Narcan Thoughts

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A story on the news this week said the Hartford Fire Department has saved 136 lives with Narcan since they began carrying it last November.  They have used it 172 times with 136 positive results, according to the article.  (Kudos to an outstanding department!) The story also mentions the Connecticut State Police have saved 100 lives with Narcan since October 2014.  Google almost any fire or police department in the state who has started carrying Narcan and there are glowing reports of lives saved by their members.

Hartford Firefighters Save 135 from Opiate Overdoses

Connecticut had 415 heroin deaths in 2015, and over 600 fatal opiate overdoses of all types.  I have seen nothing to suggest that the number is declining in 2016.

Neighboring Massachusetts had 1,379 opiate overdose deaths in 2015, an increase of 7 percent over 2014.  According to MA state data,  Narcan was administered to 9,128 EMS patients in 2015.

Mass EMS Stats

The articles claiming lives saves to each administration of Narcan are a bit overblown.  Clearly not every patient administered Narcan by first responders would have otherwise died.  First responders do carry ambu-bags and paramedics are often only minutes behind.  Despite this, there is little doubt in my mind that first responder Narcan has been a successful program.

For all the high numbers of first responder administered Narcan in the Hartford area, paramedics and EMTs administer Narcan at even greater numbers than the first responders.  While the fire departments often beat us to the scene, it does take a few moments to access and assess a patient, and once we arrive, they defer to us.  I have on one occasion told them to go ahead and give their drawn up dose.  I have only once told a fire department (not Hartford) the Narcan they were getting ready to administer was not needed.  (The patient while altered was arousable with stimulation).  And I have yet to see and only rarely heard of a fire department inappropriately administering Narcan in our area.  I am thrilled the fear some had of inappropriate administration doesn’t appear to have come to fruition.  

I will be curious to see what the final fatal opiate overdose numbers will be for Connecticut in 2016.  I suspect they will be higher than 2015 despite the life-saving  first responder Narcan program  such is the rate of overdose we are seeing.  Sure, we had periods of increased overdoses due to bad batches of the drug hitting the street in the past, but nothing sustained like we are seeing with the current epidemic.  Narcan alone cannot put an end to the slaughter.  On the fatal overdoses I respond to, the patient has almost always overdosed alone and has been found far too late to be saved.

Last week, I observed a heroin addict prepare to shoot another up in an alleyway just off Park Street as I walked past with my just out of the bakery hot-pressed Cubano sandwich.  My height enabled me to better see what others might not have.  I hesitated.  The one with the USB cord wrapped around his arm saw me and told the other to hold up.  I felt like I had stumbled onto a tribal ceremony.  The man with the syringe, seeing my uniform, said, “No worries.  He’s EMS.  We are safe with him here.  Yo,” he called to me.  “Thank you for what you do.”

“Okay, okay,” the other man said, holding his shaking arm out.  Just give it to me.”

“You have Narcan?” I asked, somewhat stunned by the scene, their brazenness and my sudden inclusion in their moment.

“Yeah, man.”

“All right, Be safe,” I said, and resumed walking to my parked ambulance just down the street.  Later, I almost wished I had asked if I could observe out of curiosity, but lines are lines, and while impartial, I did not want to imply sanction.

My partner and I did a walk by later and found the alley empty, except for a spoon, a saline vial, and torn heroin bag wrappers.

If I had any advice to people doing heroin (aside from don’t get started), it would be don’t do it alone.  Have Narcan handy.  Don’t wait to call 911.  Never give up on treatment.

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