Lazarus drug saves life of Demi Lovato after overdose

When reports surfaced that pop star and former Disney ingénue Demi Lovato overdosed on heroin on July 24, the music-sphere was devastated but perhaps not shocked. Just a month earlier, Lavato had released the song “Sober,” a haunting confession of relapse after six years of sobriety. Her lyrics reminded family, friends and fans that she’s only human. 

“Momma, I'm so sorry, I'm not sober anymore. And daddy, please forgive me for the drinks spilled on the floor. To the ones who never left me, we've been down this road before. I'm so sorry; I'm not sober anymore.”

In her first public statement since her overdose, Lovato shared with her followers on Instagram that addiction is not something easily conquered. In that Aug. 5 post, she thanked God for keeping her alive and fans for their love and support. She reminded people she had never hidden the fact that she suffered from addiction and asked for their love and prayers. 

While it has not been conclusively reported that heroin, and not another opioid, was the cause of her overdose, by all accounts, Lovato is lucky to be alive. Thanks to the fast actions of friends who gave her a life-saving dose of the miracle drug Narcan, she was revived. 

Narcan, the trade name for naloxone, is an opiate antidote that can literally bring an opioid user back from the brink of death. The rampant use of opioids like heroin and fentanyl and prescription pain pills such as OxyContin, Percocet and Vicodin is at an all-time high, and experts like Kelly Barth, D.O., an internist and psychiatrist who concentrates her efforts on the management of patients taking opioid medications, are advancing in all directions to combat this nation’s rising opioid crisis. 

Barth explained that when someone is overdosing on an opioid, breathing may slow to a dangerous level or stop altogether. Without this lifesaving intervention, it can be impossible to wake a person from this state, making naloxone a remarkably valuable arrow in an otherwise empty quiver. 

It’s most commonly administered via a nasal spray or intramuscular injection — like an Epipen — and quickly gets into the bloodstream. Once there, it immediately attaches to opioid receptors in the brain, blocking the opioids. The respiratory system is also involved, and by removing the opioids attached to receptors, naloxone enables the person to start breathing again, which brings the victim out of sedation. 

Another important advantage of the prescription drug naloxone is that it only reverses an overdose. In other words, it cannot be used to “get high.” If given to a person who has not taken opioids, it will not have any effect, since there is no opioid overdose to reverse.

Naloxone reverses 93 percent of overdoses. That’s the good news. The bad news is many recipients don’t survive a year after their overdoses, Barth said. As beneficial as naloxone is for reversing overdoses, the bottom line is it does not treat the underlying problems, meaning there are many challenges still ahead for Lovato and others who return to using drugs. 

After nearly two weeks in the hospital following her overdose, Lovato was released on Aug. 6. Sources close to the star say she entered rehab straightaway. In her Instagram post, she expressed to fans that she needs time to focus on her sobriety and road to recovery. Barth said that sounds positive. After someone makes it through an overdose, getting her or him immediately into treatment is the most important step, she said. Therein lies a patient’s greatest opportunity for survival.

Not who you might think

Every day, more than 115 people in the United States die of opioid overdoses, according to the National Institutes of Health, approximately 43 from heroin. Unlike the myriad celebrities who succumbed to their drug use, Lovato is fortunate. She’s alive. And by every measure that defines success, she seems to have it all — not your stereotypical heroin user.  

Or is she? Barth said today’s heroin user can be young, white, suburban. Or not. Drug addiction doesn’t necessarily have a definitive look anymore, Barth added. Because heroin use has been increasing in recent years among men and women, most age groups and all income levels, some of the biggest increases have been found in demographics with historically low rates of heroin use — women, the privately insured and people with higher incomes. That has surprised even the experts. 

There was a time not terribly long ago when heroin use in Charleston was virtually unheard of, Barth said. It wasn’t until recently that it began to claim locals as users. 

What could account for that?  

While the answer, Barth said, is multi-factorial, a national push to get doctors to stop prescribing opioids — including to pain patients — has not decreased overdoses but has in some cases caused patients with legitimate chronic pain to turn to illicit drugs. And, because of its cheaper price, heroin has become the drug of choice for many who are addicted to opioid pain relievers. 

Some of this has led to the changing face of addiction Barth explained.  

“Now we see people who say they’ve been cut off by their physicians. I used to always think, ‘I treat chronic pain patients — many are middle-aged ladies. My ladies are never going to go to heroin.’ But we are starting to see a population of people who are getting cut off from their prescription opiates and who are transitioning sometimes directly to heroin and sometimes to illicit opiates and then to heroin, buying it off the streets. We used to never see that. It’s shocking and concerning. We can’t just cut people off. People have pain. They have addiction. There are good treatments for both of these conditions, and we have to make sure people can access those treatments.” 

This is one reason Barth is so passionate about getting people into addiction treatment and naloxone into the hands of those at risk. People are dying, she said, because addiction is misunderstood — even by some health care providers. 

In 2014, only 12 states allowed basic EMS staff to administer naloxone for overdoses. Today, all 50 states have laws that allow for the drug to be administered by anyone, including family members, or in Lovato’s case, friends she was partying with. Likewise, most states have enacted Good Samaritan drug laws, so people will act the way her friends did — decisively. 

Before these laws were in place, Barth said it was not uncommon to hear about people panicking and letting their friends die of an overdose, so as not to incriminate themselves. Laws were such that not only could friends be implicated for being around illicit drugs, but the person who overdosed could also be revived and immediately arrested. 

States, including South Carolina, recognizing the implications of the epidemic, ramped up efforts to stem the rising tide and began enacting plans to increase funding to: 

Educate patients about pain management  Raise awareness of the dangers of opioid use  Prevent and respond to opioid-use disorder  Develop more treatment and recovery options  Reduce the number of fatal opioid overdoses by getting naloxone into the hands of as many as possible  Facilitate access to care instead of incarceration

Still, even though the overwhelming upside of naloxone is widely known, some health care providers drag their heels — not eager to get naloxone into the hands that could potentially save lives.

Some of that hesitation comes from a belief that addiction is not a disease, Barth said. “There is a mindset that people are choosing to use drugs, and we shouldn’t protect them from the consequences of their actions.” 

Another fear, she added, is that naloxone enables continued drug use — if someone knows they can be rescued, they will continue to use drugs. 

Barth works day in and out with this population; is that a scenario she sees? 

“No. There’s a small proportion who have gotten repeated Narcan doses — who come into the ER over and over again and have been reversed multiple times, but that’s certainly not the majority of people. What we do know is most people who misuse opioids have a very high mortality rate. Narcan is very effective at saving their lives, but without treatment or a change in what’s going on, one in 10 of those people will die within the next year.” 

That statistic haunts her. It drives her work. Upward of 80 percent of those in need of opioid addiction treatment don’t have access to treatment options, and still too many don’t have access to naloxone. 

There are currently a lot of initiatives to get Narcan in people’s hands and then into treatment, Barth said. “Treatment works. Experts know it works. But more needs to be done.”

Full-tilt approach

MUSC is coming at the opioid crisis from multiple directions: research, patient care and education. Naloxone features throughout. 

In one program, people with opiate-use disorder coming through the MUSC Health Emergency Department are identified, and if a patient is willing, they are fast-tracked to a specialist and immediately into treatment after the emergency department visit. Those immediate next steps, Barth said, are critical in terms of disrupting the using-overdose cycle. 

Typically, once people recover from overdoses in an emergency room, they might get a list of phone numbers for treatment centers but not much else, she said. If they are inclined to call, it can take weeks to get in. In that time, anything can happen, including another overdose or worse. 

The MUSC Health Emergency Department program is taking a different approach. It has a number of people at the ready to connect with the patients and explain why it’s so important to move to the next step. This team of patient navigators has been inordinately successful in being able to reach these patients; they speak a language these patients understand and trust. The navigators, themselves, have successfully made it out of addiction and to recovery and want to make a difference helping others through their dark times. 

However, if a patient isn’t ready for treatment, Barth said, a Narcan kit is provided, providing the closest thing to a safety net.

Barth is also part of South Carolina’s first comprehensive chronic pain rehabilitation program where pain patients receive physical therapy, psychotherapy and medical management every day to address chronic pain and opioid addiction and eliminate their reliance on medication that resulted from prior treatment. 

During the three weeks, the patients are weaned off their opioid pain medications, and results so far have been encouraging. Barth said patients have been able to reduce their reliance on both opioids and health care professionals and move more toward a model of wellness rather than illness.

“This program is near and dear to my heart,” she said. “We’ve needed a civilized exit plan so we’re not taking people off their pain medications and setting them up for failure. Chronic pain is an enormous and serious medical challenge. We have needed to change the culture of how we treat pain to empower people and give them tools for success. Now we have that.”   

These patients are provided with naloxone. Barth said it’s important for anyone at risk to have the drug close at hand.

Who is at risk? 

Anyone exposed to prescription or illegal opioids should be aware of risk factors that may lead to an accidental life-threatening or deadly opioid overdose. People at higher risk for an opioid overdose include: 

• Those who take prescription opioids, especially those taking higher doses. 
• People taking opioids in combination with alcohol, antidepressants, illicit drugs or sleep medications known as benzodiazepines such as Ativan, Xanax or Valium. 
• Those with certain physiological and biological factors, such as emphysema, asthma, sleep apnea, COPD, heavy smoking, renal and liver issues. 
• Those with mental health conditions such as depression, anxiety and bipolar disorder.
• Anyone who injects opioids, such as heroin or fentanyl.

Barth also pointed out that anyone who has had a reduced tolerance of opioids following abstinence, detoxification, incarceration or hospitalization is at increased risk. An overdose occurs when the body consumes more opioids than can be tolerated, and these factors increase the likelihood of an overdose.

In the weeks after news of Lovato’s overdose broke, fans took to social media with #HowDemiHasHelpedMe to share how her struggles have helped them in their personal battles with addiction, mental illness and body issues. Barth said that’s not only a healthy outlet, but it also brings awareness to a subject that was too stigmatizing to discuss openly. 

Often, when celebrities like Lovato publicly deal with the same types of trials and tribulations as so many millions of other people suffer with privately, it serves to bring much-needed attention to relevant but complex issues like the opioid crisis, Barth explained. It’s not to glorify her situation, but more to serve as a cautionary tale and sound a clarion call to action. The disease of addiction takes the lives of millions of people in all walks of life, she said, and her goal is to see as many saved through these valuable programs as possible.

At the end of “Sober,” Lavato sings: “I’m sorry that I’m here again. I promise I’ll get help.”  Barth, like so many, is pulling for her.