Narcan Demo.jpeg

An officer in Ocean County demonstrates a naloxone nasal-atomizer.

(Ocean County Prosecutor's Office)

There aren’t many who would call saving 200 lives a failure, but Howell Mayor William Gotto says it with a straight face.

“I don’t think we should be bragging about it,” Gotto said.

He’s talking about the use of naloxone, also known as Narcan, an opioid-reversal drug recently approved for use by law enforcement to help rip heroin and opioid users out of the clutches of death following an overdose. It’s not that it isn’t working. From a strictly medical perspective, the expanded use of naloxone is working brilliantly. Since a pilot program to train law enforcement officers to use naloxone was started in Monmouth and Ocean counties earlier this year, it has been successful in reversing about 200 potentially fatal overdoses in just seven months.

But that’s the problem for Gotto. There was a need to save more than 200 people in two New Jersey counties in just under eight months. It shows how dire the heroin crisis is in New Jersey and how little progress has been made to stem the tide of overwhelming usage.

“If we have to deploy Narcan it’s a failure, it’s not a success and I was offended that it was viewed as a success,” he said.

Naloxone is one-dimensional in that way. It is a lifesaver, but it doesn't treat addiction.

Gotto, the Howell police department and treatment experts across the state say without a mechanism to connect overdose patients to addiction services, it only creates a revolving door in emergency rooms and frees addicts to use again when the immediate threat to their lives has passed.

In the last 10 days, Ocean County has launched a pilot program that seeks to change that, but for the vast majority of New Jersey, treatment for an overdose ends in the emergency room.

A dire need



There were 741 heroin-related deaths in New Jersey in 2013, according to the state Attorney General’s office, a 160 percent increase since 2010. And with 501 drug-related deaths in New Jersey testing positive for other opioids last year, the number of opioid-related deaths was likely significantly higher.

Treatment for heroin and opioids in New Jersey are at all time highs, according to data for the state Division of Addiction Services, but treatment officials acknowledge there is a severe dearth of available beds.



Naloxone has been used in emergency rooms to treat opioid overdoses for decades, but only since April has a nasal-administered form of the drug become more widely available to members of law enforcement, and increasingly, the general public. In June, Gov. Chris Christie expanded a pilot program started in Monmouth and Ocean County in the months prior, spurring the training and equipping tens of thousands of first responders across the state with naloxone.

The program has been touted as a means of helping emergency officials save the lives of heroin addicts during an overdose, at a time when every minute counts.

When someone overdoses on heroin or opioids, certain receptors in the brain are overwhelmed, leading to severely repressed breathing and often death if untreated.

Naloxone targets those receptors in minutes, clearing them and blocking further reception of opioids for several hours.

Today in New Jersey, a police officer (often the first to arrive at the scene of a potential overdose) can administer naloxone, an action that can rip a user out of unconsciousness and buy crucial time to get them additional medical help.

The use of naloxone, or Narcan, has become more widespread in New Jersey in 2014.

“It’s to prevent the death of an individual. It can save someone’s life,” said Bob Baxter, addiction, prevention and education director at the North Jersey Community Research Initiative. “It would be insane not to utilize it.”

What’s more, it’s cheap and relatively risk free.

This week law enforcement officials were informed that the sole manufacturer of naloxone nasal spray, Amphastar, recently doubled the price of the drug to somewhere between $80 and $100 a dose.

It’s worrisome for the drug’s proponents but, despite the increase, researchers say it remains one of the most cost-effective means of acute medical treatment available today.

And, if someone isn’t under the influence of heroin or another opioid, the drug has no effect.

“It’s truly a no brainer,” said Kenneth LaVelle, a doctor and former paramedic who has championed the expanded use of naloxone. “Naloxone has been used by paramedics and hospitals for years. If I’m overdosing, it’s not a matter of if I’m going to get it, it’s when. As a first responder If I don’t reverse, the patient can die. That’s not helping anybody. “

It’s also available via prescription and, in recent months community groups and law enforcement have been partnering with doctors to make it more readily available to the public. This week, Baxter said it will be made available to users at a needle exchange in Newark for the first time.

But exposing naloxone to the public fills Howell Police Lt. Thomas Rizzo with concern. While the naloxone program has expanded and a new law protects users from prosecution if they call 911 to report an overdose, Rizzo said without a mechanism pushing overdose victims toward treatment, it’s all for naught.

“For somebody’s own choice and volition to do this, ok no problem we will give you all the resources we have to save you, but then there’s got to be a levy,” he said. “It can’t be ‘hey I’ll do this again tomorrow night and here comes the stampede of people to help me.’”

More than a dozen times in the past six months, Rizzo said he’s discovered heroin loaded in a syringe next to naloxone.

“This was supposed to be the magic bullet,” Rizzo said.

The need for follow up



In 2013, before law enforcement began carrying the opioid antidote, Howell Detective Sgt. Eileen Dodd said a woman in the township was given naloxone three times in one week by paramedics.

“Until the treatment options change it’s not going to get better because people need treatment,” Dodd said. “I think it will get worse.”

Naloxone is now available in an easy-to-use nasal spray. Ocean County officials have successfully revived 113 overdose victims since April.

Dr. Petros Levounis, chair of the department of psychiatry at University Hospital in Newark, said he supports the increased use of naloxone and its effectiveness, but said it does nothing to address addiction and people who are administered the drug are not given the addiction services that they need.

"You save somebody’s life, that’s fantastic, but then what? You send somebody back out and they have over 95 percent chance of relapsing -- there’s no services for these patients. We have no first line of defense,” he said.

University Hospital is slated to open an addiction clinic in early 2015, which Levounis said would have ambassadors in the emergency room waiting to connect overdose patients to addiction services once they are stabilized. He said it’s much needed, because the state doesn’t have the services needed to handle the gravity of the problem its experiencing.

“It’s a national issue, no doubt,” he said. “But New Jersey is certainly suffering from a lack of services above and beyond the national dearth of services available.”

Though a lack of addiction services remains a significant hurdle, the Ocean County Prosecutor’s Office is trying bridge the gap between overdoses and what available treatment.

They have partnered with St. Barnabas Health and local treatment centers and last week launched a pilot program that would place naloxone-treated overdose patients in detoxification centers and outpatient treatment facilities.

“This will provide actual human interaction with a trained intervention specialist and to begin a conversation with people and try and break the cycle of addiction,” said Al Della Fave, the county prosecutor’s spokesman.

Treatment remains voluntary, but if a patient is open to it, Sunrise Detox Center in Toms River has set aside 10 beds for patients at their facility for detoxification treatment and Jersey Shore Addiction Services in Neptune is offering free intake and outpatient treatment vouchers. If a patient does not have insurance and cannot pay, the Prosecutor’s Office will provide funding through money collected from drug forfeitures.

“We know there’s going to be issues that come up, but the great news is this is a start,” Della Fave said.

There is also evidence that naloxone is having an impact on the number of heroin deaths in New Jersey, though statewide data is not yet available.

Ocean County, which has become the epicenter of the heroin problem in New Jersey after recording 112 overdose deaths last year, has recorded 66 heroin deaths thus far in 2014, down from 100 at this time last year.

County law enforcement has successfully used naloxone 113 times in 2014. While buoyed by the figures, county officials know it’s only attacks a symptom of addiction and is by no means a cure.

Della Fave said a few months ago someone was given naloxone in Brick and a week later she died.

"We don't want the Narcan program to be seen as a safety net [for users]," he said. "It's been proven it's just going to lead to death."

Coronato is hopeful the county's pilot program for drug treatment will expand, just as the use of naloxone has.

“If you don’t treat them then the whole program hasn’t really met its fruition,” Coronato said. “In my opinion, quite honestly, is if you allow them to leave the hospital and go back to their house, go back to their friends, go back to their element they were in before, that’s a lost opportunity.”

Stephen Stirling may be reached at sstirling@njadvancemedia.com. Follow him on Twitter @sstirling. Find him on Facebook.