For your education Friday:
Although not on the news as much lately due to other news stories, opioids are still being used, misused, and unfortunately, contributing to overdoses. The Pennsylvania Department of Health recently posted about Narcan/Naloxone and how one can obtain it. I read the post, and there seems to be a lot of confusion or misunderstanding about what naloxone actually is, what it is used for, how one obtains it, and how one uses it.
But first...
Background on the Brain:
To put it simplistically, your brain functions by chemicals being sent from one neuron to another. Think of a relay type race, the runners being neurons and the baton being the chemicals. One runner hands off the chemicals (baton) to the next runner to send a message. If the next runner gets the baton, they continue to run. If they do not get the baton, they stay put. One of these chemicals that naturally occur in our brain is opioids, or endorphins. You may have heard of these being released when exercising to relieve pain (fits with the metaphor of runners!). When someone takes an opioid drug (ex. Oxycontin, Morphine, Heroin, Fentanyl, Oxycodone, Vicodin, Percocet, etc,), the opioid chemical flood the brain. Too many, and the person will experience an overdose. These artificial opioids fit in the same receptors as your endorphins.
[Photo credit: Linkedin]
What is naloxone?
[Photo credit: The Seattle Times]
Narcan is the brand name for the drug naloxone. Think of how Tylenol is the brand name for acetaminophen. Naloxone is an opioid antagonist, meaning it will jump in and sit in the receptors mentioned above and block any more opioid chemicals from binding. To use the running analogy, the naloxone acts as a rolled up newspaper, that will replace the baton and therefore the person won't be able to hold the baton. Naloxone is available in the nasal spray form or injectable form.
[Photo credit: Harm Reduction Coalition]
When should you administer naloxone?
Immediately. Any time you suspect someone is experiencing an overdose, you should administer the naloxone. Signs of an opioid overdose include the following: Small, constricted “pinpoint pupils”, falling asleep or loss of consciousness (nodding off), slow, shallow breathing, choking or gurgling sounds, limp body, pale, blue, or cold skin (From CDC). You should call 911 immediately, administer naloxone, and then perform CPR if you are trained.
What if I'm not sure if it is an opioid overdose?
When in doubt, you can still administer naloxone. There is no harm in administering it to someone who is not experiencing an overdose. If given to someone experiencing a different medical emergency, nothing will happen. When given to someone experiencing an overdose related to opioids, the person should regain breathing function within a few minutes or so. Sometimes, a person will need more than one dose of naloxone.
Is naloxone an enabling product?
In the mental health field, enabling has a negative connotation that it is one person encouraging or allowing another person to engage in dysfunctional behavior. A person carrying naloxone is not encouraging someone else to use heroin or any other opioid in the same sense that carrying an inhaler does not encourage someone to have an asthma attack nor does carrying an epi-pen encourage someone to have an allergic reaction to a food or bee. It is there to help save a person's life. People who have a true substance use disorder with opioids will use the substance whether there is naloxone available or not. Also, many overdoses are actually related to the presence of fentanyl which can be "laced" into the substance the person is using. That means that someone smoking marijuana, unknown to them, could be laced with fentanyl and then would be in need of naloxone. Naloxone can be seen as a harm reduction measure. Other examples of harm reduction measures are seat belts, sunscreen, airbags, ride-share apps.
Who should get naloxone?
Many first responders now carry naloxone. This is great, but really people in the general public should carry naloxone, especially family and friends of people who have an opioid use disorder. Bartenders, prison staff, probation officers, child welfare caseworkers, or any mental health counselors or therapists.
How do you obtain naloxone?
There are several methods by which you can obtain naloxone. Some counties or states offer distribution events by community agencies. In Pennsylvania, you can obtain naloxone from pharmacies with a prescription or Dr. Rachel Levine's standing order [https://www.health.pa.gov/topics/Documents/Opioids/General%20Public%20Standing%20Order.pdf] Additionally, you can visit naloxoneforall.org and request it. Sometimes naloxone costs money, but can be obtained for free through many of the community agencies or the NEXT Naloxone program (for example).
Are there trainings available?
Yes! The good news is that many are available online. You can visit naloxoneforall.org or getnaloxonenow.org.
I have completed several naloxone trainings and have two "kits" so that if needed, I would be able to administer it. It is the same idea as being CPR certified...see someone in need, help them. The idea that "they did this to themselves" (a phrase I've seen thrown around) is not an excuse to refuse to help someone live. People who need CPR may not exercise and eat unhealthy foods that, in addition to other factors, may have contributed to their need to be resuscitated, but you don't hear people refusing to perform CPR.
Naloxone can be free, and I agree that other medications like epi-pens should be free too. However, rather than being frustrated that naloxone can be free and feeling resentment, the frustration should be directed toward other medications costing money. People can advocate for cheaper and more widely available medications without reversing the progress made with naloxone.
If you have questions about this topic, please feel free to contact me, comment below, or check out the websites previously provided. I also welcome any discussions on the topic, no matter your views.
[Source: PA DOH https://www.health.pa.gov/topics/disease/Opioids/Pages/Naloxone.aspx]