Commentary: Naloxone: A Tool – Not Treatment – In Saving Lives

Commentary- Naloxone- A Tool – Not Treatment – In Saving Lives- Join Together News Service from the Partnership for Drug-Free Kids

The drug naloxone reverses overdoses, but it needs to be used as a tool — not treatment – in saving lives, much like a defibrillator for the heart attack victim. We need more effective ways to save people from drug overdoses.

Just a few months ago, the drug naloxone was credited with rescuing the pop star Prince from an overdose of the painkiller Percocet. Sadly, six days later, the musician died from yet another self-administered drug called fentanyl, a type of synthetic opiate.

Prince’s case brings attention to all of these drugs, but I’d like to focus on naloxone — known as the “opioid antagonist” — specifically to the challenge of using the drug which is sold under the brand name Narcan, among others.

Studies have shown that people saved by naloxone often have another, sometimes, fatal, overdose soon afterwards, as was the case with Prince.

Here’s what happens: When a person takes prescription opioids in excessive amounts, the drugs can suppress breathing. Naloxone typically restores breathing within minutes. But after 30 minutes, the drug begins to wear off, and may be gone from a person’s system after 90 minutes.

Short time later, naloxone can trigger strong withdrawal symptoms, such as sweating and vomiting. Some people seek opioids to calm themselves and treat their withdrawal symptoms.

Naloxone may provide a false sense of security for the provider and victim. It’s a tool — not treatment — similar to a defibrillator for the heart attack victim. In both cases, the patient needs further treatment and follow-up care for survival.

My organization, NOPE Task Force, supports and promotes the use of naloxone by first responders, such as trained emergency medical technicians and law enforcement officers.

We have concerns, though, when the drug is administered by others. In fact, laws allowing naloxone to be prescribed to third parties such as family and friends of people addicted to opioids have been passed in 39 states. Many of these laws, at the very least, should be made stronger by requiring caregiver training and requiring the caregiver to be at least 18 years old.

This is an issue very personal to me.

Naloxone- A Tool – Not Treatment – In Saving Lives- Join Together News Service from the Partnership for Drug-Free Kids
My son, Richard, and I

On June 28, 2003, my son and college student, Richard Perry, died from an accidental drug overdose in Florida. Exactly one month prior to his death, Rich had overdosed on a combination of prescribed medications and heroin, and was admitted into a hospital emergency room where he was given three vials of Narcon. He was revived and released, with instructions: “Stop using drugs,” and “return to the ER if needed.”

None of our family members, nor any of Rich’s medical doctors, were made aware of his overdose incident that occurred on May 28, 2003. At the time of this first incident, all of Rich’s finances were being handled by my husband and me, including his health insurance and all medical doctor bills.

Months before his death, Rich was being treated for depression and anxiety and was taking the prescribed medications, Klonopin, Wellbutrin, and Ritalin. He was seeing a medical doctor and a psychologist. He also had been in treatment for addiction and was attending a follow-up program.

Had we been notified of his overdose and had he been fully detoxed and given the opportunity for treatment when he was admitted to the emergency room, Rich would be alive today or would have, at the very least, stood a fighting chance to recover from drugs and lead a good life.

We need a better way to follow up on an overdose. Through NOPE, I have been supporting the “Overdose Prevention Act” in Florida, a bill requiring specific rules be followed by an emergency care practitioner whose patient suffers a non-fatal unintentional overdose. These rules or procedures include proper medical stabilization and substance abuse Screening Brief Intervention and Referral to Treatment (SBIRT).

Here’s how it would work:

  • Prior to a patient’s discharge, the attending physician shall make all reasonable efforts to contact the patient’s primary care physician and any practitioner who prescribed a controlled substance within the past 12 months to the patient, and inform that the patient has suffered a non-fatal overdose and may require substance use treatment.
  • Additionally, the attending physician would notify the patient’s emergency contact or next of kin of the event and provide materials on addiction treatment, treatment facilities and practitioners, as well as information on local involuntary treatment laws.

Our hope is to see this bill pass in the Sunshine State, and have it adopted across the nation. A similar law is on the books in Rhode Island.

And so, I, along with NOPE, am cautious about the promotion of naloxone among family and friends until scientific data demonstrates third party distribution would not have unintentional negative effects on communities.

Naloxone is not a substitute for long-term treatment. Without follow-up care and treatment for a substance abuse disorder, the victim will likely suffer a subsequent overdose with the possibility of death.

Karen H. Perry, Executive Director of the NOPE Task Force

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    Steven

    September 7, 2016 at 10:56 AM

    As a healthcare professional, a national behavioral healthcare trainer and technical assistance provider, and a person in long term recovery from opioid misuse, I understand Karen’s perspective here and my heart goes out to her for her loss. I lost many friends and a stepson to opioid overdose in my years of active addiction, and my own life was saved three times over the period of 6 years thanks to Naloxone. Karen, this is about harm reduction and saving lives, and naloxone should be easy enough to use (and is) for ANYONE to administer. It reminds me of the defibrillators in airports and malls; simple instructions on the case, ease of use, and the potential to save a life. We don’t ask whether, after someone is defibrillated, that person is more prone to “risky” behavior because that isn’t the point. the point is saving the life right now. We’ve long had plenty of restrictions and training on naloxone; I was a paramedic and part of a task force in the 80s that loaded Naloxone into ambulances and we were highly trained to use it. Unfortunately, our response times to the scene often killed people because of the delay, when Naloxone onsite would have saved a life. I respect your opinion, but my personal and professional experience, spanning 40 years now, provides me with the perspective that Naloxone should be cheap, in every person’s medicine cabinet, and easily administered (see:http://www.narcan.com/) . The addiction challenges can be addressed if the person lives another day. Without Naloxone readily available, many will never get that chance.

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    Doug H.

    July 10, 2016 at 12:40 PM

    I am a recovering addict, I’ve been clean since June 10, 2015. I tried to quit several ways: by taking a little less as a time to wean myself off, take weaker opiates, cold turkey, switch from “needles to nostrils”, among others.
    While I understand that what works for me may not work for everyone, there are a few undeniable facts: Naloxone at the ER, then telling the addict to get clean works like telling a puppy to poop outside as you clean a pile of shit. You’ll be cleaning his mess again. Follow up support is needed. For me, after 12 months of use while begging the VA and every local outpatient clinic I could find, I was finally able to get seen by a suboxone clinic. It was like a gift from God. I was somewhere that understood addiction and saw me as a client, not criminal. No judgement, they only wanted to know how much of what I used, so they could give me the appropriate dosage of suboxone. 20 minutes later I had a 1 month supply of medicine. Every morning I take one in front of my fiancé, and once I do that, the medicine takes away any chance of me wasting money on drugs, they simply wouldn’t work, not for 24-36 hours after taking the suboxone. I go there once a month for a drug test and conversation with the Doctor. I’m aware that I am lucky to be in this program, and if I fail a urinalysis, I have strike 1 of 3. If I didn’t take full advantage of this rare opportunity, then I don’t deserve it.
    They even offered mental health services for me, but I showed them that I had already secured a counselor. That place has saved my life by being not only at the forefront of a very new and difficult approach to addiction (Naloxone), but by doing it right. This is the best program, and I have no idea why it is not more widespread. I know people that have been trying desperately to get in since before I first tried, and they still never hear back from anywhere.
    Changing opiate and heroin addiction from an epidemic to a rare occurrence is not as hard as this country is making it. We need to place more suboxone certified doctors are already established medical providers.

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    Carlos

    June 29, 2016 at 9:45 PM

    Unfourtunatly there is way to many modalities in mental health, but specially substance used disorder we call treatment, but isn’t. They are mearly guesses that we call treatment by declaring it so. Case in point that dominant modality of the 12 Steps pushed by over 90% of most residential facilities.

    The problem is that these field is.prevently full off pseudoscience and clinicians are science illiterates that pay lip service to science but are oblivious and have accepted these modalities at face value and without questioning its effectiveness and over all safety.

    Why Bogus Therapies seem to work.

    Nalaxone doesn’t have a good record of effectiveness. Once patient is off the medication relapse is common and prevelet. Most politicians as well as clinicians love to wishful think that things works when it does not

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    Fr. Jack Kearney

    June 23, 2016 at 11:44 AM

    I have done too many funerals for people like Richard; my heart goes out to your family. We already have enough scientific data to suggest that we should be providing naloxone to anyone willing to get some training, including addicts themselves. No need to delay.

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