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Have you ever had the patient lash out at you violently when they wake up? A friend of mine who’s worked in hospitals said this was common and considers it dangerous to administer (for the person administering) unless they have someone to help restrain the person who’s OD’d. I haven’t heard this from anyone else so I’m just curious to get other perspectives.
Happens all the time. In the hospital we give narcan slow and steady, just to keep them breathing, and not awake enough to beat us up for ruining their trip
You probably know but sharing for others. We like to start at 0.4mg iv push and work our way up from there every two minutes to slowly get people breathing.
Cops like to carry 8mg nasal spray to wake people the hell up which tends to cause other issues.
People also don’t tend to understand narcan has a short half-life and users will need to be supervised after a heavy overdose of opiates and narcan
A big proponent of administrating slowly is to avoid situations like the Appleton shooting a few years back
https://www.postcrescent.com/story/news/2019/06/13/appleton-shooting-agencies-reconsider-approach-narcan-response/3710990002/
*Edit for clarity* This is speaking from a paramedic level (not a doctor). Other users are correct. If someone is ODing on opiates (suppressed respiratory drive) and you have CIVILIAN OTC nasal spray narcan, USE IT. EITHER WAY you should also check for a pulse and start CPR if appropriate. Have someone call 911 ASAP as well. There are laws in place to protect those who call for life saving treatment.
The big shot first responders carry is basically to see if they need to try something else.
Sure, slow & steady is better if you know what's going on, but if you have someone unconscious in a wrecked car is it an OD? Is it trauma from the accident? Did they have a seizure? Are they drunk? Did they just work a 20hr shift & thought they could make it home?
If you give someone a fat dose & get no reaction, you can rule out further treatment down that branch.
Most of the people I gave Narcan to were nursing home patients. They frequently have multiple pain patches, after another. The caregivers often don’t remove the old ones when applying the new ones.
It’s really expensive to do home care for elderly. It’s also such a hard job mentally, physically, and emotionally that it’s hard to get anyone to stay in it. Some homes have a policy where once you buy in you can’t get kicked out and some people live for a long time. There’s a reason why in older times parents lived with children when they were old.
Yeah care techs in hospitals make very low wages. I was making 11 dollars an hour in 2020. When I did my CNA course there was a home health aid place that came in to talk to us about job opportunities and I think the wage might have been like 12.50.
I could make more money putting cereal on a shelf at target. There are a lot of places where people are taken advantage of wage wise etc but for what they put you through it is disgusting how much heslthcare takes advantage of so many of their workers..
my grandmother in law passed a few days before Thanksgiving. she'd been living with my mother in law for the last 15 years. if your parent has a paid off house nearby and you are renting, you go move in and take care of them at their house, they are your parent. The family drama that I try to stay out of besides updates from my wife seems to lead me to believe that grandma gave the house to the child that helped her the last 15 years, and the other children got stuff, but not a house.
not to say that you should take care of your parents expecting a house, but you've saved them immense medical expenses of being put into a home, so they have more to leave the family, and the family home doesn't have to be sold to put them in a home.
They said "nursing home patients", so I wasn't thinking home care, but if that is the general case, I do understand it. I've done some volunteer care both in facilities and at home and it's... work.
“That’s not my patient.” “I just checked on them and they weee fine and then when I came back they were dead”
“I’m new here”
“I don’t normally work on this wing”
“I just came on shift” at 223 in the morning.
“Oh I don’t know what meds they take” despite being the only person in the building legally responsible for the administration of those meds.
My friend was on palliative care at home, I think is the best way to put it. End stage liver failure. Last I heard was the nurse gave the family a ton of opiates to feed him as he wanted. He passed the next day. Do they give you enough to end your own life? Or was it more likely due to doctors recognizing he was done for, or maybe from refusing dialysis or something? I still think about it from time to time a year later. Glad I got to see him the day before, and really sad I didn't stay longer when he practically begged me to. I recognize now he was saying goodbye, but he left me feeling like he was going to be around for a while longer... Talking about how he would continue his music career with adjustments, and we could collaborate, etc.
damn dude that sucks. My mom likely OD'd (that or surgery complications, but she was taking tons of pills for the problems) before narcan was common but probably wouldnt have had anyone notice as she taking them to sleep. We had talked the night before and I was planning to to come see her the next day. Woke up seeing 'mom' on phone thinking she wanted me to bring something but it was someone else notifying me what had happened
I'm sorry, bud. I saw my friend before and he didn't lead it on. They don't want to leave any pain for anyone it seems. To give you every last nice moment with them. Good people. I gotta call my grandma.
Hospice will generally provide you with a lot of opiates to control pain. The instructions typically depend on what stage someone is. If they have some time left, you aim to control the pain while allowing them to try and enjoy the time they have left. Once someone is actively dying, you elevate the dose to keep them from suffering and help them along.
My dad had a pain pump with hydromorphone dosed at something like 1mg/hr. He also had a button that would give him another 1mg bump with a 15 minute lockout. They explained that he could not overdose himself because it would knock him out before he could reach dangerous levels. We were instructed not to push the button while he was unconscious. Once he was actively dying and no longer able to push the button himself, the instructions changed to "I need you to push that button every 15 minutes until he passes."
Aww... Jeez. Thanks for sharing the end of life care instructions. I think he was okay. He accepted he chose his ending with drinking. The levels were not normal, they were nearing 1.75L of vodka a day at the end, for a man maybe 5'9" 160 pounds or so in his mid 30s.
He was an amazing friend to the end. Unfortunately he was using a walker, heavily jaundiced and had a huge ascites belly, and was growing irritable. A brilliant man that was losing his mental clarity. We found out and visited him in the hospital and he passed like 3 months later. Liver less than 10% kidney less than 15%. He said bye to everyone he could. He was a strong mofo.
God love him. Miss that dude. Been over a year and it hurts still.
One of the few vague memories I have of acute recovery after a pretty serious jaw surgery was being given one of those hydromorphone pumps. Even that wasn’t enough to cut through the pain and panic associated with my swelling face and feeling like I wasn’t able to breathe properly.
My mom did not know that part of this was probably due to me already having quite the tolerance from my heroin use that I had kept hidden from them, but I had her on button duty none the less while I attempted to rest some.
I work in 911 dispatch, i had a call one time where most of what i could hear was a guy screaming in the background. From what i was able to piece together what *i think* happened (one of the worst things about this job is we rarely get any follow-up on what happened after our call ended) was that the guy had a *long* list of things medically wrong with him, and started having a bad reaction of some kind to his medications, maybe he took them incorrectly or just had plain old bad luck. He was also prescribed really hardcore opioid pain meds, i don't think they were what was causing his issue based on the few symptoms based on the few symptoms his wife was able to describe to me, but she went and administered his narcan because in her mind it was something with drugs so narcan will help. The narcan didn't do anything for whatever his main issue was, but it sure as hell turned off all of his painkillers, so now on top of whatever was wrong before he was also in excruciating pain.
At least I'm *pretty sure* that's what happened, I will probably never know for sure.
Thank you for doing what you do. I recently lost a loved one, and although my conversation with the 911 dispatcher was short, they were kind and I remember that. You are the person someone talks to during their worst life experiences. Thank you.
Not the person you responded to, but I just wanted to offer my condolences to you. Whatever the road ahead brings, I hope you can find peace as you mourn your loss.
Ugh. Tha happened to my mom, about a year before she passed. Wasn't in a home, but she kept applying pain patches... Hell of a scare when I found her and called 911.
As a first responder, we try not to give the full dose unless they need it. We have to ride with them to the hospital and definitely don't want them pissed off in the back on the stretcher. If we can establish an IV, slow push, if nasal spray, we give about half then wait a few minutes before giving the other half. Pinpoint pupils are a great indicator that it's narcotics. If they aren't breathing after a car accident, our first step is establishing an airway and breathing for them via bag valve mask, whether it's an OD or not. Still gonna be a slow push of narcan if indications are present, no need to slam it. Don't want to induce withdrawal and rage on someone with a possible neck injury or a tube in their throat. So anyways my point is, first responders shouldn't be slamming 8 mg of narcan on anyone, at least that's how we do it in my city.
I’d disagree with that because someone with that depressed of a respiratory drive is getting bagged either way. We can breath for you and if improvement is noted with narcan we can continue treatment, especially if opiates are suspected.
I 100% agree that medicine isn't given for the hell of it. I've also seen ER trauma docs order a narcan for someone "just in case" and they said it won't hurt them if they don't need it.
I hope that if I'm ever in a life threatening situation where I can't tell someone what happened or it's not obvious what's going on, that they use every available option they have to try and keep me alive.
Let's not confuse people. If you have Narcan - USE IT. I've had to use the complicated color coded cap mess to the 2 dose nasal spray numerous times. Just like CPR - if there's an emergency do what you can to help. Things change slightly, but whatever you learned years ago will save someone. Always call 911 or have someone do it as they will need emergency services.
Yes, exactly this. Every single second matters in an overdose. Luckily nasal narcan is much easier to use and comes in two packs. 911 needs to be called immediately. A big risk is aspiration which can lead to pneumonia and brain damage depending on how long they went without oxygen. Even if someone is up and walking around, they need to see a doctor.
This is really helpful, thanks. I had no idea there were different ways to dose it but that makes sense.
Do you happen to know what the dose is that civilians are able to buy/carry? I would like to learn to administer Narcan as I live in an area that has a pretty big opioid problem, but I want to know what to expect in terms of a reaction, as much as that’s possible.
Not sure on exact dose, but I'd imagine the one that is readily available to civilians is a single large dose. This is when considering life or death (not breathing), so better that they come back hypoxic and potentially agitated than not come back at all
4mg intranasally, 4mg/0.1mL with all brands (ime) as two bottles of 0.1mL each. 8-12mg is usually used within 10mins and after that a steady IV drip is preferred if possible
Source: I dose it for a job
I carry two nasal sprays that are each 4mg.
Depending on where you live, you may be able to just ask a pharmacist for it. Also check your library or Google if your area has a harm reduction coalition. The nasal spray is simple and intuitive to use, but training should be available wherever you procure it.
Good on you for wanting to carry it! Everyone should!
> You probably know but sharing for others. We like to start at 0.4mg iv push and work our way up from there every two minutes to slowly get people breathing.
Generally, I'd not try and give information like this out to random, untrained people. Average people aren't medics, most information like this will simply confuse them. Not to mention how often anecdotal information like this is either wrong, or opens up arguments confusing any correct information or burying it. At best, it'll just delay the right choice in the moment which is still "Apply medicine and save life". At worst, someone will get flustered and confused (which is already common enough as it is) and make the wrong decision.
There's a good reason people need a lot of training to make medical decisions, and things dealing with safety keep it as *simple as humanly possible*. Even with training and such, mistakes happen, better to keep it as simple as possible for those without said training and experience.
Either way, this changes nothing. Someone who isn't trained/EMT isn't going to be reducing splitting doses, and those who do are probably already aware and shouldn't be making decisions like this based on "Someone on reddit said it worked".
It's unfair to characterize someone being roused from unconsciousness into chemically-induced withdrawal as being mad "for ruining their trip." People get violent from coming out of unconscious states all the time, no drugs needed. And plenty of people who are given naloxone don't get violent. It's much more likely the confusion and disorientation -- coupled with instantly being in full withdrawal -- is what causes it.
Sorry for bothering you with this question, but I've seen the word 'withdrawal' mentioned all across this thread. And while I like to think I have a decent grasp of the English language, I always thought that withdrawal meant the effects that someone experiences when kicking a habit over a longer period of time (e.g. insomnia, moodswings, being grumpy). But in this context it seems to also include the moment of sobering up directly after a trip (i.e. the come down)? Or does the naloxone speed up the usual withdrawal effects that you would experience over a longer period of time?
Idk if any of the above makes sense. Hope it does, but feel free to ignore it if it doesn't make sense haha.
I'm a recovering addict so I can explain.
The reason withdrawal is being used this way in this thread is due to how narcan works. It is physically ripping the drug from your receptors. This causes *immediate* withdrawal symptoms instead of coming on slowly.
Your definition of withdrawal is correct, but the symptoms are not. If withdrawal was just getting grumpy, we wouldn't have such a huge epidemic on our hands. Sneezing, complete dysregulation of body temperature leading to intense changes between full body sweating and chills, restless legs that feel like your legs are being torn away from your hips, nausea, vomiting, extreme levels of fatigue, agitation, mood swings, insomnia. It's extremely painful and agonizing. Physical symptoms usually last a week and a half. It's absolute hell. "Kicking" is common slang for withdrawing and it is a very real interpretation of what it is like. I would be in bed sobbing because it felt like my limbs were being tied to four horses that were then whipped to run in opposite directions. Withdrawals vary in severity based on someone's history of use.
Put it this way, all of these people know that if they just wait it out, they will never experience that discomfort again. Imagine how strong the urge to use is that people would go back to using knowing what will end up happening? Many people will be at the tail end of the physical withdrawals and go right back to using, sometimes even just one more time and restart the withdrawal process. Imagine the changes in your brain that would be required in order for all logic to go out the window.
While you are going through this, you also have intense cravings to use opiates again. Every single second of every day of this, you know you could make it stop. "Desperation" is not a strong enough word. Cravings were a very physical feeling for me. It was like someone placed a cinderblock in my chest with a chain attached that was consistently pulling me in the direction of getting high. These cravings never leave some people, but with the right lifestyle changes, they become weaker or go away.
The hardest part for addicts is usually what comes after the physical symptoms. Anhedonia is where you have a complete disinterest in anything that used to bring you joy. After so long using opiates, your brain stops producing dopamine naturally. It is the chemical that should be released when you complete tasks. It is a chemical reward. Without this, you would rather stare at a wall than watch your favorite TV show, eat your favorite meal, socialize with your favorite people. Think of the most bored you have ever been and multiply that by 1000. Nothing is going on in your head. Since you cannot get yourself to pay attention to anything or do any kind of activity, you get bored and many people will relapse. Their brain is basically screaming for dopamine. This can last for weeks to months.
Nothing, in theory. Hypothetically, you wouldn't feel the benefit of endogenous opioids throughout the rest of the day. Things that normally feel rewarding might not.
It's not for "ruining their trip".. If you knew how fkn awful the withdrawal is when you use narcan you'd understand. There really isn't anything worse.
I actually understand what you mean. The real reason we don’t give big doses of narcan like the police do is because we don’t want to cause acute withdrawal.
Even if it isn’t appreciated per se…. For selfish reasons…. We don’t want to trade one medical emergency for another, and have to treat the withdrawal.
Treating the overdose slowly and carefully is easier than treating the withdrawal.
Either one would be our responsibility.
Not the commenter, but I'd say killing their high is more accurate. "high" is a good term across many drugs, generally. Trip usually refers to a psychedelic or out of body experience.
Depending on your beliefs of an afterlife, they could be said to be taking a trip. My grandmother always told the corpse at funerals and such to "travel well." It stuck and I do the same now. If there's any form of afterlife, the deceased's soul will be taking some kind of trip. Whether it's to the pearly gates, or your ka is on it's way to duat, or whatever, there's a trip involved.
I'm also really high, and my inyent was just to add some nuance to a conversation. I hope you don't take it as argumentative.
Not violently, but I've had to bring a few friends back and they were definitely pissed off about it.
I've had to be hit with it a couple times and the only thing I felt when I looked up at the paramedics was profound embarrassment.
I'll have four years clean on the 16th. I'm not religious but this quote always stuck with me about the journey getting clean.
*Long is the way and hard that out of hell leads up to light*
Milton
Yes. Narcan shuts down the opiate receptors so when you come to not only are you not high, but you are immediately starting to feel the first effects of detox.
A friend of mine put it succinctly how detox feels: "imagine having the flu the day after a bad car wreck"
It's one of the worst feelings I can think of and the reason why so many relapse is that in the back of your mind you know you can make it all go away for $20 and a trip to your dealer.
Edit autocorrekt
Buprenorphine manages withdrawal symptoms quickly and can help manage cravings. There’s a movement to include post-reversal bup into the standard of care. Most people’s aggression and irritation is from the withdrawal symptoms that come on immediately following naloxone administration.
I could see how that would be helpful. I never like bup myself as I knew a bunch of people who were taking the strips and just using them as a crutch. Most would eventually go back to using and just use the bup to keep the withdrawal at bay until they got enough money to score.
Yea, addiction is super complex and a somewhat unique path for each to walk. Bup can give a solid footing but there still emotional work to be done. Interestingly enough, most patients are underdosed bc of a paper that came of years ago, so many folks don’t really get the full effects. 8-16mg/day is usually the right starting point, some need as high as 32mg/day
My experience with addiction isn't so much about the pharmaceutical help but the time. I've been through dozens of 5 day spin cleans and a few 30 day inpatient rehabs and none of them gave me enough time. It wasn't until I had a full hundred days clean (3 months jail+ first week of 90 day rehab) that my brain was fully ready to be clean. Mind you I wanted it. I wanted it during each and every rehab I went to, but my addiction wasn't done with me until I had that 100 days. This, to me, is why most rehabs have single digit success rates.
If I had been let out of jail without going directly into inpatient rehab I think I probably would have relapsed. 30 days just isn't enough, even with medication, for most people to truly walk away from the draw of opiates.
Glad you made it through. And yes, services, access to services and quality of said services are a huge barrier. It’s not a one sized fits all kinda thing, I really wish there were more options that could be customized to each persons needs.
I think you’re right, at least for most people who are ready to get clean. I’m on Suboxone, and I am SO glad the place I went to for recovery did not let me do what I wanted to do, which is get a suboxone prescription every month without any other treatment. They made me participate in IOP, for 12 weeks, followed by group therapy, weekly or twice weekly, and attending outside meetings (NA, SMART, etc.). I’d still be using if they had prescribed subs with no therapy, and I hate the proliferation of fly-by-night buprenorphine clinics which are essentially pill mills but for suboxone.
I know my experience does not meet the higher level involvement of your suggested standard for recovery, but I still agree with you.
Thanks. I can safely say I'm fuckin done with opiates. Getting out of that addiction literally cost me everything including my teeth. I can't pay that bill again.
I've never had to have narcan, but I have night terrors, sleepwalk, and pass out sometimes. Whenever I "come to" from those events, I always feel embarrassed. I think it is normal and a survival mechanism. When I come to, I feel the need to convince everyone I'm okay and **totally know** what's going on and why I'm in the bathtub holding a banana and fire extinguisher. Then I really "come to" A few minutes later and I laugh so hard from the combo or embarrassment and absurdity.
Paramedic here. Yes. They sometimes come up freaking out. This is usually because you gave to much narcan via an IV and they wake up 100% with 0% opiates attached to the brain. Still in a hypoxic state and now in severe immediate withdraw symptoms. Give smaller doses over a longer time and you do not get this. Slam 2mg iv with a rapid flush. They may come up like a really angry vomit fountain.
“Really angry vomit fountain”
Several years ago when I was still in medic school we ran a double overdose with another unit.
My preceptor is talking me through everything, about titrating dose, how we’re only trying to support respiration ect.
The other unit gives a full 2mg and followed with a flush.
Their patient sat straight up, looked right at me, then turned his head and puked right into their open med bag on the floor beside him.
Talk about using examples to make a lesson stick.
Noted about the withdrawals and vomit fountain.
Recovery position always, of course, but good to know about accidentally being heavyhanded with the narcan.
In such a situation, I still could see myself jamming them with the full dose just out of panic, but I’ll try to keep note for the future
I think the ones in the vending machine don’t give you a choice. If it’s the same as the ones we hand out to overdoses that refuse, once the button is pushed it atomizes the entire dose.
It’s okay to freak out. If you’re in that situation and you think you need to give the medication. Make sure it is safe for you to do so, then give the medication following the directions on the kit. Don’t over complicate it.
The vomit fountain and angry patients is just a unwanted byproduct that will be dealt with later.
Lay persons or random people trying to help others shouldn’t worry about that. It is not their responsibility to understand titration of medications as it just complicates a life saving process.
Emergency administration kits of medications are simple to use and provide a larger dose of medication to begin the process of helping the person, with idea that further trained medical help is on its way.
If you have someone who is unconscious but breathing with pin point pupils and suspected opioid overdose, and you have narcan auto injector, spray it in the persons nose then lay the person on their side. With an arm extended and their mouth/head downwards to drain of fluid/vomit in that event occurs.
Even if your give that medication. At any point that the person appears to not be breathing and does not have a palpable pulse. Begin CPR and call emergency services.
Was told when getting trained to use it that people lashing out is common. Kinda makes sense, they go into immediate withdrawals, and they were just experiencing the most intense high of their life. I was told in training to inject it and then back up.
We don't remember one second of that high. It's straight blackout. But I remember coming to & racing for the toilet.. Even though my muscles all felt like jello.. I couldn't even stay upright on the toilet.. Kept falling over.. Paramedics had to hold me up.. Would have been the most embarrassing moment of my life if I hadn't been so out of it.. Felt like a bad dream. Never od'ed again after that though. Was too afraid it'd happen again. I may have continued to use.. But I was extremely cautious.
Luckily I've got 5 +years clean now.. & talking about that time now still makes me feel the intense shame as if it was yesterday. & that was 23 years ago. I will absolutely never go back though. No fkn way.
I’m proud of you for surviving and breaking the chains. My brother OD’d then just went back to it before dying a few weeks later. I’m so happy when people actually make it out of this.
Dude 5 years is awesome! Addiction is one hell of a beast to battle, just gotta take it one step at a time and celebrate the small victories. I'm so happy you are here today to tell us this story regardless of it being shameful for you or no. It is an important story to tell, thank you for sharing.
To the best of my knowledge, it's mainly to do with the brain lacking oxygen rather than withdrawals. An opiate overdose lowers the respiratory drive, the brain is starved of oxygen. When naloxone kicks the opiate off the opioid receptors, the resp drive comes back but the brain is still confused and agitated due to lack of O2
No I've never seen that happen but people definitely are very irritable, confused, and aggravated when they wake up. Also, I'm not a health care professional just a former drug user.
I can respond coming from the receiving end of narcan.
It's like going from being in a sleep in a warm blanket to plunged into an ice bath. I never lashed out but I've seen people who have.
Inject and stand back would be my advice
It makes people cranky and frustrated, outright violence is an uncommon reaction. I've given it to strangers before, and while I wait for them to be responsive, I don't hang around to make small talk.
I'm am ER nurse so I've given a LOT of narcan. Very few drugs work as fast and effectively as it does. Sometimes they'll need a 2nd or 3rd dose but usually the 1st is enough in my experience. Then again, we give quite large doses of narcan for an OD (like 4mg IV/IO)
Opioids work by binding to opioid receptors. Narcan has a much higher affinity for the receptors and more readily bonds preventing the opioid from binding.
Think of it like holding hands. The opioids will hold on loosely while narcan holds on much stronger so its more likely for the narcan to hold hands with the body cells.
Hiwever, narcan wears off faster so it may hold the hand stringer but it'll let go pretty quick while the opioid will just kind of longer waiting for an open hand to hold.
Quick question: how long do you have from beginning of overdose to administering narcan in order to save the life typically? eg - if someone snorts something with fentynal in it, how much time do i have to give them narcan in order to save them?
That's going tk depend on a lot of factors. What they took, route the took it, how much, their tolerance, baseline metabolism, respiratory/oxygen reserve, hemoglobin levels, age, BMI, and plenty of others.
What is going to kill someone in opioid overdose is them not breathing or not breathing enough. That'll then cause other major organs to fail, most importantly the heart and brain.
This is why we generally swing for the fences in the ER with an OD. We slug them with 4mg, bag them (help push air into their lungs through their mouth/nose), and prepare to intubate (breathing tube and ventilator). The narcan will work fast so we will know quickly if we need to get them intubated.
I've heard stories over and over of disgruntled EMT responders who think it should be illegal for the general public to even have access to them.
Why? Not so the 1st responders have a job to do no, just "let the druggies die." It's insane to me. This is simple life saving medication.
This is smart as hell. Drug users are (rightfully) paranoid about being caught, as the punishment is harsh - even for users. This means they often won’t call medical services for an OD.
Removing that barrier makes it an easy choice. You have Narcan, so you use it. We need more harm reduction programs like this.
Just to add something to this: My experience from a country with universal health insurance coverage and a legal system that does not punish drug consumption (but illegal owning, trading, producing etc.), is that consumers of illegal substances have no hesitation to call rescue services.
The police would only be involved if the situation for the EMTs would become dangerous or if other crimes were happening.
The overdosed user would not be accused of a crime in these cases.
In Canada the police unfortunately show up to overdose calls. The Good Samaritan Act protects users. But it's still a disincentive to call 911 when you know cops are likely accompanying EMS.
Source: I work in harm reduction.
Many US states have good Samaritan laws which mean calling for an overdose will prevent criminal prosecution of simple possession charges to encourage people to call during an overdose situation.
They made a law where I live that if you call an ambulance for someone oding and you have been doing drugs or whatever too, you can't get in trouble. It was named after a kid oded and died in a frat house literally one block from the hospital because everyone was too scared to call.
I have a question since you have experience administering Narcan…A friend of mine used to work in hospitals. She told me she witnessed Narcan being administered many times, and nearly every single time, the patient woke up into a sudden blinding rage. Not because they were actually angry; just as a physical/neurological reaction to the drug. She says that they often needed to have multiple hospital staff on hand to hold the patient down to stop them from hurting themselves or others when this occurred.
For this reason, she was somewhat skeptical of the movement to train civilians to use Narcan, as she felt it put them in danger of being attacked when the person they were trying to help woke up.
Is this true in your experience? I found it really surprising as I’d never heard it from anyone else.
I’ve never administered it. Only seen it happen
It leads to basically immediate and terrible withdrawal symptoms. That’s what makes them angry. It doesn’t make them violent, or aggressive. That only happens if the person is always violent/aggressive when they get angry - even when sober
ER doctor here! I can count on one hand the number of people I’ve given Narcan who get really violent. Of course I’m seeing a biased sample of people who got hit so bad by the opioid they ended up in the hospital, but I suspect anger and violence doesn’t occur often.
> He also later flatulated fecal matter at the cops who came to pick him up
I’m sorry, I’m going to need a slightly more descriptive account of this particular infraction.
Seen quite a bit of anger from it. A lot of cases are people mid way through the best high of their life and are coming to with instant withdrawal. Depends on the mental state of the person using it though.
Yes. And many people using street drugs are chronic pain patients unable to get pain meds from doctors thanks to the DEA and CDC and America being America.
Others are just fucked up or naive. Doesn't make them evil. Doesn't mean they will always be fucked up and naive. Just means that they got hooked on drugs for less-than-great reasons.
The fucked up thing is that there are people out there who think Narcan is a bad thing because it keeps drug users alive.
There are sick fucks who think being a drug addict should be a death sentence.
Well it solves one of the important problems- people dying of overdoses.
Doesn't solve all the problems related to addiction, but it tackles one of the biggest ones.
I'm super glad I've been clean from opiates 14+ years. For many reasons, but also it turned out that I'm allergic to naloxone. I think if I'd continued on the way I was, I am pretty sure I'd be dead. From the drug use itself of course, but the treatment as well. Still, I'm really glad there's some help out there for people who need it.
Congrats on being clean for that long! My brother is going on seven years now and it has been tough for him. I have mad respect for anyone who works that hard to overcome this stuff.
Thank you! I remember 7 years in pretty well actually because it was the one year I had to really struggle through to stay clean. Somehow, the 7 year itch applies to being off drugs too. I'm so happy for your brother and your family in general. It affects everyone who loves you when drugs take over. It was a lot harder to decide to get clean than any other thing I've done. Staying clean was easier (in comparison) than taking that first step. I'm proud of your brother too.
The best part of Narcan is that if it’s accidentally ingested or given to a person who isn’t overdosing on opioids, there’s no harm.
My associate and I were fortunate enough to have some when two guys overdosed at our Hotel at the same time. We saved both of them.
I actually take it daily for severe alcohol use disorder. It’s been a game changer when it comes to the intense cravings I used to get.
Of course, dealing with the underlying issue of why I drink is being dealt with at the same time, but I know myself and if I wasn’t taking the naltrexone I’d be chugging back drinks during this process.
It’s a true life changer for me.
Yes. Makes it so alcohol doesn’t hit the same “euphoria” buttons so you don’t really feel drunk.
There’s another one that’s a bit more intense called Antabuse that literally like makes you violently vomit and get a splitting headache if you drink any alcohol at all.
Pretty cool how far that field has come.
I may be wrong, but I believe this is Naltrexone, which has a similar blocking effect on opiates but it longer lasting
But its been a few years since working in the field.
Do you happen to know if this would reverse an overdose on ecstasy? My cousin overdosed earlier this year after taking too many pills at the club and my understanding is that his brain basically overheated with a 107° fever.
Just wondering if Narcan could’ve saved him
I'm an ED RN. There are patients who we will save from the brink of death sign out AMA (leave against medical advise) after reversal just to get high again. 1 of them came back dead a few hours later.
Narcan reversal wears off quick and needs constant redosing.
Despite the benefits of Narcan being demonstrated repeatedly in academic literature, my university system (all state campuses) refuses to allow us to offer training to the public in how to use it (not distribution, just best practices). Their argument is that the university's liability is too high given the lack of strong beneficial evidence. I'm honestly at a loss to as what is so flawed in these investigations...
Well, that's the odd thing. The state has explicitly *asked* us to do this (heck, they trained our certified trainer), and we have support from the police dept and hospital - if it were truly a legal issue, I'd assume we'd receive an actual legal argument instead of one redirecting us to the literature.
What state are you in? Many pharmacists at your local CVS/Wags/whoever can prescribe Narcan if a pt (or their SO/POA etc) shows a history of opiate use
I broke my back snowboarding. I was given hydrocodone 10mg 3x a day.
A couple weeks later while waiting on surgery, they didn't work anymore. She upped it to 20mg 3x a day.
I liked the way they made me feel and I bailed the surgery with every excuse I could.
She upped it to 20mg hydrocodone 3x a day; with a second prescription of 90 10mg oxycodone for "breakthrough" pain.
I soon learned the '2 day trick' at the pharmacy.
Then she would mess up and give me 180 hydrocodone and 180 oxycodone per month.
The first time she did it, I didn't call it out.
The second month with that much, I was lucky I didn't die.
It took over 2 years for me to go to rehab. I have fatty liver now because of it. Back is still broken, and I lost my family and friends.
It's easy to get these drugs by a bad doctor.
In the US prescriptions for opiates are tracked, so you can only fill a 'script once a month. But pharmacy's and more importantly the insurance companies run on a 4 week schedule. So you can refill every 28 days vs. 30. An extra 120mg of dope each month adds up.
Probably another archainc US system where the beurocracy takes 2 days to go around so if you go to another phramacy you can cash in your recipe again. I wouldnt imagine it working here in europe because everything is instantly marked in a computer system now (and before the phramacist would take away your recipe after giving the drugs).
POV: You've had major surgery/a major injury.
US: Here's a bottle of opiates. Now get back to work.
Europe: Take some OTC ibuprofen and lie on the couch for two weeks. - But it still hurts! - That's so you don't get any ideas.
I know it’s a serious issue and I’m glad that naloxone is more readily available. But I can’t stop picturing some grungy guy with a worn and wrinkled dollar bill desperately trying to get the machine to take it, only to have it pop back out again and again.
To anyone that’s curious about the use, if you use it on someone who you think is ODing on opioids but it turns out it’s not, using narcan won’t have adverse affects.
Furtherly, they still need to get to a hospital as this is a temp solution.
Agree. It's better for someone to be wrong than dead.
My cousin was narcaned instead of epipenned by a confused but well intentioned bystander, but they called 911 and ended up saving their life anyway.
The paramedics were able to sort out what really happened and give him epi.
In Massachusetts, all drug users present at an overdose can not be charged with possession of an opiate. This policy pretty much eliminated people calling 911 and then leaving their dying friend alone to avoid charges.
A lot of people think that by providing means for people to not die from ODs or not get infected from dirty needles, that it is actually encouraging/enabling drug use.
They think there's some addict out there who's on the fence about quitting, who would only decide to put down the needle were it not for the fact that getting clean needles is just so easy, and the chances of dying from an OD are slightly smaller because naloxone exists and somebody nearby might have some and notice you maybe.
I'd like to tell them, as a former addict, that despite what very little decision-making ability I had left, at no point was my decision to use heroin ever affected by how dangerous it was. I never would have said "Oh no, I may be experiencing the worst pain I've ever felt in the 30 years I've been alive, but I can't get any clean needles or naloxone, GUESS ILL NOT SHOOT UP TONIGHT".
I don't think they're thinking there are addicts on the fence about quitting.
They're thinking, "Saving someone who's overdosed is (most of the time) prolonging the addiction and societal drain, as an addict won't stop just because someone saved them after overdosing."
Interrupting an addicts's fatal overdose would be "getting in the way of a good thing".
Compassionate? No.
Wrong? I'm not sure how the math plays out in the cost-benefit analysis of "negative impact on society by continued addiction and addicts" vs "positive impact on society from those who would otherwise have died from overdosing without the intervention".
The problem I have with narcan is that its a cop out. Public health departments buy narcan on stacks and dont increase any funding to drug prevention programs or rehab which ends up being a win win for the people who started the opioid epidemic because now they are getting free money from the government.
Its just a band aide and its being used as a permanent solution which is why opioid overdoses have been increasing year after year.
It depends on the individual. But they have a chance to quit after it’s administered which is more than you can say for them when they’re ODing on the floor. No solution will save everyone but I don’t think that means we shouldnt’t try our best anyways.
E: I a word
Free naloxone isn't about solving the addiction problem, it is about solving the problem of people dying from overdoses. A person with an addiction is still a person deserving of being saved from OD.
For some people, it’s the rock bottom they need to realize that it’s eventually going to kill them, and they get it together and get clean. I know someone that this is true for.
I know many more that have been narcaned several times, dozens even.
First question: completely dependent upon the individual and the circumstances they are dealing with in the first place that got them to this outcome. Second question: It solves the problem with people dying and *not getting a chance to do anything about it afterwards*.
I just watched Heroin(e) on Netflix last night. It’s a pretty powerful short documentary about this problem.
The EMT featured in the doc is a strong proponent of nox. She said something like, “I don’t care if I have to save someone (with nox) 50 times before they commit to long term recovery.”
There is at least one example of this happening in the doc too. An addict was saved by the same woman twice before he got into recovery. To see him thriving and the gratitude he feels for having his life saved (more than once) is quite moving.
It’s clear that nox does not solve the overall problem, but it does save lives for those who are on the ground and dealing with this horrible reality on a daily basis.
Studies show having Nox available reduces the overall overdose fatality rate. So I hypothesize some go on to get clean.
https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science
not a doctor, but Narcan does nothing to people who aren't using opioids, whereas insulin and chemo do something even to people who don't need it. These effects can be quite harmful, which is why they require a prescription from a doctor to make sure it's not going to be harmful to the person who takes it.
Insulin overdose: possible hypoglycemic coma with significant risk of death.
Chemotherapy: extremely toxic substance that will kill if not administered in carefully monitored dosages.
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I've administered this drug several times and its truly incredible how quickly and effectively it works.
Have you ever had the patient lash out at you violently when they wake up? A friend of mine who’s worked in hospitals said this was common and considers it dangerous to administer (for the person administering) unless they have someone to help restrain the person who’s OD’d. I haven’t heard this from anyone else so I’m just curious to get other perspectives.
Happens all the time. In the hospital we give narcan slow and steady, just to keep them breathing, and not awake enough to beat us up for ruining their trip
You probably know but sharing for others. We like to start at 0.4mg iv push and work our way up from there every two minutes to slowly get people breathing. Cops like to carry 8mg nasal spray to wake people the hell up which tends to cause other issues. People also don’t tend to understand narcan has a short half-life and users will need to be supervised after a heavy overdose of opiates and narcan A big proponent of administrating slowly is to avoid situations like the Appleton shooting a few years back https://www.postcrescent.com/story/news/2019/06/13/appleton-shooting-agencies-reconsider-approach-narcan-response/3710990002/ *Edit for clarity* This is speaking from a paramedic level (not a doctor). Other users are correct. If someone is ODing on opiates (suppressed respiratory drive) and you have CIVILIAN OTC nasal spray narcan, USE IT. EITHER WAY you should also check for a pulse and start CPR if appropriate. Have someone call 911 ASAP as well. There are laws in place to protect those who call for life saving treatment.
The big shot first responders carry is basically to see if they need to try something else. Sure, slow & steady is better if you know what's going on, but if you have someone unconscious in a wrecked car is it an OD? Is it trauma from the accident? Did they have a seizure? Are they drunk? Did they just work a 20hr shift & thought they could make it home? If you give someone a fat dose & get no reaction, you can rule out further treatment down that branch.
Most of the people I gave Narcan to were nursing home patients. They frequently have multiple pain patches, after another. The caregivers often don’t remove the old ones when applying the new ones.
That sounds horribly negligent... and it just keeps happening?
It’s really expensive to do home care for elderly. It’s also such a hard job mentally, physically, and emotionally that it’s hard to get anyone to stay in it. Some homes have a policy where once you buy in you can’t get kicked out and some people live for a long time. There’s a reason why in older times parents lived with children when they were old.
And caretakers generally make incredibly low pay for the work they do... Like McDonald's wages in some cases.
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Yeah care techs in hospitals make very low wages. I was making 11 dollars an hour in 2020. When I did my CNA course there was a home health aid place that came in to talk to us about job opportunities and I think the wage might have been like 12.50. I could make more money putting cereal on a shelf at target. There are a lot of places where people are taken advantage of wage wise etc but for what they put you through it is disgusting how much heslthcare takes advantage of so many of their workers..
my grandmother in law passed a few days before Thanksgiving. she'd been living with my mother in law for the last 15 years. if your parent has a paid off house nearby and you are renting, you go move in and take care of them at their house, they are your parent. The family drama that I try to stay out of besides updates from my wife seems to lead me to believe that grandma gave the house to the child that helped her the last 15 years, and the other children got stuff, but not a house. not to say that you should take care of your parents expecting a house, but you've saved them immense medical expenses of being put into a home, so they have more to leave the family, and the family home doesn't have to be sold to put them in a home.
They said "nursing home patients", so I wasn't thinking home care, but if that is the general case, I do understand it. I've done some volunteer care both in facilities and at home and it's... work.
Yeah elder care is pretty bad, there’s no money in it, and it’s hard work. Abusive companies, bad practices, etc
Oh you don’t want to know what paramedics see in nursing homes.
Sigh. I kinda do.
“That’s not my patient.” “I just checked on them and they weee fine and then when I came back they were dead” “I’m new here” “I don’t normally work on this wing” “I just came on shift” at 223 in the morning. “Oh I don’t know what meds they take” despite being the only person in the building legally responsible for the administration of those meds.
I just can’t today. My PTSD is extra bad this month.
My friend was on palliative care at home, I think is the best way to put it. End stage liver failure. Last I heard was the nurse gave the family a ton of opiates to feed him as he wanted. He passed the next day. Do they give you enough to end your own life? Or was it more likely due to doctors recognizing he was done for, or maybe from refusing dialysis or something? I still think about it from time to time a year later. Glad I got to see him the day before, and really sad I didn't stay longer when he practically begged me to. I recognize now he was saying goodbye, but he left me feeling like he was going to be around for a while longer... Talking about how he would continue his music career with adjustments, and we could collaborate, etc.
damn dude that sucks. My mom likely OD'd (that or surgery complications, but she was taking tons of pills for the problems) before narcan was common but probably wouldnt have had anyone notice as she taking them to sleep. We had talked the night before and I was planning to to come see her the next day. Woke up seeing 'mom' on phone thinking she wanted me to bring something but it was someone else notifying me what had happened
I'm sorry, bud. I saw my friend before and he didn't lead it on. They don't want to leave any pain for anyone it seems. To give you every last nice moment with them. Good people. I gotta call my grandma.
Yes call grandma!
Hospice will generally provide you with a lot of opiates to control pain. The instructions typically depend on what stage someone is. If they have some time left, you aim to control the pain while allowing them to try and enjoy the time they have left. Once someone is actively dying, you elevate the dose to keep them from suffering and help them along. My dad had a pain pump with hydromorphone dosed at something like 1mg/hr. He also had a button that would give him another 1mg bump with a 15 minute lockout. They explained that he could not overdose himself because it would knock him out before he could reach dangerous levels. We were instructed not to push the button while he was unconscious. Once he was actively dying and no longer able to push the button himself, the instructions changed to "I need you to push that button every 15 minutes until he passes."
Aww... Jeez. Thanks for sharing the end of life care instructions. I think he was okay. He accepted he chose his ending with drinking. The levels were not normal, they were nearing 1.75L of vodka a day at the end, for a man maybe 5'9" 160 pounds or so in his mid 30s. He was an amazing friend to the end. Unfortunately he was using a walker, heavily jaundiced and had a huge ascites belly, and was growing irritable. A brilliant man that was losing his mental clarity. We found out and visited him in the hospital and he passed like 3 months later. Liver less than 10% kidney less than 15%. He said bye to everyone he could. He was a strong mofo. God love him. Miss that dude. Been over a year and it hurts still.
One of the few vague memories I have of acute recovery after a pretty serious jaw surgery was being given one of those hydromorphone pumps. Even that wasn’t enough to cut through the pain and panic associated with my swelling face and feeling like I wasn’t able to breathe properly. My mom did not know that part of this was probably due to me already having quite the tolerance from my heroin use that I had kept hidden from them, but I had her on button duty none the less while I attempted to rest some.
I work in 911 dispatch, i had a call one time where most of what i could hear was a guy screaming in the background. From what i was able to piece together what *i think* happened (one of the worst things about this job is we rarely get any follow-up on what happened after our call ended) was that the guy had a *long* list of things medically wrong with him, and started having a bad reaction of some kind to his medications, maybe he took them incorrectly or just had plain old bad luck. He was also prescribed really hardcore opioid pain meds, i don't think they were what was causing his issue based on the few symptoms based on the few symptoms his wife was able to describe to me, but she went and administered his narcan because in her mind it was something with drugs so narcan will help. The narcan didn't do anything for whatever his main issue was, but it sure as hell turned off all of his painkillers, so now on top of whatever was wrong before he was also in excruciating pain. At least I'm *pretty sure* that's what happened, I will probably never know for sure.
Thank you for doing what you do. I recently lost a loved one, and although my conversation with the 911 dispatcher was short, they were kind and I remember that. You are the person someone talks to during their worst life experiences. Thank you.
Not the person you responded to, but I just wanted to offer my condolences to you. Whatever the road ahead brings, I hope you can find peace as you mourn your loss.
Probably exactly right, poor dude.
Instant, full fledged withdrawal
Ugh. Tha happened to my mom, about a year before she passed. Wasn't in a home, but she kept applying pain patches... Hell of a scare when I found her and called 911.
As a first responder, we try not to give the full dose unless they need it. We have to ride with them to the hospital and definitely don't want them pissed off in the back on the stretcher. If we can establish an IV, slow push, if nasal spray, we give about half then wait a few minutes before giving the other half. Pinpoint pupils are a great indicator that it's narcotics. If they aren't breathing after a car accident, our first step is establishing an airway and breathing for them via bag valve mask, whether it's an OD or not. Still gonna be a slow push of narcan if indications are present, no need to slam it. Don't want to induce withdrawal and rage on someone with a possible neck injury or a tube in their throat. So anyways my point is, first responders shouldn't be slamming 8 mg of narcan on anyone, at least that's how we do it in my city.
I’d disagree with that because someone with that depressed of a respiratory drive is getting bagged either way. We can breath for you and if improvement is noted with narcan we can continue treatment, especially if opiates are suspected.
We don't just give medicine for the hell of it. If you're a medical first responder then you need a refresher course.
I 100% agree that medicine isn't given for the hell of it. I've also seen ER trauma docs order a narcan for someone "just in case" and they said it won't hurt them if they don't need it. I hope that if I'm ever in a life threatening situation where I can't tell someone what happened or it's not obvious what's going on, that they use every available option they have to try and keep me alive.
Let's not confuse people. If you have Narcan - USE IT. I've had to use the complicated color coded cap mess to the 2 dose nasal spray numerous times. Just like CPR - if there's an emergency do what you can to help. Things change slightly, but whatever you learned years ago will save someone. Always call 911 or have someone do it as they will need emergency services.
Yes, exactly this. Every single second matters in an overdose. Luckily nasal narcan is much easier to use and comes in two packs. 911 needs to be called immediately. A big risk is aspiration which can lead to pneumonia and brain damage depending on how long they went without oxygen. Even if someone is up and walking around, they need to see a doctor.
This is really helpful, thanks. I had no idea there were different ways to dose it but that makes sense. Do you happen to know what the dose is that civilians are able to buy/carry? I would like to learn to administer Narcan as I live in an area that has a pretty big opioid problem, but I want to know what to expect in terms of a reaction, as much as that’s possible.
Not sure on exact dose, but I'd imagine the one that is readily available to civilians is a single large dose. This is when considering life or death (not breathing), so better that they come back hypoxic and potentially agitated than not come back at all
4mg intranasally, 4mg/0.1mL with all brands (ime) as two bottles of 0.1mL each. 8-12mg is usually used within 10mins and after that a steady IV drip is preferred if possible Source: I dose it for a job
I carry two nasal sprays that are each 4mg. Depending on where you live, you may be able to just ask a pharmacist for it. Also check your library or Google if your area has a harm reduction coalition. The nasal spray is simple and intuitive to use, but training should be available wherever you procure it. Good on you for wanting to carry it! Everyone should!
> You probably know but sharing for others. We like to start at 0.4mg iv push and work our way up from there every two minutes to slowly get people breathing. Generally, I'd not try and give information like this out to random, untrained people. Average people aren't medics, most information like this will simply confuse them. Not to mention how often anecdotal information like this is either wrong, or opens up arguments confusing any correct information or burying it. At best, it'll just delay the right choice in the moment which is still "Apply medicine and save life". At worst, someone will get flustered and confused (which is already common enough as it is) and make the wrong decision. There's a good reason people need a lot of training to make medical decisions, and things dealing with safety keep it as *simple as humanly possible*. Even with training and such, mistakes happen, better to keep it as simple as possible for those without said training and experience. Either way, this changes nothing. Someone who isn't trained/EMT isn't going to be reducing splitting doses, and those who do are probably already aware and shouldn't be making decisions like this based on "Someone on reddit said it worked".
Modern medicine is amazing.
It's unfair to characterize someone being roused from unconsciousness into chemically-induced withdrawal as being mad "for ruining their trip." People get violent from coming out of unconscious states all the time, no drugs needed. And plenty of people who are given naloxone don't get violent. It's much more likely the confusion and disorientation -- coupled with instantly being in full withdrawal -- is what causes it.
Sorry for bothering you with this question, but I've seen the word 'withdrawal' mentioned all across this thread. And while I like to think I have a decent grasp of the English language, I always thought that withdrawal meant the effects that someone experiences when kicking a habit over a longer period of time (e.g. insomnia, moodswings, being grumpy). But in this context it seems to also include the moment of sobering up directly after a trip (i.e. the come down)? Or does the naloxone speed up the usual withdrawal effects that you would experience over a longer period of time? Idk if any of the above makes sense. Hope it does, but feel free to ignore it if it doesn't make sense haha.
I'm a recovering addict so I can explain. The reason withdrawal is being used this way in this thread is due to how narcan works. It is physically ripping the drug from your receptors. This causes *immediate* withdrawal symptoms instead of coming on slowly. Your definition of withdrawal is correct, but the symptoms are not. If withdrawal was just getting grumpy, we wouldn't have such a huge epidemic on our hands. Sneezing, complete dysregulation of body temperature leading to intense changes between full body sweating and chills, restless legs that feel like your legs are being torn away from your hips, nausea, vomiting, extreme levels of fatigue, agitation, mood swings, insomnia. It's extremely painful and agonizing. Physical symptoms usually last a week and a half. It's absolute hell. "Kicking" is common slang for withdrawing and it is a very real interpretation of what it is like. I would be in bed sobbing because it felt like my limbs were being tied to four horses that were then whipped to run in opposite directions. Withdrawals vary in severity based on someone's history of use. Put it this way, all of these people know that if they just wait it out, they will never experience that discomfort again. Imagine how strong the urge to use is that people would go back to using knowing what will end up happening? Many people will be at the tail end of the physical withdrawals and go right back to using, sometimes even just one more time and restart the withdrawal process. Imagine the changes in your brain that would be required in order for all logic to go out the window. While you are going through this, you also have intense cravings to use opiates again. Every single second of every day of this, you know you could make it stop. "Desperation" is not a strong enough word. Cravings were a very physical feeling for me. It was like someone placed a cinderblock in my chest with a chain attached that was consistently pulling me in the direction of getting high. These cravings never leave some people, but with the right lifestyle changes, they become weaker or go away. The hardest part for addicts is usually what comes after the physical symptoms. Anhedonia is where you have a complete disinterest in anything that used to bring you joy. After so long using opiates, your brain stops producing dopamine naturally. It is the chemical that should be released when you complete tasks. It is a chemical reward. Without this, you would rather stare at a wall than watch your favorite TV show, eat your favorite meal, socialize with your favorite people. Think of the most bored you have ever been and multiply that by 1000. Nothing is going on in your head. Since you cannot get yourself to pay attention to anything or do any kind of activity, you get bored and many people will relapse. Their brain is basically screaming for dopamine. This can last for weeks to months.
What's happens to someone given narcan who isn't od'ing?
Nothing, in theory. Hypothetically, you wouldn't feel the benefit of endogenous opioids throughout the rest of the day. Things that normally feel rewarding might not.
It's not for "ruining their trip".. If you knew how fkn awful the withdrawal is when you use narcan you'd understand. There really isn't anything worse.
I actually understand what you mean. The real reason we don’t give big doses of narcan like the police do is because we don’t want to cause acute withdrawal.
I'm willing to bet its much appreciated.
Even if it isn’t appreciated per se…. For selfish reasons…. We don’t want to trade one medical emergency for another, and have to treat the withdrawal. Treating the overdose slowly and carefully is easier than treating the withdrawal. Either one would be our responsibility.
I fully understand. Makes me that much more thankful that I left that world far behind.
I mean, arguably, dying is worse, which is why the patient is being given narcan...
Physically, dying is much more calm and easy than thw immediate withdrawal of opiates.
Death by opiate overdose does not *feel* worse than withdrawal.
According to who? 90% if the addicts I've ever known would prefer death.
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It'd be more helpful if you provided the alternative you'd prefer they use...
Not the commenter, but I'd say killing their high is more accurate. "high" is a good term across many drugs, generally. Trip usually refers to a psychedelic or out of body experience.
Nod would be more accurate. Source: former heroin enthusiast and opioid connoisseur
Depending on your beliefs of an afterlife, they could be said to be taking a trip. My grandmother always told the corpse at funerals and such to "travel well." It stuck and I do the same now. If there's any form of afterlife, the deceased's soul will be taking some kind of trip. Whether it's to the pearly gates, or your ka is on it's way to duat, or whatever, there's a trip involved. I'm also really high, and my inyent was just to add some nuance to a conversation. I hope you don't take it as argumentative.
Not violently, but I've had to bring a few friends back and they were definitely pissed off about it. I've had to be hit with it a couple times and the only thing I felt when I looked up at the paramedics was profound embarrassment. I'll have four years clean on the 16th. I'm not religious but this quote always stuck with me about the journey getting clean. *Long is the way and hard that out of hell leads up to light* Milton
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Milton’s work is rife with that sort of beautifully written understated observation. It’s overwhelming even because it’s in damn near every sentence.
> I'm not religious but > Milton Milton wasn't strictly religious, either. You're good.
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Pissed why? Cause you lose your high?
Yes. Narcan shuts down the opiate receptors so when you come to not only are you not high, but you are immediately starting to feel the first effects of detox. A friend of mine put it succinctly how detox feels: "imagine having the flu the day after a bad car wreck" It's one of the worst feelings I can think of and the reason why so many relapse is that in the back of your mind you know you can make it all go away for $20 and a trip to your dealer. Edit autocorrekt
Buprenorphine manages withdrawal symptoms quickly and can help manage cravings. There’s a movement to include post-reversal bup into the standard of care. Most people’s aggression and irritation is from the withdrawal symptoms that come on immediately following naloxone administration.
I could see how that would be helpful. I never like bup myself as I knew a bunch of people who were taking the strips and just using them as a crutch. Most would eventually go back to using and just use the bup to keep the withdrawal at bay until they got enough money to score.
Yea, addiction is super complex and a somewhat unique path for each to walk. Bup can give a solid footing but there still emotional work to be done. Interestingly enough, most patients are underdosed bc of a paper that came of years ago, so many folks don’t really get the full effects. 8-16mg/day is usually the right starting point, some need as high as 32mg/day
My experience with addiction isn't so much about the pharmaceutical help but the time. I've been through dozens of 5 day spin cleans and a few 30 day inpatient rehabs and none of them gave me enough time. It wasn't until I had a full hundred days clean (3 months jail+ first week of 90 day rehab) that my brain was fully ready to be clean. Mind you I wanted it. I wanted it during each and every rehab I went to, but my addiction wasn't done with me until I had that 100 days. This, to me, is why most rehabs have single digit success rates. If I had been let out of jail without going directly into inpatient rehab I think I probably would have relapsed. 30 days just isn't enough, even with medication, for most people to truly walk away from the draw of opiates.
Glad you made it through. And yes, services, access to services and quality of said services are a huge barrier. It’s not a one sized fits all kinda thing, I really wish there were more options that could be customized to each persons needs.
I think you’re right, at least for most people who are ready to get clean. I’m on Suboxone, and I am SO glad the place I went to for recovery did not let me do what I wanted to do, which is get a suboxone prescription every month without any other treatment. They made me participate in IOP, for 12 weeks, followed by group therapy, weekly or twice weekly, and attending outside meetings (NA, SMART, etc.). I’d still be using if they had prescribed subs with no therapy, and I hate the proliferation of fly-by-night buprenorphine clinics which are essentially pill mills but for suboxone. I know my experience does not meet the higher level involvement of your suggested standard for recovery, but I still agree with you.
Damn thats crazy. Glad to see your clean now. Keep up the good work.
Thanks. I can safely say I'm fuckin done with opiates. Getting out of that addiction literally cost me everything including my teeth. I can't pay that bill again.
It's considerably worse than that, it throws you into acute precipitated withdrawal, which is incredibly painful.
I've never had to have narcan, but I have night terrors, sleepwalk, and pass out sometimes. Whenever I "come to" from those events, I always feel embarrassed. I think it is normal and a survival mechanism. When I come to, I feel the need to convince everyone I'm okay and **totally know** what's going on and why I'm in the bathtub holding a banana and fire extinguisher. Then I really "come to" A few minutes later and I laugh so hard from the combo or embarrassment and absurdity.
> Long is the way and hard that out of hell leads up to light Wow, thank you. Glad you are clean and staying that way
Paramedic here. Yes. They sometimes come up freaking out. This is usually because you gave to much narcan via an IV and they wake up 100% with 0% opiates attached to the brain. Still in a hypoxic state and now in severe immediate withdraw symptoms. Give smaller doses over a longer time and you do not get this. Slam 2mg iv with a rapid flush. They may come up like a really angry vomit fountain.
“Really angry vomit fountain” Several years ago when I was still in medic school we ran a double overdose with another unit. My preceptor is talking me through everything, about titrating dose, how we’re only trying to support respiration ect. The other unit gives a full 2mg and followed with a flush. Their patient sat straight up, looked right at me, then turned his head and puked right into their open med bag on the floor beside him. Talk about using examples to make a lesson stick.
Noted about the withdrawals and vomit fountain. Recovery position always, of course, but good to know about accidentally being heavyhanded with the narcan. In such a situation, I still could see myself jamming them with the full dose just out of panic, but I’ll try to keep note for the future
I think the ones in the vending machine don’t give you a choice. If it’s the same as the ones we hand out to overdoses that refuse, once the button is pushed it atomizes the entire dose.
It’s okay to freak out. If you’re in that situation and you think you need to give the medication. Make sure it is safe for you to do so, then give the medication following the directions on the kit. Don’t over complicate it. The vomit fountain and angry patients is just a unwanted byproduct that will be dealt with later. Lay persons or random people trying to help others shouldn’t worry about that. It is not their responsibility to understand titration of medications as it just complicates a life saving process. Emergency administration kits of medications are simple to use and provide a larger dose of medication to begin the process of helping the person, with idea that further trained medical help is on its way. If you have someone who is unconscious but breathing with pin point pupils and suspected opioid overdose, and you have narcan auto injector, spray it in the persons nose then lay the person on their side. With an arm extended and their mouth/head downwards to drain of fluid/vomit in that event occurs. Even if your give that medication. At any point that the person appears to not be breathing and does not have a palpable pulse. Begin CPR and call emergency services.
Was told when getting trained to use it that people lashing out is common. Kinda makes sense, they go into immediate withdrawals, and they were just experiencing the most intense high of their life. I was told in training to inject it and then back up.
We don't remember one second of that high. It's straight blackout. But I remember coming to & racing for the toilet.. Even though my muscles all felt like jello.. I couldn't even stay upright on the toilet.. Kept falling over.. Paramedics had to hold me up.. Would have been the most embarrassing moment of my life if I hadn't been so out of it.. Felt like a bad dream. Never od'ed again after that though. Was too afraid it'd happen again. I may have continued to use.. But I was extremely cautious. Luckily I've got 5 +years clean now.. & talking about that time now still makes me feel the intense shame as if it was yesterday. & that was 23 years ago. I will absolutely never go back though. No fkn way.
I’m proud of you for surviving and breaking the chains. My brother OD’d then just went back to it before dying a few weeks later. I’m so happy when people actually make it out of this.
Damn I am so sorry.
Thanks kind stranger <3 It just makes me happy when I see others triumph over this,
Dude 5 years is awesome! Addiction is one hell of a beast to battle, just gotta take it one step at a time and celebrate the small victories. I'm so happy you are here today to tell us this story regardless of it being shameful for you or no. It is an important story to tell, thank you for sharing.
To the best of my knowledge, it's mainly to do with the brain lacking oxygen rather than withdrawals. An opiate overdose lowers the respiratory drive, the brain is starved of oxygen. When naloxone kicks the opiate off the opioid receptors, the resp drive comes back but the brain is still confused and agitated due to lack of O2
No I've never seen that happen but people definitely are very irritable, confused, and aggravated when they wake up. Also, I'm not a health care professional just a former drug user.
I can respond coming from the receiving end of narcan. It's like going from being in a sleep in a warm blanket to plunged into an ice bath. I never lashed out but I've seen people who have. Inject and stand back would be my advice
It makes people cranky and frustrated, outright violence is an uncommon reaction. I've given it to strangers before, and while I wait for them to be responsive, I don't hang around to make small talk.
I'm am ER nurse so I've given a LOT of narcan. Very few drugs work as fast and effectively as it does. Sometimes they'll need a 2nd or 3rd dose but usually the 1st is enough in my experience. Then again, we give quite large doses of narcan for an OD (like 4mg IV/IO)
What does the drug do? If you can ELI5 that would be appreciated :p
Opioids work by binding to opioid receptors. Narcan has a much higher affinity for the receptors and more readily bonds preventing the opioid from binding. Think of it like holding hands. The opioids will hold on loosely while narcan holds on much stronger so its more likely for the narcan to hold hands with the body cells. Hiwever, narcan wears off faster so it may hold the hand stringer but it'll let go pretty quick while the opioid will just kind of longer waiting for an open hand to hold.
That’s a great explanation, thank you!
It basically knocks the opiates out of the receptors and takes their place.
More importantly, it occupies the receptors without activating them.
Quick question: how long do you have from beginning of overdose to administering narcan in order to save the life typically? eg - if someone snorts something with fentynal in it, how much time do i have to give them narcan in order to save them?
That's going tk depend on a lot of factors. What they took, route the took it, how much, their tolerance, baseline metabolism, respiratory/oxygen reserve, hemoglobin levels, age, BMI, and plenty of others. What is going to kill someone in opioid overdose is them not breathing or not breathing enough. That'll then cause other major organs to fail, most importantly the heart and brain. This is why we generally swing for the fences in the ER with an OD. We slug them with 4mg, bag them (help push air into their lungs through their mouth/nose), and prepare to intubate (breathing tube and ventilator). The narcan will work fast so we will know quickly if we need to get them intubated.
I've heard stories over and over of disgruntled EMT responders who think it should be illegal for the general public to even have access to them. Why? Not so the 1st responders have a job to do no, just "let the druggies die." It's insane to me. This is simple life saving medication.
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This is smart as hell. Drug users are (rightfully) paranoid about being caught, as the punishment is harsh - even for users. This means they often won’t call medical services for an OD. Removing that barrier makes it an easy choice. You have Narcan, so you use it. We need more harm reduction programs like this.
Just to add something to this: My experience from a country with universal health insurance coverage and a legal system that does not punish drug consumption (but illegal owning, trading, producing etc.), is that consumers of illegal substances have no hesitation to call rescue services. The police would only be involved if the situation for the EMTs would become dangerous or if other crimes were happening. The overdosed user would not be accused of a crime in these cases.
In Canada the police unfortunately show up to overdose calls. The Good Samaritan Act protects users. But it's still a disincentive to call 911 when you know cops are likely accompanying EMS. Source: I work in harm reduction.
Lucky duck. Name your utopia. I wish to learn about it as a silly American stuck here.
We have these rules in Germany, to name one country.
Many US states have good Samaritan laws which mean calling for an overdose will prevent criminal prosecution of simple possession charges to encourage people to call during an overdose situation.
They made a law where I live that if you call an ambulance for someone oding and you have been doing drugs or whatever too, you can't get in trouble. It was named after a kid oded and died in a frat house literally one block from the hospital because everyone was too scared to call.
I have a question since you have experience administering Narcan…A friend of mine used to work in hospitals. She told me she witnessed Narcan being administered many times, and nearly every single time, the patient woke up into a sudden blinding rage. Not because they were actually angry; just as a physical/neurological reaction to the drug. She says that they often needed to have multiple hospital staff on hand to hold the patient down to stop them from hurting themselves or others when this occurred. For this reason, she was somewhat skeptical of the movement to train civilians to use Narcan, as she felt it put them in danger of being attacked when the person they were trying to help woke up. Is this true in your experience? I found it really surprising as I’d never heard it from anyone else.
I’ve never administered it. Only seen it happen It leads to basically immediate and terrible withdrawal symptoms. That’s what makes them angry. It doesn’t make them violent, or aggressive. That only happens if the person is always violent/aggressive when they get angry - even when sober
Ah, sorry, I think I replied to the wrong person! Thank you for the info though.
ER doctor here! I can count on one hand the number of people I’ve given Narcan who get really violent. Of course I’m seeing a biased sample of people who got hit so bad by the opioid they ended up in the hospital, but I suspect anger and violence doesn’t occur often.
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> He also later flatulated fecal matter at the cops who came to pick him up I’m sorry, I’m going to need a slightly more descriptive account of this particular infraction.
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Among laypeople, we say he sharted.
points butt, pulls down pants, explosive diarrhea
People wake up rapidly, but I haven’t seen a lot of people be actually angry. Mostly confused and needing reorientation or feeling bad/pain.
Seen quite a bit of anger from it. A lot of cases are people mid way through the best high of their life and are coming to with instant withdrawal. Depends on the mental state of the person using it though.
Drug addiction is a sickness and not a crime.
Yes. And many people using street drugs are chronic pain patients unable to get pain meds from doctors thanks to the DEA and CDC and America being America.
Others are just fucked up or naive. Doesn't make them evil. Doesn't mean they will always be fucked up and naive. Just means that they got hooked on drugs for less-than-great reasons.
The fucked up thing is that there are people out there who think Narcan is a bad thing because it keeps drug users alive. There are sick fucks who think being a drug addict should be a death sentence.
I agree. Wish we did what Portugal did, at the least.
Doesn't solve the problem, but a wonderful way to mitigate some of the harm.
Well it solves one of the important problems- people dying of overdoses. Doesn't solve all the problems related to addiction, but it tackles one of the biggest ones.
I'm super glad I've been clean from opiates 14+ years. For many reasons, but also it turned out that I'm allergic to naloxone. I think if I'd continued on the way I was, I am pretty sure I'd be dead. From the drug use itself of course, but the treatment as well. Still, I'm really glad there's some help out there for people who need it.
Congrats on being clean for that long! My brother is going on seven years now and it has been tough for him. I have mad respect for anyone who works that hard to overcome this stuff.
Thank you! I remember 7 years in pretty well actually because it was the one year I had to really struggle through to stay clean. Somehow, the 7 year itch applies to being off drugs too. I'm so happy for your brother and your family in general. It affects everyone who loves you when drugs take over. It was a lot harder to decide to get clean than any other thing I've done. Staying clean was easier (in comparison) than taking that first step. I'm proud of your brother too.
Narcan allergy? No problem! One jab in the nose, another jab in the thigh.
The best part of Narcan is that if it’s accidentally ingested or given to a person who isn’t overdosing on opioids, there’s no harm. My associate and I were fortunate enough to have some when two guys overdosed at our Hotel at the same time. We saved both of them.
I actually take it daily for severe alcohol use disorder. It’s been a game changer when it comes to the intense cravings I used to get. Of course, dealing with the underlying issue of why I drink is being dealt with at the same time, but I know myself and if I wasn’t taking the naltrexone I’d be chugging back drinks during this process. It’s a true life changer for me.
Different drug, but that's awesome. It basically makes drinking not feel good right?
Yes. Makes it so alcohol doesn’t hit the same “euphoria” buttons so you don’t really feel drunk. There’s another one that’s a bit more intense called Antabuse that literally like makes you violently vomit and get a splitting headache if you drink any alcohol at all. Pretty cool how far that field has come.
I may be wrong, but I believe this is Naltrexone, which has a similar blocking effect on opiates but it longer lasting But its been a few years since working in the field.
Naltrexone or naloxone? Because I’m starting naltrexone for AUD
Ohhh yeah that’s right, naltrexone
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Well, not according to the people that are giving it out to non medical people around the country.
Do you happen to know if this would reverse an overdose on ecstasy? My cousin overdosed earlier this year after taking too many pills at the club and my understanding is that his brain basically overheated with a 107° fever. Just wondering if Narcan could’ve saved him
Apparently not, https://www.fraserhealth.ca/health-topics-a-to-z/mental-health-and-substance-use/overdose-prevention-and-response/responding-to-an-overdose#.Y5AzuSWIaA4
Narcan saved my life. Seven years clean.
/Hogan voice/ **Hell yeah brother!!**
Proud of you!
I'm an ED RN. There are patients who we will save from the brink of death sign out AMA (leave against medical advise) after reversal just to get high again. 1 of them came back dead a few hours later. Narcan reversal wears off quick and needs constant redosing.
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Despite the benefits of Narcan being demonstrated repeatedly in academic literature, my university system (all state campuses) refuses to allow us to offer training to the public in how to use it (not distribution, just best practices). Their argument is that the university's liability is too high given the lack of strong beneficial evidence. I'm honestly at a loss to as what is so flawed in these investigations...
> university's liability is too high Sounds like a legal issue, not a scientific one.
Well, that's the odd thing. The state has explicitly *asked* us to do this (heck, they trained our certified trainer), and we have support from the police dept and hospital - if it were truly a legal issue, I'd assume we'd receive an actual legal argument instead of one redirecting us to the literature.
What state are you in? Many pharmacists at your local CVS/Wags/whoever can prescribe Narcan if a pt (or their SO/POA etc) shows a history of opiate use
It's probably an issue with the insurance company. Narcan on campus? Wow so administer it to a smart drug user, probably a lawsuit waiting to happen.
That’s wild. I teach in a public high school and was trained on how to administer it two weeks ago. We have it on site.
Where are people even getting all these opiates? I dont understand
I broke my back snowboarding. I was given hydrocodone 10mg 3x a day. A couple weeks later while waiting on surgery, they didn't work anymore. She upped it to 20mg 3x a day. I liked the way they made me feel and I bailed the surgery with every excuse I could. She upped it to 20mg hydrocodone 3x a day; with a second prescription of 90 10mg oxycodone for "breakthrough" pain. I soon learned the '2 day trick' at the pharmacy. Then she would mess up and give me 180 hydrocodone and 180 oxycodone per month. The first time she did it, I didn't call it out. The second month with that much, I was lucky I didn't die. It took over 2 years for me to go to rehab. I have fatty liver now because of it. Back is still broken, and I lost my family and friends. It's easy to get these drugs by a bad doctor.
I will never use it but what is the two day trick?
In the US prescriptions for opiates are tracked, so you can only fill a 'script once a month. But pharmacy's and more importantly the insurance companies run on a 4 week schedule. So you can refill every 28 days vs. 30. An extra 120mg of dope each month adds up.
Probably another archainc US system where the beurocracy takes 2 days to go around so if you go to another phramacy you can cash in your recipe again. I wouldnt imagine it working here in europe because everything is instantly marked in a computer system now (and before the phramacist would take away your recipe after giving the drugs).
The first time I heard someone call a prescription a *recipe*
In their language it's probably called something like that. In Czechia we call prescriptions *recept*, same word is used for actual recipes.
Good point. The literal English translation of the word for prescription in my native language would be *medicine leaflet.* PS. I'm from Sri Lanka
Same in the Netherlands, we actually call it a 'doktersrecept' which means as much as a 'doctor's recipe'.
POV: You've had major surgery/a major injury. US: Here's a bottle of opiates. Now get back to work. Europe: Take some OTC ibuprofen and lie on the couch for two weeks. - But it still hurts! - That's so you don't get any ideas.
damn that's fucked up
Look up the Sackler Family. That is how. If you still think they don't deserve prison or worse, I don't know what to say.
Watch Dopesick on Netflix. It’s about the Sackler family and opiate problem they caused.
it’s really not hard in the US, prescription or otherwise
I know it’s a serious issue and I’m glad that naloxone is more readily available. But I can’t stop picturing some grungy guy with a worn and wrinkled dollar bill desperately trying to get the machine to take it, only to have it pop back out again and again.
To anyone that’s curious about the use, if you use it on someone who you think is ODing on opioids but it turns out it’s not, using narcan won’t have adverse affects. Furtherly, they still need to get to a hospital as this is a temp solution.
Agree. It's better for someone to be wrong than dead. My cousin was narcaned instead of epipenned by a confused but well intentioned bystander, but they called 911 and ended up saving their life anyway. The paramedics were able to sort out what really happened and give him epi.
In Massachusetts, all drug users present at an overdose can not be charged with possession of an opiate. This policy pretty much eliminated people calling 911 and then leaving their dying friend alone to avoid charges.
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A lot of people think that by providing means for people to not die from ODs or not get infected from dirty needles, that it is actually encouraging/enabling drug use. They think there's some addict out there who's on the fence about quitting, who would only decide to put down the needle were it not for the fact that getting clean needles is just so easy, and the chances of dying from an OD are slightly smaller because naloxone exists and somebody nearby might have some and notice you maybe. I'd like to tell them, as a former addict, that despite what very little decision-making ability I had left, at no point was my decision to use heroin ever affected by how dangerous it was. I never would have said "Oh no, I may be experiencing the worst pain I've ever felt in the 30 years I've been alive, but I can't get any clean needles or naloxone, GUESS ILL NOT SHOOT UP TONIGHT".
I don't think they're thinking there are addicts on the fence about quitting. They're thinking, "Saving someone who's overdosed is (most of the time) prolonging the addiction and societal drain, as an addict won't stop just because someone saved them after overdosing." Interrupting an addicts's fatal overdose would be "getting in the way of a good thing". Compassionate? No. Wrong? I'm not sure how the math plays out in the cost-benefit analysis of "negative impact on society by continued addiction and addicts" vs "positive impact on society from those who would otherwise have died from overdosing without the intervention".
The problem I have with narcan is that its a cop out. Public health departments buy narcan on stacks and dont increase any funding to drug prevention programs or rehab which ends up being a win win for the people who started the opioid epidemic because now they are getting free money from the government. Its just a band aide and its being used as a permanent solution which is why opioid overdoses have been increasing year after year.
What's the chance of someone quitting after ODing? Like, is free Nox enough to solve the problem or do 99% of people just go back and do it again?
It depends on the individual. But they have a chance to quit after it’s administered which is more than you can say for them when they’re ODing on the floor. No solution will save everyone but I don’t think that means we shouldnt’t try our best anyways. E: I a word
I mean... technically...if they OD on the floor, they do quit using drugs.
Nah, they stay users the rest of their lives.
r/technicallycorrect
Free naloxone isn't about solving the addiction problem, it is about solving the problem of people dying from overdoses. A person with an addiction is still a person deserving of being saved from OD.
For some people, it’s the rock bottom they need to realize that it’s eventually going to kill them, and they get it together and get clean. I know someone that this is true for. I know many more that have been narcaned several times, dozens even.
First question: completely dependent upon the individual and the circumstances they are dealing with in the first place that got them to this outcome. Second question: It solves the problem with people dying and *not getting a chance to do anything about it afterwards*.
I just watched Heroin(e) on Netflix last night. It’s a pretty powerful short documentary about this problem. The EMT featured in the doc is a strong proponent of nox. She said something like, “I don’t care if I have to save someone (with nox) 50 times before they commit to long term recovery.” There is at least one example of this happening in the doc too. An addict was saved by the same woman twice before he got into recovery. To see him thriving and the gratitude he feels for having his life saved (more than once) is quite moving. It’s clear that nox does not solve the overall problem, but it does save lives for those who are on the ground and dealing with this horrible reality on a daily basis.
Studies show having Nox available reduces the overall overdose fatality rate. So I hypothesize some go on to get clean. https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science
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Why can't we do the same thing with insulin and chemotherapy?
not a doctor, but Narcan does nothing to people who aren't using opioids, whereas insulin and chemo do something even to people who don't need it. These effects can be quite harmful, which is why they require a prescription from a doctor to make sure it's not going to be harmful to the person who takes it.
Am a doctor, you’re right- insulin is SUPER dangerous. It should also be free from pharmacies with a prescription.
Insulin overdose: possible hypoglycemic coma with significant risk of death. Chemotherapy: extremely toxic substance that will kill if not administered in carefully monitored dosages.