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.