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Narcan for Everyone (iChiefs Article)

Drug overdose deaths have steadily increased; they now lead all causes of injury-related deaths, having surpassed motor vehicle crashes several years ago. No wonder then that Narcan administration programs have become a major public-health initiative.

Starting in 1996, community programs trained and equipped civilians with Narcan. Over a 14-year period, 53,000 individuals, who were largely friends and family of opioid users, were trained, resulting in more than 10,000 overdose reversals.

As the number of opioid overdoses continued to spiral, in some communities literally out of control, then-Attorney General Eric Holder declared a public health crisis in 2014, vowing to increase law-enforcement actions. He also encouraged law-enforcement agencies and first responders to carry Narcan. Today, most law-enforcement officers, firefighters and EMS providers carry Narcan and routinely administer it to suspected overdose victims.

Last November, the Food and Drug Administration fast-tracked approval of a Narcan nasal spray made by Adapt Pharma. You’re very likely to start seeing a lot of this product, partly because of its low cost (government and EMS pricing is $37.50 per dose) and a recent collaboration with the Clinton Health Matters Initiative to provide a free carton to every high school in the United States.

Narcan can be administered many different ways. Evzio is a considering auto-injectors sold to civilians. A typical public-safety kit includes a preloaded syringe of naloxone and an atomizing device that allows intranasal administration of the drug. The newest product made by Adapt is a totally self-contained device that doesn’t require needles or an atomizer. Regardless of the method or dosing strategy, rapid administration can be lifesaving.

Studies of heroin users suggest that more than 38% have overdosed at least once. Death from a heroin overdose is exceedingly rare, on the order of 3-6%. When it happens, the cause is most often hypoxia resulting from respiratory depression. Few overdose patients die immediately after drug use (approximately 15%). More often, there is a window of 40-50 minutes, during which interventions including ventilation and Narcan administration are likely to be successful. Despite the ever-increasing number of opioid overdoses and deaths, we still have a very poor understanding of the actual cause of these deaths.

Some emergency responders express concern that the proliferation of Narcan will encourage drug use. Careful analyses have not shown this to be true; in fact, administration of Narcan by peers actually seems to encourage drug-addiction treatment.

Additionally, as a stark reflection of the rising number of overdoses, despite the sharp increase in distribution of naloxone kits since 1996, we continue to see one overdose reversal for every 5-6 kits distributed.

Narcan is also a very safe drug. It binds with and reverses opioids. If given to someone without opioids in their system, it has no effect. When given intravenously, rapid administration is more likely to result in violent behavior or significant withdrawal symptoms. Side effects are rarely reported with intranasal administration. In many states, Narcan is being sold over the counter.

Firefighters and EMS providers should all become familiar with Narcan and consider carrying it in their EMS bags. There doesn’t appear to be any change in the rising number of opioid overdoses; a quick peek at your local obituaries probably shows an inordinate number of youth, many of whom were opioid-overdose victims. We often arrive in the window of time where we could make a difference. Narcan is a tool that can help us to better serve our communities.

Mike McEvoy, PhD, NRP, RN, CCRN, is the EMS chief for Saratoga County, N.Y., and vice chair of the EMS Section. Hes been a member of the IAFC since 2007.


Note: Naloxone, known by the brand name Narcan, is the reversal agent of choice for opioid overdoses.

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