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Quincy, Mass., is a pleasant, working-class city of 92,000 people on Boston’s South Shore. It is saturated with history and, for the past decade or so, saturated with opioids.

Deaths from overdose of heroin and prescription opioids more than tripled nationally between 2000 and 2010. Overdose is now the leading cause of injury-related death, surpassing auto accidents. It kills twice as many people in the United States each year as AIDS.

New England is the epicenter. Addiction to heroin and to prescription opioids has become so common in the northeast that Pete Shumlin, the governor of Vermont, devoted his entire State of the State speech to the issue this year. The federal government reported that at last measure, the Boston area had the highest rates of emergency room visits related to illegal drugs, and related to heroin, of any of the 11 major metropolitan areas tracked. In Quincy, 47 people died of overdose during one 17-month period in 2008 and 2009.

Overdose is reversible. A drug called naloxone — brand name Narcan — stops opioid overdose nearly instantly. If an injection or nasal spray of naloxone is given to someone who is unconscious, blue and not breathing from an overdose of heroin or opioid painkillers, that person will almost always be sitting up and talking in one to three minutes. Naloxone is non-addictive and has no black-market value. It is harmless; if administered in error to someone not overdosing, naloxone has no effect at all.



Naloxone has been around for a half a century. But until very recently, it wasn’t in the hands of people who could save the most lives. Only ambulances and hospitals had it — inadequate in an overdose when, as Maia Szalavitz wrote in this column in 2011, “time is brain.” She argued for distributing naloxone over-the-counter and in first-aid kits.



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We are still far from that point. But there has been tremendous progress in getting naloxone into the hands of people who are first on the scene at an overdose. One group is the police. All over the country, police forces are beginning to train their officers in how to use naloxone and provide them with kits. The New York City Police Department is doing this on Staten Island, where the death rate from opioid overdose is roughly four times that of other boroughs.

Quincy was the pioneer. Its response began — as is often the case — with the near-death of a “good” kid. Brendan Holler was an honors student and high-school baseball star who began stealing his father’s pain medicine and moved on to heroin. In 2009, his mother, Nancy, found him collapsed on the floor of the bathroom in their home, not breathing. Police arrived, then firefighters, then a basic life-support team. They all gave him CPR. But Holler had to wait for an ambulance to get the naloxone that saved his life.

Nancy Holler went to the next City Council meeting with a simple question: Why aren’t police and firefighters carrying this?

The firefighters still don’t. Capt. Richard Bryan said that Quincy’s firefighters, unlike other responders, were not covered by liability protections. “We live in a litigious society. It’s not wanting to put our people in jeopardy.” He said the department was trying to “dot I’s and cross T’s” so firefighters could administer naloxone.

But the police department was eager. With the vigorous support of organizations that work with drug users, they lobbied the Massachusetts health department for money for training and the drug itself. “Our statistics show that officers arrive first on the scene,” said Lt. Detective Patrick Glynn. In October 2010, all Quincy police began carrying naloxone in their cars

“I’ve been on the force for 29 years, 21 of them in narcotics, and the question we asked was always ‘how many arrests did you make?’” Glynn said. “But we have to take another approach, treating drug addiction as a disease.”

It was a shift in mind-set not all police were ready to make. “Some believed it was not really part of our job,” said Glynn. “But we would respond to an emergency with a defibrillator, or an epipen,” argued Glynn. An overdose of opioids is “a poison, and we have an antidote in nasal naloxone.”

Overdose deaths continued to rise elsewhere. But after Quincy police began carrying naloxone, they dropped there by 70 percent, said Glynn. So far, Quincy police have been called to respond to overdose 262 times. Eight of the victims were already dead when police arrived, and four more had taken non-opioid drugs (only opioids are susceptible to naloxone). The other 250 had their overdoses reversed by naloxone.

The drug also revives people who accidentally overdose on pain medicine, attempted suicides and even drug-sniffing police dogs, who can overdose on the job.

Quincy’s police are now fielding questions from departments across the country. When I visited last week, Lieutenant Glynn had just gotten back from meeting with police in Tulsa, Okla., and had spent some of the morning on the phone with Atlanta’s police department.

At first, Quincy’s police didn’t get a lot of overdose calls — the first one came a month and a half after the program began. Part of the problem was that people didn’t know about it. But bystanders were also afraid of arrest. Calls did pick up, especially after Massachusetts passed a Good Samaritan law in 2012. It allows people “acting in good faith” to possess and administer naloxone, and protects bystanders or the victim from arrest for possession of small quantities of drugs.

People who work with drug users had mixed opinions on whether users more readily call 911 now. Part of their hesitation is that the “no arrest” rule is muddy. If you are carrying large quantities of drugs, or already have a warrant, it doesn’t protect you. If lack of liability protection even dissuades firefighters, it may take a lot to convince drug users.

Although police are often the first officials at the scene of an overdose, they are almost never the real first responders — those are fellow users, friends and family.

In most overdoses, others are present. These bystanders should be able to get naloxone without a prescription. It’s a lot safer than many other over-the-counter drugs, especially because for the last five or so years it’s available in nasal spray form — no needles.

Until that happens, however, the best way is through “standing order” laws, which allow organizations that work with drug users to train laypeople and give them the drug.

Related More From Fixes Read previous contributions to this series.

Massachusetts has standing order laws, and last week in North Quincy, I watched Warren Nicoli use them. Warm and loquacious, Nicoli has been an AIDS educator for 23 years. He works with Manet Community Health Services, which has six branches in the South Shore. Manet is one of two dozen community groups and health centers in Massachusetts that train and supply bystanders with naloxone.

Nicoli said many of his clients are parents of active users, and a quarter of the people he trains are users themselves — he often does trainings on the street. This time, however, he was in a Manet clinic, training by appointment. The client, Jane (she asked me not to use her last name) was about 50, well groomed and apparently educated. She came in carrying a cup of coffee from McDonald’s, her sunglasses pushed back onto her head. She is in recovery from heroin use and is familiar with naloxone, which saved her own life.

“I’ve had people overdose,” she said. “I’ve had to call 911. The paramedics got there and saved them.” She is serious about her recovery meetings and goes regularly — but drug dealers often go to these meetings, too, to lure back customers. Overdoses are most common after a period of abstinence, as users’ tolerance has eroded.

Nicoli gave her the steps: Check to see if the person is really overdosing. Call an ambulance. Make sure the E.M.T.s will be able to get into the building and can find you. Do rescue breathing. “That may bring them out of overdose,” he said. If it doesn’t, use the naloxone. “It can’t hurt anybody. If you decided to administer it to me right now, it would have no effect. You can’t make a mistake so if you don’t know, do it.”

He took out a plastic bag with the three pieces of a naloxone syringe, the drug replaced with water for teaching purposes. “The box says ‘do not pre-assemble,’ but I’m going to tell you the opposite,” he said.

“Good, because I’m a panicker,” said Jane.

It took about two minutes to teach Jane and me how to assemble it, and a few seconds for us to assemble and use the syringe. (This video made by Boston Public Health shows how.) “It’s half the dose up one nostril and half up the other,” said Warren. If it doesn’t work within three minutes, use the second syringe in the kit, he said. Then take the person to the emergency room; naloxone can wear off before the overdose does.

While New York City has a network of 52 programs that can train bystanders, their work is limited by a requirement that a doctor write each prescription. Mary Travis Bassett, New York City’s health commissioner, said that since 2009, naloxone has saved about 200 to 250 lives in the city, “although we don’t hear about all the lives saved.”

That number — identical to Quincy’s, which has just over 1 percent of New York City’s population — is about to change. A standing order bill just passed the New York state Senate and Assembly and awaits Gov. Andrew M. Cuomo’s signature.

Remarkably, the vote in both chambers was unanimous. A few years ago, many people argued that naloxone would encourage drug use. (There is no evidence for that.) But now even fierce opponents like Gov. Paul LePage of Maine are softening a bit. He still opposes equipping police and E.M.T.s with naloxone but has agreed to allow family members to get prescriptions. The Portland Press-Herald reported that the governor changed his mind after a state representative he was close to explained that drug addiction affects all kinds of families — including, the representative said, his own.

Addiction has never discriminated by social class. With opioid and heroin use exploding, it reaches more and more “good” kids. This is a tragedy — it is in any family. But that fact also helps the people who make decisions to understand that addicts are not just addicts — they are also our children. In the case of naloxone, this saves lives.

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Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and the author, most recently, of “Join the Club: How Peer Pressure Can Transform the World” and the World War II spy story e-book “D for Deception.”