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First-ever heroin death confirmed in county; legislation linked to issue

Jan 18, 2017 By Katie Roenigk, Staff Writer

Fremont County has confirmed its first-ever death directly caused by heroin.

Coroner Mark Stratmoen said Levi Little, 27, of Dubois, died accidentally Dec. 19 of respiratory insufficiency due to heroin and fentanyl toxicity.

Fentanyl is a "highly toxic" pharmaceutical opiate that often is used as an additive to heroin, Stratmoen said in a public health message he released Tuesday in response to Little's death. The fentanyl increases the effects of the heroin, resulting in a product that has "a very narrow window between effective and lethal doses."

Because the heroin manufacturer typically adds the fentanyl, Stratmoen said the user may not be aware of the increased potency of the drug purchased.

"When you're talking about illegal drugs ... a person never really knows what they're getting," he said. "It's not like (taking) a 300 milligram tablet of ibuprofen. ... There's no regulation (or) quality control."

He says his office is obligated to inform the public that the use of heroin involves a high risk of death.

The issue has been prevalent in other parts of the country in recent years, Stratmoen said, pointing to areas as close as Larimer County, Colorado, where Fremont County's pathologist is located.

"They see an average of two heroin deaths a week," Stratmoen said. "And they already are having a serious issue with it on the east side of (Wyoming). I think it's worth a public health notice when it finally shows up here."

Legislation

Stratmoen believes heroin's resurgence likely is due to its low cost compared to pharmaceutical drugs.

Abuse of prescription drugs has become a problem locally: Last spring, Stratmoen reported that prescription drugs were the second most abused substances in Fremont County next to alcohol; in 2015 he said 15 of the 40 accidental deaths recorded involved alcohol and drug overdoses, and of the drug-related deaths, prescription drug overdoses were the leading cause.

He is in support of proposal working its way through the Wyoming Legislature that would grant immunity to anyone administering an opiate antagonist to someone experiencing a prescription drug overdose.

Senate File 42 defines "opiate antagonist" as narcan or any other brand name used for naloxone hydrochloride approved by the United States Food and Drug Administration for the treatment of an opiate-related drug overdose.

"I am fully in favor of anything that makes the opiate antagonist more available," Stratmoen said. "It's not a solution to the addiction problem, but it is a mitigating factor in the number of deaths."

He noted that there is no known danger of overdosing on opiate antagonists.

"It's a very safe thing," Stratmoen said.

He has contacted Wyoming Sen. Cale Case, R-Lander, and Senate President Eli Bebout, R-Riverton, to express his opinion about SF42. Both senators said they are in favor of the proposal, which was approved on second reading Wednesday.

Language

SF42 further defines an opiate-related drug overdose as a condition - including extreme physical illness, a decreased level of consciousness, or respiratory depression resulting from the consumption of an opioid - that a "reasonable person" would believe to require medical assistance.

The file does not establish a duty for anyone to administer the opiate antagonist, but anyone who does administer the drug is personally immune from any related civil or criminal liability. The person should contact emergency medical services as soon as possible, however, as the antagonist may wear off, and overdose may resume.

SF42 also allows practitioners or pharmacists to prescribe opiate antagonists to people at risk of experiencing opiate-related drug overdoses, to people in positions to assist the person at risk, or to people who, in the course of their official duties or business, may encounter a person experiencing an opiate-related drug overdose. Such practitioners or pharmacists also are immune from any related civil or criminal liability.

Legislators in the Senate indicated 45 other states have the same legislation in place.

In addition, senators discussing the bill noted that narcan can be administered through the nose and does not require intravenous intervention.

The Wyoming Department of Health was awarded a five-year federal grant beginning in fiscal year 2017 which allows expenditure for an opioid overdose treatment reporting system. Wyoming anticipates spending $62,500 to get the system started in fiscal year 2018 and $12,500 annually after that to maintain the system.

Currently, according to the SF42 fiscal note, there are approximately 500 naloxone administrations per year in Wyoming, based on Emergency Medical Service reporting, but it is anticipated that the number will go up as a result of the legislation.

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