The first two doses of Narcan are free, the third time, you die

[MillCreek]

http://www.npr.org/2017/06/29/534916080/ohio-town-struggles-to-afford-life-saving-drug-for-opioid-overdoses?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20170701

Interesting proposal and I can see the frustration that leads to making it.  I have had three people this year OD in my clinics and have brought them back with Narcan.  They think a medical facility is a good place to use since if they OD, they will likely be discovered and revived in time.

[Ben]

"God should be the only one who decides when somebody dies, not a councilman," he says.

One might argue that by the third time, God is sending a message.

[RoadKingLarry]

Only fault I can find is one too many 2nd chances.

[Fly320s]

Only fault I can find is one too many 2nd chances.

I was thinking two too many.

[Ben]

I was thinking two too many.

I'm a firm believer in second chances, because sometimes people just screw up - sometimes stupendously. So the availability of Narcan is a good thing to me. Maybe I'm biased because I would never do it, but if I were saved from a deadly overdose, I would look at it as a blessed second chance and turn my life around right that second. I like to think others that would make a mistake of this magnitude would also look at it as life-changing and fix themselves.

On the other hand, I have zero patience for people like those Millcreek describes and those in the article. "Oh look! I can keep being stupid!" It's like using abortion for your monthly birth control. Drop dead already.

[Hawkmoon]

Out on Central Avenue, the city's main drag, John Blankenship is sipping an afternoon coffee. Like many people in this city, he has lost family to opioid addiction: His son died at 23 and his daughter died on her 25th birthday.

Blankenship says the city may face financial ruin, but as a taxpayer, and a father, he doesn't think letting people die should be an option.

"God should be the only one who decides when somebody dies, not a councilman," he says.

I'm sorry, but it occurs to me that Mr. Blankenship seems to have failed massively in the parenting role, and he is perhaps not the person I'm most likely to give credence to in this discussion.

[MillCreek]

^^^Perhaps it is because I work in healthcare, but I have seen way too many upstanding middle and upper class religious families with kids addicted to heroin to write it off as a parenting failure. I am sure that parenting issues apply in many of these cases, but by no means all of them. 

[Fly320s]

I'm a firm believer in second chances, because sometimes people just screw up - sometimes stupendously. So the availability of Narcan is a good thing to me. Maybe I'm biased because I would never do it, but if I were saved from a deadly overdose, I would look at it as a blessed second chance and turn my life around right that second. I like to think others that would make a mistake of this magnitude would also look at it as life-changing and fix themselves.

On the other hand, I have zero patience for people like those Millcreek describes and those in the article. "Oh look! I can keep being stupid!" It's like using abortion for your monthly birth control. Drop dead already.

I'm betting that heroin isn't the first drug these people have used.  Also, I doubt these ODs are their first bad experience with drugs.  To me, that sounds like there have been several second chances long before they get their first chance to be saved my Narcan.

[lupinus]

^^^Perhaps it is because I work in healthcare, but I have seen way too many upstanding middle and upper class religious families with kids addicted to heroin to write it off as a parenting failure. I am sure that parenting issues apply in many of these cases, but by no means all of them. 

Same for when you have people that have led normal upstanding productive lives and have sibling's​ that are useless druggies.

Sent from my Pixel XL using Tapatalk

[BlueStarLizzard]

^^^Perhaps it is because I work in healthcare, but I have seen way too many upstanding middle and upper class religious families with kids addicted to heroin to write it off as a parenting failure. I am sure that parenting issues apply in many of these cases, but by no means all of them. 

I say yes and no. You don't know what goes on behind closed doors and I'd say a twofer in one family may indicate that something was going on.
Mind you, not necessarily anything that could be legitimately construed as abuse or neglect, but you have to wonder what *expletive deleted*ed those two heads up so much that addiction and passive suicide was a good idea.

As far as upstanding middle and upper class, religious or not, families... IMHO, a lot of them tend to turn out either carbon copies of the parents or *expletive deleted*ck ups with very few in between. And, for the record, both the carbon copies and the *expletive deleted*ck ups are messed up in the head, just in different ways.

[lee n. field]

What's a dose of narcan cost? 

[RevDisk]

What's a dose of narcan cost?  

Injectable? 2005, it was $0.92.  Couple years ago, $15. Now $30 ish.
The EpiPen like version, Evzio, was $287.50 in 2014. $375 in 2015. $1,875 in 2016.  $2,250 in 2017.
Nasal spray version is $63, but regularly discounted to mid $30's.


A person might need multiple doses. I'd certainly mandate that townships switch to injectable over the easier and much quicker nasal spray version unless you could negotiate a really good price. Govt regs on injecting drugs is a pain, but for small towns, still cheaper to get every bloody EMS, fire fighter and cop certified than to use the EpiPen version two or three times.

Pfizer has said priced their narcan "responsibly" with "sensitivity to the need for the product" and "the investments necessary to produce high-quality generic drugs as well as ensure appropriate distribution through licensed medical professionals." In other words, feds mandated it so they jacked up the pricing to celebrate their lobbyists' success.

[MillCreek]

^^^Much of the imported heroin is now being cut with Fentanyl or Carfentanil, which significantly increases the potency, makes an accidental overdose more likely, and may require multiple doses of Narcan to reverse.  We sell a kit of two doses of nasal Narcan in our pharmacies for around $ 150.

[RevDisk]

^^^Much of the imported heroin is now being cut with Fentanyl or Carfentanil, which significantly increases the potency, makes an accidental overdose more likely, and may require multiple doses of Narcan to reverse.  We sell a kit of two doses of nasal Narcan in our pharmacies for around $ 150.

They get super annoyed when you save them from dying and kill their high with "too much" Narcon. Experienced EMS personnel know to just give them enough to not die, and let the hospital folks deal with redosing a patient who gets very upset. After the tenth or twentieth OD case says you owe them X dollars for completely reversing $X worth of heroin and gets combative when you laugh, you're going to give up and go along.   

[Viking]

And then this happens:
http://www.wsbtv.com/news/local/forsyth-county/warning-fentanyl-resistant-to-narcan-appears-in-georgia/542727515

[RevDisk]

Unless I'm not remembering correctly, you could legally buy Fentanyl precursors from China in industrial quantities and get them bulk shipped to the US until quite recently. China is starting to crack down, but still. When China makes the precursors in hundred liter vats, and the stuff is 50 times stronger than morphine, no wonder drug dealers are using it to fluff up their street drugs.

[GigaBuist]

I don't understand why people would repeatedly knowingly enter the realm of ODing.  I can see how it would happen on accident but is there something I'm missing?  I assume you go unconscious at some point and then the fun ends.

Is there something I'm missing?  I've never touched a high dose of an opiate, just regular dose prescription pills used appropriately.

[zahc]

I think that drug problems are not something you "get". Addiction is like a computer bug or something for the brain so it makes sense that it doesn't make sense.

[Firethorn]

Is there something I'm missing?  I've never touched a high dose of an opiate, just regular dose prescription pills used appropriately.

Especially for opiates, zahc has a point.  The drugs kind of short-circuit the brain to the point that people will prioritize the drug over survival.

That said, many of these addicts were created by our own medical system.  It would probably be far cheaper to simply give them high quality drugs of known purity than to deal with the consequences we're seeing now.

With a supply assured, they're far more willing to look at detoxing and such.

As for the prices of the drugs, we need to back off on various federal mandates.  Encourage negotiation like what other countries do.

Its things like this that are driving heath care costs through the roof.

[RevDisk]

I don't understand why people would repeatedly knowingly enter the realm of ODing.  I can see how it would happen on accident but is there something I'm missing?  I assume you go unconscious at some point and then the fun ends.

Is there something I'm missing?  I've never touched a high dose of an opiate, just regular dose prescription pills used appropriately.

Fentanyl and more generally purity levels.

End users have little to no way or inclination of thoroughly testing their drugs before using. The amount of actual drug vs misc filler greatly varies. So the effective amount of heroin can vary greatly. Fentanyl is potent stuff. Super condensed.


Think your pills. You have a bottle of pills. Imagine the pills are at random strength/dosage. You 'need' to take one everyday. How likely would you be to OD if a couple of the pills randomly had 20x the dosage but looked the same? And you don't want to learn enough to test the pills or pay for testing for purity.

Huge number of these folks were on oxy or other prescription drugs. Quite a few got addicted off the real stuff, prescribed by a doctor. The pill mills are getting cracked down on. It's easier and cheaper to score heroin than legal drugs. Unethical drug dealers are cutting the heroin with far cheaper fentanyl, at uneven and unstandardized dosage levels. Which kills people quickly.

[MillCreek]

Unless I'm not remembering correctly, you could legally buy Fentanyl precursors from China in industrial quantities and get them bulk shipped to the US until quite recently. China is starting to crack down, but still. When China makes the precursors in hundred liter vats, and the stuff is 50 times stronger than morphine, no wonder drug dealers are using it to fluff up their street drugs.

The chemists are creating fentanyl analogs quicker than they can be outlawed.  Your state or Federal law has a list of specific fentanyl compounds that are illegal, but the manufacturing chemists can add an acetyl group here or a butyl group there and voila, it is a different chemical compound that is not illegal.

http://www.sciencemag.org/news/2017/03/underground-labs-china-are-devising-potent-new-opiates-faster-authorities-can-respond

[grampster]

Wanna sell a little pot and get caught?  As Cheech and Chong said...."Bailiff, wack his pee pee."  Get caught selling Heroin or any big time hard drug and get convicted?  Death penalty after the gavel comes down.  Not long ago we hung horse thieves.  Sell *expletive deleted*it that kills people, you need to go.

[Andiron]

Wanna sell a little pot and get caught?  As Cheech and Chong said...."Bailiff, wack his pee pee."  Get caught selling Heroin or any big time hard drug and get convicted?  Death penalty after the gavel comes down.  Not long ago we hung horse thieves.  Sell *expletive deleted*it that kills people, you need to go.

Supply and demand,  you'll run out of rope before you run out of people willing to risk said rope for the money.

[GigaBuist]

Fentanyl and more generally purity levels.

End users have little to no way or inclination of thoroughly testing their drugs before using. The amount of actual drug vs misc filler greatly varies. So the effective amount of heroin can vary greatly. Fentanyl is potent stuff. Super condensed.


Think your pills. You have a bottle of pills. Imagine the pills are at random strength/dosage. You 'need' to take one everyday. How likely would you be to OD if a couple of the pills randomly had 20x the dosage but looked the same? And you don't want to learn enough to test the pills or pay for testing for purity.

Huge number of these folks were on oxy or other prescription drugs. Quite a few got addicted off the real stuff, prescribed by a doctor. The pill mills are getting cracked down on. It's easier and cheaper to score heroin than legal drugs. Unethical drug dealers are cutting the heroin with far cheaper fentanyl, at uneven and unstandardized dosage levels. Which kills people quickly.

All things I know but now it makes sense.  If an addict isn't sure of what they're getting they're possibly going to OD so they put themselves in a safe place (hospital) before they go through with it hoping to get revived.

[GigaBuist]

Wanna sell a little pot and get caught?  As Cheech and Chong said...."Bailiff, wack his pee pee."  Get caught selling Heroin or any big time hard drug and get convicted?  Death penalty after the gavel comes down.  Not long ago we hung horse thieves.  Sell *expletive deleted*it that kills people, you need to go.

Eh, the same argument was/is/could be made for alcohol, which kills people, and the prohibition of both leads to the same race for higher potency to make smuggling easier.  Even with alcohol being legal you see it in younger kids that are in the 17-20 year old group.  Hard to hide two cases of beer but way easier to stuff a single half gallon of vodka somewhere. Way easier to get into overdosing too.  Good luck killing yourself with Bud Light.  Hell, good luck getting semi-drunk off that stuff! :)

With the opiates we've gone from opium to morphine to codeine to heroin to oxycontin to vicodin to methadone to fentanyl.  There's probably a lot of steps I missed in the progression but the general idea is there.  We nixed the Bud Light of the opiate groups and now we've got people ODing on the seriously heavy stuff that shouldn't be used for recreation at all.

The death penalty won't fix the problem.  Most of the problem is coming from legit doctors prescribing legit pain medicine. You're fighting human nature here the whole way.  It's an addiction/abuse problem that will never end because opiates are so damned good at their job.  Mitigating the abuse and deaths are really all we can do.