POLITICO New York: Bill would mandate rehab for addicts given Narcan

Politico

Bill would mandate rehab for addicts given Narcan

Josefa Velasquez | September 8, 2015

ALBANY — With the growing availability of an overdose-reversing drug for heroin addicts, a state senator from Western New York wants to require anyone who’s given the drug to enter rehab.

The proposal prompted criticism from a public health official and advocates, who warn that mandatory treatment doesn’t work.

State Sen. Rob Ortt, a chairman of the Senate’s heroin task force, is crafting a bill that would require anyone administered naloxone, better known by its commercial name Narcan, to enter treatment.

“Narcan is certainly a life-saving drug — it certainly has saved lives, there is no question it is a tool to save lives — but it’s not the solution in and of itself,“ the freshman Republican told POLITICO New York. “If these folks aren’t getting treatment after being revived by Narcan, that’s a problem. If our first responders have to continue to respond to the same individuals over and over again, that’s a problem.”

“We need to ask ourselves: What is the end goal here? Is the goal to stop the epidemic, or is the goal to just enable the addiction or enable the use of heroin and opioids? To me, the goal is to save lives, but also to end addiction and try to treat this epidemic,” he said.

The premise for Ortt’s legislation, still in its infancy, is to prevent addicts from using naloxone repeatedly as a failsafe.

“If you’re just going to go back and [keep] reviving the same person multiple times, that’s a real issue, and I don’t think you’re solving the problem of the heroin epidemic,” Ortt said. “If the goal is to reduce the epidemic, reduce death and reduce people who are addicted to heroin, then we have to do more than just administer Narcan. So that’s the idea or the concept of what I talked about.“

Christopher Mears, the chief of police in the town of Ogden, which is in Ortt’s district, said that there have been instances of repeated revivals on the same person.

”Narcan is a great tool to save a person’s life immediately, but it’s not going to solve the problem. Especially if you’re seeing, like what we’re talking about, one or two administrations of Narcan to the same person. Obviously they’re not getting any better. It’s just treating the immediate emergency and not the deeper cause,“ he said.

Albany County Sheriff Craig Apple has also seen repeat administrations of the opioid-antagonist on the same person — but he said it’s the exception, not the rule.

“I can’t really say that we’ve had a bunch of repeats,” Apple said. “Have we had several revived by Narcan? Absolutely. Are they repetitive? Not normally.”

Matt Curtis, the policy director at VOCAL New York, an organization focusing on HIV/AIDS, drug addiction and homelessness, said the state should focus its efforts on ensuring high-quality patient-centered facilities — like harm reduction services, which provide counseling, needle exchanges, medical testing, needle exchanges and other programs — rather than on mandating treatment.

“Legally enforced treatment has no scientific evidence showing efficacy. And of course it’s only something society wants to foist on people who use drugs,” he told POLITICO New York in an email. “I get that it’s complicated and needs some unpacking, but the bottom line is that mandated/coerced treatment is premised on the sick and profoundly paternalist idea that people who use drugs are mindless zombies incapable of rational action.”

Many people addicted to heroin get naloxone kits from harm reduction services, like the Washington Heights CORNER project that Patty has been part of for about a decade. She got the kit she kept in her home for as a preventative measure for her husband, who had also been using heroin.

Addicts who have been imprisoned and mention their addiction can also receive naloxone kits from police departments, Apple said.

“Obviously, the name of the game is to get them off of it. But in the meantime we could, at least, save a life, and they’ll have a wake-up call and get the help that they need,” he said.

Erie County health commissioner Gale Burstein said that there are cases where users have to be administered naloxone more than once because heroin on the market is becoming increasingly potent and more than one dose is needed to revive a person.

“Individuals who are resuscitated with naloxone are going to resume their drug use behaviors unless we can get them into care,” she said.

But, she said, “We know from good studies that if people are mandated into a certain type of care or treatment and they don’t realize they have a problem and they’re not willing participants in their treatment, it will fail.”

She also said she was also concerned about Ortt’s bill because she worried there wouldn’t be enough providers to treat a sudden surge in the number of people seeking help for addiction.

“We don’t have enough addiction providers to address the huge, emerging problem of opioid addiction that we have in our community. If we were to mandate this treatment, we wouldn’t have enough providers to carry through the mandate,” Burstein said. “There aren’t enough providers in the community to be able to treat with counseling and then also medically treat with methadone or Suboxone.

“So those are some flaws with that legislation, although the premise is true that if those individuals who overdose … they’re addicted. They can’t help it,” she said.

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