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The Narcan Debate

Healthcare professionals wonder whether the opioid overdose antidote could encourage drug abuse.

The prevalence of opioid abuse is a terrifying reality-and overdoses are becoming increasingly common. Between 2002 and 2014, the rate of heroin-related overdose deaths more than quadrupled, with more than 10,500 deaths occurring in 2014 alone.1

However, heroin overdoses do not make up the total count of opioid overdoses; in fact, they don't even make up the majority. Between 1999 and 2014, the rate of deaths caused by prescription opioid overdoses quadrupled, and in 2014, more than 14,000 deaths were caused by such overdoses.2

"People who are addicted to heroin make up a significant portion of those who overdose, but the majority overdose on opioid painkillers," said Roger Crystal, MD, the CEO of Opiant Pharmaceuticals. "That population really has a unique need, and it's a need that we thought we could address."

narcan opioid abuse ED With this problem in mind, Opiant Pharmaceuticals developed and formulated Narcan Nasal Spray, a naloxone nasal spray that serves as an antidote to opioid overdose. It can be administered by anyone, anywhere, within a matter of seconds to halt the effects of an overdose, potentially saving the user's life.

The nasal spray differs from sprays typically used for patients with allergies because it is a single-shot device that does not require any priming and can be used in all directions - something critical for emergencies, when the patient is often lying flat.

Truly, Narcan is able to save lives in a period of time much shorter than the wait for emergency responders. So why are many people concerned about the increased prevalence of Narcan in their town's hospitals, ambulances and homes?

The Narcan Debate
Narcan's primary selling point-the ease of reversing the effects of an overdose-also motivates the antidote's opponents.

Detractors argue that the accessibility of the antidote allows Narcan to serve as an enabler for addicts, who could potentially push their luck with the amount of opioids they use, knowing that an antidote is available to keep them alive.

"Narcan creates a deadly psychological vacuum in which people using [drugs] know it exists-and that it will save their life," said Harold Jonas, PhD, LMHC, CAP, founder of Sober.com. "So the person using thinks they don't need treatment for substance abuse and they continue using at-will."

In Jonas' experience working with people impacted by addiction, he has seen that many view Narcan as something of a safety net. "The drug user's thinking is, 'If I use and overdose, there is Narcan, so I'll be okay,'" he explained.

However, Crystal's experience has shown him the opposite.

"When people become addicts, they don't always exhibit rational behavior," he said. "They only think about their next hit. They're not necessarily concerned about the consequences. When I worked in the ER, I remember a heroin addict who had deliberately lacerated his thigh, just to get opioid medication."

Enabling Addicts?
Despite believing that naloxone serves as a safety net for many addicts, Jonas still makes a point of keeping naloxone nearby whenever he is working with people who are addicted to opioids. "I can understand how some people see Narcan as an enabler for addicts," Jonas said. "However, if we didn't have Narcan there would be more deaths, brain damage, etc."

"Before this product, the only people able to use injectable naloxone were people who were trained, like medical professionals and paramedics," added Crystal. "If you're the mother of a teenager who's abusing OxyContin, you'd rather have a device you can use easily than realize your son's stopped breathing and not be able to help."

narcan nasal spray opioid overdose Truly, having access to this lifesaving treatment has changed the way the world handles opioid addiction.

With the prevalence of the antidote in communities, an overdose is no longer a death sentence, and thousands of people have likely been saved: Between 2012 and 2016, the state of New Hampshire alone administered Narcan 7,671 times.3

With Narcan being FDA approved and simple to use, its use is likely to become even more widespread in the near future.

Long-Term Impact
Beyond saving lives in the immediate aftermath of overdoses, naloxone has the potential to continue helping those who were saved by it-despite its opponents' argument that it enables addicts, potentially leading to more overdoses.

"For some people, being saved from an overdose is sort of an awakening," said Crystal. "It encourages a patient to pursue sobriety and treatment."

Additionally, the ability to reverse an overdose sooner without the assistance of medical personnel can serve to combat the emergency department overcrowding that plagues the healthcare sector.

Despite the undeniable positive effects, naloxone can only do so much. It can only help once someone has already pushed his or her body to the limit; it does nothing for people who are only beginning to fall into the grasp of addiction.

"The opioid addiction epidemic is a macro problem, and Narcan is a micro solution," Jonas said. "Narcan allows a person to live. Getting healthy after the overdose is the underlying critical issue."

Sarah Sutherland is a staff writer at ADVANCE. Contact: ssutherland@advanceweb.com

References
1. Centers for Disease Control and Prevention. Heroin. 2016.
2, Centers for Disease Control and Prevention. Prescription opioid overdose data. 2016.
3. NH Bureau of EMS. Monthly Narcan Use Data Report. 2016.
 

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When I worked in PACU I experienced many patients especially orthropaedic, needing a great deal of narcotics post procedure. Many had a tolerance built up from being on a lot of pain medication at home. I also remember when we started that pain scale with the smiley faces. No one should be in any pain. Sometimes I felt like I was taking care of a race horse because of the amount of narcotcs needed to quel the pain. I feel the drug companies are responsible for much of this problem. I worked for 43 years mostly in PACU. Now that the "horse has run out of the barn" they think they should close the door.

Bernadette Abrecht,  RN retired,  area hospitals in Baltimore.January 08, 2017
Baltimore, MD




     

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