With heroin overdoses sweeping parts of the state, New York’s Senate Task Force on Heroin and Opiate Addiction is unfortunately quite busy.
It has successfully called on Gov. Cuomo to create a statewide registry of naloxone — Narcan — distribution, usage and overdose reversals. Narcan is the quick-acting opiate antidote that shoves drug molecules off the brain’s receptors and “wakes” the overdose victim.
Narcan is a life-saver, no question. But it’s clear that rescuing addicts from overdose death — while necessary — doesn’t go far enough.
It’s increasingly common for emergency personnel to encounter individuals they’ve revived several times already. Sometimes these “patients” are taken to the emergency room, but many bolt from the ER before any referral to treatment can be made. Others don’t even get that far: they simply refuse further aid and walk away from the setting — a sofa, sidewalk, McDonald’s bathroom — where they were found unresponsive.
And then it’s off to find their next fix — partly to quell the withdrawal symptoms that Narcan has unleashed (by putting the body in an uncomfortable state of a flash opiate detox) and partly because many addicts have so much trouble stopping even if they want to.
The tragic cycle of overdose-resurrection-fix plays out hundreds of times each day across the country. According to Toms River, NJ, Police Chief Michael Little, “We’ve had people who have been ‘Narcanned’ in excess of five to 10 times.”
Although Narcan is inexpensive (a single dose costs authorities about $20), most of the revived require monitoring and added care. There were nearly 12,000 Narcan uses and almost 86,000 emergency-room visits prompted by opioids in 2014 in New York state alone. Those visits are costly. More than half of overdose victims require inpatient care, which according to one study costs an average of $30,000 per overdose.
What to do? On June 22, Cuomo signed S. 8137. One of the bill’s provisions would amend state mental-health law to extend the period individuals may be held involuntarily at drug-treatment facilities for 48 to 72 hours.
Three days isn’t enough. More is needed for users who are in an extreme spiral of self-destruction.
If the local police or emergency squad needs to rescue the same person three times in two months or five times in six months, arresting the individual for possession is a policy worth considering.
To be clear, jail isn’t the goal — diversion to treatment via drug courts is.
Drug courts impose swift, certain and fair consequences when participants fail drug tests or commit other infractions, such as missing meetings with probation officers or skipping work-training classes. The sanctions can escalate, depending on the number of infractions committed, ranging from mild, such as a warning from the judge, to community service and more intensive probation supervision and flash incarceration (temporary stays of one to 10 days).
Crucially, these courts typically offer offenders dismissal of charges for completion of a 12-to-18-month treatment program.
Drug courts are more effective than conventional corrections options like mandatory jail or traditional probation. (Under standard probation, an offender might fail many drug tests and miss appointments, for example, before corrections authorities react — and then it might be in a draconian manner.)
Offenders whose cases are handled by drug courts are about one-half to one-third less likely to return to crime or drug use than those who are monitored under typical probationary conditions. Two-thirds of drug-court participants graduate drug-free at 18 months, while attrition from standard treatment programs ranges from 40 percent to 60 percent within days or weeks of enrollment.
Judges could likely improve such results if they were more receptive to drug-replacement therapies, such as methadone and Suboxone. (Methadone generally works better for long-term hard-core addicts; young users can be detoxed with Suboxone or maintained on it for months, even years.)
State Sen. Robert Ortt, who co-chairs the Senate Heroin Task Force, is considering introducing legislation that would mandate long-term treatment for anyone who is revived with Narcan.
“Our police are responding multiple times to that same individual,” Ortt said. “If we had a house that was always having domestic issues or noise complaints, those would become nuisance properties that were monopolizing our resources, so we have to address this from that angle.”
He’s right. Addicted people can do well with monitoring, expectations and accountability. After amply demonstrating they are self-destructing, the humane move is to compel treatment.
Sally Satel is an addiction psychiatrist and a resident scholar at the American Enterprise Institute. Sean Kennedy is director of coalitions at AEI.