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Is publicly available naloxone a good thing?
The introduction of a nasal injection allows a drug like naloxone to be delivered safely
By Art Hsieh
As a health care provider, I can see the pros and cons of providing naloxone to narcotic abusers so that the chances of an accidental overdose can be mitigated.
Naloxone only acts for a short period of time and the potential for it to not completely counteract the overdose is real.
Plus, patients can abuse multiple drugs concurrently, and removing the "braking" ability of heroin might result in more significant issues.
However, as a public health provider, it seems to make more sense to try to reduce the harm caused through a more timely intervention, rather than waiting for EMS to arrive.
The introduction of a nasal injection allows a drug like naloxone to be delivered safely and reduces some of the potentially serious side effects associated with intravenous or intramuscular injection.
I'm interested in how you feel about this and whether your system has any experiences with publicly available naloxone. Share your thoughts below.
Comments
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John Malcolm Thursday, April 26, 2012 5:15:32 PM I think that giving Nalaxone (Narcan) to the public would be a true catch-22. While it would help the overdose patient, wouldn't it also give them a false sense of security in the fact that they can binge and have a magic cure? 
Irish Kat Thursday, April 26, 2012 6:08:44 PM Bad idea...I agree with you, John. Give them a false sense of security to do more drugs.
Christopher Bente Thursday, April 26, 2012 6:36:47 PM Not a fan of the idea. First off if someone falls unconscious due to an accidental overdose how will they give themselves narcan? I honestly don't see them premedicating themselves with it, thus ruining their high.
Two, who is going to pay for this? Admittedly narcan is inexpensive, but do I want my tax dollars (medicare/medicaid) paying for this? Not particularly.
I don't really see this helping anyone. Would giving narcan to people hurt anyone? No, but is it honestly going to help?
KevinAmy Johnson Thursday, April 26, 2012 11:16:22 PM Christopher Bente you bring up a good point. I think an od progresses in a way that would make it impossible for the victim to self administer an antidote. I guess if they have a heroin buddy, like diving, it might work. I can see the psa now...don't do h alone. I do hate to see life wasted like that, so tragic.
Eliza Wheeler Friday, April 27, 2012 2:21:53 PM Christopher Bente the narcan is given to people who may be in the position of responding, the intention is not that someone gives themselves narcan, obviously that makes no sense. None of the 188 narcan distribution programs receive any federal money, but have resulted in over 10,000 lives saved since the first program started in 1996. Those are 10,000 people that are our mothers, fathers, brothers, sisters, friends, colleagues--all of whom were given a second chance at life. KevinAmy Johnson Friday, April 27, 2012 4:28:06 PM Eliza Wheeler Wow, I've never heard of a real program!? I'm glad those people had a second chance. By the way who the heck is a od responder? Is it methadone clinic staff or something of the sort. Thanks for the numbers, encouraging. Eliza Wheeler Friday, April 27, 2012 5:04:29 PM KevinAmy Johnson Oh yes! There are many programs in the US that provide access to narcan, that's what is funny about the article above, it presents this issue as if this doesn't already happen! Programs all across the US have been distributing narcan to mainly drug users themselves since 1996. Most narcan distribution happens at needle exchanges, where we have contact with drug users, and the idea started because it is most often other drug users who are present when someone overdoses, and have fears about calling 911. We also distribute narcan to family members or other friends who may have a loved one who is using (either prescription drugs, or heroin)--so they are the "od responders" so to speak. Here is a report about narcan distribution programs that was just published in February, that has a map that shows where they all are: http://www.cdc.gov/mmwr/pdf/wk/mm6106.pdf
Adam Arthur Pederson Tuesday, May 01, 2012 1:17:57 PM Eliza Wheeler - I see your point, as a former addict about to be 4 years clean I know the impact of another chance. However to play the devils advocte, whos to say that some of those 10,000 people didn't od the next time and die, or contuine in their addiction. Again, I believe that this is a positive step, however like anything it there is a side to it that worries me. Friday, May 04, 2012 7:35:14 PM Adam Arthur Pederson- Im sure many (to many) of those 10,000 went and od'd and died. But, how many cardiac arrests get brought back only for them to grab a cheeseburger and have another heart attack, or low BG that we bring back up only to have to go back hours or days latter and do it again because they won't watch their insulin and sugar levels. I have always been of the mindset if it saves one person isn't it worth it?
Dwight Jones Thursday, April 26, 2012 7:18:59 PM If you view drug use as a crime, you may have some reservations, granted. But if you see drugs as a societal illness, like prostitution - always with us - then prejudging its use or distribution may be misplaced if you are a caregiver. Yours is not to reason why. KevinAmy Johnson Thursday, April 26, 2012 11:34:54 PM My very first call was a narcotic od. My partner DIVP 2 mg of narcan before I could get the BVM set up. All the fire fighters laughed as I pulled the npa out of his nose as he looked at his new apartment guests.
Despite or maybe do to the fact we ran a bunch of ods there was a underlying bad attitude toward junkies in our city. (I actually enjoy working a good outcome od.) I even heard rumors of "Ban Narcan" t shirts going around off duty. Not very professional to say the least, however you have to wounder how someone who tries their best to preserve and care for life may look at people who essentially are throwing their own away. I think narcan for the public sends a dangerous message...no consequences. Consequences or dying, is after all what stops many people from doing drugs. Eliza Wheeler Friday, April 27, 2012 2:18:18 PM Respectfully, dying or the fear of dying is not the thing that stops people from doing drugs. If it was, our country would probably not have such a long, solid history of millions of people struggling with drug addiction and alcoholism. I wish, for the many loved ones and friends I've lost to drug addiction, that the fear of dying had been enough to get them to stop using. I have spent over 10 years distributing narcan to drug users, their friends and family. I have saved four people myself. I have taken reports of literally hundreds of uses of narcan by laypeople. Having or using narcan during an overdose does not keep people from going to treatment when they are ready, it simply keeps people alive another day to have that chance to get better. Unfortunately, some people believe that the lives of people that abuse drugs are not worth saving in the first place, and therefore this whole argument is futile. Because I have loved many people in my life that struggle with addiction, I don't like to engage in that hurtful argument to begin with. To me, all human lives are worth saving. Thank you for sharing your experience as a first responder, though, undoubtedly you have saved many lives, and for that, you are a hero.
KevinAmy Johnson Friday, April 27, 2012 4:44:24 PM Eliza Wheeler I hope I didn't come off insensitive toward drug addicts and their loved ones. I too believe all lives are worth saving, not my place to judge. Someone else much more qualified has that job! Oh I just noticed Oakland, CA, that explains a few things. I doubt your position exists in smaller less...progressive cities. I was going to guess Vancouver, BC. Be safe and keep up the good work. Oh the consequences comment is probably not exceptional jargon for the treatment and recovery world, I'm guessing. Too harsh maybe. However personally that's what stops me from doing many a dumb thing. I'm sure you can also think of times in your own life you found that to be true. Just because addiction is powerful doesn't mean it negates the fact you will suffer consequences, whether your councilor mentions them or not. Ask a cop. Thanks for the kind words, you be safe, and know you are appreciated. 
Allie Oop Friday, April 27, 2012 3:05:50 AM If you're dumb enough to abuse narcs you deserve to die & stop wasting society's resources 
Dan White Tuesday, May 01, 2012 2:04:56 PM Allie, if you are dumb enough to believe you know who is worth saving and who is not, you cannot be a good Medic. Friday, May 04, 2012 7:27:04 PM Oh my, I hope your not a medic! If you are it is time to get out of the field. You are way to cold to be giving good patient care. If I was a patient that you took care of and saw this comment, I would start questioning weither or not you took good care of me.
Friday, May 04, 2012 7:28:35 PM Oh and if my boss saw me make a comment like you made, I would be looking for a new job!
Andrew Schlagel Friday, April 27, 2012 7:50:29 AM I live in an area with little to no ALS level services. If we were to give police and first responders naloxone to be delivered via mucosal atomizer the patient could be treated, transported without introducing hypodermic products and limit potential withdrawal issues.
I do not believe these products should be available for OTC as farce "WAR ON DRUGS" continues to plague our country. Nonetheless, opiates are the number one prescribed and illicit overdose 'I' deal with. Although, cocaine seems to be making a comeback, and the new synthetics are increasing popularity too? 
Edward Peters Friday, April 27, 2012 3:58:03 PM To the folks who are actively against making naloxone available to narcotics abusers : Do you actually understand how naloxone works? Did any of you happen to know that naloxone actually has a lesser risk profile than many OTCs?
None of us seem to have any difficulty understanding that time is brain when it comes to initiating CPR, getting a patient to the stroke centre, or getting D50W into a hypoglycemic. Why the disconnect with regard to overdose patients? Our job as EMS providers is to bring competent, compassionate, care to those in need, not to judge our patients for why they need our help.
Making naloxone available to addicts also gives us the opportunity to educate the individuals seeking to possess it. Prior to passing judgement I strongly suggest reading the results from places such programs have been implemented. Dan White Friday, April 27, 2012 8:12:39 PM Mr.Peters is correct. Publicly available Narcan saves lives http://www.nta.nhs.uk/news-2011-naloxone-report.aspx It gives folks another chance, that they would not get any other way. EMS should support its use, because just like Glucagon it buys time for you to get there and have a living patient to support when you arrive, rather than a code blue.
Elizabeth Grant Saturday, April 28, 2012 1:40:48 PM Thanks, Edward. To those who feel that drug addicts should face additional "consequences" for their substance use or feel that the care they provide is a waste of their time or resources, do you similarly judge your patients who were incompetent drivers and wound up in an MVI, or your cardiac/diabetic patients who can't quit smoking and need to lose weight? Perhaps you yourself are in less than perfect shape and need to lose a few pounds or some bad habits....
Harm reduction programs such as those operated here in Vancouver not only save lives, they save a great deal of money and resources to the "system" as well. Many people addicted to drugs came to that state through a long and sordid history of neglect and abuse. Prisons are more expensive than Narcan every time.
Elizabeth Grant, Paramedic, BC Ambulance Service. Edward Peters Saturday, April 28, 2012 2:04:29 PM For anyone interested here's a link to the Insite safe injection program currently running in Vancouver. http://supervisedinjection.vch.ca/
Kevin Sleepy Thursday, May 10, 2012 10:37:10 AM It would be nice to see it in the hands of all first responders , till ALS or other medical personnel arrive on scene. Every life is worth trying to save, no exceptions! 
