Prescriptions for Narcan (opioid reversal): input requested

[hoosierdoc]

Opioid overdoses are becoming more and more common, especially in Indiana. Both heroin and prescription drugs. There's now a few delivery methods of narcan, a reversal agent to block opioid effects for a short time. There is an auto injector like an EpiPen, and a nasal spray atomizer system. Indiana law now allows lay people to administer this drug to people with no medical training if they believe the person is critical from a potential opioid overdose. Many police departments carry this medicine now.

The question is: should docs give this script to abusers and/or family members of abusers. Some argue without training it will cause problems, other claim it will empower abusers to accelerate their use since someone can always rescue them if they use too much.

I ask this because it's being debated in a medical forum I follow. I'm interested in your opinion as members of the public.

 

[SSGSAD]

I am going to say, family members YES, abusers no .....

Do not want to comment further .....

 

[Cameramonkey]

family, yes. Junkie, no.

In that limited scope, its not much different than keeping a fire extinguisher or gun at home for protection from relevant threats.

I wouldnt want to be prevented from keeping a fire extinguisher if my child had a psychiatric condition that made him a pyromaniac. Same thing with this.

But I do see the logic of it becoming a safety net if the junkie gets it, preventing him or her from seeking treatment.

 

[HoughMade]

What are the effects of Narcan when a person is not overdosing?

What is the medical risk/benefit analysis? I'm not great at predicting the future, so whether it may "encourage" a user to use more seems like pure speculation to me and presumes a user who engages in a rational analysis regarding whether to use....which seems fanciful.

I would not prescribe unless I was able to explain the risk/benefit analysis to the potential end user of the product and document informed consent.

 

[jblomenberg16]

What are the effects of Narcan when a person is not overdosing?

What is the medical risk/benefit analysis?

I would not prescribe unless I was able to explain the risk/benefit analysis to the potential end user of the product and document informed consent.

This is the question that I have. We carry Epi pens for our kids, and I always wondered what would happen if I accidentally used one when I didn't need to. Sounds like an Epi pen most likely will have harmless effects (other than a massive adrenaline rush), but not sure what happens with Narcan.

In my opinion, if the side effects of incorrect use are similar to Epinephrine pens, then seems logical to offer prescriptions that allow family members to administer them.

The $64,000 question in my mind is if they are used to treat drug abuse (which often is an illegal act) does this put the doctor and or family in a sticky situation for maintaining common nuisance (person abusing a controlled substance in their place of residence)?

 

[CHCRandy]

No. It is enabling them to continue using.

Can Narcan save people but leave them with permanent brain damage??

 

[SEIndSAM]

What are the side effects if the medication is used before overdose or not needed.

The Cincy and Northern KY Police all carry this with them now. I would have to find the Cincinnati Enquirer article I read (it's probably behind a paywall), but a significant number of people have been save by the Police using this medication.

To answer the question, I believe that the family members of a known abuser should be able to receive a a script for this just by asking (as long as the side effects are not a "high" on their own).

 

[hoosierdoc]

I should clarify that an abuser can be of legally prescribed drugs as well. Three times as many people die from prescription narcotics and than street drugs.

If you're not on narcotics and are given his medicine, it really should not do anything to you. The law provides for the lay person administration of this medicine in specific instances. If it is used incorrectly or maliciously, The criminal justice system can accommodate that.

I agree there needs to be instruction and informed consent. The tricky situation is that you are teaching someone to do something to someone else, who may not have consented to receive the medicine. But I said above, there really is not much potential harm if this is given to the wrong person. The biggest risk would be giving a large dose to a daily methodone user who has quite a dependency built up. Immediate withdrawal of methadone is ugly. Of course it is better than dying, so we still give it to methadone patients in distress due to oversedation.

for some perspective, it used to be illegal to treat patients without examining them or at least a phone call. Now we are allowed to treat partners of patients with STDs without seeing them. This has its own set of risks and difficulties, and many ER doctors will not write that script.

 

[hoosierdoc]

Also something to consider, many addicts have either burned the bridges with family members or are adultson their own and are not living with family. Does a roommate or a significant other count as family?

 

[17 squirrel]

Narcan, It ruins the effect of the Self Cleaning Oven option.

 

[Dirtebiker]

No. It is enabling them to continue using.

Can Narcan save people but leave them with permanent brain damage??

Heroin addicts do not need to be "enabled"!
I have a friend and a family member who both have children that are addicted. If MY child was, I'd want the opportunity to save his life if I found him overdosed.

 

[jd4320t]

I say only for trained professionals and LEO's. If anyone can have it users will just use more.

 

[Dirtebiker]

I say only for trained professionals and LEO's. If anyone can have it users will just use more.

I don't think so. I think addicts either take all they have, or what it takes to get their high. I don't think they consider "I can just keep going until I O.D., them Mom will save me"!

 

[LEaSH]

I'm not sympathetic to the addict. I have known too many.

Those that choose to save them, family or friend, spend your own money on them please.

 

[Denny347]

I carry it, it is a nasal spray. If I administer it and they are NOT over dosing, it will not harm them, there is noting in their system for it to bind to. Why would anyone care WHO has it? If an abuser has it and OD's, they will not be able to administer it to themselves...because they are ODing. They never realize they are ODing, it is someone else with them that does. The argument that this would be a crutch is silly. Addicts do not think like we do, they are typically pissed when they come to because this stuff reverses ALL the effects, ruining their high. I get that addicts create a lot of hardship for the rest of us, but I'll be DAMNED if I'm going to let another human die in front of me if I could do something very simple to prevent that. I know how it feels to have someone die from an OD and see the sorrow it brings. If I can intercede I will and I hope more people will do the same. It is not for me to decided that their life is not worth my time to help.

 

[SMiller]

My concern is the short amount of time in which the narcan works, once it wears off they are back to being overdosed, if they SOR or worse yet don't call a ambulance they are right back where they started.

I find since I do not get paid and am not required to help or administrator help to people who overdose my care factor is very low, for those that are quick to judge unless you have dealt or been around these people don't be quick to judge, they make it damn hard to care after a while.

 

[Denny347]

My concern is the short amount of time in which the narcan works, once it wears off they are back to being overdosed.

It doesn't work that way. It binds until it is expelled by the body.

 

[printcraft]

Sounds like it could devolve from good idea to a tool ripe for abuse.
AKA methadone clinic.
Once a month a flurry of activity for about 1 hour/dozens show up to see the "doctor" for a checkup and script.
FAST checkup as they would go in the door and be outside again in under 5 minutes flat.

 

[OutdoorDad]

As a layperson with no medical training...

Eliminate the distinction between abuser and family member/roommate/significant other.
Either we agree that an individual who is in medical distress should have access to treatment, or not. Who administers the treatment is irrelevant in my opinion.

And an abuser who overdoses is unlikely to self administer. So regardless of who has the prescription, another individual is most likely going to make the life or death decision.

Although there are many who would say "let them die", I'm not in that camp.

"Death by overdose" isn't the kind of social strategy I can get behind to address this problem. It reeks to closely to the out of touch hubris of "let them eat cake".

I suspect that quality control and unknown potency is a greater contributor to overdose than those trying to maximize a high by walking the knife edge between buzz and death. In short, I suspect that the vast majority of overdoses are accidental. And I don't think the availability of an antidote enables. Addiction is far more complicated than that.

If it were that simple, no one would smoke. Haven't you heard? It can kill you?!?

I have a glucose pen or two stashed around. I had to get a prescription for it. My wife is diabetic. I think I got "trained" on it at some point when I was written a prescription. Frankly, I'll read the instructions if I ever need to use it.

And I believe that considering the negligible downside, both the narcotic pen and the glucose pen should be available without a prescription to whomever cares to purchase them. A user/diabetic or family/friend/concerned citizen.


You didn't ask about public funding. So I'll keep those thoughts to myself.

 

[Denny347]

There are some cold people here...cold. And this from a hardened cynic.