Hennepin County attorney statement on Narcan alarms overdose-prevention advocates

Physicians and advocates say the agency’s language could scare people from using the medication to reverse an opioid overdose

Narcan user
Naloxone, also known as Narcan, is a prescription drug used to stop an opiate overdose.
Jeffrey Thompson | MPR News 2015

A statement posted Thursday night on the Hennepin County attorney’s website sparked outrage in the overdose prevention and drug recovery communities. Advocates and physicians say the prosecutor’s office mischaracterized the anti-overdose medication Narcan, and that the agency’s words could cause people to fear the life-saving medication.

Narcan, also known by the generic name naloxone, is a medication that can be used to reverse an opioid overdose. Almost 50,000 people die each year by opioid overdoses in the United States.

A statement posted on the Hennepin County attorney’s website detailed criminal charges against a man who sexually assaulted a woman and threatened her with a syringe of Narcan. The statement originally claimed that Narcan “can have serious physical side effects if it is injected in someone who is not overdosing.”

The office’s language immediately started ricocheting around recovery and overdose prevention circles, said Brit Culp, a substance use disorder counselor and anti-overdose activist in her personal life.

“To put it lightly, we were pretty pissed,” Culp said. “There was a lot of outrage because a lot of us do an intense amount of work in trying to share fact, to decrease the level of stigma and misunderstanding.”

While many people who use illicit opioids understand or have direct experience with Narcan, Culp said, the danger is that it will make others wary of administering Narcan or making the medication more widely available.

“It had this language that the general public would see and just assume that naloxone is a dangerous substance that can be used to threaten and coerce, where that is absolutely not the case,” Culp said.

MPR News left messages with the county attorney’s office Thursday and Friday but was told no one was immediately available to comment on the language in the statement and criminal complaint.

Dr. Katherine Katzung, who chairs the emergency department at Abbott Northwestern Hospital, said she frequently uses Narcan to treat patients she suspects may have overdosed.

“What the Narcan is doing is it’s trying to knock the opioid off the opioid receptor, and it’s pretty specific for that,” Katzung said. “If you were not on any opioids, there shouldn’t be any impact.”

The agency’s statement was later updated to include information that the woman who was assaulted had opioids in her system when the man was threatening her with Narcan.

Katzung said someone who has opioids in their system, even if they’re not overdosed, could go into opioid withdrawal after Narcan is administered. But implying that Narcan could have “serious side effects” is not accurate.

“Opioid withdrawal is uncomfortable for the patient. They may get a faster heart rate, get nausea, vomiting, feel sweaty, get stomach cramps and feel all-over horrible,” Katzung said. “But it wouldn’t be life-threatening to the patient to receive it.”

Lexi Reed Holtum is executive director of the Steve Rummler Hope Network, which successfully pushed for a law in 2014 that made Narcan more widely available in the state.

“We’ve worked so hard in the last six, seven years to help educate and inform people that naloxone is a totally benign drug, and has no abuse potential and is absolutely safe,” Reed Holtum said. “It should be over the counter.”

Lexi Reed Holtum paused near Steve Rummler's grave
Lexi Reed Holtum paused near Steve Rummler's gravestone at Lakewood Cemetery in Minneapolis in April 2016. Holtum and Rummler were engaged when Rummler died from an overdose of heroin and other narcotics in 2011.
Jeffrey Thompson for MPR News 2016

Now that it’s been 15 years into an epidemic that has claimed thousands of lives in Minnesota, Reed Holtum said she’s shocked that the prosecutor’s office in the largest county in the state could mischaracterize Narcan. It’s not just the Hennepin County Attorney’s Office. Her group and others have spent years trying to correct people’s inaccurate impressions of Narcan.

For the first time in more than a decade, the number of people who died of overdoses in Minnesota last year declined slightly. Reed Holtum said she believes that’s largely due to the availability of Narcan. She said statements like those posted on the county attorney’s website could incite fear in the state and even spread across the country.

“If someone feels like they could potentially do harm by a totally benign, safe drug, then they’re going to be in a state of fear to potentially save a life, they’re going to pause, they’re not going to use it, they’re going to think they’re doing something wrong,” Reed Holtum said. “That is absolutely inaccurate.”

Within 24 hours of posting, the Hennepin County Attorney’s Office updated the language on its site and social media, saying that the office has “long supported the use of Narcan in the hands of first responders and regular citizens to save the lives of people in the throes of an opioid overdose. The research is clear that injecting Narcan is safe for the vast majority of people.”

The updated language also said the victim “knew that if she was injected with Narcan when she was not overdosing, it could cause her physical harm.”

Culp, the activist, said the updated language is better, but still implies that Narcan harms opioid users apart from causing withdrawal.