The Rise of Peer-Based Naloxone Distribution Programs

A life-saver. Shutterstock

Vernon Lewis was drinking with friends in an alley when he noticed that one of his companions had stopped breathing and was turning blue. The situation might have caused most people to panic, but Vernon calmly pulled a small vial and a syringe from his pocket, loaded the barrel, and injected a clear liquid into his friend’s thigh. Within seconds the man took a deep breath.

“What happened?” he gasped.

“You overdosed, man,” said Vernon. “I just saved your life.”

Saving lives is all in a day’s work for Vernon, an active drug user and outreach worker who has used naloxone, a medication that reverses opiate drug overdose, on eleven different people. He gets the antidote from the Harm Reduction Action Center where he resides in Denver, Colorado. The Center trains drug users and their loved ones, methadone clinics and service providers on how to recognize and respond to overdose from opiates such as heroin and prescription painkillers. The program has reported 80 overdose reversals since it launched in 2012, the majority of which involved active drug users administering naloxone to their peers.

Not long ago, the idea of giving drug users access to a medication traditionally reserved for paramedics and hospital emergency rooms was rife with controversy. Some worried that offering drug users the opportunity to reverse an overdose would encourage them to use more drugs. Others feared that it was foolish to expect someone who might be high to respond appropriately to a life-threatening situation. In fact, in 1996 when Chicago was considering the first peer naloxone program, even drug users had reservations.

Dan Bigg, Director of the Chicago Recovery Alliance (CRA), a harm reduction outreach organization, recalls when members of CRA met with a group of active drug users to gauge their interest in a naloxone program. Many of the users initially balked. Several had overdosed before, and naloxone, which paramedics delivered intravenously at high concentration, had put them into sudden, violent withdrawal.

“Back then, naloxone to an opiate drug user was like garlic to a vampire. It was their Kryptonite,” explains Dan Bigg. “Not all were willing to use it on each other.”

Bigg and his colleagues addressed the users’ concerns by explaining that paramedics often deliver naloxone at higher concentrations than medically necessary and that smaller doses would not cause acute withdrawal. Furthermore, injecting naloxone into the muscle tissue rather than the vein allows the antidote to take effect more slowly. After much discussion, the user group voted to support a naloxone program.

Once CRA found physicians willing to risk their licenses to prescribe naloxone to drug users, word quickly spread about the miracle drug that saved lives from overdose. Today, according to the latest CDC report published in 2012, community groups nationwide have trained over 53,000 people on naloxone use and report over 10,000 peer reversals. Some programs, such as the DOPE Project in San Francisco, a program of the Harm Reduction Coalition, use funding from the public health department to distribute naloxone through syringe exchange programs, jails, methadone clinics and outreach settings. They reported 1,192 successful reversals from 2003 to 2013. In North Carolina, the NC Harm Reduction Coalition launched a statewide naloxone distribution program in 2013 and has reported 51 reversals in six months. They are now working with law enforcement departments throughout the state to equip officers with naloxone.

But not all naloxone programs have the luxury of funding or popularity. In Michigan, a gray area surrounding the legality of naloxone distribution has forced one program to operate underground in many areas. Two months ago, one of their outreach workers was pulled over by police, who confiscated his naloxone kits. The program founder, who does not wish to be named, says, “A few days ago I was training a group of parents on how to use naloxone to save their kids. I started thinking about what would happen to my own kids if I got arrested for doing this.”

Michigan is one of 31 other states that do not have laws protecting medical providers or people who administer naloxone from liability if something goes wrong. And although naloxone is a legal medication, it is only available without a direct prescription in states that have adopted standing order laws. Standing orders allow certain groups or individuals, such as nurses or community groups, to dispense medication under a medical prescriber’s orders, but without the prescriber present. The most common example of this is flu shots at pharmacies.

Standing orders have allowed naloxone distribution programs to grow exponentially in many states. But as with any program that experiences rapid growth, going mainstream can mean compromising the spirit of the founding ideals. Begun as peer distribution among active drug users, naloxone is quickly gaining traction among more socially acceptable groups such as law enforcement, parents who fear losing their children to drug overdose, and chronic pain patients. Some of the original naloxone distributors caution that these “harm reduction lite” programs should not come at the expense of programs that serve active drug users.

“It’s great that we are getting naloxone to cops and parents,” says one program manager who does not wish to be named. “But we can’t forget that 90% of the lay overdose reversals over the years have been from active drug users. People are more likely to use with each other than around their parents or police.”

Getting naloxone to people who need it most is something to keep in mind as these programs expand. And though naloxone distribution has come far since 1996, founders like Dan Bigg say that the work isn’t over until naloxone is more affordable and available over-the-counter. This week the FDA approved an auto-injectible form of naloxone and they are currently considering making naloxone available over-the-counter. But in the meantime, community groups will continue to hand out naloxone in the hopes of offering another chance at life to people who overdose.

“Some of the people I saved with naloxone went back to using drugs,” says Vernon of Denver. “But at least three or four got clean. One guy is back with his wife and family now. You never know what people will do with a second chance unless you give it to them."

Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform agency in the South. She writes a regular column for The Huffington Post on overdose prevention, drugs, sex work, HIV/AIDS, law enforcement safety and health.