North Adams, Massachusetts resident Stephen Murray is a former firefighter and paramedic who spent almost a decade as a first responder in Berkshire County. Now a community implementation specialist for Boston Medical Center, Murray works on overdose prevention, post-overdose work, and Naloxone access. Murray is in long-term addiction recovery himself.
This month, a paper he co-authored on expanding access to Naloxone on the state and federal level was published in the American Journal of Public Health. Murray tells WAMC that he believes lives can be saved if the government makes the overdose reversal drug widely available over-the-counter.
MURRAY: We found through research that Naloxone access lowers overdose rates in a community. We saw it ourselves here in Berkshire County as we started to expand Naloxone access. First responders are being called on less and less to respond to non-fatal overdoses, and what we know is that the true first responders in an overdose are other people who use drugs, and so, the more Naloxone we can get into the hands of people who are actually on the ground level, the better. And one of the major barriers to access that we found is that, basically, the areas where you can Naloxone on during the week are syringe programs, pharmacies, and other access points which are generally under what we would call like bankers hours, so, 9 to 5. And the problem is that overdoses aren't set on a clock, and so people often run out on the weekend, or they'll run out on the overnight, and they're not able to get more to be prepared for the next overdose.
WAMC: Now, what is the paper proposed the federal government pursue to address that that access issue?
So one of the major components of this papers looking to move Naloxone over-the-counter. There's been a lot of calls for this recently, it's actually over-the-counter in some other countries. But basically, Narcan is a prescription medication that has a statewide standing order in most states, where, basically, it can be dispensed without a prescription. But it still has to go through a, like, sort of registered program. And what moving over-the-counter would do is it would make it so that it can be picked up in gas stations or 24-hour convenience stores or bodegas anywhere around the around the country. And so the FDA, their role in this, and there's been applications to do this that are in different levels of process, but to become a nonprescription drug, basically, the medication has to be able to be used appropriately for by the consumer for like a self-diagnosed condition. And so overdoses are easily diagnosed by the people who are witnessing them, and so that meets that criteria. The second is that they don't need a health practitioner for safe and effective use, and so we've been arming people and bystanders and training teenagers and the elderly in how to administer this medication, so it's been done both safe and effectively. And it has low potential for misuse or abuse, per the FDA language. And so, Naloxone has a benign safety profile, has no potential for misuse or abuse, and there's no real contraindications to giving it in the suspected overdose.
Now, you've been on the front line of the opioid epidemic in Massachusetts, out here in Berkshire County. Speaking now in spring 2022, where are we with that on the ground level right now?
The important thing to realize is that the rate of fatal overdoses has not gone down here in Berkshire County. And in fact, you know, as the rest of the state saw only modest increases in 2020, we had a 44% increase in fatal overdose here in Berkshire County. And so I wrote a paper that I released out, back in 2021, where looking at how the beginning of the COVID pandemic impacted overdose here in Berkshire County. And what we saw was a noticeable spike in fatal overdoses in the months of March, April, May, and June. And then that kind of leveled back out after that, just sort of our norm. So, you know, this is an ongoing problem. I've responded to more than more than 100 overdoses here in Berkshire County in my career. Unfortunately, I’ve had to be the one to deliver a lot of bad news to families. And I think one other thing to just sort of keep in mind is that the impact of fentanyl and our drug supply, not just for opiates, but also first for stimulants like cocaine, per our recent drug checking data through Brandeis University, what we know is that approximately 25% of powder cocaine tests positive for trace amounts of fentanyl. And what that's telling us that most likely at the sort of last phase of dealing, the person who's cutting the drugs are doing it on the same table without properly sanitizing that surface, and between doing opiates and cocaine. And so what we're seeing is people who have very little to no opioid tolerance who believe that they're using just cocaine overdosing on fentanyl. So this is a whole nother layer of this crisis that continues to worsen. And, you know, there's no real good signs that our drug supply is improving. So this is just an ongoing problem that continues to become more complex, I think, as time goes on.
This paper seems to sort of redirect federal approaches to drug use from stemming the access to the drugs themselves to providing a much easier means of access to safety precautions knowing that drugs are in the community. Can you break that down for us? Is a change in pace for how the government has approached this issue to date?
Sure, you know, I think that what we're seeing is that the government is – the federal government at least – is opening itself up more to the idea of harm reduction, looking at safety rather than, you know, focusing on treatment. And there's a couple of really good reasons for this. I think one is that if we're only concerned with the treatment aspect of this, we're missing a lot of people who are recreationally using drugs, the people who don't consider themselves to have a substance use disorder. And so if all of our resources are going towards treating people with substance use disorders, people who are recreational users of stimulants, for example, are not getting any sort of safety training or feedback to understand some of the risks that they're at in their sort of more casual use of drugs. And then the other part is that here in Massachusetts, we're definitely ahead of the curve in terms of state policy towards harm reduction. We have a great Department of Public Health here that has done some really bold and forward thinking things. I don't know if you're aware of the crack pipe debate that happened federally not that long ago, but here in Massachusetts, we actually already through state funds allow the purchase of those by syringe programs. And smoking is a great alternative to injection for a lot of different reasons. The first being that it lowers your risk for overdose. It's a slower onset of the drug. And then the second is that it lowers the risk from injection drug injuries or the spread of blood borne pathogens like HIV and hepatitis C. So there's a lot of really good reasons why, to me, harm reduction is drug user health, it's preventative health. We know from other things that preventative health is much cheaper to provide then caring for long-term chronic illness. A good example is that a syringe only costs about 7 cents, but to treat HIV is about a $300,000 per patient costs. So we see the benefit of preventative medicine and I think that that is sort of starting to be reflected in federal policy.
