Summary/Abstract

Drug Policy and Naloxone and Opioid Overdose Mortality. Is the Government guilty of wanton disregard?

Content

After becoming sufficiently annoyed and disgusted with the Fashion Industry and the media's callous coverage of the attire that so called "celebs" wore to Phillip Hoffman’s funeral  - Fashion labels promote what celebs wore to Hoffman’s funeral, I decided an uncensored, non-politically correct editorial was warranted.  My first reaction was to think who honestly gives a damn what some celeb wore to his funeral? This man is dead. His life is over. Have we become so desensitized to the value of human life that we encourage this sociopathic, predatory vomitus and ignore the systemic factors etiology.  We as a society obviously do or these shameless opportunists would cease to exist. What is horrifying is that people actually read this crap. Oh my, look what so and so wore to his funeral. I think it is fair to surmise that we are definitely missing the point and the sad reality of this morbid quagmire is being obscured by media sensationalism. I for one certainly don't care if they were wearing t-shirts and jeans or designer gowns. A brilliant man is dead and over 100 die every day in this country from sheer negligence. Legislators should be held accountable for their commissions and omissions and cease attempting to practice medicine. This needs to stop.

After the bile in my throat had retreated, I started to reflect on the tens of thousands of opioid addicts that have needlessly died from an overdose when a safe and extremely effective antidote, if administered in time, will reverse an overdose and save a life. Tens of thousands of families have lost children, fathers, mothers, sisters, wives, husbands and brothers as a direct result of congressional and societal ignorance, apathy and negligent disregard. For the past ten years, overdose deaths have skyrocketed and in many states they have surpassed motor vehicle accidents as the number one cause of accidental death. Addiction is a disease folks so unless this is a politically correct and socially acceptable form of genocide perhaps we should follow the lead of states that have enacted legislation that provides for the distribution of Naloxone to lay people. Unlike alcoholism, IV opioid drug users typically use in pairs or groups. In many major cities, there are "establishments" that are referred to as shooting galleries where addicts congregate after copping (purchasing drugs) to shoot (inject) their drugs. The death rate from overdose would decrease dramatically if Narcan (Naloxone) was readily available to lay persons.  A mother who finds her child with a needle hanging out of his arm lying on a bathroom floor, cyanotic and hardly breathing could save him rather than calling 911 and hoping that  the EMTs would arrive in time. An addict in a shooting gallery could be revived by another addict. It is really simple to wrap your mind around this issue.

Heroin overdoses have increased dramatically across the country as pill mills in Florida that had supplied 85% of the nation’s pain medications (OxyContin, hydrocodone, Opana, morphine, etc,) were shut down. Tens of thousands of prescription opioid addicts were kicked to the curb without sufficient treatment resources available to handle the onslaught resulting in the natural migration to other available narcotics, primarily heroin. It was certainly simple enough to forecast the surge in heroin use as it was readily available on the streets. History has taught that availability governs usage.  Supplies for raw opium in Afghanistan, the worlds largest producer, had sored over 60% in the previous year which insured a continuous supply to satisfy global demand.  The availability of Heroin set the stage for the Cartels to reestablish dominance in the opioid market place. The Cartels have been battling the Pharmaceutical manufacturers for market share and have put high purity, cheap product on the streets to attract, convert and secure a new generation of prescription addicts. The spike in heroin overdoses is but a sneak preview of the increased mortality rates we will witness if congress and the FDA don't rethink this problem and draft and push through legislation that supports harm reduction and treatment. This problem will not self correct.

The ultimate solution to the overdose epidemic would be to make Naloxone an over the counter drug. Nora Volkow, Director of the National Institute of Drug Abuse (NIDA) 1 and a high ranking CDC official went on record in meeting that was sponsored by the FDA, the Centers for Disease Control and Prevention (CDC) and the National Institute on Drug Abuse stating that he drug (Naloxone) should be available without a prescription. This meeting took pace in April of 2012 and in the interim more people have died than in the Vietnam war. Naloxone as of 2012 only had one US manufacturer. This seems to indicate that the margins are thin. It was said one of the reasons why it is problematic in making it available without a prescription is, yes you guessed it, money and of course FDA red tape.  So let us do the math. To change the status of Naloxone from a prescription drug to an over the counter drug would cost in the range of 10 – 20 million dollars. Lets use the high mark - 20 million dollars. Recent studies have projected a close to 50% reduction in opioid overdose mortality in states with Naloxone distribution programs. According to the CDC, opioid overdoses have claimed 125,000 lives over the past decade and mortality rate have increased each year. If you divide the 20 million by the 62, 500 which is 50% of the 125,000 it comes to $320.00 per human life. Has life become that cheap?

Although Washington talks a good game, if one looks at the budget for 2014, once again more monies are allocated to enforcement and interdiction than to prevention and treatment. As Albert Einstein once said, “Problems cannot be solved with the same mindset that created them.”

Now to my final destination which is to pose the question to the reader what constitutes involuntary manslaughter which is also classified in some states as negligent homicide. I believe an argument could be successfully put forth that failure to provide access to a medically safe and time proven drug that prevents death meets the legal criteria for involuntary manslaughter. That means that the legislators in each state and the Federal Government and the FDA are guilty due to wanton disregard of the testimony and statistics provided by experts in  the medical community, the CDC and multiple state organizations that deal with Naloxone distribution every day. Their neglect and failure to act accordingly have resulted in over 125,000 deaths. Why? 

Below I have included definitions of Involuntary Manslaughter and Wanton Disregard and an example taken from the Financial sector.

Involuntary manslaughter.

A killing can be involuntary manslaughter when a person's reckless disregard of a substantial risk results in another's death. Because involuntary manslaughter involves carelessness and not purposeful killing, it is a less serious crime than murder or voluntary manslaughter. The subtleties between the degrees of murder and manslaughter reach their peak with involuntary manslaughter.

Wanton Disregard

A standard of severe negligence. Wanton disregard is a very serious accusation that indicates that a person behaved extremely recklessly. Wanton disregard is not malicious, but it is more serious than carelessness. Wanton disregard can be used as evidence of gross negligence. In a lawsuit, wanton disregard might result in punitive damages depending on the severity of the situation and state laws.

Example:

“For example, let's say that a financial advisor at a large firm uses the company's online database to store sensitive information about his clients. The database is hacked and a client's identity is stolen. The client tells his financial advisor that he thinks his identity was stolen through the financial advisor's firm. The financial advisor notifies the appropriate people within the company, but they do not correct the problem. This would be considered wanton disregard because while the company is not intentionally or maliciously exposing its clients' sensitive financial data, but it is recklessly ignoring a problem that it has been made aware of”.(source: Investorpedia)

Please contact your state and federal legislators and encourage them to support the distribution of Naloxone to lay persons . Help save someone’s life by speaking up. America's silence on this issue constitutes Wanton disregard.
We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”
― Elie Wiesel

For more information on Naloxone, visit the Harm Reduction Section on Chooper’s Guide. Finally we are interested in your feedback on this issue. Please take a moment and leave a review with your comments.

1 Naloxone Debate: FDA Hears Testimony About Making an Overdose Antidote Nonprescription | TIME.com http://healthland.time.com/2012/04/13/naloxone-debate-fda-hears-testimony-about-making-an-overdose-antidote-nonprescription/#ixzz2sheWB34K

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New York Steps Up and Does it Right

BILL NUMBER:S6477

TITLE OF BILL:  An act to amend the public health law, in relation to opioid overdose prevention

Actions

• Feb 4, 2014: 1ST REPORT CAL.104
• Jan 28, 2014: REFERRED TO HEALTH

Meetings

• Health: Feb 4, 2014

Votes

VOTE: COMMITTEE VOTE: - Health - Feb 4, 2014

Ayes (15): Hannon, Ball, Farley, Felder, Golden, Larkin, Savino, Seward, Young, Rivera, Montgomery, Hassell-Thompson, Peralta, Hoylman, Serrano
Ayes W/R (1): O'Brien

Memo

BILL NUMBER:S6477

TITLE OF BILL:  An act to amend the public health law, in relation to opioid overdose prevention

PURPOSE:

Allows health care professionals to prescribe or dispense an opioid antagonist by a non-patient specific order and provides protections against criminal and civil liability as well as professional disciplinary action resulting from such prescribing.

SUMMARY OF PROVISIONS:

Section one amends the Public Health Law § 3390 to protect a health care professional who prescribes or dispenses an opioid antagonist, in good faith and with reasonable care, from any criminal or civil liability or any professional disciplinary action that could result from dispensing, prescribing, or administrating of an opioid antagonist. This section also expands a health care professional's authority to prescribe, dispense, and distribute an opioid antagonist directly or by non-patient specific order to a person at risk of experiencing an opioid-related overdose or to a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid- related overdose. Lastly, this section allows a person or organization acting under a non-patient specific order to store and dispense an opioid antagonist without being subject to provisions of title eight of the Education Law except provisions regarding storage of drugs

Section two provides that the act shall take effect immediately.

JUSTIFICATION:

New York State, like the nation, is in the midst of a severe prescription drug crisis. Prescriptions for opioids, particularly oxycodone and hydrocodone have skyrocketed. The Centers for Disease Control and Prevention reports that every 19 minutes, one person dies from an accidental overdose or suicide as a result of prescription drug abuse. In 2012, the legislature enacted the seminal I-STOP legislation to track controlled substance prescribing, prevent doctor shopping and weed out unscrupulous doctors. One unfortunate side effect of successfully restricting street access to these controlled substances, is that addicts are turning to other drugs, such as heroin.  Heroin has now become the cheaper alternative to opioids. On Long Island it is estimated that heroin addiction has increased fourfold since 2011.

As detailed in the Senate Health Committee's white paper The Prescription Drug Crisis in New York. A Comprehensive Approach, there is a need to look at the complete spectrum of drug abuse in order to address this crisis. While the state has made great advances, much more is needed. One of topics raised at the roundtables held by the Health Committee in 2011 and 2012, was access to Naloxone (Narcan). Naloxone, sometimes referred to as the drug-overdose antidote, counteracts the life threatening depression of the central nervous system and respiratory system caused by an opioid or heroin overdose.

 If timely administered, Naloxone can prevent overdose deaths. The Department of Health recommends administering Naloxone directly to an individual overdosing on an opioid after calling 911 and checking for breathing.

In 2005, the state authorized non-medical persons to administer Naloxone to an individual in order to prevent an opioid or heroin overdose from becoming fatal. In 2011, the state adopted good samaritan protections for witnesses and victims of overdoses. By removing the threat of prosecution, this measure encourages witnesses of an overdose to call 911 before it becomes deadly.

Due to the increase of opioid abuse, expanded access to Naloxone has become necessary priority to save lives. In Nassau County, EMTs administer Naloxone through their police department's ambulance services and in Suffolk County the state provided first responders with Naloxone. Expanding upon the success of existing programs, more lives could be saved if Naloxone was available to addicts, their families and other people likely to be in a position to assist a person at risk of an opioid related overdose. Currently, parents and family members of addicts are being turned away from Naloxone training programs or are attending the programs and not receiving Naloxone due to the shortage of prescribers participating in such programs. Under this legislation one prescriber would be able to issue a non-patient specific order to numerous programs, allowing for increased access. This legislation will enable the person who is likely to discover an overdose victim the ability to save their life, a life that could otherwise be lost if the victim has to wait for the EMT to arrive.

LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS:

None

EFFECTIVE DATE:

Immediately

• Same as: A8637-2013
• Versions S6477-2013
• Sponsor:HANNON
• Multi-sponsor(s): None
• Co-sponsor(s): BOYLE, CARLUCCI, HOYLMAN, MARTINS
• Law Section: Public Health Law
• Law: Amd §3309, Pub Health L