Recently, President Trump and his administration have declared “war” on the opiate crisis that is gripping America.
Of course, opiates have been around for centuries. As a matter of fact, the first recorded used of this drug was by the Chinese in the seventh century as they realized it was an effective means of blocking pain. Sometime later, it was added to tobacco and smoked for recreation usage.
Since then, the world has struggled with an opiate addiction. Each generation seems to have their particular form of the drug. Morphine, heroin, and the new kid on the block, Fentanyl, are all derived from the same ch
emical compounds and produce similar effects.
Now, a solution has emerged to the problem: Arm the public with a reversal agent, the medication Narcan.
Before we discuss the benefits and drawbacks of public Narcan administration, let’s look at how opiates affect the body. You have special cell receptors that are designed to stimulate good feelings when they are stimulated. We call these naturally occurring “feel-good” chemicals endorphins.
Endorphins are released whenever your body wants to transmit a euphoric feeling to the brain. Opiate derivative drugs bind to the same receptors as endorphins, but in much higher quantities. Some of these receptors (Mu and Kappa) also decrease breathing, heart rate and blood pressure when stimulated. Therefore, taking a medication that causes a surge of Mu and Kappa receptor stimulation can cause the patient to stop breathing, drop blood pressure, or even death.
This, and addiction are the reasons why opiates are so tightly controlled by the Food and Drug Administration (FDA). Of course, there are acceptable medical reasons why your physician would choose to prescribe Morphine or Fentanyl, however, they are given under tightly controlled circumstances.
The recent rise in overdose deaths is partially to blame for a shift in drug culture. Heroin has fallen out of fashion to its much more powerful cousin Fentanyl in street selling. Heroin requires the poppy plant to produce; Fentanyl is synthetic and is only limited by the number of chemicals a cook has on hand to make it. Because of this, those who purchase Fentanyl on the black market have no idea how powerful the drug that they are buying might be. This has led to a huge uptick in opiate related deaths.
Narcan is a wonderful drug that Emergency Rooms and ambulances have used for decades. Narcan (Naloxone) is classified as an opioid antagonist. That means that it “unseats” the opiate drug that is bound to the central nervous system receptors. The drug delivers instant reversal of opiate overdose symptoms. I have used Narcan on countless occasions and would estimate the average effectiveness time to be less than 60 seconds from a snoring coma to a wide awake patient. Truly, it is a modern miracle of medicine.
Because it can be administered safely by a layperson (sprayed in the nose), Narcan has been issued through government grants to non-medical members of the community. The benefits to this are obvious: even an untrained person can quickly and effectively revive someone from a narcotic overdose.
However, there are also many risks. Consider this: Narcan administration is not entirely safe. From firsthand experience, many patients are unruly and combative when Narcan is administered. Your average opiate user might have paid a large price for their illegal drug and won’t appreciate their “high” being instantly taken away.
Furthermore, Narcan lowers the seizure threshold, making it easier for the patient to experience convulsions. This also puts them at risk for complications such as flash pulmonary edema and psychosis. None conditions cannot be managed effectively without medical training.
Consider this: The average response time for an ambulance in the State of Mississippi is 11 minutes within a city and slightly longer in the county. Ambulance crews are equipped with Narcan but also the tools to treat a patient after the drug has been given.
Furthermore, paramedics and EMTs have spent years in training on how to render emergency care in all types of situation. I believe in letting the best person do the job and there simply isn’t anyone better to treat an overdose than an EMS crew. In my opinion, we should focus more of our efforts on prevention of this type of emergency rather than treat the symptoms.
Stay safe out there.
