Moving the Needle

Two months ago, a heroin user overdosed on the Southwest Salmon Street overpass across Interstate 405, about a block from the headquarters of Outside In.

Someone alerted the staff at the nonprofit social-services agency, and someone else called 911. But Haven Wheelock, who runs Outside In's needle-exchange program, ran out the door carrying a dose of a drug called naloxone.

The heroin user was down, unresponsive and turning blue. Wheelock injected him with naloxone, used to snap people out of an overdose.

"It was a scary situation," says Kathy Oliver, Outside In's executive director and Wheelock's boss. "But he came to and walked to the ambulance when it arrived."

Until last year, naloxone, also known as Narcan, was administered almost entirely by medical professionals.

But Oregon lawmakers sought to broaden its availability for application by friends, family, caseworkers, other drug users and anyone else who's around people using heroin.

The results so far have surprised even the strongest advocates of expanding naloxone's use.

Heroin deaths have fallen by nearly half in Multnomah County since the law expanding access to naloxone went into effect, according to early numbers compiled by the county.

County officials say there were 29 overdose deaths between July 9, when the law went into effect, and the end of 2013. They say the county had 52 overdose deaths for the same time period in 2012.

Officials say they can't attribute all of the 44 percent decline to the availability of naloxone, but that the new law is the only major change between the two time periods.

"Usually the things we do in public health have a longer time line, because they're very prevention-focused," says Kim Toevs, a senior manager for the Multnomah County Health Department, which oversees the county's needle-exchange program.

"It's not often in public health we get to do work that has an immediate life-saving impact."

Oregon had for years been considered in the forefront of protecting the health of drug users. Outside In, for example, started its needle exchange in 1989.

But the state had fallen years behind other places that expanded the use of naloxone, and until last year had shown little interest in making the drug more available ("Who Wants to Save a Junkie?" WW, March 6, 2013).

Chicago, San Francisco and New York had seen sharp decreases in heroin deaths after officials allowed wider public access to naloxone.

A 2012 report by the Centers for Disease Control and Prevention found expanding the use of naloxone by nonmedical professionals had saved an estimated 10,000 lives in the 15 states where the laws had been changed.

Under the 2013 Oregon law, anyone can administer naloxone after going through a training program on how and when to use it. People who go through the training are then given a naloxone kit. (The drug is usually injected but also comes as a nasal spray.)

So far, Outside In is the only group in the state that is providing training and distribution. Wheelock, who rushed to inject naloxone into the overdosed man, is the only person  in Oregon training people how to administer the drug.

Oliver says Outside In has trained 689 people since the law went into effect in July. Her organization has reports of naloxone being administered 239 times by people they have trained.

"Not all of those would have resulted in a death, but there is no doubt some would have," Oliver says. "I firmly believe we did prevent a fair number of deaths by overdose."

Toevs says the county plans to expand training and distribution of naloxone to its three needle-exchange programs, which are all located in eastside Portland and serve as many as 7,000 people.

"Even if we can't get to every drug user," Toevs says, "if we get to enough of them, the likelihood one of them will have naloxone on hand when someone needs it will be increased in a meaningful way.” 

WWeek 2015