Editor's note: This is the first in an occasional series about the battle against heroin use.

By CHRIS PARKERcparker@tnonline.comCarbon County coroner Bruce Nalesnik has seen his share of lives cut short by overdoses of heroin and other opiates. And that share is looming large as more people become mired in addiction."I've been a coroner for 19 years now, and it's easily quintupled from when I first came into office," he said of drug overdoses."Here in Pennsylvania, overdose deaths have increased 473 percent since 1990. Between 2009 and 2013, county coroners identified almost 3,000 heroin-related overdose deaths. Nationally, more people are dying from heroin overdoses than car crashes," Gary Tennis, secretary of the state's Department of Drug and Alcohol Programs, said at a public hearing in August.The numbers continue to rise as addiction to heroin and other opioids engulfs the nation. Pennsylvania is seventh in the nation for drug-related overdose deaths, according to the U.S. Centers for Disease Control and Prevention.Now the state is making a drug that reverses the effects of opioid overdoses more widely available. Naloxone, commonly known by its brand name, Narcan, can be administered through the nose or by injection, and takes just moments to reverse opiate effects.Gov. Tom Corbett on Tuesday signed the bill into law, making Pennsylvania the latest of 17 states to distribute naloxone. The law allows police and firefighters to administer naloxone, and allows it to be prescribed to addicts' family members or others who are likely to need to administer it. Now, only medical professionals, including emergency medical technicians, can administer the drug.The law also exempts those who call to report an overdose from being charged, but only if that person stays with the victim and gives his or her name to emergency responders.On the front linesTamaqua Police Chief Rick Weaver spoke at an opioid addictions hearing in August."We have first aid kits in our vehicles. We have AEDs in our vehicles. We have fire extinguishers in our vehicles. Why do we have all those things? To save lives. Why wouldn't we have Narcan? Why don't we have Narcan now?" he said.Police often arrive at an overdose scene before the ambulance, he said."We find them, lying on the floor, lying on the bed ... if we were to administer Narcan, we could save a life," he said.Weaver also supports addicts' friends and family members having naloxone on hand."If they could give them Narcan before we got there, they could potentially save their son or daughter's life," he said.Lansford Fire Company No. 1 Chief Joseph Greco also believes it would be good to allow firefighters to administer naloxone, but said that to qualify, the volunteers would need training."It's definitely a good life-saving tool," he says. "It's probably something we could explore."Lehighton Ambulance Association administers Narcan about three times a month, Administrative Coordinator Joni Gestl said.Paramedics give the drug when a patient exhibits altered levels of consciousness, accompanied by indications that include decreased respiration, pinpoint pupils, the presence of drug paraphernalia, or track marks on the skin.The dose, whether injected or given by nasal spray, depending on the patient, is carefully titrated given starting with the least amount to restore normal breathing.Paramedics must act quickly: a patient whose breathing is suppressed because of a heroin overdose can suffer brain damage or die within minutes. While Gestl appreciates that Narcan can save lives, she's cautious about people seeing it as a simple solution. If police are allowed to administer the drug, she said, they will need training and medical direction.For example, if the patient is an addict and is given a full dose of Narcan, "you've just put them into acute withdrawal," she said. "When you use the nasal spray, you're more likely to be giving them a full dose, and that causes abrupt withdrawal."The patient may vomit, and his airway can be compromised. The person giving the Narcan also must be ready to handle the effect of any other drug that may be in the patient's system."That's why you need medical direction," she said.The cost of the drug is included in the ambulance service bill; it is not billed separately.Denise Doremus, operations coordinator for Pocono Mountain Regional Emergency Medical Services, said her organization responds to about 65 overdose cases a year. Since September 2013, EMTs have administered about 55 doses of naloxone."It can be a lifesaver," she said.A double-edged sword?While Greco, Gestl and Nalesnik agree that naloxone can be a lifesaver, they also worry that it could evaporate motivation to quit."There is more to the problem than just throwing Narcan out there. We need to help these people get out of a really bad habit. Narcan is going to save lives, but we have more work to do," Gestl said.She's in favor of making rehabilitation and treatment mandatory for overdose patients."I don't know that we're helping them to get better by administering Narcan and then letting them walk away. Because they are just going to re-use," she said.Nalesnik has similar concerns."If it can save lives, it's a good thing. The question is, are you encouraging widespread abuse?" he said. "Narcan may be a double-edged sword, but saving a life may outweigh the detriments."Schuylkill County coroner David Moylan wants to make sure anyone who administers naloxone knows how to do it and what may happen."If someone has a lot of heroin on board, Narcan can wear off and they can slip back into a coma. You have to be careful about inducing withdrawal in an addict. I wouldn't want the general public to be using it without adequate training," he said.State Rep. Jerry Knowles, R-124 supported legislation, but said, "I'm concerned that if a heroin addict knows Narcan is available through a family member or friend, this might encourage them to use heroin without fear of any consequences. We also need to remember that there's no guarantee Narcan works each and every time."Training is crucial, said Schuylkill County Chief Detective Dolly Malec, who favors police carrying the drug. She spoke at the August hearing."This is very important, because as a police officer, if you can get there first and use Narcan, you can save lives. I've seen Narcan in action. It brings them out of it like that. What you get is a very angry person screaming at you. 'Do you know how much I just paid for that heroin? Do you know you just took my high away from me?'" she said. "And they want to punch you in the face."