EMS distributed naloxone kits may make a difference
EMS participation in harm reduction strategies, like giving a naloxone kit to an overdose patient who refuses transport, is worth the cost
When I was in paramedic school, I performed my internship at one of the largest urban centers in the country. At that time, the city was in the middle of a heroin crisis. EMS units were responding to numerous overdose calls daily, including mine.
We ran the overdose calls in a fairly routine way: bag the patient, start an IV and administer a coma cocktail of naloxone, thiamine and dextrose. All was well and good, except when the patient regained consciousness and refused to be transported.
In one instance, the medic gave the victim a vial of naloxone before he walked away. I was surprised and asked the medic why he would do that. He shrugged his shoulders and said something to the effect that if the patient was going to overdose again, at least one of his friends could administer the naloxone and maybe prevent another EMS response.
Fast forward 31 years and it’s déjà vu all over again. Guilford County (N.C.) EMS units are carrying naloxone kits that are being provided to patients who overdose on narcotics, are resuscitated and refuse transport. In addition to naloxone, the kits contain information regarding narcotic addiction and assistance.
It’s a classic harm reduction model — strategies and techniques aimed at reducing the potential for harm. It’s based on the mindset that drug addiction is a disease, not a choice. Kicking the habit and staying clean are not simple choices either. The urge to use narcotics is both physically and psychologically driven.
Other examples of harm reduction include providing clean needles to intravenous drug users to avoid infection; substituting legal methadone in exchange for illegal heroin; outreach services that contact patients and provide access to treatment programs; and now naloxone kits that might prevent an accidental fatal overdose.
For many people who are not familiar with drug addiction, this might seem like enabling addicts to continue to recreational drug use and activity at the expense of taxpayers, or to promote and condone the use of illegal narcotics. Evidence points to the contrary. Clean needles and naloxone does not increase the frequency of narcotic use; rather it can provide the time needed for counseling and psychotherapy, combined with physical withdrawal, to be effective in pushing the addiction into remission.
Another misconception is the profile of a narcotic addict. Most folks perceive addicts as the heroin junkie who shoots up in an alley somewhere.
But the fact is, nearly half of all opioid overdose deaths were the result of prescription narcotic use, not from injected heroin. The Centers for Disease Control and Prevention has called opioid overdose an epidemic in the U.S. Six out of 10 overdose deaths involved a narcotic. 2014 saw 28,000 narcotic overdose deaths, the highest number on record. On average, 78 Americans die from narcotic overdoses every day.
So, can a naloxone kit inside an ambulance make a difference in those numbers? Hardly, but that’s not the point.
A naloxone kit given to a patient who refuses transport may make the difference for one person.
If that difference is that it prevents an untimely death and allows that victim to make a choice to fight against addiction, removes that person from an expensive and frustrating cycle of going to an emergency department and back onto the street, and gives hope to the family and friends that their loved one might return to society, then perhaps it’s worth the cost of one naloxone kit.