Narcan the new AED?

[PAFSI]

Should Narcan be as readily available as the AED? http://www.jems.com/article/news/fda-hold-hearing-naxolone-use

 

[ChorusD]

This is like treating the symptom and not the cause. Making Naloxone more available doesn't actually reduce the number of overdoses, it only gives people the perception of a safety net, sort of a get out of jail free card for abusing opiates. In turn it would probably increase the actual number of overdoses.

Aside from that, I know of a few medics who don't know the limitations of Narcan so how can we expect people without any formal training in pharmacology to know the limitations. It is possible that a false sense of security will be created that delays actual treatment for overdoses on drugs other than opiates.

Having said all that, there is such a thing as an accidental overdose with people who are not actually drug abusers. It happens. Maybe the FDA should consider giving prescribing physicians the option of prescribing Naloxone in conjunction with narcotics for use "in case of emergency" somewhat like Epi auto injectors.

 

[Urbanems]

This is like treating the symptom and not the cause. Making Naloxone more available doesn't actually reduce the number of overdoses, it only gives people the perception of a safety net, sort of a get out of jail free card for abusing opiates. In turn it would probably increase the actual number of overdoses.

Aside from that, I know of a few medics who don't know the limitations of Narcan so how can we expect people without any formal training in pharmacology to know the limitations. It is possible that a false sense of security will be created that delays actual treatment for overdoses on drugs other than opiates.

Having said all that, there is such a thing as an accidental overdose with people who are not actually drug abusers. It happens. Maybe the FDA should consider giving prescribing physicians the option of prescribing Naloxone in conjunction with narcotics for use "in case of emergency" somewhat like Epi auto injectors.

That last idea might be a little difficult... if they really overdosed on an narcotic, they would probably be altered, and couldn't give themselves the narcan. If they weren't to that point thought, it could be useful.

 

[adamjh3]

That last idea might be a little difficult... if they really overdosed on an narcotic, they would probably be altered, and couldn't give themselves the narcan. If they weren't to that point thought, it could be useful.

Our if they have a family member that's halfway in the loop it could help

 

[mycrofft]

Naloxone is not harmless, is a drug. It does not act as a safety net and narcotic addicts will not view it as such. Management of a drug (temperature, outdates, presence/absence, medically recording use) is vary complicated outside the clinical or EMS provider setting.
Answer: no.

 

[Aidey]

There are auto injectors of narcan but I don't think they are approved in the US. In some places in the US and Canada narcan is passed out with clean needles, I believe it is usually pre packaged with a MAD attached.

 

[bigbaldguy]

I've had to call EMS to meet the aircraft on landing twice and call them at the gate once in the last 2 years for passengers who downed massive doses of hydro (and assorted benzos) before getting on the plane. It's getting pretty bad. They get wheeled to the plane in a wheelchair get poured into a seat then proceed to cause mass panic when they look like they've stopped breathing and no one can wake them up. Never had one actually reach the point where I'd be willing to give it though. On one occasion I think the only thing that kept one guy breathing was my sheer mental energy as I sat there and stared at him and thought over and over "Don't you stop breathing you SOB don't you do it cuz I don't wanna do the paperwork on a death in flight and we're already 2 hours late" for the last 20 minutes of the flight.

 

[DrankTheKoolaid]

re

Why don't they just simply make BVM's readily available instead. I don't particularly want to wake them up anyways. Provide ventilatory support while EMS is enroute. Narcan should not be used as a crutch because what I see happening is the Narcan being given and the patient regaining consciousness and an increased resp drive and professional help not being activated. Whoever found them thinks oh hey, johnny the future Darwin award winner is OK so I can leave now. Only to have the Narcan wear off before the narcotic and have the patient right back where they were before the Narcan was administered

 

[Arovetli]

JEMS predictably strikes again with poor reporting.

Read these.

http://www.ncbi.nlm.nih.gov/pubmed/21612385
http://www.ncbi.nlm.nih.gov/pubmed/10424852
http://www.ncbi.nlm.nih.gov/pubmed/16183444
http://opinionator.blogs.nytimes.com/2011/09/27/drugs-risk-and-the-myth-of-the-evil-addict/
http://healthland.time.com/2012/04/...-making-an-overdose-antidote-nonprescription/
http://articles.philly.com/2012-04-...iption-drug-overdoses-exchange-dirty-syringes

 

[mycrofft]

I re-read the JEMS article. It will prevent OD's...not. Their reasoning is tautologically seductive.

Article fails to note the rise is due to prescriptive practices, people keeping leftover pain meds, sales of diverted/stolen/counterfeit Rx painkillers (always loved that word). Not much use when they're foaming and agonally breathing, but, what the hey...

Does it really have to be titrated so closely if the pt is bound for the hospital? Maybe it can join Glucagon....naw.

 

[Fox800]

Why don't they just simply make BVM's readily available instead. I don't particularly want to wake them up anyways. Provide ventilatory support while EMS is enroute. Narcan should not be used as a crutch because what I see happening is the Narcan being given and the patient regaining consciousness and an increased resp drive and professional help not being activated. Whoever found them thinks oh hey, johnny the future Darwin award winner is OK so I can leave now. Only to have the Narcan wear off before the narcotic and have the patient right back where they were before the Narcan was administered

:beerchug:

Narcan is not a benign medication. I drill this into my students' heads. A lot of them underestimate the likelihood and consequences of withdrawals symptoms, seizures, vomiting and potential airway issues associated with that, combativeness, etc. They see naloxone as this harmless wonder drug for any and all overdoses.

Heck we don't even give naloxone unless the patient has respiratory depression. If they're zonked out but breathing fine we leave them be.

 

[mycrofft]

"Why don't they just simply make BVM's readily available instead?"

BVM's are not benign either, especially without an airway seaing off the trachea from the esophagus.



Sorta reminds me of a doc who ordered us to give Ampicillin to a pt who said she was allergic to PCN. Head nurse said "Do it, we have epi and benadryl". (Yeah right).

 

[DrankTheKoolaid]

"Why don't they just simply make BVM's readily available instead?"

BVM's are not benign either, especially without an airway seaing off the trachea from the esophagus.



Sorta reminds me of a doc who ordered us to give Ampicillin to a pt who said she was allergic to PCN. Head nurse said "Do it, we have epi and benadryl". (Yeah right).

That is also true. But why give non ALS folks medications when non ALS interventions that work quite well already

 

[mycrofft]

See my reply higher up.
Pun unintended.
If you have heroin or oxy addicted friends, take my CPR class.

 

[Cup of Joe]

If you want to make a drug more widely available, I think the education about that drug needs to come with it.

In NY, any agency cannot just decide to carry epi auto injectors. I know of agencies who do not carry them. The process is pretty simple: all the personnel need to be trained in their use, it needs to be approved by the agency medical director, etc.

Now, if we wanted to add naloxone to all ambulances, I think we need something similar, and it needs to be focused on not only the drug itself and the pretty straight-forward administration, but identifying its indications, contraindications, and its effects on the patient.

 

[medicdan]

If you want to make a drug more widely available, I think the education about that drug needs to come with it.

In NY, any agency cannot just decide to carry epi auto injectors. I know of agencies who do not carry them. The process is pretty simple: all the personnel need to be trained in their use, it needs to be approved by the agency medical director, etc.

Now, if we wanted to add naloxone to all ambulances, I think we need something similar, and it needs to be focused on not only the drug itself and the pretty straight-forward administration, but identifying its indications, contraindications, and its effects on the patient.

Absolutely agree. I don't think there's disagreement that all personnel who would be administering the medication need to be well trained in the use. No question.

I think the question is whether we are treating only the symptoms, and not the underlying causes.

 

[Cup of Joe]

I think the question is whether we are treating only the symptoms, and not the underlying causes.

And what I think is making Narcan more widely available is only part of the solution. It may save lives, but are we only putting off the consequences of that person's drug use by using it.

My opinion is that if Narcan is used, there needs to be a way to follow up with that patient: maybe something like a psych hold, that can allow the underlying issues to be identified.