Nalox­one can save some­one who’s over­dos­ing on opi­oids

The Republican Herald - - LIFESTYLES - by robert ash­ley, m.d. (Ash­ley is a syn­di­cated writer)

Dear Doc­tor:

Did the sur­geon gen­eral re­ally just sug­gest that the gen­eral pub­lic carry nalox­one in case they en­counter some­one hav­ing an opi­oid over­dose? For starters, where would you even get such a thing? And two, how is the av­er­age per­son sup­posed to know who’s over­dos­ing — and on opi­oids?

Dear Reader:

The opi­oid epi­demic is un­doubt­edly a na­tional cri­sis. No other group of drugs has led to such a stag­ger­ing num­ber of over­dose deaths in this coun­try. Of the 63,632 over­dose deaths in 2016, twothirds were re­lated to opi­oids, with syn­thetic opi­oids such as fen­tanyl and its il­le­gal analogs prov­ing es­pe­cially dan­ger­ous. Over­dose deaths from those drugs dou­bled in 2016 com­pared to 2015. Fur­ther, be­cause these deaths are of­ten con­cen­trated in spe­cific coun­ties, the drugs have led to the de­struc­tion of fam­i­lies and even com­mu­ni­ties. They’re widely avail­able, and can be in­jected, in­haled or taken orally.

Opi­oids sup­press the res­pi­ra­tory sys­tem by in­hibit­ing the nat­u­ral im­pulse for breath­ing. In short, with an over­dose, peo­ple sim­ply stop breath­ing. As for nalox­one (Nar­can), it’s an opi­oid re­cep­tor an­tag­o­nist, mean­ing that it blocks the ac­tion of the opi­oid. The drug typ­i­cally is given in­tra­venously in emer­gency sit­u­a­tions by med­i­cal per­son­nel, quickly rev­ers­ing the res­pi­ra­tory de­pres­sion. Even if the drug can’t be given by vein, it can be ad­min­is­tered by in­jec­tion into a mus­cle or un­der the skin; it can even be placed within the nose via a spray. Although nalox­one is a life­saver, it must be quickly given to pre­vent death.

That fact prompted the sur­geon gen­eral to state that nalox­one should be car­ried by mem­bers of the gen­eral pub­lic in the event they en­counter an opi­oid over­dose. Al­ready, nalox­one — in in­jectable or spray form — can be ob­tained with­out a pre­scrip­tion in 46 states. (The other four re­quire a doc­tor’s or­der.) Be­cause phar­ma­cies carry the med­i­ca­tion, one could sim­ply ob­tain the med­i­ca­tion from a phar­ma­cist, who could then teach how to ad­min­is­ter it.

As the sur­geon gen­eral pointed out, nalox­one would be ben­e­fi­cial for fam­ily mem­bers and friends of peo­ple strug­gling with ad­dic­tion. The need is es­pe­cially great in ar­eas far from the med­i­cal per­son­nel gen­er­ally needed to pro­vide the drug in a timely fash­ion.

As for when it should be ad­min­is­tered, that would be when a friend or fam­ily mem­ber — whom you know to be tak­ing a pre­scribed or il­le­gal opi­oid — be­comes non-re­spon­sive and stops breath­ing. First, you would per­form CPR, com­plete with res­cue breath­ing, and if you get no re­sponse af­ter 30 sec­onds, you would give nalox­one. The drug should work quickly, but if it doesn’t, you would ad­min­is­ter it again in two to three min­utes.

One note of cau­tion: The nalox­one may pre­cip­i­tate a se­vere with­drawal from the drug, but opi­oids should not be given to com­bat this. In­stead, fur­ther med­i­cal at­ten­tion would be re­quired.

But in­creas­ing the avail­abil­ity of nalox­one won’t elim­i­nate all deaths from opi­oid over­doses. For starters, we could face a short­age of the med­i­ca­tion and will likely need greater pro­duc­tion of nalox­one. And, of course, we need greater ac­cess to re­sources that can help us both treat and pre­vent opi­oid ad­dic­tion.

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