The official cause of death was “oxycodone toxicity.” So reads the coroner’s report on 30-year-old Jessica Grubb, whose story of heroin addiction inspired President Obama in March to put $1.1 billion into new funding to battle prescription painkiller and heroin abuse. While Grubb died of an overdose, it wasn’t related to heroin. After hip surgery, Grubb was given oxycodone, a powerful opioid painkiller, and discharged from the hospital with an IV port. Once she began administering the drug, which has an almost identical molecular makeup as heroin, she never stood a chance. The West Virginia woman, who had been sober for six months and was once a straight-A student, died March 2. “Death is an adverse outcome that most families live in terror of,” said David Sack, MD, chief medical officer for Elements Behavioral Health, which owns treatment centers such as Promises and The Right Step. “People assume that because it’s prescribed by a doctor, it’s safe.” Nothing could be further from the truth. Heroin and prescription opioids like oxycodone and hydrocodone (e.g., Vicodin, Percocet, OxyContin), morphine, fentanyl and methadone killed over 28,000 people in 2014, more than any year on record and a one-year increase of nearly 15%, according to the Centers for Disease Control and Prevention (CDC). At least half of those deaths involved a prescription opioid. The good news is that an opioid overdose doesn’t have to end in death. Naloxone hydrochloride can reverse overdoses almost instantly and is becoming more readily available to addicts and their families. And now the Obama Administration has just released $11 million to help states buy and distribute naloxone. The drug is nontoxic, is not addictive, and is easy to administer through nasal, intramuscular or intravenous application. As of June 2014, the CDC reported that 644 naloxone distribution programs had reversed more than 26,000 overdoses from heroin and prescription painkillers.
Naloxone Pharmacy Access by State
Naloxone is currently available at CVS pharmacies in Arkansas, California, Connecticut, Indiana, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Montana, North Carolina, New Hampshire, New Jersey, New York, North Dakota, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia and Wisconsin. The company expects to announce additional states throughout the year as lawmakers approve use of the medication by laypeople. By the end of the year, Walgreens will make naloxone nasal spray available without a prescription at its pharmacies in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin and the District of Columbia. Many smaller pharmacies also carry naloxone. But make no mistake. Naloxone is no substitute for treatment. “If you used it already, it really means you need more treatment,” Dr. Sack said.
People who are close to users of heroin or other opioids may someday be faced with an overdose situation. Opioids attack the central nervous system, which can cause a person’s breathing and heart rate to slow to the point that both ultimately stop. That’s why it’s important never to leave someone who is overdosing alone. If the person is conscious, walk them around and monitor their breathing. The following are overdose symptoms:
- Awake, but unable to talk
- Small or constricted pupils
- Cold, clammy skin
- Slowed breathing or absent breathing
- Bluish lips
- Muscle spasms
- Changes in heart rate
- Loss of alertness
Call 911 immediately if you or anyone else is experiencing these symptoms.
Treating Opioid Addiction
Addiction to prescription opioids typically results from misuse of the medication. “Start low and go slow” is the advice from the CDC when taking opioids for long-term pain. While people who abuse painkillers may also be suffering from depression or anxiety, most heroin users are self-medicating. Heroin can appear to offer a fast escape from past trauma, loneliness, depression and any number of negative emotions. But with continued use, more of the drug is needed to get the same effect, increasing the risk of overdose. Several options are available for effectively treating addiction to heroin and prescription opioids, including behavioral counseling and medication. Research shows that combining both types of treatments is the most effective approach. Medication can help restore normalcy to brain function and approaches like cognitive behavioral therapy can help the person understand the problems in their life that drove them to drugs in the first place. Grubb didn’t have such expert care. She reportedly was in a long-term rehab that shunned medication-assisted therapy. In addition, she didn’t have anyone nearby to provide naloxone when she had overdosed. Grubb was home alone after the surgery and died in her sleep. Her parents have yet to decide whether to sue the hospital for sending their daughter home with a potentially fatal dose of opioids. The discharging doctor, unlike the rest of the hospital staff caring for Grubb, was unaware of her addiction.