Public Access Narcan

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Medical emergencies, like cardiac arrest, anaphylaxis, heroin overdose, (and being bitten by a Black Widow spider), require quick treatment to save a life.   Our public health system recognizes this.  We have AEDs, epi-pens and now increasing access to Narcan. All great initiatives.  Before I advocate for public access anti-spider bite kits, let me address Public Access Narcan.

Public Access Defibrillators are put in spots where patients are more likely than others to suffer sudden cardiac arrest.  We see public access defibrillators in airports, casinos, health clubs and in town halls, outside the tax assessor’s office.  Epi-pens are given to school nurses in case students with allergies to substances like peanuts have sudden anaphylaxis. These devices have been credited with saving many lives.  I wonder how effective or realistic a public access Narcan program would be. I would not put Narcan in health clubs or outside the tax assessor’s office, but I might consider putting it in the bathrooms of establishments like fast food restaurants and laundromat in certain areas of town.  I have not yet responded to an overdose at a school, but there have no doubt been overdoses at schools, likely more than sudden cardiac arrests.  If they can have AEDs and epi-pens in schools, they surely have room for a dose or two of Narcan.  I would put Narcan there, and I would put Narcan by the clerk’s desk at low-rate motels. I would put Narcan on city buses (done a few on these) , and in the gazebos of city parks. I’d even put one in the Zion Hill Cemetery based on the drug paraphernalia we saw when we drove through it one morning last week before the daily caretakers had swept the place.

I am very impressed that Massachusetts is able to record and report on the number of patients who receive Narcan from EMS responders. It likely wouldn’t be too hard to track the zip codes and addresses of all the Narcan administrations.  Certain blocks could qualify for a Narcan alarm box on their street corner. Of course, you would need to configure the box so when activated, it would notify 911 to get EMS rolling. If the address was near a bar or nightclub, you could even consider putting Narcan in vending machines in bathrooms next to the condom or tampon machines.

In Connecticut Narcan is sold over the counter in pharmacies and often given away free at inner city clinics. But for those who frequent the night, maybe Narcan could be made available at grocery and convenience stores around the clock. They could sell it by the register or perhaps in another place people likely to deal with a heroin overdose might look, next to the ice machine.

I have never treated a patient bitten by a Black Widow spider, but I did treat a patient who used the powder that came in the pictured glassine bag.

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