heroin overdose aftermath

If you haven’t spent time in emergency rooms or drug treatment centers, then what I am about to tell you may seem (to use 60’s jargon) really far out. But, stay with me to the end. I think this new approach to opiate overdose has the potential to save lives—and, at the end of the day, isn’t that what we believe medicine is all about?

 

The basics of opiate overdose

For those of you who haven’t taken care of people who have overdosed on heroin or other opiates, there are a few things you should know:

  • Heroin, when injected in large enough doses, suppresses critical brain functions and can shut off the drive to breathe. When that happens, unless the person is given an antidote to the effects of heroin on the brain, such as naloxone, the person will die from lack of oxygen (anoxia).
  • Naloxone is usually administered by injection in order to resuscitate an individual with a heroin overdose.
  • Naloxone administration is usually administered only by health professionals (paramedics, emergency physicians).
  • The person who overdoses at home or on the street will only be successfully resuscitated if someone is with them who can call 911 and if 911 responds rapidly enough so that naloxone is administered before anoxia causes overwhelming brain damage.
  • Naloxone is relatively safe when administered in the setting of a heroin overdose (i.e., it produces more good than harm)

So, given all of this, it is reasonable to ask: Why not give people at risk (e.g., heroin addicts (and/or their families, friends, cohabitors, etc.) prescription naloxone to be administered “in case of emergencies?” We give families, friends, and cohabitors of insulin-using diabetics prescription glucagon, an antidote to administer in the case insulin shock (a.k.a., extremely low blood sugar due to insulin injection).

Well, would it surprise you that, maybe, just maybe, folks feel differently about victims of insulin overdose than they do about victims of heroin overdose—even though the underlying risk factors for both have genetic determinants?

 

Naloxone at home

bottle of narcanA brief article in the NY Times Health section (Dec. 11, 2007) by Dan Hurley provides us with some reactions to a proposal by “growing numbers of researchers and public health officials advocating a daring new strategy to put an injectable antidote for heroin overdoses directly into the hands of addicts.”

As usual, the story opens with the story of one individual, but one uniquely positioned to educate us about heroin addiction. Mark Kinzly, an ex-addict working in a needle exchange program, tells the story of overdosing on heroin after 11 years of not using the drug. He was watching a ballgame when he passed out in a colleague’s apartment. His colleague, also working in the addiction field, “dialed 911 and then injected naloxone.” He saved Mr. Kinzly’s life—and, is, therefore, in my book, a medical hero.

Dan O’Connell, director of HIV Prevention in the New York State Health Department, which supports “in-home” naloxone programs, says:

From a public health perspective, it is a no-brainer. For someone who is experiencing an overdose, naloxone can be the difference between life and death.”

I agree.

I have a hard time coming up with any downsides to the naloxone programs. Naloxone is safe. Heroin overdoses are deadly. Naloxone doesn’t “cause” heroin addiction, it just saves addicts from fatal overdoses.

But bias and beliefs, of course, always come into play in any public policy discussion. Dr. Bertha Madras, deputy director for demand reduction at the White House Office of National Drug Control Policy is quoted in the Times as saying of the naloxone program:

“It’s based on what some people would consider the right thing to do.”

[SO????]

[OK, Bertha, tell me what kind of study you want to do here? We know the first line antidote for heroin overdose is rapid administration of naloxone. We know that delay in administering naloxone is associated with brain damage and, in some cases, death. So, are you suggesting we design a study to compare the outcome of delayed naloxone administration (via paramedics) with quick naloxone administration via a roommate in the face of overwhelming evidence that naloxone has no significant side effects when administered to reverse a heroin overdose?? I wonder if you could even get that kind of study approved by an Institutional Review Board (IRB)?]

I think the real issue here is that Dr. Madras seems to be more worried that naloxone in the home could mean that some addicts may feel more comfortable with the risks of their addiction, and, therefore, will not be amenable to reform. She is quoted again as saying, “in the absence of scientific evidence we don’t engage in policies that bring more harm than benefit.”

I am a #1 fan of evidence-based medicine, but Dr. Madras doesn’t quite apply it correctly here. The evidence has unequivocally demonstrated that rapid administration of naloxone reverses fatal outcomes of heroin overdoses. It also documents that it is a safe antidote for a heroin overdose. Where there is no evidence based on her (presumed) premise that somehow having naloxone in the home of an addict will lead to fewer recoveries from addiction than would occur in homes of addicts without access to naloxone.

 

San Francisco pilot program:

According to the NY Times article, a study in San Francisco’s 2005 pilot program found that of 20 overdoses witnessed by addicts trained to administer naloxone and CPR, all 20 survived. Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, which operates a naloxone distribution and training program in New York and San Francisco [those hot beds of bleeding heart liberals], found:

“We are just beginning to get really good evidence that it’s [a naloxone program] associated with a significant reduction in overdose deaths….and we know it’s safe. We’re not seeing any bad outcomes.”

Come on guys, open your minds and your hearts. This is an innovation that has the potential of saving lives. No, it doesn’t cure addiction. But reversing heroin overdoses at home does keep an addict alive and, therefore, open to the possibility of overcoming his/her addiction. Ask any mother, father, sister, brother, spouse, child, or friend of an opiate addict.

I think you will learn that saving the lives of their addicted loved ones is definitely a goal we, as a society, should shoot for…Thank heavens for innovators and free-thinkers such as the folks who thought up this approach…they benefit us all in ways we could never fully imagine.

If you would like to read more about this topic there is a good review in the Annals of Emergency, February 2007.

13 COMMENTS

  1. Thank you for this thoughtful and reasonable discussion of the naloxone program. I manage this program at one of the needle exchange programs in Massachusetts and it is a life-saving tool for our clients. It does not prolong their addiction or make them believe their drug use is now risk-free. Anyone who has experience with drug users knows this is nonsense, unless they don’t understand the complexity of drug use at all. Thank you again for keeping an open mind. This program works, period.

  2. I wish I knew this earlier. My brother had some friends home and didn’t expect me back too soon. Luckily I was early because he od-ed and his friends ran without calling an ambulance. I had to wait ’till helped arrived and sincerely, I thought he’ll die.

  3. Great thing someone came up with this drug! Let me say something: we won’t get rid of heroin if we won’t cut its roots. It will be a better strategy to fight against the causes rather the effects.

  4. I would like to know if it is required by paramedics to administer nalaxone to drug overdose patients or is it at their discretion?

  5. I just had to save a friend who fell out last night. I had to give him CPR as best as I could remember it being taught to me in school. I guess it worked, but it was a long 4 or 5 minutes. Anyways, with Naloxone is it administered IV or can you administer IM (intra muscular)? IM would be much easier since most addicts’ veins are difficult to find. Also, does it launch an OD victim into immediate widthdrawl when they come back? I think it is a great idea to make it more available and educate people about it. Unfortunately, there are so many people out there who would prefer that heroin OD’s would do away with the user. This makes any type of program like this, needle exchanges, or even Methadone clinics an uphill battle to get started.

  6. My 19 year old son nearly overdosed a week ago and my husband and I were on the phone with 911 who talked us through this nightmare until the police arrived. the police was there within minutes but they couldn’t help and were literally just standing around. Thank goodness our son came to before the ambulance got there. The ambulance took almost 30 minutes!!! I would feel so much better if I had an antidote at the house but I’ve never given anyone a shot! so along with getting a prescription for Naloxone would have to come training as to how to administer it. Thank you for your article!!

  7. The Dangerously Euphoric Violet DelightOften, medications for pain are made from opoid plants. These purple-flowered plants produce opium poppies, which are used in the production of the analgesic, opium. Opium is what we in the U.S. call narcotics, and they dull and numb one who ingests what may be made by these opium poppies, as there are several drugs that have been developed from what these plants provide that are these prevalent narcotics. Some medications are from natural opium, such as cocaine, or the opiates from the poppy seeds can be used to create semi-synthetic medications, such as Heroin. Heroin was marketed by Bayer Pharmaceuticals for 12 years, and during that time this company told others that heroin was a non-addicting form of morphine (pure opiate drug), since there were many soldiers addicted to morphine after the U.S Civil War. During that same period of time, Bayer marketed heroin for children who coughed. Of course, Heroin is very addictive, and is pointless creation is no longer available.While Poppy plants exist and are grown in areas of IndoChina, Afghanistan is the number one producer of poppy plants. The United States is the number one country that consumes what is derived from these plants. Opium-derived medicines once could be bought freely in the U.S. by anyone less than 100 years ago. Yet now, they are classified by the Drug Enforcement Agency as narcotics, and are scheduled by them, according to the danger they potentially could cause another who takes them. While prescribed to patients for such issues aside from pain on occasion, such as chronic coughing and diarrhea, their greatest benefit is for the relief of pain experienced often by patients is the primary reason doctors prescribe opoid drugs, and they do so often. Vicodin, a mild narcotic, is the most frequently prescribed medication in the U.S. presently.If patients take opium-derived drugs for long periods of time, tolerance may develop, and the patient may need to take more of the drug to acquire an effect of relief. In addition, the patient may develop a dependence on these types of drugs, which can lead to addiction and possible abuse. This is why overdose of these types of medicine occur- as the reasons for taking these drugs initially become replaced with relief due to addiction in some who take narcotics for a long period of time. Dan Abshear

  8. I seen a guy over dose today on heroin he was in and out of consciousness. I do not know who he was but his friend was also using there was two fits laying on the ground and elastic the works they call it I remember from way back in the day. what should I do if I see this guy again in the same state overdosing on heroin, I have a feeling I am going to see this happen again.

    • Try shaking and slapping their face but not violent just enough to annoy them if they are wanting to fall asleep, don’t throw cold water on them as it can put them into shock. This is no substitute for ambulance or a naloxone injection. If you catch it in time or they feel like they are overdosing as they are injecting then pull their needle out straight away and try to keep them standing or walking around but be careful they don’t fall (theses methods aren’t safe but it’s better to keep them alive than let them die ) IF you are experienced in injecting and they have veins then you can inject them with 2ml of saline to flush the veins this will nullify some of the hit I have done this myself twice and it’s saved my life. The second time i boiled water quickly and poured in a teaspoon of salt, dissolved it then shot it up it was touch and go but I got in me and it took the hit away… The best thing to do is NOT TAKE HEROIN, DONT TRY IT EVEN ONCE!! ESPECIALLY IF YOU HAVE HAD TRAUMA IN YOUR PAST OR YOU SUFFER FROM DEPRESSION ETC this drug is waiting for you and once you try it there’s no going back ive struggled with it for 10 years ive lost a lot and wasted my twentys on this and now ive just got into my 4th methadone program & this is my last, ive had enough if I don’t stop it will kill me & now I am a father & there’s more to live for I’m now responsible for a little human being & whatever happened in my past is now irrelevant because I have to play a part in somebody else’s future… Seriously don’t try it.

  9. Hi. My bf of 8 years broke his back 2 years ago. He became addicted to the pain killer.. morphine :( he took sum august just gone n died during that night. He was just 36 years old, He didnt use any drugs before he done his back, he did enjoy havin a good drink tho. He was a good honest working man. I woke up at 8:30 am n found him. His skin had already started turning blue so i think he had died hours before i woke up but i dont know. It has crushed my world. I miss him so much.

  10. I’ll not buying the logic, because the most terrifying downside risk isn’t even mentioned or discussed. The problem is the effect that it will have on a users dosing decision. Users are very aware of the OD risk and it has a strong influence on the dosage they choose. Almost all overdoses are accidental, either the purity is greater than expected or it’s a cocktail, and interactions occur.

    The OD risk is the only thing that prevents a user from pursuing the strongest euphoric rush possible, enabling hyper-dosing isn’t the least bit enlightened. Insulin users don’t fantasize about a really good high, very strange comparison.

    If users have access to narcan, it will become enabling paraphernalia. Users want to get high, they aren’t responsibly dealing with a medical issue.

    • I believe your conclusion is flawed, perhaps because you haven’t had a chance to read up on modern concepts of the neurobiology of addiction. First of all, given the variability of what is in narcotics sold on the street, dosing decisions are highly risky in today’s opioid epidemic age. Heroin is adulterated with fentanyl, carfentanil, and other very potent synthetics that can kill instantly. Addicts often have little knowledge and little control over what is in what they take. Second, addiction to opioids is a brain disease, just like addiction to nicotine. Both kill the user – one more quickly than the other. Both aren’t a choice once the addiction has been established. Yet, one of these conditions is still socially acceptable, albeit less than a few decades ago. I bet you would not want to deny an addicted cigarette user access to programs or drugs to help them stop smoking so they can save their lives. Yet, you seem to think that someone with an addiction to heroin or other narcotic should or even could “deal responsibly” with their addiction. Of course, if the addict doesn’t have access to Narcan when they “irresponsibly” shoot up, they likely will die. I urge you to become more informed about this problem that is now the leading cause of death in people under 50. We have many good articles on our site under the tag “substance abuse & addiction” (https://thedoctorweighsin.com/tag/substance-abuse-addiction/) and, of course, you can always google it. Shame and blame is not going to solve this national crisis.

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