To combat overdose epidemic, Manatee officials call for increased use of 'heroin antidote' | Bradenton Herald

MANATEE -- Dr. Mark Sylvester can't count the number of patients he's lost to heroin overdoses in the past year. One patient was 16 years old.

After five years of working with addictions as a psychiatrist, Sylvester knows how complicated treatment can be. Saving addicts from dying of an overdose can be extremely simple by comparison, requiring only a quickly administered heroin antidote of naloxone, or Narcan.

"Anyone who's using heroin needs this," said Sylvester, whose office is in Lakewood Ranch. "If you're playing with fire, you should have a fire extinguisher around."

The Florida Legislature made access to those overdose extinguishers much easier during the 2015 session. Gov. Rick Scott signed a bill into law in June allowing doctors to prescribe naloxone to third parties such as family members and friends of addicts. That way, if someone is concerned about someone they know overdosing on heroin, they can have it on hand if an overdose occurs.

Naloxone is the generic version of Narcan -- drugs that counteract the depression of the central nervous system, which is what causes death in opioid overdose victims. It can be administered nasally and by an auto injector.

The auto injector is more user friendly, coming in a small box that gives audioinstructions when the lid is taken off, directing users to press the box against the victim's thigh for five seconds until injection, which is the quickest way to stop an overdose.

They can be cost-prohibitive at about $900 a pop -- $200 each with insurance. The nasal administration is much cheaper at $41 a dose but it is less user friendly.

Sylvester said there hasn't been a huge demand for naloxone since the law passed, which he attributes to lack of awareness. But he believes if everyone who knows a heroin addict had the drug on hand, overdose deaths would drastically decrease.

"If we could have a fire extinguisher on every street corner, we would watch those overdose (fatality) numbers go down," Sylvester said. "As they have in other states, such as Massachusetts, probably by 50 percent."

Overdose deaths have exploded in Manatee County this year with 86 through mid-June, up from 63 deaths total in 2014 and 19 in 2013. There were 659 overdose calls in Manatee through June, so about 13 percent of overdoses result in death. The rest have been able to contact Emergency Medical Services and get Narcan in time, reviving them from death.

Naloxone prescriptions

The awareness issue extends to physicians and pharmacists. Many doctors aren't aware they can prescribe the medication to third parties, and those who are run into problems when pharmacists don't know how to fill the prescriptions, Sylvester said.

Some third parties worry about problems caused by administering naloxone incorrectly. Naloxone has no negative side effects if it's given to someone who isn't overdosing, Sylvester said. And Florida Good Samaritan laws protect those trying to deliver medical treatment in emergency situations.

Sylvester tries to combat the lack of awareness by making it as simple as he can for third parties to get a prescription.

"If you came in and said: 'Hey, I'm in a townhouse and someone comes over and bangs on my door every night and says her boyfriend is overdosing,' I can write a prescription for your neighbor's boyfriend," he said.

Some paramedics in Manatee are concerned that the readily available antidote to overdoses will make some addicts more flippant about their drug use. But Sylvester said it's far more important to get the drug out there and save lives.

"The priority is keeping these people alive," Sylvester said. "Naloxone does that, so it should be out there. I can't get treatment for someone who's dead."

The naloxone available to the public does not have exposed needles. Addicts would likely use available needles to abuse opioids, and then wouldn't be able to receive the life-saving naloxone when it was needed. That's why it's available via auto injector or nasally.

Use by first responders

The new law also allows first responders other than EMS to administer naloxone. Manatee County EMS Chief Steve Krivjanik said he was happy to see the legislation, agreeing with Sylvester more naloxone out there would mean fewer deaths.

"The sooner overdose victims get it, the better," Krivjanik said. "And it's limitless where you could put it."

EMS has spent $90,000 on Narcan doses so far this year, so it has been a significant cost, Krivjanik said.

First responders such as firefighters and police officers are aware it's available now and have shown interest in getting it. No one else has yet, however, and they're working out the details, said Bradenton police Chief Michael Radzilowski.

"There's more to it than people think. There are some problems we'd have with it, like temperatures required for storage," Radzilowski said. "EMS has coolers to store these in ambulances, but we don't have that. And the last thing we'd want is to get on scene and try to administer it only to find out the dose has gone bad."

The Manatee County Law Enforcement Council has been discussing it for a while, Radzilowski said. While they aren't getting naloxone in the foreseeable future, they're continuously researching and looking at what would be required. Luckily, he noted, Manatee paramedics are typically on scene just as quickly as law enforcement.

Radzilowski said cost doesn't worry him as much and, if it becomes necessary, they'll find the funds somewhere if it means saving a life.

"Honestly, everyone in this county wants to help this situation," Krivjanik said. "Which is great to see."

Kate Irby, Herald online/political reporter, can be reached at 941-745-7055. You can follow her on Twitter @KateIrby