Narcan (Naloxone) Training

Preparation, Preparedness & Prevention Emergency First-Aid
1

Just received Narcan certification yesterday and they passed out Naloxone kits (two per person).

This was all in a grant to help fight the Opioid Overdoses and help better the communities.

Minnesota has had a standing order for Naloxone since 2015. So, it’s available to anyone at a Pharmacy.

I really think this is a great addition to my car bag. It comes with a bioshield for rescue breathing / CPR.

I am BLS - Healthcare Professional Certified and felt like this free training was stupid NOT to get. Everything was free. It was easy.

This isn’t the exact kit I got, but the closest I could find to make it easy on me.

Soooo, my question:

Does this type of thing propagate the abuse and usage of Narcotics, specifically, Opioids?

The reason I ask, is that was one person’s rhetoric during the evening was very, blatantly, anti the rescue program. I mean, I get it. I don’t like my tax dollars being used on the “War On Drugs” either, but it appears Naloxone, in the grand scale, is actually very useful for many cases of drug overdoses, even prescribed.

Nonetheless, with all the stupid mofos driving around booting, shooting, snorting, and more while driving and in public, I added this to my daily grab bag. Added a couple bandages and a trauma pad to the kit to make it that much better for my uses.

What say you? Viable training that any “Concerned Community Member” should do? Or, the program is enabling and dangerous as is? Waste of tax dollars/grant monies? I am interested in your opinions as I had no idea this training existed until last night before my wife and I signed up.

As a prepper, I love having this stuff on hand. As a realist, I am hoping that my statistical need for this stays extremely low and it expires from non usage.

2

Our kits look easier to use. Open package, remove tip and push. Looks more like a nasal spray. I’m glad we have them too.

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3

Does this type of thing propagate abuse? I think ‘yes,’ but I don’t know what the data say. My guess is a user will use whether narcan is thing or not.

Am I going to add it to my bag? Nah, bruh. I am still too crispy over dealing with these people in EMS and in the ED. If I see them lying in a pool of their vomit and piss barely or not breathing, I will do the ‘responsible citizen’ thing and call 911 and move along.

4

A few weeks ago, I worked an accidental opioid OD on a diabetic who recently had back surgery. Took his insulin before breakfast, took his prescribed oxycodone, and subsequently went down from either being hypoglycemic or the opioids. Chicken or egg; but with pinpoint pupils, resp @ 6/min, and BGL 26, who cares. Regardless, he took a full 2.0mg plus another 0.4mg narcan IV to effect a change in respirations. The D50 that came after got him “back”.

That is the only legitimate accidental OD I’ve worked, but have heard of a few others from my coworkers. Particularly due to polypharmacy with elderly patients.

As for the street drug kind? On the clock and off are two different things. I’m with chuckman in that on my own time, an OD is not my emergency and I’m not going to make it one. Call 911, put them in the recovery position, and let Jesus take the wheel while I go about my day.

Junkies will get their fix regardless if narcan is available.

5

They showed us 4 different kinds. The Ezvio Auto-Injector looks the easiest, but is about 345 dollars unless I use my insurance, than it’s free… And, not doing that for something random. The FDA approved snap-packs look so simple. Those are about 40, but are free at many times and places across our area.

The vials/needles are by far the cheapest, but hardest to administer for most, plus I would rather not deal with anything close to an addict’s veins/blood as a non-medical professional. The luer-lock is easy, but in a rush could be hard. But, I have a good feeling I could use it effectively at this point.

I can understand that. I suppose I am in a bit of a privileged spot to not have to encounter situations and people like that often. I know that I wouldn’t put myself in danger for someone in that situation; but never know what I might run into out there.

That was my biggest concern. Percentage wise, statistically, I figured legitimate situations due to prescribed are on the very rare side of things, while ODs due to abuse are the main reason for this being in Standing Order.

Thanks for all your feedback. The input and conversation is very much appreciated.

6

In my area, I’m a bigger fan of cops, first responders, and firefighters that know how to properly use a BVM. Not that I’m knocking naloxone, I just see a lot of people not able to do basic stuff. I have seen Narcan administered inappropriately a few times FWIW.

The nasal (MAD) setup is the way I would reccomend.

Eff treating junkies off duty.

7

I agree. I have only worked a handful of actual accidental OD’s. I don’t call shooting smack accidental by the way.

8

Having just gone through our refresher, make sure your partners can use it on you. A lot of these opioids absorb through the skin, which is no bueno. Make sure you’ve got good gloves too.

Having at least two people there when you push it is a must (my policy requires it). If you give too much they’ll come up swinging. Our paramedics usually give enough to save them but they’re usually at the border of conscious and unconscious to avoid combativeness.

9

Absolutely.

Titrate dose to respiratory effort, not LOC. “Sleepy and breathing” is the goal.

10

^
This.

The proper answer to “not breathing” is airway adjunct and BVM. BLS before ALS. If opioids are t the problem you haven’t helped anyone.

11

So, waking them up to sign the refusal of transport is not the goal?

12

There’s a big difference between a heroin nod and a full on OD. The problem is that Narcan isn’t that effective against the synthetics that are going around, and in many cases it takes multiple doses. The other thing to really consider is that often people become violent when snapped out of their OD.

If the job is to respond to an overdose and render aid/treatment, then that’s the job. I don’t think I’d burn up a personal stash, if I even had one, if other options were available.

13

Back in the day they were skills labs…a certain, successful intubation, IV, narcan, extubate when we got to the ED. I’d say half the time they’d be alert enough to sign off…they’d leave as soon as we opened the door.

14

Most of these people will be on a narcan drip in the hospital. IV boluses for reversal are notoriously unreliable.

15

Mass naloxone fielding is the new thing, great panacea for the opioid epidemic, and everyone is doing it. 4mg nasal spray is most popular. Helpful if needed, a diagnostic if not. Big talking point for LE buy-in has been accidental exposures to rescuers. BVMs are great, but getting cops and lay rescuers to bag properly can be a neat trick esp if the patient is of less interest to the rescuer. An average of current SOPs: suspect opiate OD, safety first, give first dose, no effect give second, stand by for BLS tasks and EMS. Most LE won’t have airway adjuncts or more than two doses. Patients can refuse if AO for EMS, or go to jail for applicable charges with LE after medical clearance. Addicts with scripts use them more than we know/track, and never report their OD incident. If an emergency call is generated, expect an increasing amount of folks to have their own like nitro and epi pens. There is room for discussion of good sam uses and public-access, but safety issues abound and it isn’t an IFAK item in my view.

16

That is a great way to look at it. I make the newer guys start large bore lines on OD patients. They could be hypotensive and we might need to give fluid so it is justified. Plus, they are getting experience that will pay off when we have a bad trauma call and we have someone bleeding out everywhere. I always try to look for ways to help others gain experience.

17

Just wanted to confirm what someone else brought up. Don’t be surprised if narcan doesn’t work like it used to. We have been giving up to five doses for some guys riding the grey death express. BVM is going to be your friend until you get to the ER where narcan is in larger supply.

18

Leave Narcan to the paramedics to dispense when they’re on the clock. The cops and firefighters are dong enough social work without any more mission creep into pharmacology, besides I’ve never seen a junkie who was appreciative of being robbed of their high even if it was killing them.

19

In most cases, no, not really. Most people who are abusing opiods are simply trying to chase the next high. As their tolerance increases, they need more and more until they OD and die. So, I supposed you’re propagating their abuse, but that will simply last until the next time they OD and no one is around.

In rare cases, there are groups of (usually young) peoplle who have “Narcan parties” where they will intentionally OD and have people with Narcan on standby to bring them back.

20

Not to sound mean but letting the dopers go would save lot of taxpayers money in the short and long term.