I live between Dayton and Springfield, Ohio, ground-zero for heroin overdoses. Last week in Springfield, there were 19 overdoses in 24 hours. They are revived on-the-scene using naloxone administered by medical personnel.
I highly suspect there are many repeat offenders; addicts get revived over and over again.
I have heard it postulated that naloxone has actually made the problem worse. The hypothesis is that addicts are much less fearful of dying from an overdose due the availability of naloxone, therefore they’re less cautious on the amount they’re injecting.
Thoughts?
On the same topic, there is an outcry that we should stop administering naloxone to those who OD. Or perhaps a “two strikes you’re out” policy: an addict won’t be revived after their second OD.
I truly doubt the presence or absence of naloxone mitigates an opioid addict’s behavior while shooting up one iota. The need for the fix overrides such considerations.
What naloxone does do is buy a very small percentage of those opioid addicts another shot at recovering from their addiction, which is a disease. Said disease has, as a part of its natural history, potential for relapses even when the disease is aggressively treated and the patient is highly motivated. Yet many people do manage to recover and live clean and sober for decades, despite some early relapses.
But hey, let’s stop offering life-saving treatment to people with addictive disease! It’ll get more than a few of those people out of our hair! And let’s extend it to those damned diabetics who take too much insulin and go into a hypoglycemic coma! No more glucagon injections or IV glucose infusions for them! That just brings them back to do the same behavior over and over again. They’ve shown they can’t manage their own lives by failing to eat and exercise properly; that’s how a lot of them got diabetes in the first place! :rolleyes:
Also, don’t seatbelts encourage drivers to drive faster, since they know if they get into an accident they’ll be safe? So let’s remove seatbelts from cars.
I think posters are being a little hard on the OP. It’s a reasonable question, even if the following points are shaky. Some people do drive more aggressively because they think modern safety systems will save them.
I agree totally with QtM, but in addition to his comments, how would you manage “two strikes you’re out”? Do you tattoo addicts on their foreheads when you administer Naloxone, so the next first responder knows not to treat them?
Qadgop is absolutely right. I doubt that non-addicts can really understand how strong the urge to use can be. Just like no one gets in their car thinking today is the day to get into a fatal accident, no one uses heroin thinking today is the day to take a lethal dose.
Second, for people who are physically addicted to heroin, naloxone is very unpleasant experience. If you were using drugs to treat pain, that pain will suddenly come back. In less than five minutes you go from floating on top of the world to puking your guts out and going through instant opiate withdrawal. Opiate withdrawal is extremely uncomfortable. I have actually heard addicts say that they would rather die than get narcan.
As for the OP’s plan to treat addicts like morally-deficient things that deserve death instead of medical treatment … I’ve tried, but I have nothing to say on that subject outside the pit. So Crafter Man, instead of hiding behind “there is an outcry,” what is your opinion on the subject?
Ohio may be different but in NYC about half of the overdoses in 2016 involved fentanyl, which is apparently more potent than heroin ( and which naloxone is not as effective against) In addition, it is cheaper than other drugs so that people who believe they are taking heroin or cocaine are actually getting a mix containing fentanyl. In other words, it’s not so much that addicts are less cautious about the amount that they are using - it’s more similar to a situation where someone thinks they are getting a mixture of 50 % heroin and 50% impurities/non-opiate cutting agent but they are actually getting 50% heroin and the other 50% includes another opiate.
Doreen, are people actually cutting cocaine cut with opiates? I mean, yeah, speedballs are a thing, but in my naïveté, I’d be surprised if something advertised as straight cocaine were cut with anything but inactive ingredients and other stimulants. Am I totally off base there?
Also, for what it’s worth, I’d like to expand your (solid) point about how street opiates are cut. It’s not just that the drugs the user bought are stronger than anticipated, though that certainly happens. Fentanyl is about 33 times stronger than morphine. A therapeutic dose of intravenous morphine for an opiate-naïve patient would be about 3.33 mg (3300 μg), and a therapeutic dose of fentanyl would be about 0.1 mg or 100 μg. When cutting heroin with fentanyl, it becomes difficult to ensure the adulterant mixes homogeneously with the drug being cut.
I have zero first-hand experience with this, but I’ve been reading that it’s possible (even common) for addicts to shoot up once and get little fentanyl, while the second dose from the same bag happens to have a lot more fentanyl in it and the user ODs.
Things get substantially worse with carfentanil, which I’m led to believe is the opiate of choice for elephants (well, for vets who treat elephants). But that’s because the stuff is on the order of 10,000-100,000 times more potent than morphine, so a clinically useful dose for a human being is on the order of 0.5 μg. That’s tiny.*
If you cut a 5-dose bag of heroin with carfentanil, you’ll be lucky if you are able to do so with 10 particles of the stuff. If a user gets three or four of those particles in a single dose, they may well be dead. Apparently, this is actually happening. According to the linked article, a lethal dose straight fentanyl is about the size of a few grains of salt. A lethal dose carfentanil is not visible to the human eye.
Again, I don’t have any direct experience with this stuff. But the things I’ve read suggest that the standard deviation of street opiate strength is getting a lot bigger, which means we’re seeing more “surprise” overdoses.
Bonus speculation to illustrate the extraordinary tininess of 0.5μg: If a human being weighs about 165 pounds and a blue whale weighs about 300,000 pounds, the whale’s body mass is about 1800 times that of a human being’s. If the therapeutic dose for carfentanil is proportional to mass for both species, that means that a reasonable dose for a blue whale is just under 1 milligram. 10 milligrams of oral morphine is about right for a human, but if you gave a blue whale 10 milligrams of carfentanil, you’d kill it.
The question in the OP’s title is fine, but I think people are responding to what reads (to me, at least) as a thinly veiled desire to punish opiate addicts by letting them die. I’m jumping to that conclusion, but I’m not jumping very far.
Thankfully, I have almost no experience with opiate abuse (directly or indirectly) but I have a close friend who once had a serious drinking problem, and though he’s been sober for years, he told me some interesting stories about how people react to addiction even now.
Some people have a very strange understanding of addiction; they aggressively blame the addict for some sort of moral collapse. These people see cirrhosis of the liver (alcoholism) or HIV acquired by sharing needles as some sort of cosmic punishment for the addict’s weakness.
This seems, in my experience, to be primarily an American-Puritan perspective, though the Philippines seems to be cut from the same cloth. There’s a fear (a deeply irrational one, IMHO) that if we attenuate the ravages of addiction even a little bit, we’ll somehow be encouraging addiction. For example, some people are appalled by the idea of treating a heroin addict with methadone.
The OP’s “does Narcan encourage opiate abuse?” question is reasonable on its face, though shaded, IMHO, with this Puritan strain of judgement (and that’s OK). The “two strikes and you’re out” sentence at the bottom of the first post, though, is shot through with Puritan vindictiveness.
Again, this is just my opinion, but I suspect that others are reacting strongly not to the first sentence, but the last.
I saw a NatGeo program on this subject just yesterday. A dealer being interviewed said that news of a client overdosing was good for his reputation and boosted sales. It got me wondering what proportion of users were either attempting to kill themselves or wouldn’t mind if, in the course of getting high, they died.
I don’t have any personal experience, but that’s the gist of the articles I’ve read. Although it’s possible that those articles are just listing any drug that could theoretically be cut with fentanyl rather than those that have actually been found to be cut with it.
I’ve seen posters around here, apparently aimed at lay folks, encouraging people to give naloxone to OD victims. I guess people who spend a lot of time around addicts are supposed to keep a dose or two handy at all times, just in case it’s needed. Is it really safe enough to be administered by untrained responders? What are the possible side effects? What happens if it’s given to a (previously) healthy person who isn’t ODing on opiates? Or someone who’s ODing on some other drug?
If the the alternative to administration is death, yes. It’s the same reason we encourage non-doctors to perform CPR or administer epi-pen shots for extreme allergic reactions. It’s not that giving the stuff is perfectly safe, it’s that NOT doing so carries a high risk of death.
If there are no opiates in the person’s system giving naloxone will pretty much have no effect. There might be some heightening of pain perception in some people, but pretty much the only people who are going to see effects are people with opiates in their system. If they’re OD’ing on a non-opiate it pretty much won’t do anything. In that respect, it’s arguably safer than epi-pens (among the possible side effects of those are “heart attack” and “stroke”) and CPR, which, if done right, is likely to break ribs.
From my viewpoint, it’s pretty hard to argue against making this available other than some bias against addicts apart from medical issues.
Narcan is pretty damn safe. The biggest dangers in its use are in opioid-addicted patients with cardiovascular conditions, where reversing the opioid effects may cause significant blood pressure drops. Otherwise healthy people, whether or not they are taking opioids will have minimal chance of life or health threatening side-effects.
So in the vast majority of cases it’s riskier to not give it to an unresponsive patient than to give it.