Is It Just Me, Or Is This Naloxone Bandwagon Getting A Little Crowded?

Way back in 2008, I called naloxone the most abused drug in the EMS drug box.

That comment arose from a discussion on an EMS forum where a distressingly high number of paramedics saw nothing wrong with using maximum doses of naloxone to “wake someone up” or “ruin the high” of some junkie.

Not to reverse opiate-induced respiratory depression. Not as a treatable cause of cardiac arrest (In theory only. In practice, it doesn’t work.)

Nope, purely given as punishment. I’ll admit that I’ve done it myself, twenty years ago. I was a new and cocky medic with a bit of an attitude problem then. I know better now.

But that kind of crap goes on even today. In the premier episode of A&E’s Nightwatch*, one of the NOHD medics gave naloxone to an awake, adequately breathing patient, simply because he didn’t think the guy was answering truthfully, or quickly enough to suit him.

Um… no.

Not kosher.

We give naloxone for opiate-induced respiratory depression, ie an overdose. As my good friend EMS Artifact puts it, “Addicts take heroin to induce a pleasant stupor. If they’re pleasantly stuporous but still breathing adequately, it’s not an overdose. It’s just a dose.”

After he gives the naloxone, he remarks to his partner that the patient’s oxygen saturation had improved slightly, as if that end justified the means.

I could have accomplished the same thing with a nasal cannula, with none of the potential side effects of naloxone. Learned how to do it way back in EMT school, even.

But now, seems like every state is in a hurry to make naloxone legal to use by EMTs and laypersons, to combat a growing epidemic of narcotic overdoses. My state did it, as have a growing list of others.

And on the heels of that, comes this news report out of Illinois:

A new proposal in Springfield could equip Illinois public schools with life saving Narcan to reverse the effects of a heroin overdose. Lawmakers say the school nurse would have the miracle medicine on hand in case someone overdosed in the building. The new legislation would make school districts and authorized personnel immune from civil liabilities if Narcan is administered in good faith. “If an event were to occur at school, whether it is during school days, after school in the grounds, or during a sporting event. then there would be the availability of that drug to use,” says Senator Dave Syverson.

Is this really a problem?

If you have to worry about little Johnny shooting horse in the bathroom between Algebra II and Chemistry, I’d suggest that your school system has bigger problems than naloxone can solve.

First of all, naloxone is not a “miracle drug.” Like any drug, naloxone has side effects. Some of those side effects can be quite severe, like seizures, flash pulmonary edema, profound hypertension, or combativeness.

One should only administer the drug if the potential benefits outweigh the risk of those side effects.

And while opiate-induced respiratory depression is such an indication, I don’t trust an educational system in love with ludicrous zero-tolerance policies that suspend kids for chewing Pop Tarts into gun shapes, or charge a kindergartener with sexual harassment for kissing a classmate on the hand, or suspend a kid for wearing NRA shirts, or have a girl and her mother arrested for drug possession for bringing ibuprofen to school with that responsibility.

At least the junkie’s buddies know to administer naloxone only if their buddy is dying. I don’t trust most school officials with that kind of judgment call.

Just the other night, we had a schizophrenic patient high on meth. She was a frequent flier valued repeat customer, who this time called 911 for a nonexistent gunshot wound to the neck. One of the cops who responded jokingly suggested, “Just give her some Narcan and let her sign a refusal.”

He was genuinely surprised to learn that naloxone does not reverse the effects of methamphetamine.

Or cocaine.

Or alcohol.

Or PCP.

Or Soma, Xanax, or any of the other non-opiate prescription drugs commonly abused around here. And if you administer naloxone to someone who has done a “speedball,” ie a mixture of heroin and stimulants such as cocaine, meth or PCP, you may have well and truly screwed the pooch.

You see, cops and paramedics have an entirely different definition of “narcotic.” To a cop, a narcotic is any controlled drug that falls under the Harrison Narcotics Act of 1914. To a medical professional, a narcotic means an opiate, or a synthetic opiate derivative.

And naloxone only works for those kinds of drugs.

I can forgive a cop for not knowing the difference, but I’ve also met far too many EMTs and even a few paramedics who didn’t, either.

Add to that the fact that we’re currently experiencing nationwide drug shortages, and have for the past five years or so. It wasn’t so long ago, before naloxone became the next Big Thing, that The Borg and many other EMS agencies were sweating running out of it, with none available for resupply.

Now with the increased demand comes skyrocketing prices. Naloxone that was dirt cheap ten years ago now costs around $52 for a 2 mg pre-filled syringe.

Before more states jump on the naloxone bandwagon, make sure you’re doing it because there is a legitimate need, not just keeping up with the Joneses, and make sure you’re giving it for the right indications.

And those reasons are not to ruin a junkie’s high, or wake someone up who is still breathing adequately.

* Overall, not a bad show. There were only a few derp moments, but that naloxone bit induced epic levels of facepalm.