FDA approves Narcan over the counter

[MillCreek]

https://www.nytimes.com/2023/03/29/health/narcan-over-the-counter.html

https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray

It will be interesting to see what the price is.  Our pharmacies sell it at cost for just under $ 65 for a box with two sprays.  In Washington, you can also get a free kit via mail.  I carry a couple of sprays in the truck just in case I encounter someone overdosing.  The sticky wicket now is that Fentanyl is the drug of choice locally and it they have a tolerance and depending on the Fentanyl dose, it may take more than two doses of Narca to reverse.

[BobR]

Hopefully those that decide to purchase their very own Narcan will let their family and friends know they have it or it is a waste of money. Most people ODing can't give themselves Narcan from what I have seen.

bob

[Nick1911]

That's interesting.  I do not think I would opt to keep that in my kit, as I lack the training qualification in emergency medicine to properly diagnosis opioid overdose.

[MillCreek]

Speaking as someone who had administered it three times at work, here are some handy instructions:

https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/150-126-NaloxoneInstructions.pdf

https://store.samhsa.gov/sites/default/files/d7/priv/five-essential-steps-for-first-responders.pdf

https://www.dhs.state.il.us/OneNetLibrary/27896/documents/19DOPP/NARCAN-Quick-Start-Guide.pdf

https://www.health.ny.gov/publications/12028.pdf

[cordex]

That's interesting.  I do not think I would opt to keep that in my kit, as I lack the training qualification in emergency medicine to properly diagnosis opioid overdose.

As I understand it, the value of Naloxone is that it is considered safe to give to someone even if they are not experiencing an overdose.  That's why they can pass them out like candy to cops.

That said, whether I ever get any would be completely dependent on price and shelf life.  My calculations might change if I ever had a family member known to abuse opioids.

[BobR]

That's interesting.  I do not think I would opt to keep that in my kit, as I lack the training qualification in emergency medicine to properly diagnosis opioid overdose.

The beauty of Narcan is it doesn't matter if it is given and not needed. Better to suspect an OD and give it rather than give nothing. In the ER we would automatically give 2mg of Narcan and 0.5mg of Romazicon (benzo reversal) as soon as we got IV access if the EMTs had not already done it. At that point we weren't sure of the type of OD.

bob

[MillCreek]

A bunch of us geezers at work who used to do EMS were talking about this the other day.  When we first rolled up on a 'man down' call 20-30 years ago, drug overdoses were very far down the differential diagnosis in terms of our immediate actions right out of the truck.  Now, narcotic overdose is right there near the top and your Narcan spray or syringe is not far from your hand.

[BobR]

I have never read the insert for street use Narcan so I don't know if they say call EMS after giving or not. So, if you ever have to administer Narcan out in the wild make sure you call EMS so the person can get definitive treatment. The biggest problem is the half life of Narcan is usually about 60 minutes (+/-) where depending on the opiate it can be much longer. So you revive someone with Narcan, they feel better, walk away and then the Narcan wears off and the opiate takes over and they get a second OD out of it.

bob

[cordex]

Any of you Narcan veterans ever have someone come up swinging when you take away their high?
From what I hear the cops deal with that pretty regularly.

The only time I saw it given the chick was nearly dead and after two hits of Narcan was breathing again but not yet conscious when she got taken away by EMS.

[BobR]

I haven't seen it much with Narcan reversal but I have seen some very mean toddlers when their Ketamine wears off. Seen a few mean little ones after giving them chloral hydrate also, you know they will grow up to be a mean drunk.

Usually in the hospital setting we would "whiff" (give tiny amounts over time to reach desired level) the Narcan via IV, you can control how fast they come out of their stupor. I don't think I ever pushed the full 2mg rapidly, just to prevent the violent behavior.

bob

[Bogie]

Who am I to stop someone from achieving the oblivion they desire?
 
Jen's dead, and has been so for a couple of years now.
 
One time when I dragged her to the ER (faster than a bambalance to that part of Cranklin County), they hit her three times with the stuff, and she finally -started- to come around.
 
Some of the "long half life" opiates are things like Methadone - which is theoretically prescribed to stop the abuse...
 
And don't even get me started on the folks who put on a patch. And then another. And then another, Lather rinse repeat...

[HeroHog]

Thanks to the VA, I have 2 in our medicine cabinet.

[230RN]

A bunch of us geezers at work who used to do EMS were talking about this the other day.  When we first rolled up on a 'man down' call 20-30 years ago, drug overdoses were very far down the differential diagnosis in terms of our immediate actions right out of the truck.  Now, narcotic overdose is right there near the top and your Narcan spray or syringe is not far from your hand.

I find that "now"
very sad.

Solution, to my simple little mind?  Kill the expanding market by killing the profit.

But my simple little mind can't imagine any way in the world that we can kill the high prices and profit.

'Tis a puzzlement.

[K Frame]

I read a short article some time ago that said that as Narcan use goes up the number of assaults on first responders are going up as junkies realize that their high has been broken and they are pissed.

[MillCreek]

I read a short article some time ago that said that as Narcan use goes up the number of assaults on first responders are going up as junkies realize that their high has been broken and they are pissed.

This is true, along with the number of patients who escape from the ambulance before it arrives at the hospital or immediately elope from the emergency room upon arrival at the hospital.  They do this for three reasons: fear of arrest, fear of the medical bill, or they want to score again as soon as possible.  The typical street overdose patient does not have medical insurance, so I think fear of the bill is further down the list.

[Nick1911]

Are illegal drug OD patients typically arrested?  Guess I assumed not, as it would cause folks to avoid getting help.

Also kind of file it under "things police are too busy to care about"

[MillCreek]

Are illegal drug OD patients typically arrested?  Guess I assumed not, as it would cause folks to avoid getting help.

Also kind of file it under "things police are too busy to care about"

They certainly are not arrested at the ER or off the ambulance just for the drug use.  The biggest impact of the fear of arrest is a group of usually teenagers who has someone OD and no one calls 911 because they are afraid of being arrested for drug use or possession. 

Washington actually passed a law about this, but it is not well-known:

RCW 69.50.315
Medical assistance—Drug-related overdose—Prosecution for possession.
(1) A person acting in good faith who seeks medical assistance for someone experiencing a drug-related overdose shall not be charged or prosecuted for possession of a controlled substance pursuant to RCW 69.50.4013, or penalized under RCW 69.50.4014, if the evidence for the charge of possession of a controlled substance was obtained as a result of the person seeking medical assistance.
(2) A person who experiences a drug-related overdose and is in need of medical assistance shall not be charged or prosecuted for possession of a controlled substance pursuant to RCW 69.50.4013, or penalized under RCW 69.50.4014, if the evidence for the charge of possession of a controlled substance was obtained as a result of the overdose and the need for medical assistance.
(3) The protection in this section from prosecution for possession crimes under RCW 69.50.4013 shall not be grounds for suppression of evidence in other criminal charges.

[tokugawa]

We have a lot of addicts.  It is a self correcting problem if we would just stop meddling with them.

[230RN]

We have a lot of addicts.  It is a self correcting problem if we would just stop meddling with them.

You mean, like, ummm... remove the profit motive?  What a novel idea !