Monday Musings: Who Knew Saving Lives Would Be So Controversial?

Naloxone saves lives, so why are people reluctant to use it?

Just after I finished writing this review of the book Overdose, I received an email from the Canadian Nurse Journal, highlighting a blog post about take-home naloxone kits. How timely. In my mind, making naloxone available to save lives is not all that different from providing CPR and an automated external defibrillator (AED) to save lives. Opioid overdoses and cardiac arrests are both emergencies that lead to death more often than not. Both types of deaths could potentially be prevented with immediate intervention.

If you’ve not heard about naloxone, or the brand name Narcan, it’s a drug that reverses the effect of opioids, such as heroin and fentanyl, as well as prescription opioids. It’s given by injection or through a nasal spray. I’ve seen how fast it works. The first time I saw it used was when I worked in an ICU. I remember being so amazed when the patient woke up within a couple of minutes.

Photo by Pharmacy Images on Unsplash

As far as medications go, naloxone is pretty safe. If you give it to someone who needs it, you can save a life. If you give it to someone who doesn’t need it, nothing should happen. It either helps or doesn’t do anything.

The important issue though is that you only have minutes to give naloxone to someone who needs it. According to the Centers of Disease Control and Prevention (CDC), “It can restore normal breathing within 2 to 3 minutes in a person whose breath has slowed, or even stopped, as a result of opioid overdose. More than one dose of naloxone may be required when stronger opioids like fentanyl are involved.”

So why isn’t it more available?

If you know someone with severe allergies, they probably carry around a rescue device called an EpiPen. The EpiPen contains the medication epinephrine, which decreases the allergic response. This, hopefully, keeps the person breathing until emergency help arrives or they get to an emergency department. Like naloxone, they may need more than one dose. It would be silly, of course, to suggest that a bystander would tell someone in anaphylactic shock that they can’t give them their EpiPen dose because they believe that the allergic reaction was their own fault and saving their life would only encourage another anaphylactic incident to occur. After all, who would do such a thing to someone who is sick and needs help?

But it happens every day to people who are addicted to opioids. People who are addicted to heroin and other opioids have a chronic disease, one that can lead to death. That is a fact. And yet, unlike people with severe allergies, those who have addictions are often made to feel that they are to blame for their illness. If they would just try a little harder to get their act together, they’d be fine. Need naloxone to reverse the effects of an overdose? Sorry, no can do because, well, it was your own fault. What this attitude doesn’t take into account is that this harm reduction strategy can help people eventually seek help for their disease, and they can go on to live productive lives.

Naloxone myths continue

It’s easy for myths to spread when people don’t understand something. The Indiana State Department of Health; Trauma and Injury Prevention, has a great PDF that describes six of the most common myths. Here are just three:

1- Teaching people how to use naloxone encourages them just to take more drugs, since there is a way to reverse the negative effects.

This is not true. This study, published in 2017, found no evidence that drug use increased if those who used knew how to administer naloxone. In fact, the authors wrote, “Active heroin users and users in agonist maintenance [medications that help people withdraw from opioids]  decreased heroin and polydrug use after training.”

2- If people who are addicted to opioids have access to naloxone, they won’t go for treatment.

Another untruth. In this commentary article, the authors refute this notion with several points.

3- The same people need naloxone over and over again.

I could see how some people may think this, but again, it’s untrue. Although there will always be some people who repeat certain behaviors and will need repeat naloxone treatments, most do not.

So, who should carry naloxone?

So who should get it? In my opinion, anyone really. But realistically, people who should have naloxone handy are those who:

• Take high doses of prescription opioids

• Use illicit opioids

• Use drugs like cocaine, methamphetamine, and others

• Spend time with people in either of these categories

• Live or work in neighborhoods where people are using illicit drugs

The Ohio State University also recommends that homes, where there are prescription opioids, should have naloxone kits in case a child gets into the medication.

According to the CDC, naloxone is available in all states without a prescription. The “gotcha” is you have to find a pharmacy that will provide it. It is also available throughout Canada, “through pharmacies, public health units, and a range of health and social service organizations.” This document outlines how each province or territory distributes it.

Why have naloxone easily available if you don’t take opioids yourself? If you take any type of drug not purchased in a pharmacy, you may think you’re not taking opioids. But increasingly, drug dealers mix fentanyl with these “other drugs.” It doesn’t take much fentanyl to cause an overdose.

Are there drawbacks?

The only drawback to having a naloxone kit is that if you are the one who needs it, you can’t give it to yourself. So the people around you need to either have their own kits or know where you keep yours and how to use it.

I get it, it’s not easy

I understand. We have been so programmed to think that drug addiction is someone’s fault. If only they would fight that urge to use. If only they were strong enough to say no. But it’s not that simple. Using naloxone isn’t the answer that will solve the opioid addiction crisis. It’s being reactive to a problem that needs us to be proactive. But right now, it saves lives while we figure a way out of this mess we’ve created.

What do you think? Leave your comment below. Let’s get a conversation going.

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