Heroin opiate overdose kit

[caregiver222]

Approval has been granted to sell nalaxone without a prescription in drug stores. This drug is a heroin and opiate agonist. It will reverse an overdose. In the injectable form the dose that is sold is both outrageously priced and only a small dose. Two local pharmacies wanted sixty dollars U.S. for the so-called "emergency kit!"  This is twenty times what hospitals pay. Furthermore the pharmacist provided incorrect instructions for use. "Narcan" has a relatively short half-life. Remember that! In the field it is common for a paramedic to administer the drug to a comatose patient and suddenly the person is up, awake and feels great. They don't want to go to the hospital. If you use this drug you MUST call 911 for additional doses. It will wear off in a short time and you will be right back where you started from. They state the drug should be given intramuscularly. If the patient is awake that is acceptable. If the patient is comatose the drug should be injected under the tongue. This is a very vascular area and the drug will go immediately into the bloodstream.  Opiates cause depression of the respirations. They do n ot affect the heart. If the patient goes into respiratory arrest you can use an ambu-bag to simply bag them. I have done so for two hours in the field when narcan was not available. You can also give mouth to mouth,. Don't panic. Better to continue with mouth to mouth and wait for 911 that to hustle a patient in respiratory arrest into a car to take them to the hospital. Remember to watch the airway. Vomiting is the big problem. If they vomit and you do not have airway management equipment you lose them. Clearing the airway is difficult and must be done immediately. It also makes mouth-to-mouth VERY unpleasant. Turn the head to the side, sweep out the vomitus. Use a rag if you have one handy. One problem is that everyone has learned CPR. The FIRST thing they do is start CPR.  Without checking the carotid opulse on the side of the neck. This forces the stomach contents upwards and you lose the airway. End of story if you don't have suction. In opiate overdoses eventually the heart will stop, but more commonly the only problem is the respirations. You DON'T NEED CPR. Check the carotid pulse first.

[caregiver222]

You are correct in stating that narcan can throw an addict into withdrawal, which is not pleasant.

[caregiver222]

The "single use" one-time emergency kits cost $60 in my neighborhood pharmacy. The multiple-dose vial, which should be on hand in any facility that has addicts around I purchase for $17. Then you need a sub-cu needle, which can be purchased without prescription. The drug is not toxic and it is not possible to cause harm by injecting too much, except for inducing withdrawal symptoms.  It has no effect whatsoever on heart rate or respirations.

[EvolverU]

Hi,
I agree. Narcan is an invaluable drug to have on hand if one is an opiate addict -- particularly if you inject. While addicted, I used it to save two OD's. I injected them intravenously because they were cyanotic & I wanted it to work instantly. It worked. They do provide (or @ least they used to) vials of Narcan @ Needle Exchanges.

I also wanted to mention that Narcan is an opiate antagonist, not an agonist. It works because it has the opposite action of an opiate agonist & blocks the signals that cause the opiate effects from getting to the receptor sites. This is why an antagonist or even an agonist-antagonist (like Suboxone) will throw folks into withdrawal.

Thanks for posting. That was fascinating info re: Narcan & 'self-splinting'! :)

[EvolverU]

Sorry, should clarify that an agonist-antagonist like Suboxone will throw one into withdrawal if it's taken while an opiate is still in the system. If you talk to anyone who's an addict & who was given Narcan to revive them, they'll tell you they didn't feel to hot when they came to. :)

[caregiver222]

It's an interesting drug. During the 1970's the U.S. Navy experimented with breaking the spines of cats and injecting them with Narcan. Surprisingly the cats recovered without paralysis. So they did a field study and injected narcan when the patients showed up at the ER. There was no evidence it helped prevent paralysis. I experimented injecting it into auto accident victims who had head flexure. What happens is amazing. THEY SELF SPLINT! In other words you don't need a collar (but we put them on). The head becomes rigid in position. When a person suffers trauma endorphins are released and they feel no pain. Sometimes you get a person with a severed arm and they are talklng to you like you were in a coffee shop. The narcan blocks the endorphins. You would think this fact would be well known, but every week we rediscover the wheel. Today paramedics do not have a protocol enabling them to inject narcan except for drug overdoses. The down side is the pain, but it is not always possible to apply axial traction and a proper collar to a patient in a crushed car who is rubber-necking. I would always use the narcan in these situations.

[caregiver222]

It's not the shelf-life. It's the half-life. I have injected a comatose heroin overdose who became completely normal. It took 25 minutes for him to crash, and that took about four minutes until complete unconsciousness again. It was like falling off a cliff. I managed to stay with him in his apartment watching television while he insisted he was "fine" and didn't need to go to the hospital.  His weight was about 175 and the amount of opiates he injected is unknown. I timed the period until he again became unconscious., I gave him a second injection. THEN I took him to the ER. The drug has no real side effects. The problem is that the people become very normal. If injected into an addict, it may also cause withdrawal symptoms, to include cramps and pain. I keep a multi-dose vial around, which is very inexpensive, but requires a prescription. It was so cheap that until recently you didn't even have to sign for it. Decades ago, In the hospital it used to be scrounged because it will prolong an erection in a normal person by blocking the substances that cause blood to drain from the penis. The intramuscular route takes too long. We used to always inject it under the tongue. We did use it in an intravenous drip after the initial injection.

[motye51]

I'm glad you wrote on here that the Narcan has a short shelf life.  I didn't know this and I was considering going and getting some to keep at our Wed night N/A mtg. People come in loaded all the time.....Not so sure now if that will work. How short is short?