl – an opioid that can be 100 to 10,000 times stronger than morphine.

Michelle Hall, 22, of Lake in the Hills said she started experimenting with heroin at age 16 and picked it up again at 19 after having surgery on her ankle. She began snorting and injecting heroin.

“They would give me morphine and Norco, and it was so easy to get refills,” Hall said. “I’d just call and say I’m in pain when I really wasn’t. I have a high pain tolerance, but I liked taking the drugs.”

Norco is a brand-name prescription drug that contains hydrocodone and acetaminophen.

After being sober for seven months, she decided to inject heroin again and passed out for six hours in a bathroom of the sober-living house where she lived.

“It was scary, and I wanted nothing to do with heroin again, and said I’d get back on track,” Hall said. “Within a few days, I was using again.”

The second time, Hall woke up in an ambulance. She had been driving and came to a stop light and overdosed, and someone in a car behind her put her car into park and called 911.

Hall now has been sober since Nov. 26, 2016, and she has given naloxone to other people multiple times. She said she thinks it is important to carry around at all times.

“You never know when you’ll need it, even going to Walmart or something. There are public restrooms, and that’s where I would go if I was using,” Hall said.

Administering naloxone

To prevent users from taking a double dose of heroin, Nelson suggests a protocol where once naloxone is administered, the person is checked into a hospital or treatment center and monitored.

Crain said the coalition has seen users go out after receiving naloxone for another high, not because they want to use again but because they don’t want to go through withdrawal.

“Imagine the worst flu you’ve had where you’re throwing up and have diarrhea, and multiply that times 100,” Crain said.

Crystal Lake Deputy Police Chief Tom Kotlowski said it is the department’s policy that if someone is given naloxone, he or she also is taken to a hospital.

But as more community members get their hands on naloxone, bystanders might not know when to use naloxone, Nelson said.

“First responders and EMS services are not a problem because they can tell [when someone is overdosing],” Nelson said. “But bystanders can be a problem. It could kill them because after the naloxone, the person will try to get high again and could be worse off than when they started.”

Nelson said data still are being collected, but research indicates that most people given naloxone aren’t really overdosing to begin with. Out of 100 people who receive naloxone, only one of them likely would have died, but the problem is knowing who that one person is.

​“When you use heroin and are overdosing, you look dead,” Nelson said. “How do you know if they are circling the dead or enjoying a high? A small amount of people with naloxone would have died without it, but most others don’t need it.”

Kotlowski said naloxone has saved lives, and he only has seen one instance of a family who administered it and a man didn’t survive.

“There is no harm to anyone if they are administered Narcan,” Kotlowski said. “It isn’t going to harm someone who isn’t in an overdose state.”

Buying naloxone

​Walgreens, Jewel-Osco and other drug stores now are selling naloxone over the counter, and some opioid prevention experts have suggested all families should buy a dose to keep in their medicine cabinet.

Crystal Lake-based Aptar Pharma makes the unit dose dispenser that comes with each dose of naloxone nasal spray.

Centegra Health Systems monitors, trains and dispenses naloxone to police departments in the Substance Abuse Coalition program, Crain said. Funding for naloxone comes from the McHenry County Mental Health Board.

Lindahl said she once rented a hotel room with her friend. They used heroin all night, woke up the next morning and used again. Lindahl’s friend fell off the bed, and tried to wake him up.

“I knew we had Narcan, but at first I was afraid to do it because I knew I’d have to call 911, and I was afraid I’d get in trouble,” Lindahl said. “But I knew I had to do something because I didn’t want him to die.”

Illinois has a good Samaritan law that grants immunity to people who call 911 to report a drug overdose or who arrive at the hospital suffering from an overdose. There are exceptions to the law, however, such as not exempting anyone from drug-trafficking charges.

Lindahl gave her friend a dose of naloxone, went to the front desk, told someone to call 911 and left the hotel. The man survived.

In February, AptarGroup Inc. is donating 500 kits of naloxone to the Substance Abuse Coalition, and the coalition will work with schools, agencies that work with high-risk populations and families and friends of users to distribute the kits. People can contact the coalition to receive a kit and free training.

“We want to get naloxone into the hands of people likely to be around when something happens,” Crain said.

‘Conditioning people to think

we can always bring them back’

The Peltzman effect showed that with the introduction of seat belt laws in the U.S., traffic death rates fell, but people began to drive faster and more aggressively while wearing their seat belts. Nelson said he worries naloxone can have the same effect, and he said, “We are conditioning people to think we can always bring them back.”

“By giving people naloxone and knowing they have a parachute in case they overdose, it might make them push the envelope they otherwise might not push,” Nelson said.

Crain said she has spoken with treatment providers and has not seen individuals who feel that way.

“I’m not going to say there are individuals who don’t feel that way, but when they come to treatment, they are not going, ‘Oh, there’s naloxone, so I can do more,’ “ Crain said.

As fentanyl becomes more prevalent, people need more doses of naloxone to bring them back.

Lindahl, who has been sober since September 2016, overdosed again in January 2016 and was given four shots of naloxone. She said she thinks fentanyl was mixed into the heroin because it took so many doses to bring her out of withdrawal, and she ended up in the intensive care unit for two weeks.

Kotlowski said the department has seen instances where it requires a number of doses to revive someone.

“Narcan absolutely saved my life. If it wasn’t for that, I’d be dead,” Lindahl said. “Certain ignorance from certain people gives Narcan a bad name. I have heard about Narcan parties, but I really don’t think it’s like that. For me, when I was using, I would rather you not have Narcan around because it’s going to ruin my high.”

Hall said she does not think having naloxone would affect the amount an addict chooses to use.

Finding a solution to the epidemic

Crain said that ultimately, naloxone will not be a solution to the opioid epidemic. The only solution, she said, is recovery.

“Narcan by itself being in police hands and more community members knowing about it has allowed more people to get the response they need at a critical time,” Crain said. “But we look at, ‘How do we have enough access to treatment so they don’t have to continue to revive people with Narcan?’ “

According to a new study that reviewed emergency medical service data, one in 10 Massachusetts residents who were revived from an overdose by a fast-acting antidote went on to die within a year.

Among those who died, about 40 percent died outside of a hospital, and more than half died within the first month.

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