Opioid antagonist reverses 4 overdoses in 2 weeks
He lay on his bedroom floor, gray and lifeless, evidence of heroin use scattered about the room.
His mother found him there, unresponsive and not breathing. She called the Lawrence Township Police, pleading for help for her 22-year-old son. Officer Matthew Grossi and Sgt. Christopher Longo rushed to the house—Grossi arriving at 9:57 p.m. Nov. 5, Longo a minute later.
Had this been a week earlier, Grossi and Longo could have done little to counteract the effects of the heroin. They would have used CPR to keep the victim breathing, and waited until the paramedics arrived.
But Grossi and Longo weren’t helpless. On Oct. 30, the Mercer County Prosecutor’s Office equipped every law enforcement agency in the county with Narcan, an opioid antagonist. Opioids, such as heroin, morphine and Vicodin, depress and can stop breathing by blocking communication between the brain and the body. Narcan counteracts this by knocking the opioid off the brain’s receptors, stopping the effects of the opioid. The results often are sudden and drastic.
New tool in-hand, Grossi and Longo sprung into action. Grossi lay down on the floor and confirmed the victim was not breathing. Longo assembled the Narcan kit—a vial of antidote, a syringe and an atomizer—and handed it to Grossi, who sprayed one dose in each of the victim’s nostrils.
The victim shot awake within a minute. As soon as he opened his eyes, he started speaking. He demanded to get up, but the officers told him to stay down and rest. After a few minutes, he stood, walked downstairs, out the front door of his house and into the waiting ambulance. The Lawrence PD duo had recorded the first overdose reversal under the county’s new Narcan program.
The second came two days later, on Nov. 7, when Hamilton Police officers Matthew Mayhew and Michael Kenna reversed the heroin overdose of a 23-year-old male. Then, on Nov. 13, Hamilton Police used Narcan to reverse the overdose of a 22-year-old female. On Nov. 15, HPD did the same for a 24-year-old male.
In all, police reversed four overdoses in the first two weeks of Mercer County’s Narcan initiative. These are the early returns on a $19,000 investment by the Mercer County Prosecutor’s Office. The agency purchased 600 Narcan kits at $31 a pop, all in an effort to stem a rising number of overdose deaths. No taxpayer dollars were used, Mercer County First Assistant Prosecutor Angelo Onofri said, with his office instead relying on drug forfeiture funds.
The program remains on track despite the manufacturer’s announcement in mid-November that the price of Narcan would double.
“There are some times where it’s just the right thing to do, and that’s what this is,” Onofri said. “We equip the police to respond to just about every type of emergency situation possible. This, unfortunately, was not one they were equipped to deal with. Now they are.”
Narcan, the brand name of the drug naloxone, only works if those receiving it have opioids in their system. Anyone receiving Narcan who did not use an opioid will not respond to the antidote. Narcan is not addictive, and has not been shown to increase drug use or dependency, Onofri said. It simply acts in the moment it’s dispensed to block opioids from the brain’s receptors.
Mercer County is part of a statewide effort to arm law enforcement officers with the drug, an effort made possible by a law called the Overdose Prevention Act. Signed by Gov. Chris Christie in May 2013, the act did two things: granted immunity to anyone helping or seeking help for an overdose victim, and permitted emergency workers and police officers to carry Narcan.
At the same time the law passed, in spring 2013, Ocean County Prosecutor Joseph Coronato began his own effort to combat drug use in the state, spurred by a one-week period in April 2013 where eight people in Ocean County died of overdoses. A year later, in April 2014, Ocean County became the first in New Jersey to give its police officers Narcan. As of Nov. 18, there had been 111 reversals in Ocean County since the program started.
The number of deaths has fallen, as well. As of Nov. 18, 66 people in Ocean County had died of drug overdoses in 2014, down from 100 in the same period last year.
Last year, 34 people in Mercer County died of drug overdoses, and officials hope to see the same decrease now that Narcan has been introduced. The Mercer County Narcan program draws heavily from the Ocean County initiative, which itself was based on a program launched in Massachusetts in 2010. The Ocean County Prosecutor’s Office openly shares its program, and even posts its details on its website.
“There’s no reason to reinvent the wheel,” said Al Della Fave, public affairs director at the Ocean County Prosecutor’s Office. “We’ve been there. We’ve done it. We’ve done the shopping. We’ve done the research. We’ve done the policy-building. It’s all done.”
Narcan arrives in Mercer County at a time when it is increasingly needed. Heroin, in particular, has soared to new-found prominence not only in Mercer County but across the state. Between 2012 and 2013, heroin-related deaths for 18-25 year olds in the state rose 24 percent, according to a campaign by the Partnership for a Drug-Free New Jersey. There were 741 heroin-related deaths in New Jersey in 2013, a 160-percent increase since 2010.
Heroin calls up a certain image of destitution, but that’s not the case anymore, said Kevin Meara, a Hamilton councilman and founder of City of Angels, an addiction support and recovery organization. Many people now progress to heroin from other opioids, usually prescription drugs, due to heroin being relative cheap.
“This is not about a minority who lives under a bridge in Newark or Camden or Paterson or Trenton,” Meara said. “I’ve got kids who got 30 Percocet because they had their wisdom teeth pulled. I’ve got kids who blew their ACL out on the soccer field, and wind up getting a prescription for 130 OxyContin. When their legs heal or their dental work heals and the prescription stops, the addiction is born.”
Meara and another Hamilton resident, Paul Ressler, are no strangers to the world of addiction. Meara’s son, KC, died from a heroin overdose in 2008 at age 24. Ressler’s son Corey died of an overdose in 2010 at 22.
The pair have devoted themselves to bringing awareness to the issue, as well as getting help for those who suffer from addiction. Both men were on the state’s Overdose Prevention Taskforce, which was responsible for figuring out how an Overdose Prevention Act would work in New Jersey. They traveled to Massachusetts to see how the Narcan program worked there, and were trained to use Narcan. They also kept in close contact with Onofri as the Mercer County Prosecutor’s Office began planning its Narcan initiative.
That planning began June 17, when Gov. Christie announced he had approved a statewide expansion of the Narcan program. Initially, only Ocean and Monmouth counties were participating.
At that point, Onofri and Mercer County Prosecutor Joseph Bocchini, Jr., began working closely with the Ocean County Prosecutor’s Office, local police departments, municipal officials and Dr. Kenneth Lavelle, a physician with Jefferson Hospital in Philadelphia who provided guidance in launching Ocean County’s program.
Training began this past summer, with each of the police agencies in the county sending at least one person to be trained on how to use Narcan. Those officers, in turn, trained everyone else in their department.
Police officers are always the very first responders to an emergency, and they have welcomed the addition of Narcan to their jobs.
“There’s always a sense of urgency when you’re responding to a medical emergency like this,” Robbinsville Police patrolman Scott Kivet said. “With this tool, it gives us the golden hand to help us out that we didn’t have before. It definitely helps.”
Critics have said Narcan merely removes the threat of death from a risky activity, thus encouraging more drug use. But officials say addicts don’t think like that, and law enforcement agencies can’t afford to, either.
“That’s how the detractors look at it,” Della Fave said. “My God, I’m sorry, but we can’t see it that way. We see it as a life saved. Maybe, being so close to death’s door, they’ll use it as an opportunity to turn their life around.”
Still, Meara said the state must go further to help addicts now that it has introduced Narcan. During a call where Narcan is deployed, law enforcement’s responsibility now ends once the victim has arrived at the hospital. Activists like Meara and Ressler want to go beyond that, requiring anyone revived by Narcan to be placed immediately in a recovery center to get clean for at least 30 days.
“While Narcan is great, it’s a band aid on a machete wound,” Meara said. “We’re bringing them back from the dead. It’s a shame we’re reduced to that. We really should be doing all our work back here, to where they don’t get to that point.”
A system like that would require more rehabilitation centers with available space, and funding to support it all. That does not exist now, Meara said.
Coincidentally, the Ocean County Prosecutor’s Office has started work on similar initiatives. In what it’s calling the Narcan program’s second phase, the office has begun to train family members of addicts in how to use Narcan, and advertises pharmacies where Narcan can be purchased.
Coronato’s office also has partnered with local hospitals and treatment centers to allow anyone treated with Narcan in Ocean County to enroll immediately into a long-term rehabilitation center. It’s all part of a multi-pronged attack, Della Fave said, that also includes increased penalties for drug dealers and beefed-up enforcement in schools.
“The Prosecutor believes it’s essential to cut the cycle of addiction,” Della Fave said. “We’re looking for every possible avenue to curtail the problem.”
There are no such plans in Mercer County at the moment, as local agencies are still adapting to the Narcan initiative. For now, officials like Onofri are left hoping a near-death experience will be enough to shake those saved by Narcan.
“The folks that this is being administered to could be someone’s child, parent, brother, sister,” Onofri said. “You are really giving them a second chance. You can’t dictate what they do with that second chance, but the hope is they do see the light, get help and try to turn their life around.”