Marking a first for a public agency in California, the San Francisco health department began dispensing a controversial anti-overdose medication to heroin addicts Saturday at a city-sponsored needle exchange program.
Despite criticism that it could encourage further addiction, San Francisco health officials say their plan to distribute the prescription medicine, known as naloxone, will save lives and possibly give addicts a chance to eventually go clean.
A mix of health department staff and volunteers trained 11 drug users in a Tenderloin-area clinic. Officials hope to expand that number substantially over the next few weeks.
"We know this saves lives and has almost no side effects. It's a miracle drug," said Dr. Josh Bamberger, who oversees the new program at the city Department of Public Health.
A few other public agencies around the country have taken similar steps. In California, a private, nonprofit health group in Mendocino County two months ago began offering naloxone to a small group of clients.
But officials say San Francisco is the first public agency in the state to distribute the medicine.
The step is part of a 3-year-old initiative that seeks to reduce the harmful effects of drug use in San Francisco rather than solely trying to keep addicts from taking drugs. Other efforts include methadone treatments, needle-exchange programs to reduce the transmission of diseases and medical attention for complications from addiction, such as skin infections.
The naloxone program requires people who receive the drug to be trained in how to administer it and how to perform other rescue techniques to assist overdose victims. The medicine is injected into an arm or leg and doctors say victims can recover in a matter of minutes. It is mainly used with heroin overdoses but is also effective with other opiates such as morphine and Oxycontin. Each addict in the training program this weekend received two syringes pre-filled with naloxone.
Officials describe naloxone as a nonaddictive, non-mood-altering drug that doctors and paramedics have used to treat victims of opiate overdose for decades. The medication has no street value and the common generic version costs as little as a dollar a dose.
The drug works by blocking opioid receptor sites in the brain.
Critics, including some physicians, worry that dispensing naloxone to addicts may cause more harm than good. Some fear addicts may not call paramedics after they revive a friend, while others are concerned that public funding of such a program endorses addiction.
"This is a huge mistake," says Dr. Eric Voth, a Kansas addiction specialist and spokesman for Drug Free America, a national group that targets drug abuse. "It just isn't safe to remove this from a medical setting and put it in the hands of addicts who are notoriously unreliable," he says.
Voth adds he would rather see the money spent on treatment programs so addicts could get off the drugs.
Health officials in Portland, Maine, scrapped plans to distribute overdose medication to heroin users last year after intense public pressure.
Doctors say there is a possibility, although rare, that someone recovering from an overdose after being treated with naloxone may experience a dangerous seizure.
And for those addicted to opiates, naloxone immediately pushes them into an agonizing withdrawal that often produces nausea, tremors and extreme sweats. Because of the discomfort, some addicts may want to shoot up again quickly, possibly setting themselves up for another overdose, critics say.
Peter Warren, a spokesman for the California Medical Assn., says the organization agrees with efforts to reduce the harmful effects of addiction but is wary of any initiative that doesn't include efforts to get addicts into treatment and counseling.
Many naloxone programs encourage users to enter such programs but don't require it.
Last year, a six-month study by researchers at UC San Francisco, partially funded by the city Department of Public Health, tracked 24 addicts who were given naloxone, along with eight hours of training, latex gloves and alcohol swabs. In all, participants reported witnessing 20 overdoses and successfully used the medication on 14 occasions.
For various reasons, the other six overdose victims were not given naloxone but survived.
Alex Kral, director of Urban Health Studies at UC San Francisco and an author of the study, says that a large publicly funded naloxone program in San Francisco is needed and viable. He points out that groups in San Francisco have been providing naloxone underground for several years.
"I think the medical establishment is slowly coming around to this and seeing it as a solution to a needless problem," he says.
New Mexico currently is dispensing the drug in several locations throughout the state and both Baltimore and New York City are planning to start similar programs in the next few months. Some private doctors and community-based organizations have also recently started providing the medication. (Los Angeles health officials say they have no plans to distribute naloxone.)
New Mexico and Connecticut have passed laws limiting liability for nonmedical people who administer naloxone, including law enforcement officers or friends who are trying to save an addict. In San Francisco, doctors say they don't need a liability law because they are prescribing a legal medication and are covered by patient-client relationship.
But a friend who administers the drug to an addict could be held liable for any ill effects.
Nationally, heroin use is climbing dramatically, aided by a plunge in the drug's price.
The number of new heroin users during the last decade grew by more than 100,000 per year -- a pace not seen since the early 1970s. It's estimated that 2% of all heroin addicts die each year.
Although overdose deaths in San Francisco have eased in recent years, the city averages more than 120 annually. That often surpasses the city's homicide numbers.
Health officials say that people who have gone through drug treatment and fall back into their old habits are at particularly high risk of overdose. They often don't decrease the amount of drug they use to match their newer, lower tolerance to the drug. That's why some programs around the country are dispensing the anti-overdose medication to addicts leaving jail after short terms.
Contrary to popular belief, many addicts who overdose on opiates survive for up to an hour. That leaves a large window of time to treat an overdose victim, including the use of naloxone, doctors say.
Research shows that most people overdose near someone else and that up to three quarters of all addicts don't call paramedics if a friend is overdosing.
Dr. Karl Sporer, an emergency physician at San Francisco General Hospital, says many addicts instead rely on a slew of popular street remedies that are believed to revive overdose victims, like filling their pants with ice or injecting them with milk.
Because the idea of dispensing naloxone to addicts is relatively new, there is little research proving the programs reduce mortality rates. Anecdotally, officials in New Mexico and Chicago say they've seen up to a 20% drop in overdose cases since they've started distributing naloxone.
Bamberger, the San Francisco health official, expects that his department will train up to 600 users over the next year. Addicts interested in receiving naloxone must first go through an hourlong training on how to administer the drug as well as how to provide rescue breathing and other life-saving techniques.