Should We Limit How Many Times Someone Is Saved with Naloxone?

“It’s hard to feel empathy for an intoxicated person who caused a crash when you are looking at innocent people he has killed.”

On November 1st, Wilmington, North Carolina resident Jonathan Hayes plowed his pickup truck into the back of a family car, killing a two-year-old boy, Mason Richardson, and injuring the boy’s pregnant mother and sibling. The fire department and EMS personnel who arrived on scene found Hayes unconscious from an apparent heroin overdose and revived him using the opioid antidote, naloxone. This was the fourth time Hayes had been brought back from an overdose with naloxone.

This incident and others like it have ignited firestorm debates around the country, unleashing grief, anger and frustration at the lives lost to the irresponsible actions of people under the influence. But the ire is often directed at a surprising scapegoat: naloxone. Used to reverse overdose from opioids such as heroin and prescription painkillers, naloxone (also called Narcan) has rapidly increased in availability across the country in an effort to reduce overdose deaths. Once a medicine reserved strictly for emergency personnel, in many states naloxone is now available to laypeople through pharmacies or community distribution programs. Advocates for naloxone point out that the medicine saves lives and gives people a second chance to make changes. But others hold opinions such as those published in the comments section of the Wilmington Star News after Hayes’ accident:

“It’s a shame that he was given a second chance to live today, the little boy didn't get one at all.”

In many places, distributing naloxone to laypeople and their loved ones at risk of an overdose is criticized even without any deaths involved. A pharmacy on Staten Island decided to help fight the local heroin epidemic by offering naloxone for free to anyone at risk of an overdose. The gesture was met with comments on Facebook like this one:

“Disgusting, let’s give this to junkies for free so they can get high again a few hours later.”

Comments like these are disturbing to many, but particularly to people who have been revived with naloxone more than once.

Mike Page, also a Wilmington resident, was horrified when he heard the news of the accident. Page has a two-year-old daughter and he empathizes with Mason’s family and their grief. But Page also has a history of heroin addiction. Today he is living drug free and is a devoted husband and father, a passionate community volunteer, and a peer support specialist who helps others find recovery from drug addiction. But back in the throes of his addiction, he overdosed and was revived at least three times with naloxone.

“It’s unfortunate that it took as many times as it did for me to change my life but that is the reality of this condition,” says Page. “For some people, one shot [of naloxone] is all they need. For others it takes multiple opportunities. Who are we to decide how many chances is enough?”

Not only is Page using his multiple chances with naloxone for good, but he brings a unique perspective and hope to the people he serves precisely because it took so many tries for him to create change.

“I am an example to others that recovery is possible, but also an example that recovery is not easy or guaranteed after the first overdose,” says Page, who has helped four other people seek substance use treatment in just the past three months. “Every time I overdosed or stopped using drugs because my family or law enforcement intervened, I would repeat the same mistakes because I still thought that I was in control of my situation. It took a long time for me to believe that I needed help and to have the humility to ask for it. My family and I are so grateful for all the chances I got.”

Mike was fortunate to live long enough to go through the stages of growth required for any person, drug user or not, to recognize the need for a personal change and take action. Every person grapples with inner demons and for many of us it takes years, if not a lifetime, to truly change. But not everyone is granted so many chances and the consequences reach far beyond the tragedy of one death.

Kim Brown of Davenport, Iowa, lost her son Andy to a heroin overdose on May 25, 2011. He was 33 years old and left two young sons behind who miss their father every day.

“The grief doesn’t get better as the years go by,” says Brown. “I know people who overdosed and were brought back [with naloxone] almost a dozen times. Their families showed them love and kindness, and over the years they have gone from being homeless to having homes, from being jobless to having jobs, and they give back to the community in so many ways. I wish my son had had those opportunities as well.”

In Brown’s hometown of Davenport, naloxone is not readily available to laypeople and law enforcement does not carry it. Brown struggles every day to convince public officials to adopt the life-saving measures that are sweeping through other states, but she encounters pushback against increasing naloxone availability.

“I get a lot of pats on the head and ‘we’re sorry for your loss’ comments, but there is no sense of urgency here to help people who use drugs,” says Brown.

Daniel Meloy, Township Administrator and Public Safety Director for Colerain, Ohio, admits that during the majority of his career in law enforcement, he was one of the public officials who had difficulty empathizing with people who use drugs.

“During most of my 28 years in law enforcement, I took the side of the victims of burglary and car crashes caused by drug users,” he says. “It’s hard to feel empathy for an intoxicated person who caused a crash when you are looking at innocent people he has killed because he got behind a wheel when he shouldn’t have.”

In recent years, however, Meloy’s views have changed as he became educated on the nature of addiction and the difficulties faced by people who use drugs even when they want to stop. Meloy is currently a champion for a new program in Colerain called Quick Response Teams. After every drug overdose that occurs in Colerain, a team of first responders and addiction specialists visit the person who overdosed to offer case management and access to drug treatment. Since the program launched in early 2015, more than 80% of the people visited have enrolled in drug treatment programs.

“I had never realized how many people want to stop using drugs but just can’t access treatment,” says Meloy. “Our Quick Response Teams now have the opportunity to meet with people who overdose and their families to listen to their situation and try to help. We can’t just sit back and condemn people who struggle with addiction. We need to get them the resources they need.”

Currently, the duty of first responders is to save every life possible, regardless of the person’s culpability in the tragedy. But after deaths like Mason Richardson’s in Wilmington, many people are vocalizing frustration. Some have even suggested there should be limits on how many times naloxone can be administered to the same person. Meloy and many other first responders reject the idea of limits on naloxone.

Jim Albright, Director of Guilford County EMS in North Carolina, says, “We often treat diabetics with hypoglycemia numerous times before they can regulate their insulin and intake. Most medical care providers see opioid addiction similarly … It takes multiple attempts at treatment to make it ‘stick,’ and then it is a lifelong commitment to stay clean, just like the control of diabetes or any other chronic disease.”

People are understandably angered and frustrated over tragedies such as the death of little Mason Richardson. Jonathan Hayes can and should be punished for his crime of driving under the influence. But naloxone is not the problem. Saving lives is not the problem. First responders doing their job is not the problem. The problem is a broken mental health system that drives people who can’t afford treatment to self-medicate with illicit drugs. It is a broken economic system that makes selling drugs the most viable financial option in some neighborhoods. It is a broken criminal justice system with its catch-and-release policy of sucking people into jail and spitting them out again into the same problems they had before. It is a broken medical system where people who desperately need and want treatment can’t afford it. It is a broken society that holds people with chronic conditions like diabetes to one standard and chronic conditions like addiction to another.

In the vast majority of circumstances, saving the life of one person does not cause the death of another. And certainly, a life does not decrease in value the more times it is saved. The real problem here, the one that lies at the root of all the others, is that we as a society do not consider the lives of people who use drugs to be as valuable as the lives of people who do not. Imagine the public outcry if anyone suggested that EMS should refuse medical treatment to a teenager who caused a fatal car crash because he was texting. Imagine telling that teenager’s mother that society would be better off if he had died before the crash. And yet, it is acceptable to suggest that people who overdose be denied medical treatment and allowed to die. And we forgot that those people too have families and loved ones who would be devastated by the loss.

Naloxone is about second chances, pure and simple. Some people will make good on that chance right away. Others need more opportunities. But it is not up to the rest of us to draw that line in the sand. We should grieve the loss of people like Mason and penalize the impaired drivers who cause these tragedies. But we cannot and should not play God.