UPDATED, March 29, 2016: Narcan Nasal Spray was misidentified as Narcan in this story. Narcan Nasal Spray is a registered trademark for the ready-to-use nasal spray application of naloxone hydrochloride to revers the effects of opioid overdose. Adapt Pharma Operations Limited is the exclusive licensee of the Narcan trademark and has developed and commercialized an FDA-approved nasal spray containing naloxone under the Narcan Nasal Spray brand. The author regrets the mistake.
It’s a simple act of mercy, says Philomena Kebec of the Bad River Ojibwe tribe in Wisconsin, when asked why she carries naloxone in her purse at all times.
Naloxone, also known under the brand name Narcan Nasal Spray, is an opioid antagonist used to counter the effects of overdose from narcotics such as morphine or heroin. Kebec carries the nasal spray version of the drug that can be sprayed into the victim’s nostrils.
“I think everybody in Indian country should consider carrying naloxone, just in case,” Kebec said. “We want to save our peoples lives so they have a chance to get sober.”
Kebec noted that overdoses are most likely to happen to those who are trying to get sober from opiates but have relapsed. “Their bodies can no longer handle the amount of the drug they had been using prior to getting sober,“ she said.
“Sometimes people with addictions don’t get sober right away; they may relapse.”
For narcotic addicts, a relapse can be deadly. According to recent story in the New York Times, about 125 Americans died per day in 2014 of drug overdoses. The Times compared the rate of death rates to that of the HIV epidemic in the late 1980s.
Naloxone offers a little mercy. The Center for Disease Control (CDC) data showed that laypersons reported using naloxone in 26,463 overdose reversals from 1996 through 2014.
Cities and counties across the country now allow police and emergency rescue personnel to carry and administer naloxone, and the Bureau of Indian Affairs allows many of its officers to carry naloxone on patrol and many Indian Health Service pharmacies now dispense the drug.
Wisconsin’s Hope Law enacted in December 2015 provides criminal immunity for drug users who help overdose victims either by waiting for emergency rescue services after calling 911 or taking them to the hospital for help. The law also gives criminal and civil immunity to those who administer naloxone to overdose victims.
Several other states, including Minnesota have enacted similar laws. Minnesota is home to 11 reservations. The Huffington Post recently reported that CVS pharmacies in 12 states sell naloxone without a prescription.
“Even though I am the one with the prescription, I can administer the drug to someone who is experiencing an overdose,” said Kebec, explaining that brain damage can occur in as little as three minutes after a user overdoses.
Heroin has hit the Great Lakes region hard. Beltrami County authorities responded to four overdoses in one day last month. The city of Bemidji and the Leech Lake reservation of Minnesota are in Beltrami county. According to the Star Tribune of Minneapolis, there have been similar bursts of heroin overdoses in other parts of the state within the past year.
After seeing the high rates of heroin use and overdose, and a dramatic increase in rates of HIV and Hepatitis C, as a result of addicts sharing dirty needles, in her community, Kebec and other Bad River community members formed a grassroots harm-reduction committee, Gwayakobimaadiziwin or “making changes to make things right in your life.” Members of Gwayakobimaadiziwin are working to make naloxone available and educate tribal members about addiction, HIV and Hepatitis C and the role that naloxone can play in saving lives. (The CDC reported in 2015 Native Americans and Alaska Natives had the highest rate of diagnosed HIV infections due to injection drug use.) They are also working with nonprofit organizations to get a needle exchange program going in Bad River.
“We had two overdoses in the past three months – at least one survived because of naloxone,” Kebec said.
The dangers of narcotic addiction include greater risk of getting HIV, Hepatitis C and of giving birth to addicted babies because the drug is passed along to the child in the mother’s womb.
According to the Wisconsin Department of Health Services, Ashland County, in which the Bad River Reservation is located, has the highest rate in state of neonatal abstinence syndrome, a group of problems that can occur when a newborn has been exposed to addictive opiate drugs while in the womb.
Members of Gwayakobimaadiziwin are also working to get naloxone more readily available to tribal members through public and tribal health programs. Although IHS pharmacies are supposed to provide naloxone, the drug may not be on hand or available for tribal members without a prescription.
The price of purchasing naloxone over the counter for Bad River residents involves not only the cost of the drug, $40, but also as much as an hour’s drive to the nearest CVS pharmacy.
“We have no money. Our hope is to get support from public health organizations to make naloxone and clean needles available to those who need them,” she said.
Gwayakobimaadiziwin members hope to find a local physician who will issue a blanket prescription order for naloxone so that the drug, which does not produce a high and is non-addicting, can be easily available legally for the community.
Kebec knows some tribal members oppose naloxone and needle exchange programs as a way of enabling drug use. Many people in Indian country favor banishment as the primary means to address the drug problem in their communities.
“I think those in favor of banishment don’t understand the disease of addiction,” Kebec said.
Terry Schemenauer, criminal justice coordinator for Ashland County and member of Gwayakobimaadiziwin agreed. “This is about safety for the community. It’s not about promoting drug use,” he said. “Addicts are going to get needles anyway. If the needles are dirty they run the risk of spreading HIV and Hepatitis C. This puts the whole community at risk.”
Al Jazeera recently published a story about the role naloxone can play in reducing overdoses in Indian country.
Tristan Ahtone, author of the story, reported that from 2007 to 2009, Native Americans died of drug overdoses at twice the rate of the general U.S. population. From 1999 to 2013, the number of Native Americans who died from drug overdoses increased fourfold. Last year nearly 11,000 patients at Indian health care facilities were diagnosed with opioid use disorder.
Clinton Alexander, program director of Sacred Spirits, a harm-reduction program in Minnesota was quoted in the story. Alexander works to get clean needles and naloxone to those who need them.
Alexander noted that North Dakota does not provide the same immunity to its residents as Minnesota and Wisconsin. Alexander told Al Jazeera that a better law enforcement strategy would be to create laws so that users don’t fear calling police in the event of an overdose.
Fargo, North Dakota police are investigating a woman for dealing heroin after she saved the life of a man overdosing on heroin by injecting him with naloxone.
“Nobody starts out life wanting to be a drug addict. A lot of our work is educating people about the disease of addiction,’ Schemanauer said.
“We, as Anishinabeg don’t abandon our people who are sick. We’ve dealt with epidemics before. We already have the tools to make our people whole again with the help of our spirituality,” she noted.
On March 10, the Senate passed a bill to combat opioid abuse. The legislation will make naloxone more available.