Prescriptions for Narcan (opioid reversal): input requested

[IndyDave1776]

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.

The problem I see is that it is easy to conclude that you do not believe that general availability of such a product is good or helpful which becomes a springboard to its being available only to state-sponsored personnel. The same principle can easily be applied to "I don't believe an armed jackleg citizen with a gun can protect himself or anyone else, therefore, possession and use of firearms should not be allowed."

As I see it, belief or nonbelief in a favorable outcome is not really relevant.

 

[Scuba591]

The problem I see is that it is easy to conclude that you do not believe that general availability of such a product is good or helpful which becomes a springboard to its being available only to state-sponsored personnel. The same principle can easily be applied to "I don't believe an armed jackleg citizen with a gun can protect himself or anyone else, therefore, possession and use of firearms should not be allowed."

As I see it, belief or nonbelief in a favorable outcome is not really relevant.

You are correct. I think it will be less than effective. Many a program are not implemented due to cost vs benefit ratio analysis. If effective is defined as saving one person then sure implement. I do not have the depth of vision you mentioned though. I see you comparison... I just can't make that leap for myself. Some time ago we tested a plunger type device with cardiac arrests. I think I remember the numbers form the testing being quite favorable. We were bringing back patients usually around the 27 to 30 minute mark. It was effective. For reasons not known to me... they are not on the rig for our use.

 

[Dirtebiker]

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.

I'm pretty sure they don't get high on Narcan.

 

[Dirtebiker]

I'm not sympathetic to the addict. I have known too many.

Those that choose to save them, family or friend, spend your own money on them please.

Have any of the "many" been your child?

 

[Dirtebiker]

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.

Repped!

 

[Dirtebiker]

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 to ask you the same thing I asked LEaSH.
Were the family addicts your children?
If not, would you say "let my kid die!"? "He'll never become a positive contributing member of society!"?
I wouldn't, and I doubt you would. (I hope I'm right!)

 

[Dirtebiker]

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.

You must spread some Reputation around before giving it to IndyDave1776 again.

 

[IndyDave1776]

You are correct. I think it will be less than effective. Many a program are not implemented due to cost vs benefit ratio analysis. If effective is defined as saving one person then sure implement. I do not have the depth of vision you mentioned though. I see you comparison... I just can't make that leap for myself. Some time ago we tested a plunger type device with cardiac arrests. I think I remember the numbers form the testing being quite favorable. We were bringing back patients usually around the 27 to 30 minute mark. It was effective. For reasons not known to me... they are not on the rig for our use.

Why does there have to be a program? Why can the .gov not simply get the f**k out of the way and let us make our own decision on spending or not spending depending upon our own personal belief in the potential effectiveness? I don't need a .gov program to supply me a fire extinguisher. I don't need a program to supply me with a gun for personal protection.

 

[IndyDave1776]

You must spread some Reputation around before giving it to IndyDave1776 again.

Thank you for the kind thought!

 

[jsharmon7]

I see this as being very similar to the needle exchange program. It isn't encouraging bad behavior, it's simply acknowledging the facts of the situation. I'm one of the least sympathetic people you will probably meet, but letting someone die when you could do something simple to save them is being complicit in their death. Until other solutions can be found to combat heroin/pill abuse then at least give access to medical supplies that may save a life or prevent spread of disease. Doctors should be allowed to provide Narcan if he/she believes it may be a benefit.

 

[IndyDave1776]

I'm not sympathetic to the addict. I have known too many.

Those that choose to save them, family or friend, spend your own money on them please.

I overlooked this the first time through. It seems that our positions can coexist quite nicely. I don't expect anyone else to be dragooned into paying for something that they either will not use/have used to their benefit/have used within their idea of right and proper. I simply expect the .gov to get the hell out of my way if I want to spend my money on it, especially given that it is an abuse-proof product.

 

[Snapdragon]

As a layperson with no medical training...

Eliminate the distinction between abuser and family member/roommate/significant other.
Either we agree that an individual who is in medical distress should have access to treatment, or not. Who administers the treatment is irrelevant in my opinion.

This.

Many people engage in unsafe behaviors which necessitate some sort of interventional medication. Do we also deny smokers access to inhalers, or non-compliant diabetics access to insulin, simply because they brought it on themselves?

 

[AA&E]

Personally, I do not understand why we have a requirement for prescriptions for medicines that have no potential for abuse or harm. Narcotics.. I get it. Antibiotics.. I get that too (although one could argue doctors are guilty of over prescribing these drugs). But something where the potential for abuse is non-existent? A pharmacist can explain (and usually do) side effects, possible interaction issues, etc.

I have friend whose doctor couldn't get him in last week when he had a reoccurring medical issue that he has a lengthy documented history of, and for which a certain medicine is always prescribed. He requested a prescription be phoned in since they weren't able to squeeze him into their schedule and they refused. Told him he should go to an urgent care facility or emergency room. He called an urgent care facility. Since his family doctor wasn't affiliated with their hospital they wouldn't have access to his records. Therefore, if he came in the diagnosis process began from square one with xrays, blood work, etc. All so he could get a corto-steroid prescription? Ridiculous.

 

[ghuns]

The thriving metropolis of Walkerton, population 2K, has just started equipping its officers with Narcan.

The days of narcotics being a big city problem are long gone.

Our docs and pharmacists pass out drugs like candy that have potential to do far more harm than Narcan, the ONLY purpose of which is to actually save a life. And yet many INGOers seem to be against people being able to get it?

If there were a nasal spray that could instantly reverse the effects of a heart attack or stroke, would you compassionate INGOers advocate denying its availability to the families of fat, middle aged, smokers, who brought their physical condition upon themselves? How about type 2 diabetics? Should we withhold Glucophage or insulin and just let the oven clean itself?

 

[chubbs]

Narcan, It ruins the effect of the Self Cleaning Oven option.

I couldn't agree more! Why offer a second chance drug for scumbags. This isn't for little billy who got curious about pot. This is for junkies, hardcore drug users who are a drain on our world. Don't feel bad for them, they did this their selves. Save them from their OD this week, they potentially hit you or a loved one head on during next weeks bender. Let nature take its course if they are that dumb. Unless they are amazing singer/guitar players(they serve a purpose)

 

[chubbs]

If there were a nasal spray that could instantly reverse the effects of a heart attack or stroke, would you compassionate INGOers advocate denying its availability to the families of fat, middle aged, smokers, who brought their physical condition upon themselves? How about type 2 diabetics? Should we withhold Glucophage or insulin and just let the oven clean itself?

None of what you described is relevant to this. There is a big deference in someone living their life unhealthy and being a scumbag addict.

 

[ghuns]

There is a big deference in someone living their life unhealthy and being a scumbag addict.

You're right. The cost to society of people living an unhealthy life is exponentially higher.

 

[mbills2223]

I'd like to be able to carry some myself as I believe I'm qualified....maybe I'll ask my PCP next time I see him

 

[Bill of Rights]

It doesn't work that way. It binds until it is expelled by the body.

Sorry, Denny, this is false information. Narcan has a shorter half-life than many of the drugs it reverses, meaning the person may deteriorate between time of administration and further care... or lack thereof, since they may not seek that further care with this at home. I'm sure you've given this and know what you've seen... I don't dispute that. I wonder how long you've been with people who have not gotten other care, after you give it. (For those who don't know, the half-life is the amount of time it takes for half of the dose given to metabolize, meaning that if you give 2mg of Narcan, how long does it take for there to be only 1mg left in the person's body. In the case of Narcan, that's 64 minutes, plus or minus 12 or so, meaning that if you're not with them as little as ~45 minutes later, you might not see them when it wears off and they need another dose... and it's going to take roughly an hour and a half, minimum, for the amount to degrade down to 0.5mg. An overdose can be mitigated with as little as 0.4mg in an adult.)

As a layperson with no medical training...

Eliminate the distinction between abuser and family member/roommate/significant other.
Either we agree that an individual who is in medical distress should have access to treatment, or not. Who administers the treatment is irrelevant in my opinion.

And an abuser who overdoses is unlikely to self administer. So regardless of who has the prescription, another individual is most likely going to make the life or death decision.

Although there are many who would say "let them die", I'm not in that camp.

"Death by overdose" isn't the kind of social strategy I can get behind to address this problem. It reeks to closely to the out of touch hubris of "let them eat cake".

I suspect that quality control and unknown potency is a greater contributor to overdose than those trying to maximize a high by walking the knife edge between buzz and death. In short, I suspect that the vast majority of overdoses are accidental. And I don't think the availability of an antidote enables. Addiction is far more complicated than that.

If it were that simple, no one would smoke. Haven't you heard? It can kill you?!?

I have a glucose pen or two stashed around. I had to get a prescription for it. My wife is diabetic. I think I got "trained" on it at some point when I was written a prescription. Frankly, I'll read the instructions if I ever need to use it.

And I believe that considering the negligible downside, both the narcotic pen and the glucose pen should be available without a prescription to whomever cares to purchase them. A user/diabetic or family/friend/concerned citizen.


You didn't ask about public funding. So I'll keep those thoughts to myself.

I'm going to offer a slight correction: The pen you refer to is insulin, not glucose. Same problem, other end of the spectrum (too little insulin vs. too much)

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.

They'll still test positive, I believe. This isn't like a sponge that soaks it all up and eliminates it, it's more like putting the wrong key in a lock. Not only will the lock not open, but you can't put the right key in until the wrong one is removed.

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?

I'm in this camp. I think people should be able to obtain whatever medication they wish, with the onus on them to ensure they either choose the right one on their own or seek education from someone (pharmacist, MD, RN, whatever) who has more information than they do. The diabetic can go to the store and buy a whole case of candy bars. They typically do not do so, but they have the ability. Parents can go to the store and buy and administer aspirin to their young children, despite Reye's Syndrome. Again, they typically do not, as they've mostly been educated not to and why. I don't see the difference, other than doing so with medications is outside of our "normal" paradigm.

I'm pretty sure they don't get high on Narcan.

They don't.


OK, so I know Hoosierdoc is knowledgeable about this (obviously), as are a few other posters here. I also see much ignorance of the effects of this medication amongst our members. I don't mean that as an insult, I'm only saying that there is a lack of knowledge. I'm going to do what I can to fix that now.

Narcan (NARCotic ANtagonist) is, as I said above, kinda like the right type of key, but not cut for that specific lock. It attaches to the receptor that the narcotics attach to, blocking them and preventing the narcs from connecting and creating a high. It will also knock them off of the receptor for a short time. It works only on opiate narcotics, like heroin, morphine, demerol, fentanyl, and dilaudid. It will not work on Darvon/Darvocet (is that even available anymore, Doc?), nor on xanax, valium, barbituates, ativan, PCP, etc.

When I was first trained in its use, we were taught to give it SLOWLY, what they called "titrating to effect", and give just enough to keep the person breathing. It was jokingly said that if the ER had been jerks to you that day, slam the Narcan as you go through the doors, because by time you get to the bedside, the person will be violently angry, not to mention projectile vomiting everywhere, but at that point, it's not our problem. Realistically, I don't know anyone in EMS who would leave a patient that way and risk an injury to ED personnel. The main point, though, is that yes, as indicated upthread, they wake up pissed as hell that you just killed their high, and if you throw them into acute withdrawal and they begin vomiting that way, they are putting their airway at risk, meaning they could inhale their own puke and draw it down to their lungs and kill them. (Lungs are typically not fond of stomach acids.)

So... here's my take. I like that the police have it. When the person comes up swinging, they are aware that that may happen and are ready and able to deal with it (usually; I've seen addicts throw cops, firefighters, and medics around like rag dolls) They also have radios and can call an ambulance to "step it up" because someone's airway is jeopardized. I like that family members can have it, IF they are told what to expect and are prepared (mentally and/or physically) to deal with that eventuality. I can even get behind John Q. Public having it; the "consent" issue Doc raised is a non-issue as far as I'm concerned, given that a person getting this when they're dying of overdose falls under "implied consent"- and if they're trying to commit suicide, that's not generally a rational act. Again, I want John Q. Public to know what he's getting into when he gives this stuff to Andy the Addict.... I want him to know that Andy is likely to clean his clock if John is not careful.

The drug itself has no pharmacologic side effects that worry me. The physiologic effects are another story entirely.

Hope this helps.

Blessings,
Bill
(A.S., EMT-P, Graduate Nurse)

 

[17 squirrel]

Quote Originally Posted by 17 squirrel View Post
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.

Bill of Rights,
They'll still test positive, I believe. This isn't like a sponge that soaks it all up and eliminates it, it's more like putting the wrong key in a lock. Not only will the lock not open, but you can't put the right key in until the wrong one is removed.





Yes , I realize that they will test positive, but the only people that will know that is the drug testing facility. but what most people don't know is when you go to the clinic ( doctor ) and you are prescribed drugs and you are required to take a drug test at work or for acquiring new employment the drug testee simply informes the drug testing facility that they are on a prescription to these certain drugs. And poof their test comes up clean and the employer has no knowledge that he has employees that roll through the Methodone clinic 6 mornings a week. Or over medicating on a prescription from the pain management doctor.
Other than seeing obvious drug abuse, the employer generally has no idea that they are employing people on opiate's and other narcotics.