Denver’s largest needle exchange program, the Harm Reduction Action Center (HRAC), has issued a caution about the risks associated with high-dose naloxone products used to reverse opioid overdoses. According to their recent newsletter, while the primary goal of naloxone is to restore breathing, administering high doses can precipitate severe withdrawal symptoms in opioid-dependent individuals.
Concerns Over High-Dose Naloxone Products
HRAC noted that since the emergence of fentanyl in the drug supply around 2013, questions have been raised about the effectiveness of standard naloxone dosages, such as the 0.4 mg/1 ml injectable format, in reversing fentanyl overdoses. However, the center emphasized that misconceptions about higher doses acting faster or being more effective have been exploited by manufacturers of high-dose products like Narcan (4 mg), Zimhi (5 mg), and Kloxxado (8 mg).
“High-dose and long-acting naloxone products may induce withdrawal symptoms in opioid-dependent individuals, causing significant discomfort and health risks,” the newsletter stated. International harm reduction experts have raised concerns about the aggressive marketing and use of these products without sufficient testing on their withdrawal effects.
The Trauma of Withdrawal
At the Compassionate Overdose Response Summit in March, Malcolm Visnich of Prevention Point Pittsburgh shared his personal experiences with naloxone. In one instance, he was revived from an overdose with a low dose of naloxone, which restored his breathing without inducing severe discomfort. In contrast, another overdose involved multiple high-dose naloxone administrations, leading to extreme nausea, anxiety, and prolonged trauma.
“For months after that bad overdose, I was hesitant to use around others,” Visnich explained, adding that he often chose to use drugs alone, increasing his risk of fatal overdoses. Harm reduction advocates warn that solitary drug use is highly dangerous, as no one is present to administer naloxone in case of an emergency.
Overdose Trends and Policy Recommendations
HRAC highlighted the ongoing spike in overdoses in Denver, urging a compassionate approach to opioid overdose response. They recommended prioritizing the availability of standard-dose naloxone, which can restore breathing without inducing withdrawal symptoms. The center emphasized the need for harm reduction programs to educate laypeople, families, and first responders on appropriate overdose reversal techniques.
A city staff presentation on overdose trends is scheduled for Dec. 18 at the Denver City Council’s Safety, Housing, Education, and Homelessness Committee meeting.
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Advocacy for Needle Exchange Reforms
HRAC is also advocating for changes to city regulations that limit the operation of needle exchanges. Currently, Denver allows only three needle exchanges, all of which must maintain a 1,000-foot buffer from schools. HRAC Executive Director Lisa Raville noted that this restriction has made it nearly impossible to find a new location for the center.
During the public comment period of a recent City Council meeting, HRAC board chair AJ Boglioli argued that these restrictions hinder the ability to save lives. “Needle exchanges save money, save lives, and provide dignity,” Boglioli stated.
Aubrey Wilde, advocacy program director for the Colorado Coalition for the Homeless and an HRAC board member, highlighted how the center serves as a vital communication hub for clients who lack phones or internet access.
Next Steps for Policy Changes
The Safety, Housing, Education, and Homelessness Committee will discuss the proposed reforms to needle exchange restrictions on Dec. 18. If approved, the matter will require two additional votes by the full City Council before the changes can take effect.
By easing restrictions on needle exchanges and promoting accessible harm reduction tools, HRAC hopes to address Denver’s growing overdose crisis while preserving the dignity and safety of those most at risk.
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