The drug Narcan has been used in Dubuque ambulances and crash carts for years, but it will likely save many more local lives this year than ever before.
Narcan, formally known as naloxone, counteracts overdose effects for opiates such as heroin and morphine. The drug is most often issued intravenously and reverses the effects of opiates within minutes of application.
Law enforcement officials are still in a fight to curb the frightening heroin abuse trend in Dubuque. Sgt. Gary Pape, director of the Dubuque Drug Task Force, said heroin investigations are up nearly 30 percent since 2010. That includes a spike from three investigations in 2011 to 19 so far in 2012. Investigations include search warrants, undercover drug purchases, seizures and traffic stops.
There have been zero fatal overdoses in Dubuque this year, thanks largely to the use of Narcan, which is carried on every ambulance in the county.
"We have seen an increase in heroin abuse," said Alice Prochaska, emergency department director at Mercy Medical Center-Dubuque. "It's a priority to administer Narcan so we can reverse the heroin."
Narcan was developed in the 1960s and is not available over the counter, though the Food and Drug Administration has discussed such a move. A prescription for the drug is most readily available to health professionals and law enforcement officials. Gil Kerlikowske, director of the Office of National Drug Control Policy, recently urged to expand distribution of the medication to addicted people, pain patients and their families, according to a story in Time magazine.
Critics of Narcan say it encourages heroin use and that it is not a true preventive measure.
Gail Gabbert, a drug counselor at the Galena Clinic, the only methodone clinic in the area, is in favor of giving as many people access to Narcan as possible.
"I think it's a lifesaver," she said. "I wouldn't believe anybody is going to use heroin or opiates in greater amounts because they can be brought back from the brink of death. I don't see anything but good coming from it."
The Centers for Disease Control has received more than 10,000 reports of overdose reversals from Narcan since the first opioid overdose prevention program began in 1996. The CDC believes the drug has no effect on non-opioid overdoses, such as with cocaine or alcohol.
Wayne Dow, EMS supervisor for the city of Dubuque, said 48 doses of Narcan have been administered to 40 patients so far in 2012, compared to 47 patients in all of 2011.
The doses are given for heroin and other opiates, as well as in some cases when the victim is suffering from unknown arrest. The drug blocks the opiate receptors in the brain, bringing immediate symptoms of withdrawal. Dow said administering too much Narcan to an opiate user can throw the person into a withdrawal seizure.
"It's not something we play with," he said.
Although Narcan is the most effective way to revive an overdose victim, Marvin Ney, owner of Paramount ambulance, said other steps are taken to see if administration of the drug is necessary.
"We go from least invasive to the most; we don't just want to just slam them with Narcan," he said. "It will reverse that narcotic, but it also can bring (the victim) into a very combative state. We don't want to put them in a state where they hurt themselves or others."
The number of patients treated for heroin abuse and/or dependence at Mercy Turning Point jumped from three to 20 over the past year. Malissa Sprenger, Turning Point's coordinator, said the injection modality of heroin use has a large role in the spread of several diseases. Of the 20 patients treated, one-fourth tested positive for tuberculosis and several had hepatitis.
Sprenger said the best practice for treating chemical dependency is medication-assisted treatment, which is medication coupled with counseling and Narcotics Anonymous involvement.
"Taking medication for opioid addiction is like taking medication to control heart disease or diabetes," Sprenger said in an email. "It is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction. It helps people manage their addiction so that the benefits of recovery can be maintained."
Ney is wary of opening the drug cupboard any further as Kerlikowske recommends.
"Every time you put another drug out there that is not being supervised by a medical professional, you run more risk," he said.
Dow is worried that Narcan in the hands of the general public could be good if put into the right hands, but also could lead to more drug experimentation.
"In the wrong hands, it could be 'hit me with that if this doesn't work,' " he said. "It might create braver addicts."