Rising from the dead

Posted: November 23, 2013

The Winchester Star

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WINCHESTER — The third time Tom Beach shot up heroin, he overdosed and almost died.

“I remember walking over to the back of the chair and then I remember falling over the back of the chair,” said Beach, 42, of Winchester. “I felt all the typical things that people who die say they feel.”

His heart stopped on Oct. 4, 2012, in Falls Church, but thanks to fast-acting rescue personnel, his overdose was reversed through the drug’s antidote, Narcan.

Locally, more than 100 narcotic overdoses have been reversed using Narcan in the last four years.

“It certainly saves lives,” said Eddie McClellan, deputy chief of Winchester Fire and Rescue. “We’ve run overdoses where patients have been in full cardiac arrest, we’ve given them the medication, Narcan, and successfully resuscitated them.”

Emergency Medical Services and health professionals have been using Narcan (generic name Naloxone) for decades.

Chemically, it is similar to narcotics such as heroin, codeine, fentanyl and morphine.

Heroin and Narcan compete for opiate receptors in the brain, but Narcan displaces the narcotics. It can reverse respiratory failure associated with narcotic overdoses.

Local rescue personnel administer the medication intravenously, usually through a vein in the hand or arm.

McClellan said Narcan is typically provided in one of two situations — when a narcotic overdose is suspected or when someone is unconscious for an unknown reason.

‘The good juice’

Beach said that after the medication was given to him, he remembered slowly regaining consciousness.

“What started to wake me up was the sound of my own breathing, and I had a mask on my face,” he said. “I could feel everything in my body come back to life — it was bizarre.”

He said the police and emergency personnel in his living room told him when he woke up that he had flat-lined and died.

“When I asked how they got me back, one of the officers said, ‘We gave you some of the good juice,’” Beach said. “I’ll never forget him saying that.”

Since 2010, city Fire and Rescue emergency personnel have administered Narcan to 91 people — seven in 2010, 26 in 2011, 27 in 2012 and 31 far this year (through Oct. 1).

Frederick County Fire and Rescue has administered Narcan to 116 people — 21 in 2010, 29 in 2011, 44 in 2012 and 22 through Oct. 1 this year.

Numbers for Clarke County were not available because county officials do not collect information in the same way as Frederick and Winchester authorities.

Increasing heroin overdoses

Locally, Narcan is used most of the time to reverse heroin overdoses, according to McClellan and Don Jackson — EMS director in Clarke County and chief of the Gainesboro Volunteer Fire and Rescue Company in Frederick County.

Heroin overdoses began plaguing the region in fall 2012, according to Jay Perry, a special agent with the Northwest Virginia Regional Drug Task Force.

The drug has been around for many years, but overdoses were not as prevalent before.

To date this year, 18 heroin overdose deaths have been reported in the area, with most in Frederick County and Winchester — and more than 100 non-fatal overdoses.

That’s a stark difference from 2012, when 17 people in the region were reported to have overdosed on heroin. One died.

The Drug Task Force’s coverage region includes Winchester, Front Royal and Strasburg and Frederick, Clarke, Page, Shenandoah and Warren counties.

More heroin overdoses have been reported this year than in the past four years combined, Perry said.

One reason for the increase in heroin use is that narcotic prescription medications have been chemically reformulated to reduce drug abuse by delivering a lower-quality “high” than they once did.

The painkillers, such as OxyContin and Percocet, have also become more expensive and are not as accessible as they once were.

“Heroin has gotten cheaper and is more readily available,” Perry said. “So users are turning to it.”

As more people begin using heroin, more people begin selling it, each competing to offer a better, purer product — which can easily lead to an overdose.

Reversing  narcotic effects

Narcan, Perry said, immediately reverses the effects of heroin, which can cause someone to stop breathing and go into cardiac arrest.

McClellan said that once the medication is administered intravenously, it works within one to two minutes.

If too much Narcan is administered, it can easily throw a heroin user into withdrawal, making him or her vomit or have seizures.

“We give just enough to sustain life, breathing,” McClellan said.

Jackson said administering too much Narcan can also make an overdose patient angry.

“A lot [of patients] are not happy when they are brought back,” he said, adding that it takes away their high.

Beach said he was not angry when he was brought back from his heroin overdose. “It saved my life. I wouldn’t be here if it weren’t for Narcan.”

McClellan said a patient’s respiratory rate is key to determining if a medic will administer Narcan.

“If the respiratory drive is not depressed, slower than normal, then we probably wouldn’t give Narcan,” he said.

Narcan can also reverse the effects of overdoses from other narcotics.

McClellan urged anyone who encounters an overdose to call 911.

“If they’ve quit breathing, then certainly we need to be there within six minutes,” he said. “We do have the ability to help the patient, but if [a witness] delays in calling us, we may be able to revive them, but they may be brain-dead.”

Narcan vs. narcotic

Once the medication is administered, patients are taken to the hospital, where they run the risk of overdosing again.

“Narcan itself has a relatively short life,” said Dr. Jack Potter, who has worked in the Winchester Medical Center (WMC) emergency room for 15 years. “It will wear off long before the narcotic will wear off.”

Potter said that in some cases, Narcan is given again at the hospital, but it depends on a number of factors, including the amount of narcotic the patient has used and if any other drugs were involved.

WMC staff members use it mainly as a diagnostic tool to determine if someone took a narcotic, he said. “If you wake up [from Narcan], we know why you were unconscious — you had a narcotic overdose.”

When an overdose patient arrives at the emergency room, Potter said, doctors focus on evaluating the person medically and emotionally and offering help when he or she becomes stable.

“This is a life-changing event,” he said. “[We tell them], ‘You overdosed. You almost died. Would you like help?’”

The narcotic typically wears off in a matter of hours. Potter said most patients are out of danger within four to six hours.

Beach recalled being released from the hospital within two to three hours after he overdosed.

He added that when he arrived at home, however, he became high again from the lingering heroin in his system.

Law enforcement officials are not usually called to the hospital unless someone is committing a crime in front of doctors — for example, if the patient has heroin in a pocket, or if doctors feel he was injected by another person.

Potter said he hopes that in life-or-death situations, such as overdoses, people would choose medical care and call 911 to save someone’s life, rather than to worry about the social and legal consequences.

“When [an overdose is] recognized quickly, it’s simple to make [the patient] safe,” he said. “It’s deadly when not.”

Push for public use

A statewide effort has been made to alllow Narcan to be put in the hands of the public.

In February, the General Assembly passed a bill requiring the Department of Behavioral Health and Developmental Services  (DBHDS) to work with other agencies to create two pilot programs that would allow non-health and EMS professionals to obtain a prescription for Narcan.

“We have a tremendous problem with deaths from overdoses — heroin is part of it, but part of it is also prescription narcotics,” said Del. John M. O’Bannon III, R-Henrico County, who introduced the bill.

O’Bannon, a medical doctor, said the idea behind introducing the bill was to allow Narcan possession by drug users’ loved ones and friends, so that they could administer it in an emergency.

The medication has little to no effect on people who do not have narcotics in their system.

Mellie Randall, director of Substance Abuse Services at DBHDS, said the General Assembly allotted $10,000 to get the pilot programs started.

One program will be established in the Richmond area, and one in the far Southwest Virginia counties, including Buchanan, Washington, Russell and Wise. The sites were chosen based on need, Randall said.

“More than 10 years ago, we began to see a significant rise in drug poisoning,” Randall said, adding that the rate of death by overdose is exceeding that of motor vehicle crashes.

The programs will allow a lay rescuer to be trained in administering a nasal-spray form of Narcan — in addition to being advised to call 911 should a rescue occur — and obtain a prescription for the drug and pick up a kit with two doses to have on hand at home.

Randall added that the doses cost $30 to $40 each.

If someone participates in a rescue, he or she is asked to fill out a card and mail it to DBHDS, so the department can compile data.

A look at other states

According to a report from the Network for Public Health Law, New Mexico became the first state to amend its laws to make it easier for medical professionals to prescribe and dispense Narcan for lay administrators to use.

As of Nov. 1, 16 other states and the District of Columbia have made similar changes, including New York, Massachusetts, North Carolina, Vermont and Maryland.

“These steps appear to be working,” the report states. “The CDC recently reported that at least 188 community-based overdose prevention programs now distribute [Narcan].”

To date, those programs have provided training and Narcan to more than 50,000 people, and have resulted in more than 10,000 overdose reversals.

O’Bannon does not know if other parts of Virginia could acquire similar programs, but that would be his hope. “The best thing would be to have Narcan behind the counter at pharmacies — a loved one could just go and get it.”

Beach also emphasized the importance of access to the drug and quick reaction times to overdoses.

“My breathing and heart had stopped,” he said of his overdose. “They told me a couple more minutes [without Narcan] and I could have been brain-damaged or not come around at all.”

— Contact Melissa Boughton at mboughton@winchesterstar.com