It's a truth addicts and health providers know well: Naloxone can reverse heroin overdoses, but it can't cure the addictions that cause them.
In a small but growing number of places, people who land in hospitals after being revived by the drug are being guided toward long-term treatment. That's largely because decision makers have heard so many stories about people being brought back from the brink - sometimes repeatedly - and then turned loose to use again.
The drug, pronounced nuh-LOX-ohn and often known by the brand name Narcan, is administered via shot or nasal spray and can almost immediately revive a victim of an overdose on heroin and its painkiller relatives, known as opioids. It's widely distributed to anyone likely to encounter an overdose victim, including police, paramedics and users' families.
Billie Fisher, 33, recalled a painful withdrawal a few years back in a Camden emergency room after she was given naloxone. She just wanted to get high again, she said, and it seemed the hospital staff just wanted her out. Before she left, no one even talked to her about getting treatment for her addiction, she said.
"It was like they didn't really care," said Fisher. She acknowledged she is still using heroin and cocaine, but hasn't overdosed since the one time she was given naloxone.
In the past year in Upper Darby, a Philadelphia suburb of 82,000, police administered Narcan 111 times, including a handful of repeat uses on the same people.
"We bring them back, but that day or the next day, they're shooting up again," Police Chief Michael Chitwood said. "It's almost like a revolving door."
People trained to administer naloxone - including police, medics and addicts themselves - are told to get patients to emergency rooms quickly. But that often doesn't happen.
In Vermont, among the states hardest hit by heroin, only about 30 percent of overdose victims given naloxone by people who aren't first responders - in many cases, fellow drug users - are taken to emergency rooms, said Michael Leyden, state deputy director of emergency management.
When police, paramedics and the like give the antidote, he said, patients are much more likely to get medical help afterward. In Vermont and elsewhere, particularly the Northeast where naloxone-distribution programs are well-established, that's when treatment often kicks in:
- A pilot program announced in October in Camden County will provide money for 50 people to go through detox and win spots in a methadone clinic. The hope is that they can get placed in inpatient rehab while getting the shorter-term intervention.
- In Rhode Island, recovering addicts trained as counselors work in emergency rooms to help guide overdose patients into treatment. In its first full year after starting in June 2014, AnchorED worked with 230 people. Only 12 have been back with overdoses, and most have gotten treatment, according to program officials. The program has expanded to a 24/7 operation serving nine of Rhode Island's 11 hospitals.
- Next year, Baltimore plans to open a "stabilization center" to divert people from emergency rooms when they seek attention for overdoses. The center is to have addiction specialists and social workers on staff.
Naloxone works most of the time, but national statistics aren't kept on what happens to people who are revived. Some overdose again soon afterward. Some get treatment and get clean, but limited insurance, high costs and a shortage of spots at treatment centers can be hurdles.
Officials at Boston Medical Center give Narcan kits to patients at high risk of overdoses, including those previously revived by the drug. About 30 percent of the 395 patients who got kits in 2013 and 2014 have had multiple overdoses, officials say.
Advocates for addicts see the war on heroin as complicated and naloxone as an essential tool. After all, it saves lives - if only for a while, when further recovery lies in the patient's hands.
"What's the alternative? Not to revive someone with naloxone?" said Daniel Raymond, policy director for the Harm Reduction Coalition.
At a regular emergency room, a patient might have to wait several hours for such a specialist, said Leana Wen, the Baltimore health commissioner, who has also worked as an emergency room doctor. The city is also rolling out a 24-hour hotline to connect people with treatment programs.
Even with a concerted effort to help people after they have been revived, Wen said, it's a challenge because of the nature of addiction.
"A person who has a heart attack often does have a moment when they realize, 'I need to live my life in a different way,'" Wen said. "The people with addictions have a disease that led them to have an overdose in the first place. The key is to offer that treatment."