The concept of pre-arrival naloxone use by the public continues to evolve. As Maine considers a bill that would make it available by prescription to families and caretakers of drug addicts, the controversy over its use by the public during episodes of narcotic overdoses is centered over the moral aspects of drug abuse, rather than any medical concerns.
Narcan is safe, with a specific focus of treatment, and little interaction with the body outside of that interaction. It should be a fairly straightforward argument for its use, but public misperceptions of addiction and drug abuse cloud the issues. The recent death of actor Philip Seymour Hoffman brings those issues back into focus.
Drug addiction is an insidious illness. For many, it begins as an escape from environmental or psychological issues. It is both a physical and psychological burden — your body needs it, and your mind refuses to believe that it can go on without it. Receptors change within your brain, and it’ll take a monumental effort to overcome those changes.
Those who are in recovery are like patients who have experienced cancer — there really isn’t a “cure.” They live with the daily understanding that at any given moment, the illness may reappear, and with a vengeance.
Opioids injected into the bloodstream represent an especially dangerous level of addiction. The diseases associated with intravenous drug use, the infections that are created with poor technique, and the rapidity of onset combine to make this process especially unnerving.
EMS often sees the results of this process, ranging from patients who are not breathing or simply dead from the rapid absorption, to those with chronic illnesses or facing early death. We might not be able to minimize all of IV drug use consequences, but supporting pre-arrival use of naloxone can at least reduce the chances of sudden death, and give someone an opportunity to live another day and perhaps overcome addiction.
I don’t think it will promote greater drug abuse, nor do I think it condones the practice. If it contributes to our mission of reducing death and disability in our communities, then I’m all for it.
