Prescriptions for Narcan (opioid reversal): input requested

[Bill of Rights]

Quote Originally Posted by 17 squirrel View Post
Yep, A great thing to bring to a neighborhood. Or to be the owner of a company and find out a couple of your service trucks roll through a Clinic six mornings a week, And yet no one fails a company drug test.

Bill of Rights,
They'll still test positive, I believe. This isn't like a sponge that soaks it all up and eliminates it, it's more like putting the wrong key in a lock. Not only will the lock not open, but you can't put the right key in until the wrong one is removed.





Yes , I realize that they will test positive, but the only people that will know that is the drug testing facility. but what most people don't know is when you go to the clinic ( doctor ) and you are prescribed drugs and you are required to take a drug test at work or for acquiring new employment the drug testee simply informes the drug testing facility that they are on a prescription to these certain drugs. And poof their test comes up clean and the employer has no knowledge that he has employees that roll through the Methodone clinic 6 mornings a week. Or over medicating on a prescription from the pain management doctor.
Other than seeing obvious drug abuse, the employer generally has no idea that they are employing people on opiate's and other narcotics.

The lab/clinic results I've seen show a positive result for opiods, barbituates, etc, specifically, if those are present, but maybe not all labs do that.

And the employer has no idea that they are employing people who may go home and get blackout drunk on Friday or Saturday night, either. As long as they are not impaired while working, and as long as their work is not otherwise affected, I'm not seeing the issue.

 

[jsharmon7]

Allow me to pick your brain, BoR:

My department had not given us NarCan, however we assist medics on ODs regularly. Many times the person snaps back to life and then says "I'm fine" when medics tell them they need to be transported. Usually I tell them tough cookies and lay down on the cot, but I'd like to have a little better explanation. What you're saying is the half-life of an opioid could be longer than that of NarCan. So the effects of the substance they took could return in the next couple of hours and they would need medical attention again? Also, NarCan could cause immediate withdrawal symptoms which could lead to aspiration? This would be handy information to present if I'm understanding you correctly.

 

[17 squirrel]

The lab/clinic results I've seen show a positive result for opiods, barbituates, etc, specifically, if those are present, but maybe not all labs do that.

And the employer has no idea that they are employing people who may go home and get blackout drunk on Friday or Saturday night, either. As long as they are not impaired while working, and as long as their work is not otherwise affected, I'm not seeing the issue.

As a employer I have seen that also, the difference is they had no prescription to cover for the drug use. And they were terminated.
So with what I read, you are good with having people / employees that stopped at the meth clinic or chew up some oxy's in the parking lot, and are now driving their own vehicle or a company owned vehicles under the influence of narcotics.. Not me... I have no tolerance for that behavior.. None...
As a citizen or employer I could care less what lifestyle they live at home.
But they need to pass the test that they agreed too when hired.
I only care about them being sound and not under the influence when they are on the company clock, or driving / operating company owned equipment.
I'm not big on going " oh ***, " man I wish I should have done something about that..

People that stop at the Meth Clinic are certainly under the influence when they leave the clinic, after consuming 30 to what ? 150 m of Methodone in one swift waffer, are good to go until the next morning.

 

[Denny347]

You must spread some Reputation around before giving it to IndyDave1776 again.

Darn it I tried to hit him for you but I gotta spread it around as well...

 

[Denny347]

Sorry, Denny, this is false information. Narcan has a shorter half-life than many of the drugs it reverses, meaning the person may deteriorate between time of administration and further care... or lack thereof, since they may not seek that further care with this at home. I'm sure you've given this and know what you've seen... I don't dispute that. I wonder how long you've been with people who have not gotten other care, after you give it. (For those who don't know, the half-life is the amount of time it takes for half of the dose given to metabolize, meaning that if you give 2mg of Narcan, how long does it take for there to be only 1mg left in the person's body. In the case of Narcan, that's 64 minutes, plus or minus 12 or so, meaning that if you're not with them as little as ~45 minutes later, you might not see them when it wears off and they need another dose... and it's going to take roughly an hour and a half, minimum, for the amount to degrade down to 0.5mg. An overdose can be mitigated with as little as 0.4mg in an adult.)

You mean my 10 minute training was unclear We would never be in a position to administer it without EMS already on the way so I can understand my misunderstanding. As always, thank you for sharing. I defer to your expertise.

 

[Denny347]

Allow me to pick your brain, BoR:

My department had not given us NarCan, however we assist medics on ODs regularly. Many times the person snaps back to life and then says "I'm fine" when medics tell them they need to be transported. Usually I tell them tough cookies and lay down on the cot, but I'd like to have a little better explanation. What you're saying is the half-life of an opioid could be longer than that of NarCan. So the effects of the substance they took could return in the next couple of hours and they would need medical attention again? Also, NarCan could cause immediate withdrawal symptoms which could lead to aspiration? This would be handy information to present if I'm understanding you correctly.

Yup, if they refuse to go to the hospital with the EMS, we have the option of IDing them to force them to based on this knowledge.

 

[jsharmon7]

Yup, if they refuse to go to the hospital with the EMS, we have the option of IDing them to force them to based on this knowledge.

Yeah, we were told to ID as well, just weren't given this information. I'd rather they go peacefully instead of having to handcuff them to a cot, so this is handy info. Most people respond better when I can give them an explanation as to why they need to do something.

 

[Bill of Rights]

Allow me to pick your brain, BoR:

My department had not given us NarCan, however we assist medics on ODs regularly. Many times the person snaps back to life and then says "I'm fine" when medics tell them they need to be transported. Usually I tell them tough cookies and lay down on the cot, but I'd like to have a little better explanation. What you're saying is the half-life of an opioid could be longer than that of NarCan. So the effects of the substance they took could return in the next couple of hours and they would need medical attention again? Also, NarCan could cause immediate withdrawal symptoms which could lead to aspiration? This would be handy information to present if I'm understanding you correctly.

You understand correctly. From a quick google, heroin has a quick onset (minutes) a peak of about 2 hrs, and a duration of maybe 3-5 hrs. Morphine is similar, as are most opiates. I posted upthread the half-life of Narcan, about an hour and a half, minimum, for it to get down to the low end of dosage to reverse a narcotic. And yes, if they're opiate-dependent, hitting them with a dose of Narcan can knock ALL of the opiates off the receptors, which translates to instant withdrawal and often, projectile vomiting. If, just to throw out a hypothetical, they're using multiple meds (because no one would EVER misuse drugs, right?) for example, narcs and benzos (like valium or xanax) or alcohol, they might be yakking their guts out, but not be fully able to protect that airway. Aspiration pneumonia would result, and the substance aspirated would likely be exceedingly acidic. To say that, untreated, this could be deadly is not an understatement.

As a employer I have seen that also, the difference is they had no prescription to cover for the drug use. And they were terminated.
So with what I read, you are good with having people / employees that stopped at the meth clinic or chew up some oxy's in the parking lot, and are now driving their own vehicle or a company owned vehicles under the influence of narcotics.. Not me... I have no tolerance for that behavior.. None...
As a citizen or employer I could care less what lifestyle they live at home.
But they need to pass the test that they agreed too when hired.
I only care about them being sound and not under the influence when they are on the company clock, or driving / operating company owned equipment.
I'm not big on going " oh ***, " man I wish I should have done something about that..

People that stop at the Meth Clinic are certainly under the influence when they leave the clinic, after consuming 30 to what ? 150 m of Methodone in one swift waffer, are good to go until the next morning.

I did say that if it was not impairing them, I didn't see the issue. If it IS impairing them, and that would include driving to and/or from, or driving on the clock, whether in a company vehicle or not, then no, that's not OK. The law addresses certain things, such as OWI. You as an employer are free to have standards more restrictive than the law, such as a pilot being told he cannot have alcohol at all within what, 12 hrs of flying? Alcohol is clearly legal to use, but his employer forbids it within that window. He has the choice to work for that employer or not. (and yes, I know FAA standards come into this, but at the moment, I'm intentionally not figuring them in, for purpose of this example.)

You mean my 10 minute training was unclear We would never be in a position to administer it without EMS already on the way so I can understand my misunderstanding. As always, thank you for sharing. I defer to your expertise.

And that is the crux of the problem. You got handed a syringe with a foam tip, got shown how to squirt it up someone's nose, and maybe got warned they wouldn't like it. That's a problem. You needed more info. I'm sorry your department didn't give it to you. I hope my post helps.

Yup, if they refuse to go to the hospital with the EMS, we have the option of IDing them to force them to based on this knowledge.

For those who don't know, his use of "ID" here means "involuntarily detained" or involuntary detention, not identification.

Blessings,
Bill

 

[AA&E]

None of what you described is relevant to this. There is a big deference in someone living their life unhealthy and being a scumbag addict.

You're right. The cost to society of people living an unhealthy life is exponentially higher.

I agree with Ghuns. My healthcare and insurance costs me a ridiculous amount because of the poor lifestyles and life choices of others. And now, I am forced into a healthcare/insurance system to assist paying for their poor choices? To hell with that. Next step in this socialistic utopia is forced concentration camps where we make these lazy bastards turn themselves around.

 

[Scuba591]

Why does there have to be a program? Why can the .gov not simply get the f**k out of the way and let us make our own decision on spending or not spending depending upon our own personal belief in the potential effectiveness? I don't need a .gov program to supply me a fire extinguisher. I don't need a program to supply me with a gun for personal protection.

Cost vs benefit ratio analysis is used in the private sector as well. Still, I am just looking at this through my colored vision of experience. I do not have another answer to give. I already give the stuff when needed.

 

[SMiller]

Allow me to pick your brain, BoR:

My department had not given us NarCan, however we assist medics on ODs regularly. Many times the person snaps back to life and then says "I'm fine" when medics tell them they need to be transported. Usually I tell them tough cookies and lay down on the cot, but I'd like to have a little better explanation. What you're saying is the half-life of an opioid could be longer than that of NarCan. So the effects of the substance they took could return in the next couple of hours and they would need medical attention again? Also, NarCan could cause immediate withdrawal symptoms which could lead to aspiration? This would be handy information to present if I'm understanding you correctly.

There is even more to it then that, I am not sure that LEO/EMS can release the person once they have given Narcan (EMS will give it via IV unless all the veins are blown out), but the kicker is not only does it wear off but once given can cause cardiac arrest and other issues, once they have been given Narcan they are going for the ride any way you look at it.


IF I was LEO and carried Narcan you can BET I would spend the time to understand everything it does and does not do.

 

[hoosierdoc]

Good info BillofRights, SMiller, and others
i'll add that intransal narcan doesn't tend to do the violent disoriented wake ups like the IV route does.

oral naltrexone (Similar but different med) can last several days and block the action longer. This law states you must call 911 immediately before or after using the narcan to summon medical help. That's for the reason BoR mentioned about it lasting shorter than heroin, Hydrocodone, methadone, basically everything else. We watch people at least 90 minutes (two narcan half-lifes) before discharge if they needed it to wake up.

also, you never know if it was a mixed ingestion or if it's not an ingestion at all. If you are giving narcan, call 911, stat.

 

[historian]

The only problem I, as someone with only first aid training have, is the fact that we can't send addicts to rehab and force them to clean up.

It makes me sad that we have to have Narcan and clean needle exchanges, but we can't force the people who are getting this treatment to get clean. I like second chances, I dislike treating symptoms and not the root cause.

 

[hoosierdoc]

You can't push a rope. If someone doesn't want help, you can't make them

 

[HoughMade]

The only problem I, as someone with only first aid training have, is the fact that we can't send addicts to rehab and force them to clean up.

It makes me sad that we have to have Narcan and clean needle exchanges, but we can't force the people who are getting this treatment to get clean. I like second chances, I dislike treating symptoms and not the root cause.

Agreed, but in my book, being alive so that there is a chance​ of turning around beats not being alive and "0" chance.

 

[historian]

Agreed, but in my book, being alive so that there is a chance​ of turning around beets not being alive and "0" chance.

You can't push a rope. If someone doesn't want help, you can't make them

I know. I was just being fruatrated. I worked with various drug-free organization for many years, but people don't want help.

We need to better fund those who want help.

 

[Hoosierkav]

Yeah, we were told to ID as well, just weren't given this information. I'd rather they go peacefully instead of having to handcuff them to a cot, so this is handy info. Most people respond better when I can give them an explanation as to why they need to do something.

Of course, though, EMS has this handy dandy tool called a BVM and oral/nasal airways and other assorted airway devices that can be used to solve the problem of the respiratory depression, which is the point of giving the Narcan. Saving the patient's life includes not breaking something that isn't broke.

If he is still unconscious, there's no need to ID him

All that said, perhaps the better question is why should we not have a process to prescribe Narcan to lay people? Regardless of what is being done at the PD/BLS level; Boston has had a long-time lay Narcan program, which reported good success; I would be interested to know about the data collection--simply because the medication was administered doesn't mean it was indicated (and what was the effect?) (and that goes for all programs).

 

[SMiller]

I know. I was just being fruatrated. I worked with various drug-free organization for many years, but people don't want help.

We need to better fund those who want help.

I thought the 80k program they go though in prison that WE have to pay for was enough...

Did I mention it drops 6 years off their sentence for completing the course that WE pay the $80,000 for?!?

Did I mention that everyone who goes to prison claims they are drug users and need help as they know how to work the system and get their sentence reduced, hell get a GED and some college education while they are at it, its worth 7 year reduction and free as well...

 

[IndyDave1776]

I thought the 80k program they go though in prison that WE have to pay for was enough...

Did I mention it drops 6 years off their sentence for completing the course that WE pay the $80,000 for?!?

Did I mention that everyone who goes to prison claims they are drug users and need help as they know how to work the system and get their sentence reduced, hell get a GED and some college education while they are at it, its worth 7 year reduction and free as well...

Unfortunately, most all 'programs' are about money, not results. This goes for the court-ordered 'rehab' on the outside as well as most anything offered to inmates in prison. You will also notice that preventing recidivism is not part of the program as that would cut into the money way too much to be acceptable.

 

[Fargo]

I thought the 80k program they go though in prison that WE have to pay for was enough...

Did I mention it drops 6 years off their sentence for completing the course that WE pay the $80,000 for?!?

Did I mention that everyone who goes to prison claims they are drug users and need help as they know how to work the system and get their sentence reduced, hell get a GED and some college education while they are at it, its worth 7 year reduction and free as well...

Where are you getting those numbers from?