This Drug Won’t Stop the Heroin Epidemic. But it Can Help.

Should police officers carry Narcan, a heroin antidote, as Eric Holder is calling for?

National Journal
Brian Resnick
March 10, 2014, 10:55 a.m.

Nar­can is the good twin to heroin’s evil.

The pa­tient is not re­spond­ing. He is not breath­ing. Pu­pils are tiny. Pulse is weak­en­ing. Skin is grow­ing colder. That deadly blue is set­tling in.  

Heroin has af­fixed it­self to the opi­ate (re­ward) path­ways of his brain, and it’s not let­ting go. Along with the eu­phor­ia this path­way reg­u­lates, it also com­mands a more ba­sic func­tion — con­trolling the steady tides of the breath­ing muscles. Back in the 19th cen­tury, heroin was mar­keted as a cough sup­press­ant. But it’s too good of one. Too high a dose, and your un­con­scious body no longer re­sponds to the bio­lo­gic­al cues that com­mand it to breathe.

Enter Nar­can, (or nalox­one, its gen­er­ic name).

Nar­can is the good twin to heroin’s bad. It’s sim­il­ar chem­ic­al shape al­lows it to push heroin out of the opi­ate re­cept­ors in the brain. But un­like heroin, it does not ac­tiv­ate those same path­ways. It shuts them down. After a para­med­ic sprays it in­to the nose or in­jects it in­to the blood stream, the ef­fect is an im­me­di­ate re­versal of over­dose symp­toms. Of­ten, this oc­curs with start­ling speed. “There’s some­body who’s on the ground, who’s lit­er­ally dead,” a fire of­fi­cial told a Bo­ston NPR af­fil­i­ate, “some­times they’re blue, some­times they’re black. And you ad­min­is­ter this stuff and some­times in a minute or two or three they’re ac­tu­ally up and talk­ing to you.”

That the pa­tients are talk­ing means they are breath­ing. And this is why At­tor­ney Gen­er­al Eric Hold­er is call­ing for more first re­spon­ders to carry the drug — es­pe­cially con­sid­er­ing heroin over­doses have ris­en by 45 per­cent in re­cent years.

“Used in con­cert with ‘Good Samar­it­an’ laws, which grant im­munity from crim­in­al pro­sec­u­tion to those seek­ing med­ic­al help for someone ex­per­i­en­cing an over­dose, nalox­one can save lives,” Hold­er told re­port­ers.

This sug­ges­tion that first re­spon­ders (mean­ing po­lice of­ficers and fire­fight­ers — para­med­ics already have Nar­can in their ar­sen­al) should carry the drug is more con­tro­ver­sial than it sounds. Al­though 17 states have laws that sup­port the use of it, Maine Gov. Paul LePage ve­toed a bill that would do the same last year. LePage thought the drug would give ab­users “a false sense of se­cur­ity.”

While his lo­gic is flawed — akin to the HPV vac­cine mak­ing young girls more promis­cu­ous — the gov­ernor is right in that the drug has some side ef­fects that need to be taken in­to care­ful con­sid­er­a­tion.

Like all drugs, Nar­can has side ef­fects. For one, a dose only lasts for 30 minutes to an hour. If the per­son who over­dosed had enough heroin in her sys­tem, she could slip back in­to res­pir­at­ory ar­rest after the Nar­can wears off. One sur­vey of re­search on the drug sug­ges­ted that the pa­tients need to be ob­served for two hours after tak­ing the an­ti­dote. If Nar­can is sold over the counter, and avail­able in the home, it alone will not pre­vent death.

Ad­di­tion­ally, while the drug will get a per­son breath­ing again, it can in­duce im­me­di­ate opi­ate with­draw­al, which can be vi­ol­ent. “This over­dose re­versal of­ten leads to a com­bat­ive, with­draw­ing pa­tient who does not want to be trans­por­ted, who then po­ten­tially could bring risks to the out-of-hos­pit­al and hos­pit­al staff,” reads a 2003 re­port in the journ­al Aca­dem­ic Emer­gency Medi­cine. However, the study didn’t find any deaths in 998 pa­tients who re­ceived the Nar­can from para­med­ics but then re­fused fur­ther hos­pit­al treat­ment.

Nar­can can cause con­fu­sion, dizzi­ness, vomit­ing, ag­gress­ive­ness, and even seizures. In Hunts­ville, Ala., the loc­al EMS med­ic­al dir­ect­or told re­port­ers that even though he car­ries the drug on am­bu­lances, it isn’t his first op­tion. “In my opin­ion, if I have some­body that is a sus­pec­ted opi­ate over­dose, the thing that’s go­ing to kill them is the res­pir­at­ory de­pres­sion, and it’s easy just to vent­il­ate the pa­tient and let the drug meta­bol­ize,” he said.

But the be­ne­fits of car­ry­ing the drug may out­weigh the risks. And spray­ing a chem­ic­al in­to the nos­trils is a lot easi­er for a lay re­spon­der than main­tain­ing con­stant vent­il­a­tion. With the right train­ing, pro­lif­er­a­tion of Nar­can has proven to save lives. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion stud­ied com­munity Nar­can pro­grams between 2006 and 2010 and found they re­versed 10,000 over­doses in 53,000 cases. An ex­ample of such a pro­gram is found in Bo­ston, which hands out Nar­can, along with train­ing, for free.

In Quincy, Mass., every po­lice of­ficer is re­quired to carry Nar­can. Since 2010, of­ficers have used the drug 179 times, re­viv­ing all but nine people. Sen. Ed­ward Mar­key, D-Mass., has in­tro­duced le­gis­la­tion that would ex­tend Good Samar­it­an pro­tec­tions to those who ad­min­is­ter the drug.

“The Opioid Over­dose Re­duc­tion Act re­moves the fear of leg­al jeop­ardy for fam­ily mem­bers, friends, and oth­er bystand­ers who ad­min­is­ter lifesav­ing drugs like nalox­one,” he said in a state­ment.

Hold­er called heroin over­doses “an ur­gent and grow­ing pub­lic health crisis,” and he’s right. And as the num­ber of heroin over­doses con­tin­ues to rise, any one in­ter­ven­tion will make an even great­er dif­fer­ence.  

(2012 Na­tion­al Sur­vey on Drug Use and Health)

What We're Following See More »
UTAH REPUBLICAN
Former Sen. Bob Bennett Dies at 82
1 hours ago
THE DETAILS

Former Utah Republican Sen. Bob Bennett died of pancreatic cancer on Wednesday after a long battle with pancreatic cancer. Bennett was defeated in a primary in 2010 by Tea Party–backed Mike Lee.

Source:
CLINTON HERSELF COULD TESTIFY LATER
Judge Approves Deposition of Clinton Aides
1 hours ago
THE LATEST

"Judge Emmet G. Sullivan, of the United States District Court for the District of Columbia, approved a joint proposal presented by Judicial Watch and the State Department to take the depositions of officials" involved in the setup and use of Hillary Clinton's private email server, "including Cheryl D. Mills, Clinton's former chief of staff, Huma Abedin, a senior adviser to Clinton, and Bryan Pagliano, a State Department employee who serviced and maintained the server." He said Clinton could be deposed later on, though that may not be necessary.

Source:
‘WORLD CLASS’ ORGANIZATION
Trump Will Not Self Fund the General Election
1 hours ago
THE LATEST

Donald Trump will not self-finance his general election campaign as he did the primary season, instead relying on "his expansive personal Rolodex" to create what he called a “world-class finance organization." 

Source:
STATE HAS UNTIL MONDAY TO RESPOND
DOJ: North Carolina’s CB2 Violates Civil Rights Act
2 hours ago
THE LATEST

Department of Justice officials told North Carolina Gov. Pat McCrory that "the law violates the U.S. Civil Rights Act and Title IX—a finding that could jeopardize billions in federal education funding. The department gave state officials until Monday to respond 'by confirming that the State will not comply with or implement HB2.'"

Source:
GOOGLE SEARCHES SPIKE
Libertarians Getting a Second Look?
16 hours ago
WHY WE CARE
×