Naloxone’s the one

A lifesaving substance that could stem the tide of local heroin overdose deaths needs to take on a far stronger street presence, a panel of professionals with assorted links to the problem said Monday.

Six speakers took part in the session, one in a series of heroin-focused discussions organized by U.S. Rep. Bill Foster, D-Naperville, at Christian Community Church in Naperville. Their message was unified: naloxone saves lives, and it needs to be put into the hands of people positioned to use it for that purpose.

“Most people aren’t aware of naloxone, and what it can do,” said Jim Scarpace, executive director of the Gateway Foundation’s treatment center in Aurora, who asserted that “access is not easily gained by some people.”

Administered by syringe or inhaled, naloxone is marketed under the trade name Narcan.

The panelists agreed that there have been promising developments in recent years, including the 2011 passage of the 911 Good Samaritan Overdose Law, which partially insulates people from prosecution when they come to the aid of someone who has overdosed, and the Overdose Prevention and Naloxone Expansion Law enacted in 2010 allowing people to administer naloxone.

Mark Piccoli, director of the DuPage Metropolitan Enforcement Group, said marijuana is and always has been the most commonly abused illicit drug, and that will remain the reality for as long as it remains illegal. Cocaine arrests have declined, he said, noting that it’s considerably less dangerous than heroin — which supports the argument for making naloxone far more readily available. It can be especially important for first responders to have it with them, Piccoli said, because they often arrive on the scene of an overdose before the emergency medical team can get there.

‘Lazarus drug’

DuPage County’s top public health official agreed that seconds can make the difference between life and death. Karen Ayala, executive director of the DuPage County Health Department, said naloxone works chemically by dislodging the heroin molecule before it can cause the brain to shut down permanently.

“The drug Narcan has been referred to as the Lazarus drug. It absolutely brings someone back to life who is on the verge of death,” Ayala said, adding that the substance can’t be used to obtain a high. “It only allows the person the opportunity to live, and therefore have the hope of recovery.”

Several large and small cities out East have implemented naloxone programs, some as recently as earlier this month. Piccoli said he was surprised and “kind of disappointed” to learn that little such activity is happening west of Iowa.

“My kudos to DuPage County for moving this forward,” said Piccoli, who maintains that everyone who knows someone using heroin should keep the counteractive drug on hand. “It can’t hurt you, there’s really no reason not to have it available, even if you’re not an addict.”

Karen Hanneman echoed the thought. A Naperville resident who became an activist after her son, Justin Tokar, succumbed to a heroin overdose in January 2011, Hanneman said she “can’t say enough” about the importance of naloxone. She said police, first responders and family members must be trained to administer it.

“This would literally be a lifesaving situation and help them out, as well. They don’t want to see anyone die,” Hanneman said.

Dynamic toolbox

Emergency measures such as naloxone are only one piece of ammunition in the fight against heroin use. The panelists emphasized that following up with treatment is critical to keep a heroin user from remaining at risk of dying from the habit. Much greater involvement of families in an addict’s recovery is also crucially needed, said Scarpace, who also is calling for increased cooperation from health care underwriters.

“This is a new game for insurance,” Scarpace said. “Insurance doesn’t understand issues of addiction and dependence as they need to. We are struggling every day with shorter stays in residential (treatment).”

Ayala said the Affordable Care Act has opened the door to mental health treatment in an unprecedented way, but services need to keep up with the expanded access. She said “if a bed is not available” and an addict has to wait for a month or two before being admitted, the new access doesn’t bring much benefit.

There’s a problematic perception, Scarpace said, that adding naloxone to the toolbox amounts to enabling a continued behavior by people who have gotten into their circumstances by choice.

“The reality is, are we in the business of saving lives, or are we in the business of allowing our values and morals get in the way of what needs to happen?” Scarpace said, noting that most addicts don’t choose to relinquish their families and jobs, and experience the other consequences of their dependency. “The choice comes into play once they know they have an addiction, and whether they decide to get treatment. … It’s a disease, it’s not a choice.”

Long battle

There was agreement that the struggle will continue its uphill arc for now. Piccoli thinks the “crest” is yet to come. DuPage County accrued a grim tally of 46 fatal overdoses last year, five more than in 2012.

“All of our stats are on the rise, unfortunately,” he said, adding that the push for more education, treatment and enforcement will help.

He said in his 35 years of enforcing drug laws, never before has he seen the landscape look like this. When he started his work in Lake County, there was some heroin, but only in isolated places.

“But it was the junkies, the hard-core addicts,” Piccoli said, noting that users now are far more likely to be high school students or young professionals.

Piccoli doesn’t expect Saturday’s arrest of drug lord Joaquin “El Chapo” Guzman in Mazatlan will have much effect on the local heroin supply. There might be a slight lull, he said, but Guzman’s Sinaloa cartel, believed responsible for 80 percent of the street drugs flowing into the Chicago region, is a well-entrenched operation that won’t just go away overnight.

“I think the reality is somebody will step up, and things will continue moving as they have,” Piccoli said.