Addiction specialists and public health workers around the country have embraced a new type of first aid against overdoses from heroin and other opium-derived drugs.
They're putting canisters of a life-saving antidote into the hands of addicts and their families to give overdose victims better odds at surviving deadly respiratory failure.
Naloxone, once known as Narcan, has been used for decades to battle overdoses in emergency rooms, and by police, paramedics and firefighters.
Public health officials believe speeding up access to Naloxone shaves precious minutes from the point when an overdose victim stops breathing until medical help arrives.
Although some critics contend the practice encourages drug abuse, advocates say it has saved more than 10,000 lives since the first give-aways were started in 1996.
A recent survey published by the federal Centers for Disease Control and Prevention noted there are now more than 50 programs giving away the drug in injectable and nasal spray forms at more than 188 locations around the country.
"Changes in drug availability and purity drive up the dangers for heroin abusers and even many prescription drug abusers,'' said Dr. Wilson Compton, head of the prevention research division at the National Institute of Drug Abuse.
"Drug users don't want to overdose, they do the best they can to achieve the intoxicating effect without overdosing, but greater availability of Naloxone has shown considerable promise in the areas where it's been tried and where there are ways to identify those who are most at risk from an overdose,'' Compton said.
Escaping an overdose is one thing. Getting free of the drug's grip is another.
Experts say heroin is so powerfully addictive that most people need chemical crutches to help them overcome their dependence.
For decades, the main treatment has been methadone, an opioid agonist that activates the same brain receptors as the drug itself, but more slowly, dampening the "high" while still preventing withdrawal symptoms.
The downside is that methadone must be administered to patients in a controlled dose every day, which limits its use to outpatient and inpatient treatment programs.
Most heroin and opioid addicts these days are likely to use a drug called Suboxone or buprenorphine, a partial opioid blocker that relieves drug cravings but produces no "high" and relatively few side effects.
Some addicts report a dose of Suboxone keeps them from withdrawal symptoms or from getting high on heroin for up to three days. But there have also been reports of rapid relapse to illegal drug use once the prescription is ended.
Suboxone is typically combined with Naloxone, the same substance used to counteract overdoses, to block the effects of the Suboxone if the user injects it. This allows certified substance-abuse specialists to prescribe the drug for home use.
Another treatment option is Naltrexone, a receptor-blocking drug that is not addictive or sedating, but which treatment counselors have had trouble getting addicts to stick with over the long term. It can only be used after a patient has gone through detoxification. A new formula of the drug that has to be injected just once a month was recently approved by the Food and Drug Administration and may offer improved compliance.
"Once a person is dependent on any opioid, it's very, very difficult to get them off,'' said Jon Morgenstern, director of Treatment Research at the National Center on Addiction and Substance Abuse at Columbia University, and director of addiction treatment at Columbia Medical Center.
"Although the medications are good, they may have to be used a long time, and all have some problems and side effects associated with them,'' Morgenstern said. "Treatment is very complicated and worrisome, with a very long trajectory."
(Contact Scripps Howard News Service medical and science reporter Lee Bowman at firstname.lastname@example.org.)