Should You Carry Naloxone?
The US Surgeon General has recommended you carry naloxone (brand names Narcan and Evzio) if you, or someone you are in contact with frequently, has an opioid addiction. The reason is the drug can reverse the effects of an opioid overdose. Much like having AEDs readily available in the event of a cardiac arrest, having Narcan on hand can reverse the possibility of a death by overdose. Thousands of people have been saved over the years since it was introduced – some more than once. While naloxone is highly effective as evidenced by hundreds of videos on YouTube showing overdose victims being revived with a single dose and walking off scene with paramedics or police officers, citizens should be aware there is usually more to the story once the overdose victim has been revived.
Immediate Withdrawal
The big question is – what happens after the overdose victim wakes up? An addict who awakens after someone uses naloxone on them is immediately in withdrawal. The opioid receptors in their brain are blocked. They feel sick, probably crave a fix, and may sometimes be combative. Stories have circulated of addicts fleeing their rescuers immediately to find more drugs to try and counteract the effects of naloxone. The sad truth is the naloxone takes them from feeling the euphoric effects of the drug to the harsh world of reality – very quickly.
Many times an addict is revived only to be jailed and go through detox in a jail cell. Some awaken in hospital rooms and are then released without a plan for treatment because many urban areas face a lack of treatment options for addicts. Placing Narcan in the hands of every citizen who is likely to come into contact with someone who might overdose also puts them at risk of dealing with an addict who may be less than grateful for the assist. It is imperative everyone who decides to carry it should also be aware of the possible situations they may find themselves in, how to handle those situations, and understand they shouldn’t take it personally if the person they just saved ends up needing to be saved again the next month, next week, next day, or later the same day.
Who Already Carries Naloxone?
Traditionally, naloxone is a treatment administered by EMS persons who have been trained to handle just about any situation which may come their way. They understand the dangers involved in coming upon someone who may have powdered opiates on their person which, if inhaled, can lead to the rescuer facing a physical “high” or even an overdose themselves. They also know how to handle a combative patient and have the means to administer additional sedatives to make the victim easier to handle. If a law enforcement officer uses naloxone, they also have special training to handle someone who is combative. The decision to put yourself in this sort of situation should not be taken lightly. Bystander involvement could be greatly beneficial, but everyone should be informed and trained on what to expect if they choose to use naloxone.
Keeping Yourself Safe
According to EMS personnel interviewed, should you come upon someone who has overdosed, the first thing you should do is call 911 from a safe distance and keep the dispatcher on the phone with you as you proceed. Assess the situation. If you are in a safe situation and have naloxone available, you can administer it according to the directions and then stand back. Make sure you give yourself an exit should you need it. If the naloxone does not awaken the patient, it is possible they have gone into sudden cardiac arrest. At that point you should begin CPR and retrieve an AED if it is available and follow directions from the 911 operator.
Any time you can save a life it’s a good thing. Learning CPR and how to use an AED in case of sudden cardiac arrest, learning how to control life-threatening bleeding in case of trauma, a working knowledge of basic first aid, and understanding how to reverse an opioid overdose are all worthwhile life skills. Taking on the responsibility to assist in any of these scenarios has value and should be entered into with full understanding of the likely outcome.
April 17, 2018 at 6:57 am, MStephenson said:
Absolutely not! This is a very short-sighted decision by the surgeon general! Not until leaders of youth groups can carry and administer epinephrine for anaphylaxis without fear of prosecution of “practicing medicine without a license” as is the case in many states! People that abuse opioids are often dangerous to others and surely will become violent when deprived of their “trip”. This observation is from my 40 years of EMS experience in a large metro area. It is simply too dangerous to give minimally trained lay rescuers the antidote to this group of drugs and expect them to be ready to deal with the withdrawal syndrome. Don’t do it!! This is in my opinion, facilitating their continued drug abuse.
April 17, 2018 at 7:25 am, Les Myers said:
Agree 100% 38 year in the field.
April 17, 2018 at 7:45 am, DAVID L. SMITH said:
My son had a fall and broke C 3, 5, and 7. Also has TBI. He has been on Fentynal Patches for 10 years and takes 15 other drugs daily including Narco, and Xanax. To my wonderment he has only OD,d twice……..American Heart has included in their Heartsaver Training the use of Naloxone……….. If you have, the entire family needs to take this course.
April 17, 2018 at 7:54 am, Eric said:
Complacency among narcotics users increases daily. Shooting up in plain view of the public is commonplace in my area. This practice allows the user the luxury of being found when they overdose and receive very effective treatment, along with act 139 protection which keeps them out of jail to boot! A heroin syringe in one hand and Narcan in the other, are you kidding me? Sadly, no! I can’t agree more witht the previous commenter…the disparity of free Narcan (PA has committed more than $30 million in funding) for narcotics users and expensive epi-pens is criminal! Why should a child who is BORN WITH a hymenoptera allergy not be afforded the same access to lifesaving medication as someone who (for the sake of this discussion) choses to use narcotics?
April 17, 2018 at 8:15 am, Dave Springer said:
Having started in EMS in 1972 I can safely say no. Let a professional titrate it as needed. Remember that YOU are the most important person on any scene. You are going home at the end of the shift period, end of discussion. If there is any way on God’s green earth your partner is going home also. After that it is all gravy.
I don’t want you to die trying to save an addict because they didn’t appreciate you ruining their $50.00 trip.
April 17, 2018 at 8:17 am, Howard said:
I’ve been in EMS over 40 years. Our medical director does not like giving Narcan in the field. Protocol says Narcan is given for “respiratory depression” secondary to possible opiod overdose. The medical director prefers to have EMS provide BVM ventilation and give Narcan in the ER under controlled circumstances. It is absurd that an EPI-Pen can’t be used by the public to save a child in anaphylaxis but Narcan be given to someone who chooses to use illegal drugs.
April 17, 2018 at 8:20 am, Dave Bresnahan said:
I too have been in EMS for decades. Saving lives is what this profession is all about. If I save someone in cardiac arrest, it is then up to other medical professionals to take additional action to prolong the patient’s life. The same is true for a over dose patient. I have the ability to save their life, and then it is up to others to take the next steps with that patient to prolong their life. That may or may not happen, but that does not change my job. If I have to help save that same patient again and again I will, because every life is sacred. I cannot fix everything that is wrong in our society, but I can take care of some things, and I will continue to do so.
April 17, 2018 at 8:29 am, Mark said:
We EMS people need to get over ourselves and acknowledge our prejudices. As medical professionals we should deliver judgment free care. Do we dent care to drunks? We see far more accidents and stupidity from ETOH. When AEDs came out we said that they public can’t be trusted with them. SO it’s OK for an addict to die from resp. arrest because they OD’d? Unless it’s a 16 year old cheerleader or the hight school quarterback. Let’s not keep Narcan away from people because some high schools are so stupid that they won’t allow epi. pens. People are dieing, folks. Time to change our thinking. If I can do it after 40 years, you can too.
April 17, 2018 at 8:52 am, Jeff RN said:
An RN who has taught CPR & First Aid for >30 years. A shared concern with colleagues is that the 2015 AHA standard-based Heartsaver CPR-AED course presents opioid-overdose in a, we believe, dangerously understated manner. As simply another scenario in which the rescuer -tho unaware of the cause of the victim’s non-responsiveness- is encouraged to proceed with the administration of narcan, and, then administer CPR. The instructional materials do not provide information about the risks involved in an opioid related rescue: unknowing exposure to fentanyl (or worse carfentanil); injury from an abruptly revived opioid victim who is angry or combative; or exposure to any of the contagious disease associated with drug use. Various governmental agencies have issued warning statements to professional rescuers regarding such risks, but these risks are not clearly identified with emphasis is the public/lay narcan rescue courses taught in our area. Further, AHA standards disallow including any non-AHA material within courses. As instructors we have an ethical and moral obligation to inform students -clearly!- of any risks associated with opioid-overdose rescue. Consider: bystander rescue of non-responsive victims is only (approx) 27%. Publicly reported incidents of injury to opioid-overdose rescuers -and it will be reported- will significantly reduce the already low % of bystanders will to step into a rescue. While truly concerned about our ability to rescue the so many young people who experience opioid overdose, I do not accept the possibility of SCA victims not being rescued because of public fears generated by injurious opioid-overdose rescues. And, may I add my voice to the above comment: We should be discussing ways to make epi-pens available to organizations to protect staff working in remote or wilderness locations, e.g controlled burn crews; ecological restoration crews; camps providing remote/wilderness expeiences,etc.
Allied 100’s opportunity to have this discussion is appreciated.
April 17, 2018 at 10:08 am, Jack said:
Jeff, RN – I appreciate and mostly agree with your comment. Just one minor correction. The BLS course clearly teaches that CPR is first. Only after CPR is under way would Narcan be administered, if it is available and you are authorized to administer it. Personally, as professionals we may put ourselves at risk on a daily basis, but without adequate personnel and training to handle a combative addict, we probably have no business administering Narcan. We want to save lives, but do we want to become a victim while trying to be a hero? AHA does understate this situation.
April 17, 2018 at 12:31 pm, Patriia Slice said:
I’ve been in the business (volunteer EMT) for 11 years now. Not much compared to some of the others responding. But I don’t think we should have volunteers carrying Narcan. Our state wants to give it away while ignorning the fact that the EpiPen costs $600 and up. These are the folks, through no fault of their own, need emergency help. If a person who uses drugs, that’s their decision. If they go into cardiac arrest, I will do CPR, and do my best to stabilize the patient. With Narcan, I have firefighters who are almost scared to do CPR, why give them a drug to a person spent their money to get that way. There are WAY bigger things to worry about. I realize it’s a medication and I think it puts my responders in harm’s way because we have no idea how the patient will respond. “You saved my life”, or “You just ruined my $50 opioid trip.” When will the responsibility to go the user rather than those that volunteer to save those that have no fault other than having diabetes or an allergic reaction. NO
April 17, 2018 at 1:42 pm, Joseph said:
Yes. We have too many regulations and not enough time to save lives. Saving someone’s life, whether a peanut allergy or self-induced narcotic OD isn’t the right of only union firefighters and union police. We should be allowed, with simple training, to purchase and administer: naloxone, epinephrine, oxygen (when indicated with a pulse oximeter), inhalers, injectable diphenhydramine, and glucagon (when indicated by blood glucose). Firearm purchase and driving a car has a lower bar and more risk than giving someone any of these life saving treatments.
April 17, 2018 at 4:26 pm, ben bagley ff-pm,flight-er r.n.bsn,acls,pals,nals,tncc,btls,reacts said:
my ems director will not allow fire rescue nor rescue squad and all E.M.R. responders to carry narcan , we have the highest percent of overdoses in east tennessee , so sad , i’ve am a retired LT.fire-medic , flight-er nurse for 40 years and volunteer with the local fd-rescue dept’s , also meth is the highest abuse too in our county of”monore” in the whole state , so sad , i’ve carried a personal A.E.D. years and a simple trauma bag , remember the life you save my be a family member or yourself
April 17, 2018 at 5:29 pm, Todd said:
EMT >5 years. I may be a new kid on the block to this discussion, but this is simple. Anyone (including EMS, FD, PD and general public) should be allowed to administer Naloxone IF given the proper training. However, this is not a “1 hour and done” curriculum. It should consist of a solid and comprehensive discussion of the risks to the rescuer and bystanders followed by the signs and symptoms that an opiate OD patient presents with, before the “how-to” portion is ever discussed. This should not be dumbed down from the curriculum that EMS are taught. If people want to carry this drug, they should be held to a universal standard (with testing) before they are allowed to obtain it. I can see some merit in allowing the general public to have access to it, but only if they are made aware of the risks of administration, can clearly recognize when an opiate OD is taking place and can properly administer it. I see much more value in giving the public access to affordable and easily available Epi-Pens. I do also see how this could be seen as a security blanket and enabler for people with opioid addiction. The last thing we want is people taking larger doses thinking that “Someone with Narcan will save me”. Carfentanil OD’s can take 3-4 doses of Naloxone before patients begin to respond to it. So the basic answer for me, is that if given the proper training, anyone should be able to administer Naloxone, but the training must be comprehensive and cover all the risks associated with administering it. If people really want to save lives, they should join the EMS community and get certified as a First Responder or EMT. It’s worth it!
I do have a huge issue with Epi-Pens in my county. I can take a $50 one day class and get certified to carry one off duty, but if I am working Standby at an event I cannot use it. When on duty, my Scope of Practice limits me to assisting people with the administration of their own Epi-Pens. The second I am on the clock, I cannot deploy the one I own even though I have been thoroughly trained in recognizing the signs and symptoms of Anaphylaxis. That is ludicrous to me.
April 20, 2018 at 2:28 pm, Ralph Bressler said:
NYS EMT for 34 years on a volunteer corps. I am surprised to see professionals making judgments about whether or not a life is worth saving. I know all the arguments about easily available Narcan encouraging drug use and do not think they are valid. Addicts will inject whether or not Narcan is available. In the few years we have used Narcan, I have saved at least 5 lives that I believe would not have been saved without Narcan. We are a BLS corps with a commercial ALS company doing intercepts but they are not always available and the response time varies. I agree that proper training needs to be done before anyone administers Narcan. Strangely, I have had few patients become combative.
I think bringing up epinephrine injectors clouds the issue. I, too, am appalled by the price of these injectors and think it incredible that the manufacturers are holding the public and EMS agencies hostage. However, to say “no” to Narcan because the price of these injectors is too high makes no sense to me.
May 14, 2018 at 11:36 am, Amy Pollock said:
Very interesting discussion here and I have two different vantage points to reply from.
I run a charity serving lunch to 180-200 homeless or food challenged every Sunday. We’re in our 9th year.
I have people high and/or drunk in line on occasion. I looked into having Narcan available for our volunteers to administer if needed. Repeatedly I was told get some folks trained and we’ll get you the Narcan. No one had stated it was because of the potential combative response. In light of not having a situation arise yet with the need for Narcan and what I have read here, I will no longer pursue having it on hand for volunteers to administer. Only a 911 call will still be made.
My other perspective is my husband. He has several co-morbidities. Including kidney damage. He is very slow to metabolize sedative drugs. He has heart failure, rheumatoid arthritis, sleep apnea, poly-neuropathy, and ‘others’ as well.
We have Narcan on hand in case his respiration became an issue as result of the pain medications he uses. In his case there wouldn’t be withdrawal or combativeness ~ probably why we weren’t told as much. And thankfully we’ve not had to use it.
We have Epi-Pens because of his severe allergic reaction to bee stings. We were informed of the cost of the Epi-Pens. We were not informed of Narcan’s cost.
My husband is unusual but not unique with his needs. We are lucky to have both medications on hand.
Based on the previous comments I agree that the cost of the Epi-Pens is ridiculously exorbitant. What can be done to make it accessible? Affordable? Is it a profit-margin problem?
Epi-Pens absolutely need to be readily available to more people in case of the emergency. It is life saving based on physical life and not based on lifestyle choices.
It seems to me Epi-Pens should be placed along side AED’s and maybe even part of the AED Training.
Narcan/Naloxone should be in the hands of those that have needs, come with education, and continue to be affordable. Obviously it’s necessary for First Responders and Medical Professionals.
The question/concern appears to be, that aside from training, profits are more important than lives. Why? And if it’s c o s t is for reasons other than profits then the public should be informed. Maybe a longer shelf life would better serve the profit margin…
May 16, 2018 at 10:55 pm, David S said:
It is scary when you have a loved one who lives with you was an addict. He was an active user of Oxsee and heroin for about two years.We did consider having the drug on hand but we never did follow through with that. Mostly because he was always gone when is getting high. . What works for us was detox and rehab and the BALM be a loving mirror.
September 10, 2018 at 9:48 pm, Meliton (Tony) Arriola said:
Absolutely not. We hear all the BS that we are winning this war on opiods. Yet the numbers of ODs with Naloxone readily available to first responders keeps going up. We tell the addicts that they are not responsible because it is a disease. We need to quit pampering them and let them accept responsibility for their actions. If they don’t take action to get off the drugs then let them accept the results of their actions. I am a disabled veteran with chronic pain that has gotten worse. Before I had my knees replaced starting in 2006 I had been on Darvocet then Vicodin for years for my knee pain. Once I had the second knee replacement in 2010 I voluntarily stopped taking them because I didn’t need them. Now, because of losers abusing the drugs, I cannot get any thing for my chronic back pain. After 3 surgeries my doctor told me to take 500mg of acetaminophen and 400mg of ibuprofen. I will not spend my money to carry Naloxone and I do not like my tax dollars paying for the “Centers of Excellence”, a euphemism for treatment centers, that our governor has paid for with tax dollars. With these efforts and with all schools, police forces, fire departments and ambulance crews the number of OD deaths continues to rise.
November 29, 2018 at 3:55 pm, Opioid Overdose and AED Use - AED Superstore Blog said:
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