From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: 23 May 1999 18:40:56 GMT

In <7i96o8$jf1$9@fir.prod.itd.earthlink.net> kurtullman@sprintmail.com
(Kurt Ullman) writes:

> I may be (okay, no may be about it) showing my ignorance, but isn't it
> fairly common for the narcan to trigger withdrawal symptoms? Would this
> be a concern.

   No.  Withdrawal is unpleasant from narcotics, but not dangerous (as
it is from alcohol or barbiturates).

> Also, the half life of narcan is less than that of most narcs, so you
> run the risk of getting better, having the narcan run out and then being
> right back where you started from.


   Yep.  You'd want to give Narcan, Wake the person up, and have them
swallow naltrexone (drug related to Narcan, but which is orally
absorbed, and has a much longer duration of action).  If they got
sleepy again, more Narcan.  Have to repeat every so often until the
pill kicks in.  And none of this very safe, as absorption from muscle
is way more erratic than IV, absorption from the gut is not to be
trusted for emergency treatment, and a sleepy person can vomit and
aspirate at any time.  In the ED they'd be on a Narcan drip for awhile
(four hours, at least).

   I saw a movie not too long ago (name escapes me) where the badguy is
a prisoner who escapes by blocking his narcotic anaesthesia by
swallowing liquid from a bitten glass "amp" (ampule/vial) of Narcan
(previously hidden by swallowing it on a string). Nice idea but
wouldn't work in practice. Wouldn't do a thing for the Brevital he'd
probably really be getting, and wouldn't be absorbed orally anyway.
I'm sure every doc in the audience shook his head and rolled his eyes.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: 23 May 1999 22:50:30 GMT

In <19990523174159.10854.00004010@ngol04.aol.com>
shapere@aol.comicrelief (Shapere) writes:

>Pardon my ignorance (or at least let it slide with a sarcastic remark),
>but what's Brevital?
>
>-elizabeth



  Thiopental.  Short acting barbiturate used for intubation prior to
induction of gas anaesthesia, and even as a monoagent, or with
fentenyl, for 15 minute painful procedures (re-break of a bone,
reduction of a severe dislocation, etc., etc).  Nifty stuff in the
hands of skilled anaesthesiologist or anaesthetist.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: 24 May 1999 06:34:35 GMT

In <7ia8pt$2er$1@nnrp1.deja.com> Peter Cash <pmazarin@my-dejanews.com>
writes:

>You may be correct about this. But what makes you think that
>stereotypical junkies are the only ones at risk for overdose? I don't
>know how things are where you live, but here in the affluent suburbs of
>Dallas, we've got high school students and retired sports celebrities
>dropping like flies from ODs. Presumably, these casual users could well
>afford a couple of jolts of Narcan. I'd be willing to bet (translation: I
>have no data 8^) that casual users are at a much higher risk of
>accidental OD than "junkies", simply because the junkies are much more
>experienced--and have higher tolerance.


   There is the point that if you have somebody who can give you
narcan, you also have somebody who call 911 and give you mouth to mouth
ventilation until paramedics arrive.  That will be just as effective
and perhaps even more so, since the basic way narcotics overdose people
die is that they simply "forget" to breathe.  Narcan won't work if your
heart has stopped, and if it hasn't, oxygenating the person is just as
good.  And really what they need.


>Of course. But since the local ODs have mostly been at parties, one
>presumes that there would be at least one person present who has a
>clear enough head to realize what is happening, and do the right thing.
>(Of course, this brings up another problem--a lot of these deaths have
>been due to combinations of drugs--e.g. alcohol and smack--that Narcan
>won't completely address.)


   But which prompt mouth-to-mouth ventilation will.  And again, you
only need to keep it up for 5 minutes or so, if you have a phone.  All
narcan saves you is embarrassment, and perhaps one of the real issues
is whether people will be tempted to use it that way on the blue
comatose party-goer.  Who might be in cardiac arrest already, or near
it, and really NEED CPR and the paramedics, not some half-drunk friend
trying to do advanced life support with IV drug antagonists.

   The other side of the argument, of course, is that some partygoers
never will call the paramedics (who come with police when called for
this kind of thing) no matter what.  So it's narcan or nothing.  I
really don't know how that tradeoff will work.

From: cgregory@gw-tech.com (Carey Gregory)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: Mon, 24 May 1999 14:01:35 GMT

shapere@aol.comicrelief (Shapere) wrote:

>(Nobody was quite sure whether a hospital would turn you in
>to the cops, and nobody wanted their roommate arrested for drugs because that
>could lead to the whole apartment being searched.)

No, but when you tell the 911 dispatcher your friend has OD'ed, the
cops are pretty sure to arrive right along with the paramedics.
Technically they can't enter and search without a warrant... unless,
of course, you *invite* them in.  When youre friend is lying there not
breathing, people have a nasty habit of inviting them in.  So, yes,
the odds are good that someone's going to be arrested and charged with
something.  (But if he dies, the supplier of the drugs will face
murder or manslaughter charges in most states.)

>"Not calling 911" isn't an all or none proposition: the
>question is, how bad does it have to be before you'll call 911?

In my experience, it has to be *real* bad, way past time to call...
unless, of course, your complaint is a tummy ache, it's 4am, you've
had it for 3 days now,  and you didn't feel like going to the clinic
when it was open....   ;-(

>Anyway, I don't know if having Narcan readily available would be "good" in
>terms of trying to prevent kids from trying heroin, but from my selfish
>viewpoint it seems like it would have been a really great thing if only we'd
>had it 4 years ago.

Unfortunately, here's what would happen if you gave it to your
overdosing friend -- his high would be instantly gone, and he'd wake
up in one hell of a foul, combative mood, really pissed that you
ruined his high, and he'd never believe you saved his life.  He'd make
damn sure you never did that again.  The trick is to do what
paramedics do, ie, give the minimal possible dose, just enough to
restore adequate respirations but not enough to bring them around
completely.  Then you get the joy of dealing with the vomiting, and
making sure their airway remains clear... all in all, managing this
scenario takes some knowledge and skill.  Not as easy as just jabbing
a needle in and fixing everything.

--
Carey Gregory

"The average dog is a nicer person than
the average person."  -- A. Rooney

From: cgregory@gw-tech.com (Carey Gregory)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: Tue, 25 May 1999 14:29:35 GMT

clw@teleport.com wrote:

>Perhaps more important, Narcan can precipitate acute withdrawl which can
>be fatal in itself.

From barbituates and alcohol, yes, but I've never heard of a fatal
withdrawal from narcotics.

--
Carey Gregory

"The average dog is a nicer person than
the average person."  -- A. Rooney

From: cgregory@gw-tech.com (Carey Gregory)
Newsgroups: sci.med
Subject: Re: "Legalize" Narcan?
Date: Wed, 26 May 1999 00:16:03 GMT

clw@teleport.com wrote:

>Nope.  Primarily hypertension, arrhythmias and hyperpyrexia.  Saw several
>cases of narcotic antagonist administration in narcotic users.  A very
>stressful physiologic experience (for the patient) and therapeutic
>exercise for the docs.  If such happened on the floor at a party, very
>likely to cause significant physiologic derrangement!

Yes, it's certainly physiologically stressful, and I can see where
preexisting conditions could be exacerbated by withdrawal, possibly
leading to a fatal event, but do you actually know of any such cases?


I can't find any documentation for cases of fatal narcotics withdrawal
on medline, or elsewhere.

--
Carey Gregory

"The average dog is a nicer person than
the average person."  -- A. Rooney