Narcan can now be administered by everyone in Ca.

mycrofft said:
Asking the question supplies the answer. "Do no (further) harm".
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Well, considering there is nothing more "harmful" than severe respiratory depression, and also considering that narcan is a relatively safe drug (especially when compared to the risks associated with not breathing) I'd say giving narcan to someone who needs it is never going to be "doing more harm". Rare complications aside, of course.

For some reason, people in the EMS community love to drone on about how ridiculously dangerous narcan is. I think part of the bad attitude towards narcan comes from a machismo that would rather intubate than simply push a med that instantly fixes the problem (if I had a buck for every time I heard a paramedic say something to the effect of "Narcan? Pfft. I just tube 'em all", I'd be rich), part of it comes from ED doctors and medical directors who don't like it because they give too much of it and then have to deal with the violence and hypertensive crises that sometimes follow, and part of it comes from simply not being experienced with the drug.

"But what about people who give it and don't call 911 and then the patient re-sedates!?!" So what? Would that patient have been better off if the narcan had never been given? Don't forget that these people often don't call 911 anyway....

I'm no authority on heroin and I'm sure the effects vary considerably depending on purity, what it's cut with, etc. But I have read that it's duration is generally shorter than that of morphine. Morphine's respiratory depressant effects from a single bolus generally peak at about 30-40 minutes and then begin to taper off at 60-75 minutes....compare that to the duration of action of narcan, which is 1-4 hours. Even at the low end (1 hour), it is unlikely that a dose of narcan given at the onset of respiratory depression will lose effect sooner than the resp depressant effects of morphine. And heroin doesn't even last as long as morphine. An OD of one of the oral opioids? Yeah, that is different. But does the fact that some people might not be helped by narcan mean that no one should have it?

If there is some compelling evidence that narcan does more harm than good, then yeah, it probably shouldn't be out there. But I don't think that is the case. The few trials involving layperson/police/EMT narcan administration that I've heard about were all considered successful.

I remember hearing the same doom-and-gloom when epi autoinjectors and even AED's were introduced. "The lay-public will never get this right. They'll kill each other left and right".
 
Good points,Halothane

Well, considering there is nothing more "harmful" than severe respiratory depression, and also considering that narcan is a relatively safe drug (especially when compared to the risks associated with not breathing) I'd say giving narcan to someone who needs it is never going to be "doing more harm". Rare complications aside, of course.
There's the money shot.

For some reason, people in the EMS community love to drone on about how ridiculously dangerous narcan is. I think part of the bad attitude towards narcan comes from a machismo that would rather intubate than simply push a med that instantly fixes the problem (if I had a buck for every time I heard a paramedic say something to the effect of "Narcan? Pfft. I just tube 'em all", I'd be rich), part of it comes from ED doctors and medical directors who don't like it because they give too much of it and then have to deal with the violence and hypertensive crises that sometimes follow, and part of it comes from simply not being experienced with the drug.

I've not heard droning about the dangerous Naloxone, and oddly we used to see a BP DROP during heroin detox done with benedryl, antispasmodics, and acetaminophen. My concern about Naloxone is when it is given in a wrong dose, and when it is given in lieu of definitive treatment. Or for home detox as the ad asked, which is abuse. Bad precedent.

"But what about people who give it and don't call 911 and then the patient re-sedates!?!" So what? Would that patient have been better off if the narcan had never been given? Don't forget that these people often don't call 911 anyway….

This patient is dying primarily due to overdose, but secondarily to inadequate treatment as mandated by the person who sent out the Naloxone. A protocol is implied, a "panacea dose" is distributed, and then they walk off with their hands in their pockets claiming victory.

I'm no authority on heroin and I'm sure the effects vary considerably depending on purity, what it's cut with, etc. But I have read that it's duration is generally shorter than that of morphine. Morphine's respiratory depressant effects from a single bolus generally peak at about 30-40 minutes and then begin to taper off at 60-75 minutes....compare that to the duration of action of narcan, which is 1-4 hours. Even at the low end (1 hour), it is unlikely that a dose of narcan given at the onset of respiratory depression will lose effect sooner than the resp depressant effects of morphine. And heroin doesn't even last as long as morphine. An OD of one of the oral opioids? Yeah, that is different. But does the fact that some people might not be helped by narcan mean that no one should have it? (emphasis by mycrofft).
The most telling argument in favor. As to length of the drug's activity, every systemic drug except when given via IV has a bell curved onset and fade. But it seems Narcan could outlast the acute respiratory impairment stage of an overdose.

If there is some compelling evidence that narcan does more harm than good, then yeah, it probably shouldn't be out there. But I don't think that is the case. The few trials involving layperson/police/EMT narcan administration that I've heard about were all considered successful. The graphic in the Connecticut study supporting their legislation implies that distribution of narcan didn't really affect the curve of drug od's.

I remember hearing the same doom-and-gloom when epi autoinjectors and even AED's were introduced. "The lay-public will never get this right. They'll kill each other left and right". I remember that too…when AED's had override buttons. And who knows how many iatrogenic cases have been triggered by epipen use? I DO know of at least one case where definitive care was delayed after epi was given…by the pt's MD father!

OK than. Let's do it but have a mandatory scientific study of the results after three to five years later.

I am still opposed generically to setting up drug administration by persons without the background to do it responsibly, though, and this is a step that way and yes that includes EMT-B's.

See next reply. It is pro-narcan program.
 
Here's Connecticut's program.

Connecticut State Mental Health and Addiction Services p[rogram's Naloxone rescue kit plan in PDF (like a power point)

http://www.ct.gov/dmhas/lib/dmhas/presentations/Naloxone.pdf

Connecticut loses more adults to opiate overdose than MVA, fire and firearms combined.
 
Whilst I agree that having narcan on hand for Layperson(s) may save lives. It may just prolong the OD till they die later.

You have to think like a user to rationalize the point.
If were all at a drug house shooting heroin into our veins one person OD's. So bust out the Narcan Kit and hit them with it. If we call 911 that means cops Fire or EMS is going to come. Now were marked... They know we use, and now they know where we live, and so on such forth.

I actually had a girl once dump her boyfriend off at a street corner because he OD'd in her car. She called his parents and said oh he Overdosed on Heroin while I was taking him home, so I dropped him on a street corner and left. I don't want to get caught into a mess with the cops cause they'll know I'm a user then.

What a girlfriend, leaves her man on the street corner to die, since her drug habit was more important..
 
ironically NYS actually does allow us to use it at the basic level.....maybe they got one thing right lol ;(
 
unleashedfury said:
I actually had a girl once dump her boyfriend off at a street corner because he OD'd in her car. She called his parents and said oh he Overdosed on Heroin while I was taking him home, so I dropped him on a street corner and left. I don't want to get caught into a mess with the cops cause they'll know I'm a user then.

What a girlfriend, leaves her man on the street corner to die, since her drug habit was more important..
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The fact that junkies don't like to call 911 is all the more reason why they should have narcan.....maybe if she had it she could have given him an IM injection and he would have been fine.

If I'm not mistaken, most opioid OD's are actually from the time-release oral analgesics, (Oxycontin, MS-Contin, etc.). Narcan likely won't help much in these cases, but it might still help in a few.

Is narcan going to save the day every time? Of course not. Does that mean it should never be used?
 
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unleashedfury said:
What a girlfriend, leaves her man on the street corner to die, since her drug habit was more important..
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For a real junkie, there is the need to fix, and then way down below there is everything else. Boyfriends aren't even close most of the time.
 
dixie_flatline said:
For a real junkie, there is the need to fix, and then way down below there is everything else. Boyfriends aren't even close most of the time.
Click to expand...

Sometimes, in heroin veritas. But usually just self-serving bull shirt.

1. Most ODs don't occur in an archetypical "shooting gallery", they occur where the user won't be disturbed and maybe with a cohort or two. If polypharmacy is involved (speedballing for example), maybe a party. But the same dynamic ensues. One way to clean a party out of junkies (and honor students) it to spread the word someone OD's and that 911's been called. Rats off a ship…..

2. Methadone, prescriptions for detox drugs to be used by a patient at home (kid you not!!!), clean syringes, all are found in the hands of people they weren't given to because the recipients sold them for drugs. I see Naloxone being used the same way.

BIG question: since cold turkey heroin detox in utero is frequently fatal to the fetus, what happens when the addicted mom gets a slam of Naloxone? Any references or citations? Experiences?


A small question: how many people on this forum are or have been addicted at some time? Statistically, the answer is "yes".:mellow:
 
Naloxone and pregnancy…AND I QUOTE...

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Opioid_Abuse_Dependence_and_Addiction_in_Pregnancy

GOOD article about addiction and pregnancy.

" The use of an antagonist, such as naloxone, to diagnose opioid dependence in pregnant women is contraindicated because induced withdrawal may precipitate preterm labor or fetal distress (13). Naloxone should be used only in the case of maternal overdose to save the woman’s life." (accents by Mycrofft).

So it is a balancing act. If you are sure the mother is dying, then save the mother, but the fetus may abort or die.
How many addicted women may try this as an abortificant? (Don't smirk. I've seen insulin overdose tried, with methamphetamine administration as their correction for insulin coma. Didn't work out so well).
 
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