Heroin overdose research leads to life-saving policy changes providing ...
When Brad Ray was 22 years old, he was with a relative who appeared to be very ill. The man was hiccupping, gasping for air, yet completely unresponsive. “We picked him up, dropped him, and he had zero response,” Ray recalls. “So we looked in his pockets and found little pouches of powder. I called 911.”
Emergency medical personnel arrived and recognized the powder as heroin and the illness as an overdose. “We had no idea he used heroin,” Ray says. An EMS worker injected the man with naloxone, and saved his life.
“He literally came back to life, and from that moment on, I realized there was an antidote for heroin overdose,” says Ray, an assistant professor in criminal justice at SPEA IUPUI. And that set the course for research that is changing Indiana policies statewide and contributing to a national conversation about treating opioid overdose.
While he was in graduate school at DePaul University, Ray volunteered at a needle exchange. “It really changed my perception,” Ray says. He began to view opioid use as a public health problem and adopted a harm-reduction philosophy. “You can’t stop drug use,” he says. “So let’s heroin is one in a class of drugs called opiates, which includes commonly prescribed pain medications like hydrocodone and oxycodone. Naloxone works on opiates including heroin, and can save not just heroin users, but anyone who might abuse painkillers or accidentally take too many.
While completing his Ph.D. work in sociology and anthropology from North Carolina State University, Ray became interested in the connection between substance use and mental illness and how these often intersect with the criminal justice system. “About 70 percent of people arrested have symptoms of mental illness, and of those, about 75 percent also have a co-occurring substance abuse disorder,” he says.
“Ultimately what we need is a standing order provision in Indiana so that family members and potential bystanders have access to naloxone and can use it when necessary. We need policies in place so that people can get naloxone and use it for a loved one.”
Ray joined the SPEA IUPUI faculty in 2012. A lot of universities offered work in a big city where there would be significant drug problems. But he chose IUPUI because of its emphasis on translational research – research that translates into practice. “At SPEA in particular, my service work complements my research,” he says. “What people do here is not just theoretical – it’s boots on the ground research. We interact with practitioners and policymakers on a regular basis.”
That work started when he joined a group that was writing a grant proposal to fund research on moving people out of the criminal justice system and into mental health and substance abuse treatment. During that process, he met Bryan Roach, then commander of the Indianapolis Metropolitan Police Department’s southwest district (and now deputy chief of administration). Roach had convened what he called a “heroin roundtable” to address the growing problem of heroin use, and he invited Ray to join them.
“I’d never worked with police before,” Ray says. “But at one of the meetings Bryan said, ‘We can’t arrest our way out of this heroin problem. We need to look for alternative solutions.’ That really won me over.”
One of the roundtable’s recommendations was to make naloxone available to all first responders because, Ray explains, police and firefighters are often on the scene of an overdose before EMS. Dan O’Donnell, MD, assistant professor of clinical emergency medicine at the IU School of Medicine and chief medical director of Indianapolis EMS, plus Indianapolis’ Public Safety Director Troy Riggs agreed to test the proposal in IMPD’s southwest district.
The trial supplied nasal naloxone to police officers and trained them in how to detect an opioid overdose and use the spray kits. “There was concern that the officers might be resistant to the training,” Ray says. “But when we surveyed them, they were overwhelmingly positive about it. The police who went through the program liked it – especially those who had seen more overdoses. They really do want to help.”
The experiment was an overwhelming success: They estimate that over 50 lives have been saved. One of the officers who saved a man told Ray, “I drive by and wave to him on his front porch just to check in and see how he’s doing.”
The program has been rolled out statewide, though individual police departments decide whether to implement it. Ray is concerned that sheriffs in small towns may be slow to sign on because they see fewer deaths by overdose but it’s especially important in rural areas where it can take EMS so long to arrive.
Ray continues to work with community stakeholders to change state laws so that naloxone is more readily available. “Ultimately what we need is a standing order provision in Indiana so that family members and potential bystanders have access to naloxone and can use it when necessary,” says Ray. “We need policies in place so that people can get naloxone and use it for a loved one.”
Ray has several related research projects underway, too. “We’re looking at overdose fatalities in Marion County and linking them to criminal histories to determine how the criminal justice system might serve as a potential point of intervention to reduce overdose rates,” he says.
As for that relative of Ray’s? “He eventually kicked his habit, and now he has a family and owns his own business,” Ray says. “Had it not been for naloxone, and the second chance that he was given, none of that would have ever happened.”