Non-Opioid Pain Management

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The state of Massachusetts just passed an emergency protocol change requiring all paramedic ambulances to carry non opioid pain management alternatives, including Ibuprofen PO, Acetaminophen PO and Ketorolac IV or IM.  Acetaminophen IV is optional.  The changes are to take place January 1, 2018. Massachusetts Pain Management Protocol Emergency Non-Opioid Pain Treatment Options Update Here […]

The Opioid Epidemic: The EMS Role (Free On-line CME)

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The Connecticut Office of Emergency Medical Services (OEMS) in conjunction with UConn John Dempsey Hospital has just released a free 1 hour on-line EMS CME: The Opioid Overdose Epidemic: The EMS Role. The auto-narrated program discusses the background of the opioid epidemic, Connecticut death statistics, Connecticut CORE initiative, the science of addiction, the dangers of […]

Testing for Fentanyl

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Across the nation harm reduction workers are going out in the street, meeting heroin users face to face and testing their powdered drugs for fentanyl.  They are not afraid because they know that touching fentanyl cannot kill you.  They do take precautions.  They wear nitrile gloves when they dip the tester strip into the powder.  If […]

Connecticut Opioid Deaths Continue to Rise

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539 people in Connecticut died of accidental drug intoxication deaths during the first six months of 2017, which projects to 1078 for the year, an increase of 17.5% over 2016, according to the state Medical Examiner’s Office. Fentanyl continued to fuel the rise in deaths. Fentanyl was present in 322 deaths during the first half […]

Katrina Journal: What’s Important

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In view of Hurricane Harvey and the rescue efforts now underway, I am posting notes from my journal when I was posted in Gulfport, Mississippi in the aftermath of Hurricane Katrina. Day One: Waiting On the morning of September 17, we meet at the office and a chair van driver takes us up to the […]

Multiple Naloxone Administrations

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One of the main reasons opioid overdose deaths have been increasing is the rise of fentanyl sold either combined with heroin or in place of heroin.  Fentanyl, which is 50 times stronger than heroin, has a stronger affinity for the opioid receptors in the brain than heroin.  Toxicologists have said that while naloxone is still […]

Light Weights – Heroin Math 2 (Why We Don’t Get Robbed of our Fentanyl)

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You carry four 100 mcgs vials of Fentanyl in your controlled substances kit.  How much would those vials be worth on the street? Let’s do the math. 100 mcgs of Fentanyl is the equivalent of 10 mgs of Morphine. Morphine is 50% as strong as heroin. Morphine is the equivalent of 50% pure heroin. A […]

Nocebo Effect

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While headlines of deadly Fentanyl creating Haz Mat scenes and causing first responders to be hospitalized continue to dominate the news, on July 10, 2017 with little fanfare, the US Institute for Occupational Health and Safety removed the statement “skin absorption can be deadly” from its Fentanyl page. You can read their safety recommendations here: […]

Couples

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The call is for a possible overdose.  A tall attractive young woman in leopard skin pants, and a Ginger from Gilligan’s Island hairdo, meets us at the apartment door.  She is high. Her balance as she sways in front of us is so bad it is making me dizzy just looking at her. “Thank you […]

An Offer Hard to Refuse: Heroin Math 1 (Pills to Mainlining)

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Thesis: People addicted to prescription painkillers who buy their pills on the black market switch to heroin because it is a better economic deal (cheaper and stronger). The Situation: When a person’s painkiller prescription runs out or their tolerance outruns their prescription, and the user still needs opioids to keep from being sick, the user […]

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