Drug Users as Life Savers

The last, best hope for somebody on the verge of an opioid overdose may be a fellow drug user trained in recognizing symptoms and how to administer a life–saving antidote, according to research conducted by the Yale School of Public Health.

Researchers led by doctoral candidate Traci C. Green found that drug users and former drug users who were trained to recognize overdose symptoms were as accurate as medical professionals in their diagnosis. These same users also knew when it was appropriate to administer the life–saving drug naloxone, commonly used to counter the effects of opioids such as heroin and morphine.

While training drug users to diagnose an overdose and administer an antidote that reverses the effects of an opioid overdose remains highly controversial, a number of states have embraced the strategy. Green said that the approach is saving lives.

“There’s a huge problem of opioid overdoses in this country,” Green said. “I’d love to see an expansion of naloxone programs in the United States. Most of these overdose deaths are preventable with cost-effective prevention efforts like the naloxone programs. Such efforts communicate very strongly the message that our society values the lives of all people—those who use drugs and those who do not—and they give addicts a chance at treatment when they are ready for it. You cannot treat a drug user who has died of overdose.”

Green and colleagues surveyed 60 active drug users and former users in five states. Thirty of those surveyed had received training at clinics on how to identify the physical symptoms of an opioid overdose. The research found that their ability to recognize overdose symptoms and, when it was appropriate, to administer naloxone, was as accurate as that of medical professionals. By contrast, those with no overdose training were more likely to miss the correct symptoms and to recommend naloxone administration inappropriately. Many of the participants had experienced an overdose personally, or had previously witnessed one. Details of the research are published in the June issue of the journal Addiction.

Naloxone is a prescription drug that has been around for decades and is frequently used by emergency responders and medical personnel to revive people who are near death from overdose. It can be injected or administered nasally and works within seconds by essentially reversing the biological effects of the drug in the body and allowing breathing to be restored, Green said. Naloxone by itself cannot be abused.

“It’s pretty dramatic,” she said. “It’s almost a Lazarus effect.”

Distributing naloxone to drug users who have undergone training is a well-established public health strategy in some states. The instruction usually takes about 10 to 20 minutes and is provided by needle exchange programs and methadone clinics. Instruction can even be as informal as viewing a DVD.

Green said that future research plans to focus on overdose among drug users in St. Petersburg, Russia, and also in Connecticut. Lauretta E. Grau, an associate research scientist, and Professor Robert Heimer were co-authors of the journal paper.