Narcan for the public

[leoemt]

An article in EMS1.com has said that they are about to release the drug Narcan to the public. The thought is that the realatives of the addicts could administer the drug to the addict instead of having the "shame" of an EMS experience. The Obama Administration is touting it as a cure for addiction.

Now I have only seen Narcan administered a few times and it is an ALS drug, not BLS. Narcan is intended to reverse the effects of the opiates and restore the respiratory rates and what not (sorry I don't know the physiology behind it). Just like the Epi-pen, narcan is for Temporary relief and is not a cure.

Maybe the ALS providers can comment, but Narcan should not be given to the lay person in my opinion. Opinions?

 

[STXmedic]

That's ridiculous. Cure for addiction? Seriously? I'll add more later, too busy at the money for a thought out retaliation.

 

[abckidsmom]

That's ridiculous. I'm not even going to try and have a logical, well thought out answer. It's crazy.

 

[Medic Tim]

This has and is happening all over the place. It is nothing new. The fact it is said to be a cure though is ridiculous.

 

[abckidsmom]

This has and is happening all over the place. It is nothing new.

So, it's an autoinjector? A kit? Do you find it to be a "cure for addiction"?

What happens when the narcotic overdose outlasts the narcan?

What situations have you seen this in?

 

[Medic Tim]

So, it's an autoinjector? A kit? Do you find it to be a "cure for addiction"?

What happens when the narcotic overdose outlasts the narcan?

What situations have you seen this in?

I was commenting on the fact that narcan is and has been handed out to addicts all over the country. As I said in the edit to my original post it is wrong to label it as a cure.

You know as well as I the half life of narcan compared to opiates. The programs I have heard of are not to replace EMS but give the person a chance until help arrives. I have seen nasal narcan kits and auto injectors.

 

[abckidsmom]

I was commenting on the fact that narcan is and has been handed out to addicts all over the country. As I said in the edit to my original post it is wrong to label it as a cure.

You know as well as I the half life of narcan compared to opiates. The programs I have heard of are not to replace EMS but give the person a chance until help arrives. I have seen nasal narcan kits and auto injectors.

Got it. I can't say I agree with it, and the "avoiding the shame of the EMS visit" is what pushed my buttons.

I've seen narcan in the hospice drug kits as a nasal spray, but never for addicts. Crazy stuff, IMO.

 

[Merck]

I can see why someone would wan to do this but I'm not sure I agree. The problem with the OD is the hypoventilation/bradypnea and hypoxia. Here narcan is a BLS skill (SC initially and IV repeat prn), as is IV, D10W, glucagon, King LT airways, epi for anaphylaxis, benadryl, salbultamol, ASA, NTG, and nitrous for analgesia.

The problem is that I have seen BLS and ALS show up on a call for an OD and casually go about prepping a SC injection of naloxone and standing around waiting for it to work.

My point is - the reversal agent is great - IF the ABCs are attended to and IF the naloxone is going to work quickly enough and IF an OD is the actual correct provisional diagnosis.

So I don't think you should be able to buy it OTC but perhaps it could be restricted - i.e. family etc can get it by Rx.

Probably be better off enrolling the family in a CPR course....

 

[Dwindlin]

So, it's an autoinjector? A kit? Do you find it to be a "cure for addiction"?

What happens when the narcotic overdose outlasts the narcan?

What situations have you seen this in?

In this area it is an auto-injector. No, anyone who knows the slightest about medicine is not touting this as a cure for addiction. Self admin is really no different than systems that treat and release their ODs, which to my knowledge has been very successful (we have only been doing it a few months here, but from reading about other programs I haven't found any cases of adverse outcomes).

Narcan is a very benign drug, the worst that happens is it can cause withdrawal, which is incredibly uncomfortable but not life threatening. The reports of autonomic instability from Narcan and just that, case reports, and not many of them to boot.

 

[NomadicMedic]

I'm curious, where is the quote from "the Obama administration" that claims Narcan is "a cure for addiction"?

 

[abckidsmom]

In this area it is an auto-injector. No, anyone who knows the slightest about medicine is not touting this as a cure for addiction. Self admin is really no different than systems that treat and release their ODs, which to my knowledge has been very successful (we have only been doing it a few months here, but from reading about other programs I haven't found any cases of adverse outcomes).

Narcan is a very benign drug, the worst that happens is it can cause withdrawal, which is incredibly uncomfortable but not life threatening. The reports of autonomic instability from Narcan and just that, case reports, and not many of them to boot.

I would be more worried about people pushing their limits of overdosing because they had a safety net then anything else.

 

[Shishkabob]

Comment?

When used on a person from a non-educated, often hysterical family/friend, it will have 2 stages: Wake them up all pissed off, violent, and vomiting due to the full dose being given.

Followed shortly after with the narcotic kicking back in since Narcan has a shorter half-life, and the person goes in to respiratory arrest with no way of reversing it because all the Narcan was used the first time.

Narcan is a very benign drug, the worst that happens is it can cause withdrawal, which is incredibly uncomfortable but not life threatening.

I'd say Narcan is much safer than most medications we give, but far from benign, and the effects of instantaneous withdrawal CAN be life threatening.

 

[Dwindlin]

I would be more worried about people pushing their limits of overdosing because they had a safety net then anything else.

Reasonable concern, though it has not played out yet. As I said we have been doing treat and release for a couple months with no ill effects. These centers rolled out their programs couple years ago also with no ill effects.

 

[Medic Tim]

I'm curious, where is the quote from "the Obama administration" that claims Narcan is "a cure for addiction"?

Aren't politics fun. The only time I really hate being in the US is during and the buildup to an election.

I went with the assumption that it was a miss-quote, scare tactic/BS or a very very loose definition of the term cure.

 

[Dwindlin]

I'd say Narcan is much safer than most medications we give, but far from benign, and the effects of instantaneous withdrawal CAN be life threatening.

I have found one case study from 1998 of a possible death due to ultra-rapid opiate withdrawal. However, the crux of the case was the actions taken by a physician and the article flat says "The hearing did not explore or decide why the patient died, nor were the merits of UROD (ultra-rapid opiate detoxification) put on trial."

 

[NYMedic828]

I have found one case study from 1998 of a possible death due to ultra-rapid opiate withdrawal. However, the crux of the case was the actions taken by a physician and the article flat says "The hearing did not explore or decide why the patient died, nor were the merits of UROD (ultra-rapid opiate detoxification) put on trial."

You would probably do better searching for cases of aspiration 2nd to opiate withdrawal induced vomiting.

At the same time though, not reversing the opiate holds the same potential for vomiting as well, and the end result of respiratory arrest.

Giving it inappropriately instead of not giving it at all may be the lesser of two evils.

 

[Jambi]

Drug users tend to be fairly adept at using their own drugs. I don't see why they wouldn't be for Narcan as well. :wacko:

 

[Medic Tim]

An article in EMS1.com has said that they are about to release the drug Narcan to the public. The thought is that the realatives of the addicts could administer the drug to the addict instead of having the "shame" of an EMS experience. The Obama Administration is touting it as a cure for addiction.

Now I have only seen Narcan administered a few times and it is an ALS drug, not BLS. Narcan is intended to reverse the effects of the opiates and restore the respiratory rates and what not (sorry I don't know the physiology behind it). Just like the Epi-pen, narcan is for Temporary relief and is not a cure.

Maybe the ALS providers can comment, but Narcan should not be given to the lay person in my opinion. Opinions?

Just read the article and nowhere does it say cure. If it is from another source they may be referring to +narcan. +narcan is supposed to be able to curb addiction. I may be wrong but the shame the article refers to in my opinion is not speaking of EMS specifically but the addicts addiction itself, the stigma of being labeled an addict.

 

[Aidey]

To the OP I am having a hard time not calling you a troll for your comment about Obama administration calling it a cure.

Guys, narcan has been handed out in clean needle kids in Canada and parts of the US for YEARS. I've heard of it being given as an auto injector and in pre-filled MAD set ups.

 

[Tigger]

The Massachusetts Dept. of Public Health has been spearheading a nasal Naloxone program in the larger towns and cities for a few years now. It's very difficult to find any sort of negative reaction to it, and by all accounts it seems that the program is well thought out. The drug is given in a MAD prefill to the families and friends of those who are currently in treatment for opioid addiction. You cannot get the drug without being in treatment, and the program also stresses the importance of calling 911 and rescue breathing among other things. The state fact sheet on the program can be found here.

A story about the 1000th "successful" use of the drug can be found here though I admit that the source may be a bit biased.

The state program also assisted police departments with high opioid OD problems in getting the drug in their cruisers (many officers are first responders, all have some First Aid/CPR/AED).

This year nasal Naloxone became a service option in the statewide protocols for BLS ambulances on standing orders.