The latest issue of the Journal of Addiction Medicine, Vol. 7 (2) March/April 2013 had several interesting articles relating to opioid addiction and its treatment. Here’s my quick summary and thoughts on one of them, “Promethazine Misuse among Methadone Maintenance Patients and Community-Based Injection Drug Users,” by Brad Shapiro et al, pp. 96-1001.

This study attempted to get an idea of the prevalence of promethazine (better known under its brand name Phenergan) use in opioid addicts both in and out of treatment.

I was interested in this article because I’ve had methadone patients misuse promethazine. Most of these patients say that Phenergan gives them sedation with methadone, but most say it’s not a true euphoria, so I’m puzzled as to why they mix the two. Since promethazine can be sedating in many people, obviously I worry about overdose deaths when it’s mixed with methadone.

The authors of this study tested for promethazine in the patients enrolled in a county hospital methadone clinic in San Francisco. Twenty-six percent were positive for promethazine and only 15% had a prescription for this medication. Also, promethazine use was associated with benzodiazepine use.

The authors then recruited two hundred intravenous drug users, and discovered that only 139 were opioid addicts. Of those 139 addicts, seventeen percent reported promethazine use in the past month. However, of the addicts who had been on methadone in the past, twenty-four percent reported promethazine use in the past month.

What does this study tell us? The authors’ conclusion was that promethazine needs to be investigated further as a drug of abuse in opioid addicts.

Well, yeah.

My clinical experience gave me some thoughts about the study. For one thing, pregnant addicts were excluded. But in my experience, pregnant patients are the ones most likely to be prescribed Phenergan because of morning sickness during pregnancy. And this study doesn’t tell us much about the overdose risk when methadone and Phenergan are combined. Early in their article, they do provide some data: In Kentucky, over 14% of decedents from methadone toxicity overdose deaths also had promethazine present in their system. In Seattle, 2.5% of fatal overdoses had promethazine present.

Promethazine, along with many other medications, prolongs the QT interval just like methadone does. I haven’t seen any studies of methadone patients comparing QT intervals before and after promethazine, which may be helpful to further assess risk.

Sorry it’s been some time since my last post; I broke my leg, had to have surgery, and only recently got out of the hospital. How’d I break my leg, you ask? Ah, I had a little trouble sticking the landing of that double axel…ok that’s not true…I broke it walking the dog.

And here is an update regarding the latest on Probuphine…

Probuphine, a new implantable form of buprenorphine, was not approved by the FDA, despite a recent recommendation by the FDA’s advisory committee to approve this new form of buprenorphine. This drug is better known under the brand name of the sublingual form, Suboxone.

According to last week’s Alcoholism and Drug Abuse Weekly, Titan Pharmaceuticals, maker of Probuphine, was told by the FDA they needed more information to show that Probuphine provided adequate opioid blockade , and they needed to show the effects of a higher dose of Probuphine. According to studies, the present formulation of Probuphine gave a lower buprenorphine blood level than compared to the sublingual form dosed at 16mg per day. The FDA asked for testing of the training that’s planned to be given to physicians who implant and remove the Probuphine cylinders.

I was quoted in the article; as I stated in an earlier blog entry, I think the present formulation of Probuphine under-dosed patients in Titan’s study. I think it should be re-formulated so that more medication is released per cylinder. Patients switching from sublingual could have their Probuphine dose varied according to how many cylinders are implanted. I also criticized the complicated procedure for both implantation and explantation. Doctors with Suboxone waivers can store the cylinders in their offices, but we’d have to assure security of the substance and keep records for the DEA. We would also have to be present with the surgeon during implantation and explantation, which is not financially practical for me, at least. Some Suboxone doctors may decide they want to learn to do the implants themselves.

I see a possible area for use of Probuphine in incarcerated opioid addicts. Prison systems say they don’t want to try to dose inmates with a controlled substance, because of diversion fears. With Probuphine, there’s less risk of diversion, and inmates’ opioid addictions could be treated with Probuphine implantation every six months. This may not give ideal blood levels, but it’s far better than letting a person with opioid addiction endure opioid withdrawal while incarcerated, which does nothing to help the underlying disorder. These people would still need psychosocial addiction treatment, though.

Educated and informed people have an opportunity to make an impact on the life expectancies of opioid addicts in Eastern Tennessee!

The Tennessee Health Services and Development Agency is holding a fact-finding public hearing, regarding the certificate of need application for a methadone treatment facility, proposed to be located in Johnson City, Tennessee.

This meeting will be held on May 28th, 5pm, in the Jones Meeting Center, Johnson City Public Library, on 100 West Millard Street in Johnson City, Tennessee.

There’s a desperate need for medication-assisted treatment of opioid addiction in that part of Tennessee. Opioid addicts can get treatment in office-based Suboxone practices now, but as discussed in previous entries on this blog, this can be an expensive treatment. Many addicts don’t have insurance to pay for this treatment, which is then out of financial reach. For other addicts, buprenorphine, being a partial opioid, isn’t strong enough. Methadone can work beautifully for patients who don’t do well on buprenorphine (known to most as Suboxone or Subutex). However, there are no methadone treatment programs in Eastern Tennessee, so a clinic in that area is desperately needed. The nearest in-state clinic is in Knoxville.

People who know methadone works and saves lives need to go to this meeting to be heard. I suspect there will be people there who know next to nothing about methadone who are nonetheless opposed to a clinic. We’ve all met them: people adamantly opposed to methadone even though their brains are uncomplicated with any actual knowledge of methadone. And there will the NIMBYs, the not-in-my-backyard people.

Citizens who know there are scientific studies showing that methadone is an evidence-based treatment shown to save lives need to go and be heard. Tell other people at the meeting about the forty years’ of studies consistently showing that methadone maintenance reduces overdose death rates, improves overall physical and mental health, increases rates of employment, reduces the risk of suicide, dramatically reduces criminal activities of opioid addicts (by a whopping 91%), and reduces the rates of new cases of HIV.

It’s hard to imagine the certificate of need could be denied, but remember attempts to locate a methadone treatment center in Eastern Tennessee have tried – and failed – ten times before. Let’s hope science and reason can win over ignorance and prejudice.

If, like me, you can’t make the meeting, please send a letter to:

Tennessee Health Services and Development Agency
Melanie M. Hill, Executive Director
Frost Building, 3rd floor
161 Rosa Parks Boulevard
Nashville, TN 37243

I want my site to be about solutions, working together, positive ideas, and not an endless bitch session.

It struck me that some of my readers may not know that 12-step meetings are run differently and have different norms of interaction than other support groups. While it’s true each group has the freedom to run its meetings as it sees fit, most follow AA’s Twelve Traditions as a pattern for interaction.
Physicians, therapists, or educators of any kind would not be allowed to talk to any group to educate them about anything. If such a person is a member of a 12-step group, he/she is welcome to talk only about her personal experience, strength, and hope. In fact, in Alanon, if there are members present who are also members of AA, NA, GA, or any other 12-step group, they are asked to keep that to themselves, as it can distract from the focus of the meeting.
In 12-step meetings, there’s no therapist or counselor in charge of the meeting. Instead, there’s a chairperson, a member of the 12-step program who opens and closes the meeting. This person is in charge only in the sense that she guides, rather than controls, the meeting. Some chairpersons guide more than others. For example, some chairpersons will interrupt a member who’s sharing something that can be harmful to the group. This could mean interrupting a “drunkalog” (long pointless sharing that glamorizes drinking or using drugs). Other chairpersons let the meeting run its course, believing that a Higher Power is always in control. The chairperson is responsible for starting and ending the meeting on time.
Members don’t give advice to each other. Or at least, experienced members of Narcotics Anonymous and Alcoholics Anonymous don’t tend to give advice to each other. Instead, members share their own experiences. They tell about what worked for them, and what didn’t work. The topic is often about how to get through situations without using drugs or alcohol, but may also be about how to live with difficult life situations, and still retain one’s serenity.
In group therapy, members are encouraged to give advice, or feedback, to other members. Some treatment centers believe that alcoholics and addicts must be confronted, so that denial can be broken through. Twelve-step meetings don’t take this stance. Instead, members offer their own experience, freely and without expectations. It’s a subtle difference, but important. Other 12-step members don’t assume they know what another person should do about life decisions; they simply offer their own experiences.
Twelve-step meetings are free. Most group therapy costs some amount of money.
No record of attendance is kept at 12-step meetings. A person is considered to be a member of Narcotics Anonymous when that person says they are a member. The only requirement for membership is a desire to stop using drugs.
Twelve-step groups don’t promote themselves. One of their twelve traditions says that new members should be gained by “attraction, rather than promotion.” However, some group have websites for group members, and some groups do advertise times and locations of local meetings as public service announcements.
Twelve step meetings are held in slightly different ways in different areas of the country. In some places, meetings range from fifty minutes to an hour and a half. At “speaker” meetings, one person tells their story of addiction and recovery for the whole hour, traditionally telling “what it was like, what happened, and what it’s like now.” At other types of meetings, all persons present are offered a chance to share or pass to the next person. In some meetings, members who wish to share raise their hands and are called on by the meeting chairperson. In group therapy, all members are usually expected to say something during the session, but at NA or AA, no one is coerced to speak.
Problems are shared at meetings, but the emphasis is on solutions. Most good meetings don’t allow the meeting to become a dumping ground for negative experience. The emphasis of meetings is on solutions to problems. In most meetings, sharing about specific drugs is discouraged. NA members are encouraged to share about what they are feeling, and what kind of help they need to remain abstinent from all drugs.
Overall, the mood of 12-step meetings is one of humbleness, where one recovering addict shares what worked for her with the rest of the group, without expectations and with humility. By contrast, in group therapy, feedback or advice is usually given by other group members. But an addict’s tendency with such an approach is to ask, “Who are you to be telling me what to do?” Narcotics Anonymous meetings recognize that advice and feedback often grates on addicts, and their meetings are constructed differently. Other member’s experiences are offered as learning opportunities.
Twelve step members aren’t perfect, to say the least. Many members are wrestling with serious mental and emotional problems. Sometimes members do lapse into advice-giving and preaching, but most lose this tendency to try to control others as they progress in their own recovery.

I’m surprised and disappointed by all the negative comments to my blog from medication-assisted treatment (MAT) advocates who strongly criticize my article on excuses people use to justify not attending 12-step recovery.

Actually, the blog entry is a re-run, from about a year and a half ago, when it didn’t get much attention at all. I first wrote the piece years ago, for patients with all sorts of addiction, and not specifically those in medication-assisted treatments. Most of my readers have interpreted the blog to be targeted at MAT patients. I guess that’s not unreasonable, since my blog is dedicated to opioid addiction and its treatment with medication.

I’m surprised that some MAT advocates, who must have endured much discrimination and misunderstanding, are equally judgmental and biased against 12-step recovery.

Hear this: 12-step recovery is an evidence-based treatment. I’m preparing a blog with all of the study references so those who are open-minded enough can read them, and make a more informed judgment of 12-step recovery. Each time the American Society of Addiction Medicine holds their review course, there’s a lecture on 12-step recovery and the literature that supports it, just like there’s a lecture on methadone and buprenorphine for treatment of opioid addiction.

I’m sorry people have had bad experiences with 12-step recovery, but to use one bad experience as an excuse to denigrate 12-step meetings in their entirety is no different than saying because one person overdosed and died from methadone, it’s dangerous and should be outlawed.

For the record, I’m not in favor of forcing anyone to go to 12-step meetings if they don’t want to. Patients in my Suboxone practice have to do some kind of regular counseling, and they have their choice of seeing an individual counselor in my office, seeing their own therapist, going to 12-step meetings and documenting their attendance, or going to an intensive outpatient program at a local treatment center. About one-third of the new patients pick 12-step meetings because that’s the cheapest option, and that’s fine with me. At the opioid treatment programs where I work, I don’t force patients to go to 12-Step meetings. In situations where patients can’t stop drinking alcohol, I will recommend AA as an alternative to try before I have to recommend inpatient drug rehab, but those patients also have the option to attend the group meetings held at our OTP. However, one the OTPs doesn’t have any group meetings, so I’m more likely to recommend AA. That’s in Boone, and from what I hear, there’s no NA up there.

My office Suboxone patients give me a unique view. I inherited a group of about 30 patients from another Suboxone doctor. She was well-loved and well-known in local 12-step meetings, and any AA or NA member who got addicted to opioids after they were in recovery were referred to her. When she retired, I got most of those patients. Some of these patients had many years of sobriety from other drugs when they got put on pain pills for some reason, and they developed a secondary addiction to pain pills. After they got on Suboxone, they continued to go to their recovery meetings as usual.
I’m starting to realize that these patients may be rare. They’re comfortable with being on Suboxone and equally comfortable going to and participating in 12-step meetings. I enjoy them very much, and they’re easy to treat, since they’ve already had recovery experience.

These patients don’t share in meetings about buprenorphine, because that’s not their problem. These patients go to meetings to learn how to live a happy life without getting high. They talk about how to get through difficult life circumstances without losing their serenity, sanity, or sobriety. For them, the fact they are on a maintenance dose of medication is a non-issue. They aren’t looking for opinions or advice about their methadone or Suboxone dose.

If you are at a place in your life where you feel you must share about medications, I agree 12-step probably isn’t going to work for you, unless it’s MA (Methadone Anonymous).

It sounds like many MAT advocates have been to some very bad 12-step meetings. I hate that, but it’s not the norm. For example, 12-step members aren’t supposed to give advice, but only share what worked for them. In Alanon, one of my favorite 12-step groups, the readings at the beginning actually tell attendees not to give advice or comment on what other members have shared, but only about what you are going through and what is working or has worked for you.

It breaks my heart to hear an NA member castigate a newcomer to the group for being on methadone or Suboxone. It also breaks my heart when patients on medication-assisted treatment put down 12-step recovery. I always think to myself, “Oh if you only knew how much this helps some people, you wouldn’t talk bad about it…”

Maybe that’s just human nature.

Some people collect stamps. I collect reasons for not going to 12-step meetings:

I’m too busy.
I don’t have a car.
I don’t have a license to drive my car.
Gas is too expensive.
I hate cigarette smoke.
I can’t smoke at meetings.
I don’t have childcare.
I won’t know anyone.
I might know someone.
I hear that it’s really a cult.
I’d have to drive too far.
All they talk about is drinking.
They sell drugs at the meetings.
The meetings are too depressing.
The people at meetings are too happy.
I get my recovery at church.
Meetings are too far away.
Meetings are too close and I’ll know people there.
My probation officer won’t let me go because of my curfew.
Going to meetings makes me want to drink or use drugs.
I have social phobia and don’t feel comfortable in groups.
I don’t want to hear a bunch of other people’s problems.
I don’t want to tell a bunch of strangers my personal problems.
The only time I ever think about drugs or alcohol is when I’m at a meeting.
The people there are a bunch of fakes, lying about being clean/sober.
The last time I went, the men wanted to hook up with me sexually.
The last time I went, the women wanted to hook up with me sexually.
I got into recovery to have a life, and going to meetings just interferes with that.

And…my all-time favorite: I don’t want to get addicted to meetings. I just love that excuse…you may be snorting dangerous pills, alienated your friends and family, be nearing financial ruin, but none of that bothers you as much as the possibility you may get addicted to going to recovery meetings.

I’m not unreasonable. I know some of these excuses have some merit, like lack of childcare. But I also know there’s usually a way to overcome these barriers. People in active addiction often overcome great challenges to continue to getting their drugs. They create clever and imaginative solutions. Similarly, people can get to meetings if they want to do so.

I’d rather hear real reasons for not going: it’s scary and humiliating to admit you are addicted. It takes tremendous courage to walk into a 12-step recovery meeting for the first time, and it takes courage to continue to go to meetings. Meetings aren’t always pleasant or convenient.
But this form of recovery has worked for millions of people in a few hundred countries. It’s been around for seventy-seven years. What other drug addiction recovery programs have been in existence for that long? Twelve- step recovery isn’t a flash in the pan, and it has multiple clinical studies to show that it works. And it’s the best deal in town, since it’s free. So even though it can be intimidating to start going to meetings, the benefits are worth the effort.

Is it possible to recover without going to 12-step meetings? I believe so, yes. But I think it’s harder and takes more time and energy. I imagine the difference to be like hacking your way through a dense forest rather than taking a wide and well-worn path through the forest.

Twelve step programs aren’t the only recovery option and may not work for everyone, but please don’t tell me it doesn’t work for you until you’ve tried it.

“Craving: Why We Can’t Seem to Get Enough” was written by Omar Manejwala, M.D., a friend of mine, a nationally renowned addiction psychiatrist, and an expert on compulsive behaviors of all kinds. This nonfiction book is, as the title suggests, all about the phenomenon of craving. It is published by Hazelden and will be released today. You can go to this link to buy the book: http://www.amazon.com/dp/1616492627/?tag=ommamd-20

Dr. Manejwala has been the medical director of Hazelden and other prestigious addiction treatment facilities, and has worked with all sorts of addicts including addicted healthcare professionals. He’s even appeared on television on show like 20/20.

This book is about more than just drug addiction; his information about craving pertains to any substance or activity. I love his definition of craving as a desire so strong that when unfulfilled “produces powerful physical and mental suffering.” (p2) His description of craving is eloquent and easily understood.

In this book Dr. Manejwala explains abstract ideas and concepts in plain language. I’ve heard him give lectures on addiction-related topics and I’ve always been impressed his skill of distilling the complicated into understandable bits. His writing also shows this gift. Though his book is easy to understand, it’s not dumbed down, as too many books on addition written for the public tend to be.

The first part of the book defines cravings and compares them to weaker wants and urges. He tells us why cravings matter: cravings lead all of us to indulge in behaviors that undermine success. In subsequent chapters, Dr Manejwala gives some simple information about brain anatomy and neurotransmitters, and shows how the brain’s structure and function affect our ability to make choices.

In a later chapter he shows how cravings can drive not only behavior, but also thought patterns, in some really interesting ways. When a person intends to act on a craving that is obviously destructive, all sorts of irrational and false beliefs can pop up, and seem to make perfect sense. These thought patterns keep the person stuck in destructive behaviors for long periods of time, leading to negative life consequences.

Another chapter shows how addictive behaviors tend to be related; that is, how a person with alcohol addiction is more likely to have or develop addictions to other drugs. That person is also more likely to develop a behavioral addiction like gambling, compulsive overeating, or compulsive shopping. This chapter explains why these behaviors can occur together.

My favorite chapter is about the brain’s plasticity. The term “plasticity,” when applied to the brain, means the brain is changeable. Our thoughts, actions, and experiences actually change the structure and functioning of the brain. This is important, because it means there are things we can do to change our cravings. Dr. Manejwala explains how thoughts, behavior, and even spirituality can free us from cravings. This fascinating chapter has some great references, too.

The next chapter tells more about how spirituality is important to recovery. The author explains why 12-step recovery and other spiritual approaches work to reduce cravings. He explains specifically how groups help reduce urges and improve behavior in ways that can’t be done by a lone individual.

Later chapters explain how insight into problem behavior is only a start in the direction of change, and how many people mistakenly think facts alone will reduce cravings. This chapter clarifies how apparently irrelevant decisions can actually be subconscious decisions to act on a craving. In this chapter, healthier substitute activities are suggested. The latter chapters have solid advice on where to go to find help with problem behaviors, and have specific tips to help with cravings for smoking, alcohol and other drugs, sugar, gambling, and internet addiction.

This gem of a book is relatively short, at 190 pages, and highly readable. I’m keeping it on my bookshelf for the references listed in the back.

This book will help addiction professionals be better able to explain cravings and addiction to patients. Anyone who has ever tried to squelch a craving – unsuccessfully – by willpower alone will be interested in this book.

Don’t miss this book if you’re interested in book about addiction and recovery.

Last week I talked to a young person, a patient at an opioid treatment program, who saved someone with her Project Lazarus naloxone kit. As you know if you read this blog regularly, Project Lazarus is a non-profit organization that started in Wilkes County, North Carolina, dedicated to reducing drug overdose deaths. As part of the project, Project Lazarus pays for naloxone kits for patients entering medication-assisted opioid addiction treatment. The patients are given a prescription for a kit that will be filled for free at a local pharmacy.

These kits are ingenious, because the naloxone is already packaged in a syringe with a spray attachment. There’s no needle. The person administering the drug pushes the plunger of the syringe to spray the medication into a nostril. Naloxone is absorbed through the skin of the nostril and into the bloodstream, reversing the effect of all opioids. In this way, naloxone immediately brings the person out of opioid-induced sedation or coma.

I talked to this person who used her kit, to get the full description of events. I’ve changed some details to prevent anyone from recognizing her.

Cindy said she was driving across town when she had the sudden urge to visit a relative, whom we will call Bob. Bob was on parole, and Cindy wanted to stop by and say hello. Bob isn’t an addict, but has occasionally experimented with illicit drugs, including opioids. When Bob opened the door for Cindy, his first words were, “I think I’ve just taken an overdose.” An acquaintance sold Bob some prescription opioid pills, and moments before Cindy stopped by he took all of them. Right away, he began to fear he’d taken too much.

Cindy wanted to take Bob to the hospital but he refused, fearing his parole officer would find out he’d used illegal drugs. Cindy agreed to stay with Bob, and warned him that if he passed out, she would call EMS, but Bob begged her not to do this.

At first they talked and watched TV, but within an hour Bob got sleepy and his head nodded. Initially Cindy could still wake him by shouting, but she was alarmed to see his breathing slow. She said his lips began to turn blue, and he was taking huge noisy breaths only a few times per minutes. She lived nearby, so she sent her boyfriend to get her naloxone kit. She pushed the plunger and sprayed the naloxone into Bob’s nostril. She said it took less than a minute for him to wake with a start. He even jumped out of his chair. He was standing up and breathing heavily. It was a few minutes before he felt like himself again. Cindy started to call 911 but Bob again pleaded with her not to do so because of his fears about what would happen with his parole situation.

Cindy was (correctly) worried the naloxone wasn’t going to last, so she sat with Bob through the whole night. Several hours after the first naloxone dose, she gave him a second dose, since he was again breathing slowly and heavily. It worked as well as the first. Thankfully, he was OK after that.

The next morning, Bob was grateful to Cindy for saving his life. He knew he had nearly died, and told Cindy he was never going to use drugs again. The event happened a week or so ago, and Cindy says as far as she know, Bob hasn’t used any drugs since.

Cindy saved Bob’s life because she had the Project Lazarus kit. I asked her what she would have done without it, and she said she would have called 911 even over Bob’s objections – she wasn’t going to watch him die.

This whole episode illustrates some of the problems that can contribute to overdoses. First, it isn’t only addicts who die from overdoses. Bob is a young adult who by Cindy’s report has only experimented with drugs. The trouble is that with opioids, your first experimentation can be the last thing you ever do. If Bob isn’t an addict, he may be able to stop using after this near disaster.

Second, it shows the new Good Samaritan law doesn’t go far enough. Bob was fearful about legal consequences of getting much-needed medical help. If Cindy hadn’t dropped by, this young man probably would have died. He had a brief period of time between realizing he may have taken an overdose and becoming so sedated he was unable to call for help, but he didn’t call, because he feared legal consequences. I think the Good Samaritan law should be broadened to include seeking help for oneself as well as for other people.

Third, would it have been better for Cindy to forget her kit and call the ambulance for Bob? Maybe, though not from Bob’s point of view. Stories like these travel fast along the drug addiction grapevine, so I’m hoping more people will get interested in having a kit that can reverse an overdose, if for no other reason than getting help without involving authorities.

I advocate making these kits available for anyone who wants one, if that’s financially possible. Over the period of a little more than a year, I’ve heard of two lives saved from opioid overdoses because other people used their naloxone kits. In both situations, the person saved was not the addict for whom the kit was prescribed, but a relative of that addict. This underlines the importance of getting these kits in the hands of friends and family members of all opioid users, even if the users are not addicts. Since the recent passage of the Good Samaritan law, it’s legal for physicians to prescribe naloxone for family member and friends of opioid addicts.

In the news last week we learned Project Lazarus of Wilkes County will get an infusion of $2.6 million over the next two years from both a private charity and government funds. The naloxone kits are only one part of the total program, and I hope to see funds for the kits expand so that any doctor can write a naloxone prescription for any opioid addict, friend or family of an addict that can be filled for free.

New Good Samaritan Law for North Carolina

In an effort to reduce drug overdose deaths, North Carolina governor Pat McCrory approved a law earlier this month that limits legal consequences for people who call 911 to summon help for a friend who has overdosed. In the past, drug users have been reluctant to summon medical assistance for an overdosed companion, fearing police may arrive, and charge them with possession of drugs and/or paraphernalia. As a result, people die from overdoses due to a lack of timely medical care. In its place, the overdosed person’s companions may try an ineffective home remedy for overdose.

The new law doesn’t give a pass for all drug possession. It says that a person acting in good faith to seek medical assistance for an individual suffering a drug overdose will not be prosecuted for possession of less than one gram of cocaine or one gram of heroin. I don’t know if that means possession of larger amounts may still be prosecuted, but I suspect so. There is no mention of prescription drug possession specifically in the law, but I hope prescription opioids would be treated the same as heroin.

This new bill, called the Good Samaritan Bill, also says that if an underage drinker summons medical help for another person, the underage drinker will not be prosecuted by law enforcement, including campus police. The law says the underage drinker must use his own name when contacting authorities, reasonably believe he was the first to call for help, and must remain with the person needing medical help until it arrives to be covered by this law.

The bill has provisions for doctors to be able to prescribe an opioid antagonist such as naloxone to any person at risk of having an opioid-related overdose. Doctors can also prescribe this medication to the friend or family member of a person at risk for an overdose, even if that person is not a patient of the doctor. Also, a private citizen who possesses an overdose kit can administer it to another person who has had an overdose, so long as they use reasonable care. This law says the private citizen is immune to civil or criminal liability.

This is a great new law, and hopefully it will reduce witnessed overdose deaths. But the law won’t help unless addicts and their companions are aware of this law. Spread the word!