Narcan: the spritz of life ...
... and where there’s life, there’s hope
Turners Falls firefighter Mike Currie demonstrates how a Narcan dosage is assembled in a department ambulance on Tuesday. Currie has been to several overdose calls where responders administered Narcan and said it was amazing how quickly the drug brings near comatose people back to conciousness. Recorder/Micky Bedell Purchase photo reprints »
Opioids are among the rare poisons with an easy, fast-acting antidote in case of acute, potentially deadly overdose.
Distribution of naloxone hydrochloride, commonly known by the brand name Narcan, may be the most direct harm-reduction strategy in place. Narcan temporarily reverses overdoses, rooting opiates out of their target receptors in the brain. If administered correctly and in time, the antidote can bring an overdose victim on the edge of death almost immediately back to sobriety. It doesn’t reverse addiction, however.
The antidote must be administered by a friend, a bystander or a first responder as users high enough to die are not clear-headed enough to save themselves. Former users and addicts who have been saved by the drug describe waking up angry and fighting.
The distribution program is intended for anyone who believes they may be in a position to witness an overdose, a broad spectrum including users, friends and relatives of users, and anyone working in a public place. Area police departments have logged overdoses or reports of heroin use in homes, hotels and in the bathrooms of fast food restaurants, libraries and churches.
Narcan is an antidote for a symptom of drug abuse, an antidote that does not exist for other drugs, but it is not a cure for the underlying problem.
The Mass. Bureau of Substance Abuse Services operates a pilot program, begun in 2007, targeting potential overdose witnesses with free training and doses of Narcan in a fast-acting nasal spray, no prescription required.
“We have documented 2,500 overdose reversals where people’s lives were actually saved,” BSAS Director Hilary Jacobs said recently.
Save again and again
The phrasing is important because some of the people saved are saved again and again. Some worry that the safety net provided by Narcan encourages users to take greater risks with their lives or provides a false sense of security; a single dose of Narcan may not be enough to save a user. Narcan is not effective on any non-opium-based substance knowingly or unknowingly taken with heroin, Percocets, OxyContin, Vicodin or other opioids.
This is a particular problem with heroin: the bags of powder sold as heroin could be anything, from pure heroin to pure Fentanyl — a powerful and lethal synthetic sometimes illegally manufactured by semi-competent chemists — to pure baby laxative or any mixture of these or any other white or brown powder. It is not uncommon for users to take both cocaine and heroin, sometimes in an effort to balance the high and low effects, and Narcan will have no effect on a cocaine overdose. The combination appears on more than one death certificate locally in the past two years.
Preserves the possibility ...
Proponents of continued and expanded access say Narcan saves lives and preserves the possibility for recovery.
Athol Police Chief Timothy Anderson this winter obtained permission from the local Board of Selectmen to equip his officers with nasal Narcan.
Narcan is in the ambulance medical kit but is not yet part of the standard police and fire equipment. Obstacles to its adoption have included the assumption that administering such a medication would be outside the realm of what police and firefighters are allowed to do, not being medical practitioners, and fear of lawsuit.
“It’s fairly new. I think most police departments up to this point didn’t even realize it was an option,” Anderson said in January.
Anderson’s effort prompted interest elsewhere, with the Greenfield and Montague chiefs voicing interest. Since then, District Attorney David Sullivan, U.S. Sen. Edward Markey and Gov. Deval Patrick have all voiced support for universal use of Narcan by first-responders.
“We are still moving forward with the Narcan program, we are in the process now of trying to set up training, then we have to try to find a way of obtaining the Narcan,” Anderson said in April.
Greenfield Chief of Police Robert Haigh Jr. also said this month that his department is working toward carrying nasal Narcan, with training, funding and development of a policy in the works
“Those things are all in the process. One of the central steps was the declaration of it being a health emergency in Mass. by Gov. (Deval) Patrick a couple of weeks ago,” Haigh said. “So it’s in the works and hopefully soon we’ll be on board with that, the mayor’s supporting it and so is obviously the District Attorney.”
A 2012 Massachusetts good Samaritan law aimed at stemming overdose deaths protects individuals calling 911 from drug possession or proximity charges — it is illegal to be present where heroin is kept, a law exclusive to heroin — and protects those administering Narcan from civil suit. There is some disagreement as to whether the language includes police and firefighters.
Gov. Deval Patrick addressed this in his March 27 declaration of a public health emergency relative to heroin and other opioids, including permission for all first-responders to carry and administer Narcan in his four initial orders.
“In terms of some of the barriers that police and fire have had implementing Narcan, this will expedite that so they will be able to carry much sooner,” said Timothy Purington of Tapestry Health, which participates in the BSAS Narcan distribution program.