Help “N” Site

Sandy Hunter, PhD, NRP

During my first job as a paramedic, I administered the antidote for narcotic overdoses, known as naloxone, sparingly and to do so required a call to the ER for a physician’s orders.  Then, I moved to work in a large city where drug overdoses were much more common and physicians trusted EMS to make the right call. So, Paramedics would routinely administer naloxone to suspected narcotic overdoses under standing orders without a need for a time-consuming call to the physician. 

Not only did I appreciate that I was able to practice under a wider range “standing orders”, I saw the drug work enough times to fully appreciate just how amazing it was (is).  People who were virtually apneic quickly started breathing within normal parameters.  Other than a few other drugs (like dextrose, nitroglycerin and valium), naloxone was one of the quickest acting medications that we used very often.  However, as great as naloxone was, it was still basically only administered by EMS and the emergency rooms.

Image Graph Narcotic Overdose Deaths

During the past several months, all emergency responders across the U.S. have (or at least should have) heard of the increase in the number of overdoses and deaths related to overdoses from narcotics that plague our nation.  Data from the CDC indicate that there are 19 states that had dramatic (statistically significant) increases in the number of overdoses between 2014 and 2015. 

 

The states that had the highest death rate per 100,000 during 2015 were (highest to lowest) West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island.   Clearly, the problem of drug overdoses has reached epidemic proportions and is a true public health crisis, one in which EMS and others must take action.

Strategies

Narcotics are lethal in large part because they shut down a person’s respiratory drive.  Thanks to the efforts of public health policy makers, many in our society recognize that drug addiction is a disease and that drug abusers should be helped; especially during a time of crisis.  At the moment when a drug addict has overdosed and is not breathing adequately, the best way to help them is to administer naloxone.

However, getting naloxone to an overdose victim can’t be solely the responsibility of EMS agencies.  The public must be prepared to help.  Fortunately, the maker of the drug and national pharmacy chains have stepped up to make this possible. 

As of summer 2017, most states have some mechanism for an individual to purchase (or otherwise receive) a kit to administer the drug nasally; states that don’t have one are working on it.  Popular drug stores in some states will allow a person to simply walk in and purchase the kit; others allow a pharmacist to prescribe it on the spot.  A complete map of states and their policies can be found here.  There is also a push to equip police officers, non-EMS fire fighters, even school teachers with naloxone. 

Risks?

Administering naloxone to a suspected drug overdose is almost completely without risk to the patient or the rescuer.  The drug is packaged in an easy to use kit (a plunger is pushed and it is sprayed into a nostril).  There are no needles involved and the packaging is disposable. 

Goals

Treating the root causes of addiction will be key in reducing the number of addicts in the U.S. and by doing so, reduce the number of drug related deaths.  Until that time, it is incumbent upon society to care for those who need it when they need it most. Getting naloxone into as many hands as quickly as possible will not increase illicit drug use; but it will undoubtedly save lives.  EMS and everyone else involved in emergency response (and public health) need to advocate for universal availability of naloxone.  Perhaps, we should put it in wall boxes like AEDs and fire extinguishers throughout public spaces. 

I remember when the idea of making naloxone more available was being debated in a meeting of a Kentucky legislative committee a few years ago.  I was asked if “EMTs and lay people” should be allowed to administer the drug.  I was shocked at the very idea and said (initially) that it was a terrible idea… that naloxone was a drug and only Paramedics should administer drugs!   A wise colleague calmly asked me “Why?”  After some well-needed reflection, I could not think of a single reason.  That was a few years ago and I can say that I am a strong advocate now for putting naloxone into as many hands for as little cost as possible, as soon as possible.

Published on August 07, 2017