Prescriptions for Narcan (opioid reversal): input requested

[Fargo]

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

Dirtebiker is correct, true opioid addicts are not really influenced by mortality concerns and nor do they use with some sort of moderation where they make value judgements about how much to use.

They use as much as they think they need to feel right, and will continue chasing that feeling until their lungs stop.

I would be very surprised if the presence of narcan has any real influence on use patterns. Usually the limiter is money/access.

Having stuff around for an addict to steal is far more enabling than the presence of Narcan.

 

[drop45]

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

Agreed. I think that the vast majority of addicts would rather not be addicts. If they could be cured of their addictions with the snap of ones fingers, they'd stand in line from here to the moon to get that chance.

 

[KJW]

There are no meaningful adverse effects of narcan (naloxone) when given to someone who does NOT have an opiod overdose. When given to an overdose patient it may precipitate acute withdrawal, for which the patient will cuss you profusely rather than thank you for saving their sorry ass. Primarily, it will simply reverse the respiratory depression in the overdose patient. You can't really screw up giving naloxone. The auto-injector is very expensive - hundreds of dollars. The nasal atomized spray is cheaper, retail cost maybe $30, so better but still not cheap. Both of these delivery methods give a 0.4 mg dose which will reverse the respiratory depression of most overdoses, although not all. In the ED we often give 2 mg doses, so 5x the dose of the auto injector or nasal atomizer. Some opiates may require doses of 10 mg to reverse the effects.
To summarize what I've said so far, there are no legitimate safety reasons to argue against lay people giving naloxone. There are cost issues that may present an obstacle for some individuals and communities or departments.
There is a moral or ethical argument about lay people giving naloxone. We have limited financial resources to distribute over all the medical needs in our communities and we must make decisions about the effective use of those funds. Making sure all children receive immunizations and that all women have access to prenatal care are just two examples of needs that almost everyone would probably agree should be met before spending money on the use of naloxone for drug addicts. A child debilitated from a preventable disease or absent prenatal care will require a lifetime of medical care and societal financial support. A drug addict saved from today's overdose has a very high probability of continued drug use and will be a drag on society in terms of uncompensated care being passed on to the insured as well as the fact that the majority of theft is driven by the need to buy more heroin. Often there is a lack of sympathy for the addict among the general public and their view may be that society would be better off if the addict died from their overdose, rather than be revived to steal, rob, and use another day. There's also the belief that knowing the family has naloxone available is a form of enabling for the addicted individual. I am not aware of any evidence to support or rebuff that belief.
My feeling is that people should have the ability to get naloxone if they have the money and think it's important. I am not so much in favor of the use of more tax dollars to provide naloxone to all police, etc. Although I think local communities will have to address that based on their local finances, community values, etc.
Someone said in an earlier post that overdoses from prescription opiates are 3x more common than from heroin. I would strongly disagree with that statement. People sure misuse their prescription opiates, maybe even have adverse events - such as falls from excessive sedation, severe constipation, etc. But people are given naloxone for and die from heroin at a much higher rate than prescription opiates. It is not even close. I base my statements on 20+ yrs of emergency medicine practice in a typical community hospital ED. I will not be writing prescriptions for naloxone. I will be directing patients and families to drug counseling.

 

[SSGSAD]

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.

Rep., sent !!!!!

 

[mbills2223]

Family yes...junkies absolutely! Will follow up later

 

[17 squirrel]

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.

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.

 

[TB1999]

Does the availability of plan b pills increase unprotected sex?

 

[Fargo]

Does the availability of plan b pills increase unprotected sex?

Probably, but as pointed out above, addicts are not really rational actors so the comparison isn't really valid. As KJW pointed out, many are pissed at being revived into withdrawal...

 

[pitbulld45]

Side effects are a bad headache if it wasn't needed and that's it.

 

[3steps]

These signs are all over Baltimore. They do wonders for tourism.
At least it explains why so many people walking the streets have no life in their eyes.

Naloxone is fine as a band-aid.
How to address the bigger problem?

https://ixquick-proxy.com/do/spg/sh...demic.jpg&sp=c4783f6867a69826ad40423ef8371df3

 

[GodFearinGunTotin]

There are no meaningful adverse effects of narcan (naloxone) when given to someone who does NOT have an opiod overdose. When given to an overdose patient it may precipitate acute withdrawal, for which the patient will cuss you profusely rather than thank you for saving their sorry ass. Primarily, it will simply reverse the respiratory depression in the overdose patient. You can't really screw up giving naloxone. The auto-injector is very expensive - hundreds of dollars. The nasal atomized spray is cheaper, retail cost maybe $30, so better but still not cheap. Both of these delivery methods give a 0.4 mg dose which will reverse the respiratory depression of most overdoses, although not all. In the ED we often give 2 mg doses, so 5x the dose of the auto injector or nasal atomizer. Some opiates may require doses of 10 mg to reverse the effects.
To summarize what I've said so far, there are no legitimate safety reasons to argue against lay people giving naloxone. There are cost issues that may present an obstacle for some individuals and communities or departments.
There is a moral or ethical argument about lay people giving naloxone. We have limited financial resources to distribute over all the medical needs in our communities and we must make decisions about the effective use of those funds. Making sure all children receive immunizations and that all women have access to prenatal care are just two examples of needs that almost everyone would probably agree should be met before spending money on the use of naloxone for drug addicts. A child debilitated from a preventable disease or absent prenatal care will require a lifetime of medical care and societal financial support. A drug addict saved from today's overdose has a very high probability of continued drug use and will be a drag on society in terms of uncompensated care being passed on to the insured as well as the fact that the majority of theft is driven by the need to buy more heroin. Often there is a lack of sympathy for the addict among the general public and their view may be that society would be better off if the addict died from their overdose, rather than be revived to steal, rob, and use another day. There's also the belief that knowing the family has naloxone available is a form of enabling for the addicted individual. I am not aware of any evidence to support or rebuff that belief.
My feeling is that people should have the ability to get naloxone if they have the money and think it's important. I am not so much in favor of the use of more tax dollars to provide naloxone to all police, etc. Although I think local communities will have to address that based on their local finances, community values, etc.
Someone said in an earlier post that overdoses from prescription opiates are 3x more common than from heroin. I would strongly disagree with that statement. People sure misuse their prescription opiates, maybe even have adverse events - such as falls from excessive sedation, severe constipation, etc. But people are given naloxone for and die from heroin at a much higher rate than prescription opiates. It is not even close. I base my statements on 20+ yrs of emergency medicine practice in a typical community hospital ED. I will not be writing prescriptions for naloxone. I will be directing patients and families to drug counseling.

I think I agree with most of this. Imagine being given a prescription for a dose of this stuff because you have a family member you're concerned about and it not be sufficient to reverse the dose taken...or before you can get it refilled again, that same person manages to get another OD.

As long as it's safe for "anybody" to administer, I have no problem with it being made available. I don't think it ought to be "free" or subsidized but if a person wants to buy it, I say let them.

 

[Bowman78]

I say let nature take its course.. This coming from one who has a few addicts in the family.. Normally those types of folks never become positive contributing members of society..

 

[Denny347]

I say let nature take its course.. This coming from one who has a few addicts in the family.. Normally those types of folks never become positive contributing members of society..

So, if they were ODing in front of you, would you not call 911 or administer Naloxone if you had it? I mean, let nature take its course and all.

 

[HoughMade]

My Theology does not allow me to ignore the fact that I've been given a second chance (or third, or fourth) when I didn't deserve it.

Far be it from me to refuse others a second chance. Whether they use it for good or not is on them.

 

[IndyDave1776]

I say let nature take its course.. This coming from one who has a few addicts in the family.. Normally those types of folks never become positive contributing members of society..

I have had an addict or two or three in my family as well. One cousin dead, largely as described in this thread via heroine use. I also have a brother who had a serious drug problem. It was a long and difficult journey, but today the only substance he uses is smoking cigarettes (I don't encourage it, but it is a hell of a lot better than drugs). This brother is also the bookkeeper who makes the operation of our family business possible, given that my other brother and I are not equal to the task. He is also one of the few people upon whom I can depend absolutely. He is also the person I trust to make the final decision regarding treatment or nontreatment should I become unable to do so for myself. You're right, we should have just let him die.

 

[Scuba591]

So I have seen a general overall increase in Heroin use from my shifts at the firehouse on the East side of Indy. It is common to have at least one O.D. per shift... sometimes more. The normal causes range from a new batch hitting the streets, buying from an unknown dealer or just simply shooting too much. I have to admit I am tired of these runs. Everyone on scene lies. They lie about knowing the person, ever doing drugs etc.. Most times. The O.D.er is usually upset about the loss of a high. I have had them come up swinging. IMPD and IFD have been using Narcan on the streets for some time now. I am reluctant about the success of a program that allows access to Narcan to non public safety personnel. I'd like to be proven wrong though. Using the stuff is easy... two pushes of a plunger, one in each nostril. I think most people could get how to use it. My experience however, shows me that there will be a barrier to use out of fear for reprisal from law enforcement and the user. Heck, most people just start doing compressions. The lack of knowledge and mindless perceptions out there would amaze most. More common than not, the user is not with or near family. They ride around in a car, go into an alley, walk to a friends house, sit on a porch... The family is not around... Unless it is that house south of 10th between Emerson and Bosart. I really hate that house. Anyway... perhaps a program will help someone until we get there.

 

[IndyDave1776]

So I have seen a general overall increase in Heroin use from my shifts at the firehouse on the East side of Indy. It is common to have at least one O.D. per shift... sometimes more. The normal causes range from a new batch hitting the streets, buying from an unknown dealer or just simply shooting too much. I have to admit I am tired of these runs. Everyone on scene lies. They lie about knowing the person, ever doing drugs etc.. Most times. The O.D.er is usually upset about the loss of a high. I have had them come up swinging. IMPD and IFD have been using Narcan on the streets for some time now. I am reluctant about the success of a program that allows access to Narcan to non public safety personnel. I'd like to be proven wrong though. Using the stuff is easy... two pushes of a plunger, one in each nostril. I think most people could get how to use it. My experience however, shows me that there will be a barrier to use out of fear for reprisal from law enforcement and the user. Heck, most people just start doing compressions. The lack of knowledge and mindless perceptions out there would amaze most. More common than not, the user is not with or near family. They ride around in a car, go into an alley, walk to a friends house, sit on a porch... The family is not around... Unless it is that house south of 10th between Emerson and Bosart. I really hate that house. Anyway... perhaps a program will help someone until we get there.

I don't doubt what you are telling us, but how do you justify morally or legally denying citizens of an ostensibly free republic such a product? Why is it not generally available in the first place, especially given that it cannot be harmfully misused either by erroneous application or by abuse?

 

[CHCRandy]

My Theology does not allow me to ignore the fact that I've been given a second chance (or third, or fourth) when I didn't deserve it.

Far be it from me to refuse others a second chance. Whether they use it for good or not is on them.

Did you save yourself or did others intervene all 3 or 4 times?

I can see saving a person from jumping off a cliff a time or 2.....but if they are just gonna keep jumping off the bridge......eventually I may grow tired of it and let em jump.

 

[CHCRandy]

So I have seen a general overall increase in Heroin use from my shifts at the firehouse on the East side of Indy. It is common to have at least one O.D. per shift... sometimes more. The normal causes range from a new batch hitting the streets, buying from an unknown dealer or just simply shooting too much. I have to admit I am tired of these runs. Everyone on scene lies. They lie about knowing the person, ever doing drugs etc.. Most times. The O.D.er is usually upset about the loss of a high. I have had them come up swinging. IMPD and IFD have been using Narcan on the streets for some time now. I am reluctant about the success of a program that allows access to Narcan to non public safety personnel. I'd like to be proven wrong though. Using the stuff is easy... two pushes of a plunger, one in each nostril. I think most people could get how to use it. My experience however, shows me that there will be a barrier to use out of fear for reprisal from law enforcement and the user. Heck, most people just start doing compressions. The lack of knowledge and mindless perceptions out there would amaze most. More common than not, the user is not with or near family. They ride around in a car, go into an alley, walk to a friends house, sit on a porch... The family is not around... Unless it is that house south of 10th between Emerson and Bosart. I really hate that house. Anyway... perhaps a program will help someone until we get there.

Maybe the government can start providing them with clean needles, FDA approved heroin, and a private nurse to administer it........

 

[Scuba591]

I don't doubt what you are telling us, but how do you justify morally or legally denying citizens of an ostensibly free republic such a product? Why is it not generally available in the first place, especially given that it cannot be harmfully misused either by erroneous application or by abuse?

As I said... I would like to be proven wrong. I would justify based off of my experiences . Legally, well I am not a lawyer. Morally, I am out there doing the work. I am contributing with my beliefs and my sweat.