Trish is shivering in her lime green polo shirt even though it's 70 degrees outside. The 42-year-old stands behind the Free Clinic's needle exchange van parked near Metro on W. 25th Street and admits she's a bit paranoid, her head on a swivel as she rubs her hands against her arms.
Trish is a heroin user and has been for 17 years, scattered around brief stretches of sobriety.
On this April morning, however, she is not at the van to pick up clean syringes for her habit, though she and her sister use the service. She's here to pick up a refill on her naloxone prescription from Dr. Joan Papp, a Metro emergency room doctor whose small pilot program aims to get the drug, which reverses opiate overdoses, into the hands of at-risk users.
"She was here a few weeks ago and said someone used it on her sister to save her life," says Chico Lewis, a 15-year veteran on the needle exchange van. "She said it was a miracle drug. She said she couldn't believe it worked."
Trish's sister is 40 and also a heroin addict of two decades. One afternoon her sister shot up and fell down. Overdose. She was purple, her breathing laboring to a near stop. Trish's 28-year-old niece found her mother and called Trish's nephew, a user himself who had access to Trish's naloxone. He rushed over the small distance on the near west side of Cleveland to administer the nasal spray.
"They said it worked right away," says Trish. "They said she just took this deep breath, this deep, deep breath, and shot up. Then she threw up, but she was fine."
Her sister had never ODed before, and without the drug might have ended up padding Ohio's already epidemic-level numbers of painkiller and heroin overdose deaths. In 2011, the last year for which data is available, there were 1,765 such deaths in the Buckeye State, a record.
"But everyone's overdosing," says Trish. "You read the obits, you have a friend die. My sister just had a friend die. That's just what happens.
"This, though, is a miracle drug."
Opiates – heroin, oxycodone, Vicodin, Percocet, etc. – latch onto the mu receptors in the brain. The drugs cocoon those receptors like warm magnetic blankets, producing the high in the user. An overdose, which usually includes mixing different drugs and alcohol, blasts those receptors with enough depressants to cause breathing to slow and stop.
Naloxone (brand name: Narcan) is an intravenous prescription drug that's been around since the 1960s. It is not a controlled substance, has no major side effects, and is not addictive. It does, however, have a stronger pull to the mu receptors than opiates. One dose knocks the opiates off the receptors, reversing the OD and restoring normal breathing. Quite literally, it's a 50-year-old miracle drug way past its time of being in the hands of users and those around users.
Dr. Papp sits in a conference room at the Free Clinic on Euclid waiting for just those users every Friday. With nominal seed money -- about $90,00 in all -- from Cuyahoga County, the Ohio Department of Health, and her hospital, she's brought Project D.A.W.N. (Deaths Avoided With Naloxone) to Cleveland as a pilot program that launched March 1. To date, she has registered 96 users, with ive refills of naloxone for documented overdose reversals, including Trish's sister. There are three additional reversals that have yet to come in for refills but that have been confirmed through verbal reports.
Naloxone is not FDA-approved for nasal use, but pilot programs around the country, like the D.A.W.N. project in Cuyahoga County and its Ohio-based inspiration, the D.A.W.N. project in Portsmouth, have begun supplying nasal adapters with naloxone for easier use – less training, equally effective.
"Users don't like to get it because it wrecks their high," says Papp. "But when they're in trouble, it knocks them right back. It literally lets them breath again. The need just hasn't been as great as it has been now. We're taking this drug that's worked really well for us in the hospital and making it widely available to people."
The restrictions on Dr. Papp's program are pretty strict. It's a prescription medication and must be given to someone who was or is an opiate abuser at risk of an overdose. One level of protection in place at D.A.W.N. is the requirement that to enroll, you must become a patient at Metro, and your medical records will indicate that you are an opiate abuser. Dr. Papp has had to turn away many parents and friends looking for the medicine for a loved one.
"This started about a year ago, the planning portion," she says. "We've noticed a lot more heroin users in the ER – estimated, about 20 percent of what I see has to do with opiates, whether it's infections or withdrawals or overdoses. And you're not seeing the lower rungs of society, you're seeing young, middle-class people from the suburbs."
Turning away those in the immediate vicinity of users is not acceptable, according to Papp, which is why she's working with State Rep. Michael Stinziano, a Columbus Democrat, on a bill that would expand access to users and their families and loved ones.
There are two other bills winding their way through the Ohio legislative process, with many more restrictions – families would have to bring users to the doctor to a get a prescription, etc. – that would do far less to curb the overdose epidemic.