Narcan in the Water

Moving on to a bigger problem than CHS, narcotic overdose deaths now exceed traffic and homicide deaths. Toward the end of my residency and in the early 2000s, we were instructed to “treat the pain, treat the pain.” The 0-10 pain scale became another vital sign. Now it’s “treat the addiction, treat the addiction.”

One approach that is getting a bit of attention is to make Narcan (naloxone) more available to the public. Mostly used by paramedics, and sometimes used in ERs, it’s a narcotic antagonist used to wake people up who have overshot the mark with Lortab, Vicodin, Norco, Percocet, T3, MSContin, Demerol, Oxycontin, fentanyl, heroin, methadone, etc.

To battle the overdose epidemic, some prescribers are writing for Narcan nasal spray with each of their narcotic prescriptions now. There are efforts also to make Narcan available directly through pharmacists. The hope is that people who overdose will do so among others who will know the OD signs, have the drug, and then use it properly.

Personally, I’m glad the overdose topic is getting attention. I guess I’m a little biased having spent about a decade building a rehab in New Mexico. I’ve also known a surprising number of people who have overdosed and died. However, and I hate to admit this, the Narcan efforts don’t excite me much. To me, the push to propagate Narcan is the ultimate in downstream problem solving. It’s waiting till an addict is essentially dead to take interest.

Plus, I’m not even sure why doctors or pharmacists are needed in the mix. Why isn’t Narcan nasal spray OTC? How much counseling by doctors or pharmacists is actually needed? Can Narcan nasal spray instructions be more complex than anything printed on Children’s Tylenol?… “If your friend is overdosing, or seems to look dead, spray this up his or her nose and call 911.” Narcan is nowhere near as dangerous as Tylenol when overdosed. You wouldn’t want to give it to someone suffering with a heart attack or a broken leg. But you also wouldn’t give prune juice to someone with diarrhea.

 

 

I’m far more interested in community systems that help addicts who request help, and are ready to take steps in that direction. Suboxone is more intriguing to me too. It can also be abused, but it’s a giant step up from methadone. Unfortunately, of all the meds in our universe, Suboxone has its own training program and providers have an upper limit on number of patients they can be treating at any given time. Wacky I say…

Suboxone is actually a combination of buprenorphine and naloxone. This is meant to prevent crushing, dissolving and injection because, taken orally, the naloxone is not absorbed. Why not do that for Oxys and other oral narcotics routinely? Who knows?

In addition to development of treatment programs for people who want help, I think county or state wide coordinated care plans could be incredibly helpful. They could also make the push to electronic medical records finally worthwhile. Many states now track which providers are prescribing which narcotics to whom.

Occasionally I get printouts in the mail about patients who have been to 20+ other providers, seeking and receiving narcotics. It’s no wonder to me so many are overdosing. However, receiving notice in the mail is too late. With the internet and EMRs, I would absolutely love to see a database for physicians with the names of patients, their designated prescribers, and specific care plans to keep every doc on the same page in real time. (Maybe that already exists and I’ve missed the memo.)

Of course educational programs in schools are likely the best upstream approach. But that won’t change the 2017 stats. Unfortunately teaching someone to steer clear of opiates isn’t as exciting as the resurrection moments Narcan provides.

Sorry to be a mild Debbie-downer. I’m sure many of you know people who have died from opiate overdose as well. Perhaps some of you have had family and friends saved by Narcan. Maybe it has saved you. No doubt it’s a miracle drug. Isn’t it strange that while we have so many agonists on the market, there’s only the one well known antagonist? (My friend Jeffrey Holland would say: “Follow the money.”) At the end of the day, I guess I’m interested in doing more than just keeping every heart beating.

All that being said, as long as Narcan OTC doesn’t exist, and if you’d like a Narcan prescription, then give Pre-R a call. We’re happy to help. However, for real recovery assistance, contact my friend Ken Starr MD or visit ENDORPHIN POWER COMPANY in New Mexico.

If you want to read more about narcotic withdrawal check our Anxiometer post.

One of President Obama’s recent parting acts was to sign legislation pointing $1 billion toward opiate abuse prevention. Let’s hope that does more than the remaining money in the bill that could potentially go to developing higher potency narcotics.

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