The antidote for a heroin overdose is so easy to give that even a child can do it.
Jennifer Stepp of Kentucky wants to teach local children how to administer the drug naloxone to people who have overdosed on opiates—starting with her 8-year-old daughter, Audrey.
“How come you haven’t trained me?” Audrey said to Stepp one day on their way to school. “If something happened to [my brother], I would want to be able to help him.”
Stepp is the mother of a 25-year-old son who struggles with drug addiction and the founder of the Bullitt County Opioid Addiction Team. An injection might sound like a daunting task for a child, but Virginia-based pharmaceutical company Kaléo manufactures Evzio, an FDA-approved naloxone auto-injector similar to an EpiPen. Stepp bought Evizo for her daughter and has since ordered more Evzio kits in order to teach more children how to respond to an overdose.
“I don’t think that a child training with an EpiPen would be very controversial,” Stepp told The Daily Beast. “I don’t think that a child that has to deal with a needle because of juvenile diabetes would be very controversial. So I think it’s not the actual act of administering [Evzio], I think it’s the subject matter that’s so controversial.”
What is not up for debate is the staggering death toll from opioid abuse. Heroin-related deaths have nearly quadrupled from 2002 to 2013, and deaths from prescription painkillers have quadrupled since 1999. In 2013, over 16,000 people died from painkillers. Currently, 46 people in the U.S. die every day from a prescription painkiller overdose, according to the CDC.
Dr. Sharon Stancliff, medical director for Harm Reduction Coalition, an advocacy group that seeks to address the adverse effects of drug use, told The Daily Beast that she is not shocked by Stepp’s approach.
“Studies have found that children in elementary schools can learn CPR although they may not be able to perform until they grow taller and stronger,” she said. “So it is not an outlandish idea [to train children in naloxone].”
Stancliff said that naloxone training “serves more than one purpose” because it teaches trainees themselves about the dangers of opioid abuse. She also pointed to a YouTube video from Injecting Advice that demonstrates how simple it is for a mature child to deliver a naloxone injection—at least to a teddy bear.
An opioid overdose can cause respiratory depression, a severe and potentially fatal reduction in the rate of breathing. Naloxone counteracts this symptom by blocking opioid receptors in the brain, causing immediate withdrawal.
Arlene Rice, co-founder of the Kentucky Harm Reduction Coalition, which is not officially affiliated with HRC, told The Daily Beast that it is safe for children to learn how to administer a naloxone injection, drawing the same parallels as Stepp to other injections that children commonly perform.
“Do and can we teach children to administer themselves an EpiPen if they have an allergy?” she asked. “Do we teach children how to give themselves subcutaneous insulin with a needle and syringe if they have child onset diabetes?”
Rice is not necessarily happy about training children, calling it “a telling sign of the severity of the opiate crisis,” but desperate times, she suggests, call for desperate measures. KyHRC, she added, is applying for a grant to order 200 boxes of Evzio for their own organization.
Dr. Traci Green, an associate professor of emergency medicine at Brown University and an expert on naloxone, told The Daily Beast that a child’s ability to use a naloxone auto-injector depends on the child’s age, hand strength, and ability to recognize symptoms. Green supports raising awareness about naloxone among children, even if they cannot administer the drug yet.
Two years ago, as the Huffington Post reported in a feature, naloxone prescriptions in Kentucky were sparse but, thanks to local advocacy, legislation was passed this March to expand access to the reversal drug, and to allow opioid addicts to purchase it without a prescription if they or a third party can coordinate with a certified pharmacist.
Medical experts argue that access to naloxone needs to increase across the board. According to the Drug Policy Alliance, 44 states have passed laws to allow easier access to naloxone but they vary in their specific provisions. Thirty-two states have Good Samaritan laws that protect people who report an opioid overdose, although less than half of these laws have a naloxone access provision.
Despite these state-level protections, naloxone is still difficult to obtain. As Corey Davis, an attorney from the Network for Public Health Law, noted in a July FDA presentation, most states still require access to a prescriber, a pharmacist, or both in order to obtain naloxone. Davis argued that, in the absence of explicit community distribution, many addicts and their loved ones will still be unable to access the overdose antidote.
“We have a medication out there that can reverse overdoses but most people don’t know the medication exists and, if they do, they don’t have an easy way to get it,” Dr. Caleb Banta-Green, a senior research scientist at the University of Washington’s Alcohol and Drug Abuse Institute, told The Daily Beast. “It is a silver bullet during an overdose.”
But despite its safety and efficacy, naloxone is sometimes met with skepticism. Banta-Green said he has fielded concerns from some paramedics and ER doctors about the dangers of laypeople using naloxone, as well as concerns that increasing the availability of naloxone could encourage riskier opioid use, but the available evidence suggests that neither of these fears is rooted in reality.
A 2014 CDC report concluded “providing naloxone kits to laypersons reduces overdose deaths, is safe, and is cost-effective.” The report reviewed data from the Harm Reduction Coalition, which found that naloxone has been used in over 26,000 overdose reversals from 1996 through June 2014.
A 2011 review of objections to the home use of naloxone in the Journal of Health Care for the Poor and Underserved found that “a growing body of evidence suggests that provision of naloxone does not encourage opiate users to increase their drug consumption, nor does it increase the likelihood that they will harm themselves or those around them.”
In fact, the review cited two studies of naloxone distribution programs that reported “a reduction in self-reported drug use” among participants.
“It is unethical to allow a narrow focus on the harms of drug use to overshadow an opportunity to save human lives,” the review concludes.
In light of this evidence, Banta-Green argues that anyone in possession of a substantial amount of opiates should have home access to naloxone as well.
“I like to say, ‘You’ve got a fire extinguisher. If you’ve got opiates in your house, you should have also naloxone,’” he said.
And for those who still have qualms about training mature children to use the reversal drug, Stepp has one final appeal.
“The people that say kids shouldn’t do this, would they rather have the child sit there, scream helplessly, and not be able to do anything?”
—Additional reporting by Robert Coolman.